Perceived and actual value of Student-led Objective Structured Clinical Examinations.

INTRODUCTION: Student-led Objective Structured Clinical Examinations (OSCEs) provide formative learning opportunities prior to Faculty-led OSCEs. It is important to undertake quality assurance measurements of peer-led assessments because, if they are found to be unreliable and invalid, they may have detrimental impacts. The objectives of this study were to explore and evaluate Student-led OSCEs hosted by fifth-year medical students. METHODS: Student-led OSCE results were analysed to examine reliability (Cronbach's alpha). The relationship between Student-led and Faculty-led OSCEs was evaluated using linear regression. Qualitative data were acquired by survey and semi-structured interviews and were analysed using an inductive content analysis approach. RESULTS: In total, 85 (94%) of 91 eligible students consented to study participation. Student-led OSCEs had a low-moderate reliability [Cronbach alpha = 0.47 (primary care) and 0.61 (human reproduction/paediatrics) (HRH)]. A statistically significant, positive relationship between Student-led and Faculty-led OSCE results was observed. Faculty-led OSCE grades increased by 0.49 (95% CI: 0.18, 0.80) to 1.09 (95% CI: 0.67, 1.52), for each percentage increase in Student-led OSCE result. Student-led OSCE participants highly valued the authentic peer-assessed experience. Reported benefits included a reduction of perceived stress and anxiety prior to Faculty-led OSCEs, recognition of learning gaps, contribution to overall clinical competency and facilitation of collaboration between peers. DISCUSSION: Student-led OSCEs are moderately reliable and can predict Faculty-led OSCE performance. This form of near-peer assessment encourages the metacognitive process of reflective practice and can be effectively implemented to direct further study. Faculties should collaborate with their student bodies to facilitate Student-led OSCEs and offer assistance to improve the quality, and benefits, of these endeavours.

Insights into rural generalist therapeutic reasoning using a simulated multi-patient emergency scenario.

INTRODUCTION: Therapeutic reasoning focuses on the decisions related to patient disposition and management. This is in contrast to diagnostic reasoning, which is the focus of much of the current discourse in the medical literature. Few studies relate to therapeutic reasoning, and even fewer relate to the rural and remote context. This project sought to explore the therapeutic reasoning used by rural generalists working in a small rural hospital setting in Australia, caring for patients for whom it was unclear if escalation of care, including admission or interhospital transfer, was needed. METHODS: This study was conducted using an interpretivist approach. A simulation scenario was developed with rural generalists and experts in medical simulation to use as a test bed to explore the reasoning of the rural generalist participants. The simulation context was a small rural Australian hospital with resources and treatment options typical of those found in a similar real-life setting. A simulated patient and a registered nurse were embedded in the scenario. Participants needed to make decisions throughout the scenario regarding the simulated patient and two anticipated patients who were said to be coming to the department. The scenario was immediately followed by a semi-structured interview exploring participants' therapeutic reasoning when planning care for these three patients. An inductive content analysis approach was used to analyse the data, and a mental model was developed. The researchers then tested this mental model against the recordings of the participants' simulation scenarios. RESULTS: Eight rural generalists, with varying levels of experience, participated in this study. Through the semi-structured interviews, participants described five themes: assessing clinician capacity to manage patient needs; availability of local physical resources and team members; considering options for help when local management was not enough; patients' wishes and shared decision making; and anticipating future requirements. The mental model developed from these themes consisted of seven questions: 'What can I do for this patient locally and what are my limits?'; 'Who is in my team and who can I rely on?'; 'What are the advantages and disadvantages of local management vs transfer?'; 'Who else needs to be involved and what are their limits?;' 'How can we align the patient's wants with their needs?'; 'How do we adapt to the current and future situation?'; and 'How do I preserve the capacity of the health service to provide care?' CONCLUSION: This study explored the therapeutic reasoning of rural generalists using a simulated multi-patient emergency scenario. The mental model developed serves as a starting point when discussing therapeutic reasoning and is likely to be useful when providing education to medical students and junior doctors who are working in rural and remote contexts where resources and personnel may be limited.

Recommendations for embedding simulation in health services.

Aspirations to achieve quality and safety goals in health services through simulation have led to significant investments in simulation equipment, space and faculty. However, the optimal governance and operational models through which these resources are expertly applied in health services are not known. There is growing evidence supporting 'service' models for simulation. In these models, simulation activities are co-designed and delivered by a team of simulation experts in partnership with health service units, specifically targeting quality and safety goals. Embedded simulation specialist teams working within these programs offer benefits not fully captured by traditional models of health education or by traditional systems for quality and safety.In this article, we explore broad and specific recommendations for establishing a simulation consultancy service within an Australian metropolitan health service. We base these recommendations on a review of current Australian practice and healthcare simulation literature, and on a specific example within a large outer metropolitan health service. The broad domains discussed include (1) governance and leadership; (2) human resources; (3) principles and planning; (4) operationalise and evaluate and (5) look to the future.The recommendations recognise that healthcare simulation is moving beyond solely addressing individual learning outcomes. The value of simulation addressing organisation and system objectives through various simulation modalities is increasingly being explored and demonstrating value. There is a growing demand for translational simulation in these contexts, and a consequent requirement for organisations to consider how simulation services can be successfully operationalised. Recommendations included in this paper are discussed and described with the intent of facilitating a deeper appreciation of the complexities associated with, and opportunities afforded by, a well-integrated simulation service.

"Who Am I and Why Am I Here?" A Scoping Review Exploring the Templates and Protocols That Direct Actors in Their Roles as Simulated (Standardized) Patients.

SUMMARY STATEMENT: Simulated patients (SPs) are increasingly used in health education and research. The aim of this article was to investigate templates and protocols that enable SPs to accurately and consistently adopt these roles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guided the search strategy for articles that detailed such templates or protocols. Embase Classic + Embase, ProQuest ERIC, Ovid MEDLINE, Ovid EMCare, psycINFO, and Scopus were searched, and 17 articles were included in the review. The templates and protocols that were located differed in structure, length, and depth and were developed or used in medical, nursing, allied health, and veterinary medicine disciplines. The validity, reliability, and replicability of studies are explored, and the quality of reporting is evaluated using the Simulation Research Rubric. Recommendations for increasing the rigor of programs and the reporting of research where SPs are adopted are considered.

Development of and First Experiences with a Framework (EASI) for Options and Implementation Opportunities for Online Clinical and Communication Skills Learning.

A preparatory framework called EASI (Evaluate, Align, Student-centred, Implement and Improve) was developed with the aim of creating awareness about interim options and implementation opportunities for online Clinical and Communication Skills (CCS) learning. The framework, when applied requires faculty to evaluate current resources, align sessions to learning outcomes with student-centred approaches and to continuously improve based on implementation experiences. Using the framework, we were able to generate various types of online CCS learning sessions for implementation in a short period of time due to the recent Covid-19 pandemic. Importantly we learnt a few lessons post-implementation from both students and faculty perspective that will be used for planning and delivery of future sessions. In summary, the framework was useful for creating or redesigning CCS sessions which were disrupted during the pandemic, however post-implementation experience suggests the framework can also be used for future solutions in online CCS learning as healthcare systems and delivery are increasingly decentralised and widely distributed.

The Balanced Scorecard: a tool to monitor IPL curriculum implementation: January 2020.

This article was migrated. The article was marked as recommended. Introduction: Implementing interprofessional learning (IPL) in health profession curriculum is difficult despite widespread acknowledgement of the importance of interprofessional collaborative health care practice. The aim of this study was to develop a balanced scorecard using a Delphi technique to document and monitor implementation of IPL in a faculty of health and medical sciences. Methods/Results: Twenty-four academic teachers and health service clinical supervisors completed two electronic questionnaires as part of a two stage Delphi survey. Consensus (70% agreement/disagreement) was achieved for 27/36 items in round one and for all 10 items in round two. Ten performance metrics were subsequently identified. Discussion: The Delphi was an efficient and effective method for identifying performance metrics for monitoring faculty IPL implementation. With a strong focus on learning outcomes and assessment, the scorecard will enable the faculty to formally monitor implementation of our IPL strategy over time. A follow up process of identifying data sources for reporting against each of the scorecard items has already highlighted gaps in our current practices, predominantly in staff professional development and assessment.