How To Get Your Clinical Teaching Team Ready For Curriculum Change: A Practical Guide.

Our health care system is constantly adapting to change at an increasingly rapid pace. Unavoidably, this also applies to the field of medical education. As a result, clinical teaching teams face the challenging task of successfully implementing the proposed changes in daily practice. It goes without saying that implementing change takes time and that you need to be patient. However, a successful change process needs more than that. Change models or strategies could offer a helping hand. The questionnaire Specialty training's Organizational Readiness for curriculum Change (STORC) is a tool aiming to do just that. With a focus on readiness for change, this questionnaire tries to support implementation efforts in PGME. Additionally, since change is a team effort, it focusses on clinical teaching teams particularly. In this paper, we offer a practical guide for clinical teaching teams on how to deal with any concerns or hurdles detected in any of the core elements of readiness for change, in order to smoothen and support the educational change processes these teams are confronted with.

Specialty Training's Organizational Readiness for curriculum Change (STORC): validation of a questionnaire.

BACKGROUND: The field of postgraduate medical education (PGME) is continuously evolving as a result of social demands and advancing educational insights. Change experts contend that organizational readiness for change (ORC) is a critical precursor for successful implementation of change initiatives. However, in PGME, assessing change readiness is rarely considered while it could be of great value for managing educational change such as curriculum change. Therefore, in a previous Delphi study the authors developed an instrument for assessing ORC in PGME: Specialty Training's Organizational Readiness for curriculum Change (STORC). In this study, the psychometric properties of this questionnaire were further explored. METHODS: In 2015, STORC was distributed among clinical teaching teams in the Netherlands. The authors conducted a confirmatory factor analysis on the internal factor structure of STORC. The reliability of the measurements was estimated by calculating Cronbach's alpha for all sub-scales. Additionally, a behavioral support-for-change measure was distributed as well to assess correlations with change-related behavior. RESULTS: In total, the STORC questionnaire was completed by 856 clinical teaching team members from 39 specialties. Factor analysis led to the removal of 1 item but supported the expected factor structure with very good fit for the other 43 items. Supportive behavior was positively correlated to a higher level of ORC. DISCUSSION: In this study, additional steps to collect validity evidence for the STORC questionnaire were taken successfully. The final subscales of STORC represent the core components of ORC in the literature. By breaking down this concept into multiple measurable aspects, STORC could help to enable educational leaders to diagnose possible hurdles in implementation processes and to perform specifically targeted interventions when needed.

Are they ready? Organizational readiness for change among clinical teaching teams.

INTRODUCTION: Curriculum change and innovation are inevitable parts of progress in postgraduate medical education (PGME). Although implementing change is known to be challenging, change management principles are rarely looked at for support. Change experts contend that organizational readiness for change (ORC) is a critical precursor for the successful implementation of change initiatives. Therefore, this study explores whether assessing ORC in clinical teaching teams could help to understand how curriculum change takes place in PGME. METHODS: Clinical teaching teams in hospitals in the Netherlands were requested to complete the Specialty Training's Organizational Readiness for curriculum Change, a questionnaire to measure ORC in clinical teaching teams. In addition, change-related behavior was measured by using the "behavioral support-for-change" measure. A two-way analysis of variance was performed for all response variables of interest. RESULTS: In total, 836 clinical teaching team members were included in this study: 288 (34.4%) trainees, 307 (36.7%) clinical staff members, and 241 (28.8%) program directors. Overall, items regarding whether the program director has the authority to lead scored higher compared with the other items. At the other end, the subscales "management support and leadership," "project resources," and "implementation plan" had the lowest scores in all groups. DISCUSSION: The study brought to light that program directors are clearly in the lead when it comes to the implementation of educational innovation. Clinical teaching teams tend to work together as a team, sharing responsibilities in the implementation process. However, the results also reinforce the need for change management support in change processes in PGME.

Factors adversely affecting student learning in the clinical learning environment: a student perspective.

PURPOSE: To investigate, from the students' perspective, factors that may adversely affect student learning in the clinical environment. METHOD: Medical students evaluated the perceived effectiveness of the clinical learning environment at the end of various clerkship rotations, such as surgery, gynaecology, paediatrics, ophthalmology. After each clerkship students answered a standard questionnaire containing closed-ended questions about supervision, patient contacts, organisation, learning effectiveness and the learning climate, as well as one open-ended question about the clerkship-site's perceived weaknesses. Because supervision is crucial to the quality of clerkships but often lacking, we compared clerkship-sites with relatively low and high ratings on supervision and analysed students' comments on the weaknesses of their clerkship-sites. RESULTS: Factors that students perceived were inhibiting learning were too few opportunities for students to examine patients independently and lack of time for supervision. In addition, lack of observation, insufficient feedback, negative attitudes of the staff towards students and teaching, the presence of too many students at one time, too few educational sessions, and poor organisation were mentioned as perceived weaknesses in open-ended comments. CONCLUSIONS: Based on these students' perceptions, effective clerkships should present students with patients with a variety of health problems who can be examined both independently and with supervision. Continuity of supervision is important and can be addressed by assigning a teacher or mentor to each student.

The relationship between professional behaviour grades and tutor performance ratings in problem-based learning.

PURPOSE: We investigated the influence of harsh grading by tutors on tutor performance rating by students. METHODS: A total of 187 tutors assessed students' professional behaviour in tutorial groups. Students rated tutor performance after receiving their grades for professional behaviour. In addition, students were asked to indicate whether they perceived their professional behaviour grades as too positive, adequate or too negative. This was considered to reflect tutors' harshness of grading. Students also rated the quality of the feedback they received from tutors with respect to their grades. RESULTS: Professional behaviour grades that students perceived as too negative, adequate or too positive were associated with tutor performance ratings of 7.4 (SD = 0.9, scale 1-10, n = 33), 7.7 (SD = 0.9, scale 1-10, n = 95) and 7.5 (SD = 0.8, scale 1-10, n = 59), respectively. Harshness of grading did not influence tutor performance ratings significantly. Tutor ratings were predicted more effectively by the quality of the feedback tutors provided on grades than by the harshness of grading. CONCLUSIONS: Tutor performance ratings were not related significantly to harshness of grading. Two explanations can be given: (1) tutor performance ratings were based on rating by groups of students and (2) the percentage of tutors who rated students' professional behaviour as unsatisfactory was low. The strong relationship between tutor performance ratings and the adequacy of the feedback given by tutors suggests that the tutor performance ratings collected in this study are a valid measure of the quality of their teaching, although, for a full picture of teaching quality, more measures will be needed.

How to introduce incognito standardized patients into outpatient clinics of specialists in rheumatology.

To know what is going on in physicians' surgery hours, assessment of practice performance is important with regard to quality assessment activities. The incognito standardized patient (SP) method is a powerful method to assess this. However, until now no reports have been published about specialists' performance using this method. In this study, 27 rheumatologists in 16 hospitals were each visited by eight incognito SPs to study the feasibility of sending incognito SPs to specialists working in different hospitals, of follow-up consultations and of simulating additional investigations. SPs recorded performance on case-specific checklists. The different steps needed for these visits are described in detail. A total of 136 first and 32 follow-up visits took place. SPs remained undetected in 98% of the visits. It is concluded that this SP method is a feasible one, however, only to be used for very specific purposes. Use of incognito SPs for larger scale projects is not recommended.

Reliability of clinical oral examinations re-examined.

Many medical schools still use oral examinations for the evaluation of clinical competence of students in their clerkship, although it has been proven that orals have poor reliability. This study investigates the feasibility and reliability of multiple oral examinations. Students in the last week of their Internal Medicine clerkship in an outpatient clinic were given several patient-based oral examinations. The student's performance was rated on a list of items reflecting clinical competence. A global judgement of the student's performance was also given. The results indicate that it is possible to increase the number of orals and the number of examiners in the day-to-day practice of an outpatient clinic moderately. The reliability when using a number of orals is better than the reliability of the common single oral examination. The reliability using global judgements appeared to be better than the reliability of averaged item scores.

A Qualitative Analysis of the Transition from Theory to Practice in Undergraduate Training in a PBL-Medical School.

In spite of numerous curricular innovations, the problems medical students encounter in making the transition from theoretical training to clinical training remain unresolved and the problem has received scant attention in the literature. We performed a qualitative study to explore students' perceptions and attitudes regarding this transition in undergraduate medical training. Twenty fifth-year students of the Maastricht Medical School participated in focus group discussions about the transition from the preclinical phase to the clinical phase of the curriculum. All focus group discussions were videotaped, literally transcribed and qualitatively analysed using content analysis. The results suggest that students have difficulty in bridging the gap between the theoretical and clinical phase of the curriculum. The problems they experience arise largely from professional socialisation processes. However, students also find it difficult to apply theoretical knowledge in clinical practice. Students find contacts with real patients highly motivating. In the clinical phase their learning changes from passive acquisition of knowledge to more active learning.Since the problem-based learning approach is supposed to enhance application of basic science concepts to clinical problems, it is surprising that students experience difficulties in applying their knowledge in practice. To facilitate the transition from theory to practice in the Maastricht Medical School some curricular changes could be introduced, such as early patient contacts to motivate students and help them learn usable knowledge. Furthermore, the advantages of a problem-based preclinical curriculum to student learning should be fully exploited. Finally, the assessment system must be congruent with the educational programme, because examinations have a powerful effect on student learning.