Assessing professionalism in health profession degree programs: A scoping review.

BACKGROUND: To identify and classify methods for assessing professionalism across health profession degree programs and identify gaps in the literature regarding types of assessments. METHODS: The authors conducted a scoping review of articles published from database inception through 24 January 2020. Included articles described an assessment approach for professionalism in health profession degree programs available in full-text in the English language. Articles were classified based on profession, timing of assessment, feedback type, assessment type, professionalism dimension, and Barr's modified Kirkpatrick hierarchy. RESULTS: Authors classified 277 articles meeting inclusion criteria. Most articles were from medical education (62.5%) conducted during didactic (62.1%) or experiential/clinical curriculum (49.8%). Few articles (15.5%) described longitudinal assessment. Feedback type was formative (32.2%) or summative (35%), with only 8.3% using both. Assessment types frequently reported included self-administered rating scales (30%), reflections (18.8%), observed clinical encounters (17.3%), and knowledge-based tests (13.4%). Ethical practice principles (65%) and effective interactions with patients (48.4%) were the most frequently assessed dimensions of professionalism. Authors observed balanced distribution among Barr's modified Kirkpatrick model at levels of reaction (38.3%), modification of perceptions and attitudes (33.6%), acquisition of knowledge and skills (39%), and behavioral change (36.1%). IMPLICATIONS: The classification scheme identified in current literature on professionalism assessment does not align with International Ottawa Conference Working Group on the Assessment of Professionalism recommendations. Gaps identified were limited description of professionalism assessment during admissions, infrequent longitudinal assessment, limited use of methods for both formative and summative assessment, and limited reports of assessments applicable to interprofessional education settings.

Understanding Paper-Based Documentation Practices in Medical Resuscitations to Inform the Design of Electronic Documentation Tools.

OBJECTIVE: Despite growing use of electronic health records, many resuscitation settings still use paper-based documentation. The fast-paced and safety-critical nature of trauma and medical resuscitation environments pose challenges for real-time documentation. This study aims to understand paper-based documentation practices and inform the design of efficient electronic documentation solutions for supporting safety-critical medical processes. METHODS: Data were collected through in situ observations of nurse documenters during resuscitation events and postevent interviews with nurses. These data were analyzed using frequency distribution and qualitative, open-coding techniques. Data analysis focused on the following 3 main documentation factors: temporal distribution of documentation, total number of filled out sections on the paper flow sheet across all resuscitations, and completeness of documentation per resuscitation. RESULTS: Findings from this study highlight the time-critical nature of these settings, showing that 74% of the documentation was completed within the first 15 minutes of the resuscitation. Some sections of the paper flow sheet were filled out more than others, and a few sections were left incomplete across all events. Interviews with nurses provided insight about documentation experiences in a fast-paced environment, including variable usage of flow sheet based on nurse experience level and patient scenarios, supplemental documentation mechanisms, and information needs and preferences. CONCLUSIONS: Several design implications are discussed to inform the design of effective electronic documentation systems. Design implications focus on layout structure, prepopulating items, section placement, and completion status of the flow sheet. Future plans for research focus on combining video review with in situ observations and conducting detailed interviews with nurses to better understand their documentation experiences and preferences.

The Use of Simulation in Physician Assistant Programs: A National Survey.

PURPOSE: The purpose of this study was to develop a national-level description of the current use of simulation activities in physician assistant (PA) education and to assess the degree to which the use of simulation varies by PA program size and institutional type. METHODS: An electronic survey on medical simulation was sent to 177 PA program directors or to a designated simulation activities coordinator, using the directory on the Physician Assistant Education Association website. The survey addressed program characteristics, types of simulation modalities in use, and frequency of use of those modalities in PA training. The specific content areas addressed were error disclosure, medical knowledge, patient care, and psychomotor skills. RESULTS: The survey was emailed 3 times from early April to mid-May 2014, with a follow-up call to nonrespondents in August 2014. Of the 177 PA programs contacted, 63 completed the survey, for a response rate of 35.6%. Results indicate widespread use of simulation by survey respondents, especially in teaching, assessment of medical knowledge, and clinical skills, with somewhat lower levels of use in content areas such as error disclosure, delivery of bad news, and team training. CONCLUSIONS: Although barriers exist to its use in training health care professionals, simulation has become an important tool for training PAs in a variety of medical and interpersonal skills. It is also clear that simulation is an important tool for conducting interprofessional training. More research is needed to identify optimal approaches to the use of simulation in health care professions training.

A multi-institutional study using simulation to teach cardiopulmonary physical examination and diagnosis skills to physician assistant students.

PURPOSE: Research demonstrates limitations in the ability of health care trainees/practitioners, including physician assistants (PAs), to identify important cardiopulmonary examination findings and diagnose corresponding conditions. Studies also show that simulation-based training leads to improved performance and that these skills can transfer to real patients. This study evaluated the effectiveness of a newly developed curriculum incorporating simulation with deliberate practice for teaching cardiopulmonary physical examination/bedside diagnosis skills in the PA population. METHODS: This multi-institutional study used a pretest/posttest design. Participants, PA students from 4 different programs, received a standardized curriculum including instructor-led activities interspersed among small-group/independent self-study time. Didactic sessions and independent study featured practice with the "Harvey" simulator and use of specially developed computer-based multimedia tutorials. Preintervention: participants completed demographic questionnaires, rated self-confidence, and underwent baseline evaluation of knowledge and cardiopulmonary physical examination skills. Students logged self-study time using various learning resources. Postintervention: students again rated self-confidence and underwent repeat cognitive/performance testing using equivalent written/simulator-based assessments. RESULTS: Physician assistant students (N = 56) demonstrated significant gains in knowledge, cardiac examination technique, recognition of total cardiac findings, identification of key auscultatory findings (extra heart sounds, systolic/diastolic murmurs), and the ability to make correct diagnoses. Learner self-confidence also improved significantly. CONCLUSIONS: This study demonstrated the effectiveness of a simulation-based curriculum for teaching essential physical examination/bedside diagnosis skills to PA students. Its results reinforce those of similar/previous research, which suggest that simulation-based training is most effective under certain educational conditions. Future research will include subgroup analyses/correlation of other variables to explore best features/uses of simulation technology for training PAs.