Critical analysis of evidence about the impacts on surgical teams of 'mental practice' in systematic reviews: a systematic rapid evidence assessment (SREA).

BACKGROUND: Mental Rehearsal (MR) the cognitive act of simulating a task in our heads to pre-experience events imaginatively. It has been used widely to improve individual and collective performance in fields outside healthcare and offers potential for more efficient training in time pressured surgical and medical team contexts. The study aims to review the current systematic review literature to determine the impact of MP on surgical performance and learning. METHODS: Medline, Embase, British Educational Index, CINAHL, Web of Science PsycINFO, Cochrane databased were searched in the period 1994-2018. The primary outcomes measure were performance improvements in surgical technical skills, stress reduction, confidence and team performance. Study quality of the Systematic Reviews was assessed using AMSTAR 2, a critical appraisal tool for systematic reviews. The reported impacts of MP in all included studies were mapped onto Kirkpatrick's framework for the evaluation of educational interventions. RESULTS: Six Systematic reviews were identified which met the inclusion criteria, of which all reported positive and varying benefits of MP on surgical performance, confidence, and coping strategies. However, reported impacts on a modified Kirkpatrick's framework did not exceed level 3. Mental practice was described in terms of mental imagery and mental rehearsal with most authors using each of the terms in their search strategies. The impacts on transfer to practice and the long- term acquisition of skills, but also personal uptake of mental practice routines were not reported. CONCLUSION: The majority of studies demonstrate benefits of MP for technical performance. Overall the systematic reviews were of medium to high quality. However, studies lacked a sufficiently articulated evaluation methodology to examine impacts beyond the immediate experimentations. This is also due to the limitations found in the primary studies. Future research should look at longitudinal mixed method evaluation designs and focus on real clinical teams.

Simulation of realistic nephrology case scenarios to facilitate intra-professional team learning.

BACKGROUND: Learning in the workplace maximises relevance to clinical practice and facilitates the education of the whole multiprofessional team. Provision of structured teaching is becoming increasingly challenging with shift pattern working and staff shortages. This article describes a simulation course designed to facilitate team learning to improve the care of nephrology patients, and presents outcome data over 2 years. METHODS: A full-day course, using high fidelity manikins, was designed for nephrology specialty trainees and nurse specialists. Nineteen learners (eleven specialty trainees and eight nurse specialists) and nine multidisciplinary team faculty members attended. Evaluation used pre- and post-course assessments, with a 1-year follow-up questionnaire. RESULTS: Following the course, improved knowledge scores, 56% to 72% (P<0.05), and confidence scores, 57% to 71% (P<0.005), were demonstrated. Qualitative analysis found 'intra-disciplinary interaction', 'reflection' and 'practical skills' were the greatest enablers of learning. In the 1-year follow-up questionnaire, specialty trainees reported that the course improved clinical practice and helped preparation for consultant roles. CONCLUSIONS: This course improved knowledge and confidence in managing nephrology scenarios across the multidisciplinary learning group, and the model could be used in other hospital specialties.

"That's your patient. There's your ventilator": exploring induction to work experiences in a group of non-UK EEA trained anaesthetists in a London hospital: a qualitative study.

BACKGROUND: European health systems depend increasingly on the services of health professionals who obtained their primary medical qualification from other countries. There has been a significant increase recently in fully qualified specialist doctors arriving from the European Union to provide short term or longer-term solutions to health human resources needs in the UK National Health System. These doctors often take up senior consultant positions. As a result, the NHS has had to learn to deal with both expatriation and repatriation of EU doctors as a constant dynamic characteristic of its own ability to deliver services. We conducted a qualitative study to explore the acclimatisation experience of EU doctors with qualifications in anaesthesia arriving in the United Kingdom to take up clinical employment in the NHS. The question we ask is: how do specialty registered anaesthetists who trained in other European countries experience the process of acclimatisation to practice in the United Kingdom in a large hospital in London? METHODS: We did individual interviews with non-UK, EU-qualified doctors with Certification of Completion of specialty Training who were registered with the General Medical Council in the UK and could practice in the NHS as specialist anaesthetists. The doctors were all interviewed whilst working in a large NHS teaching hospital in London, UK. We analysed qualitative data from interview transcripts to identity themes and patterns regarding senior doctor's acclimatisation to the British system. RESULTS: Acclimatisation conceived of as transfer of clinical expertise was problematic for doctors who felt they lacked the right kind of support. Doctors sought different opportunities to share wider perspectives on care deriving from their previous experience. CONCLUSIONS: Hospital conceptions of acclimatisation as a highly individual process can offer an idealized view of clinical work and learning in the new system. Socio-cultural theories suggest we create regular learning opportunities for international staff to critically reflect on practice with local staff to acclimatise more effectively.

The challenge of reform: 10 years of curricula change in Italian medical schools.

Italy has a long history of versatility in medical training in which the tension between 'knowing' and 'doing' is a recurrent theme dating from the origins of the first European medical faculties in Bologna in the eleventh century. Italian medical schools are currently undergoing widespread reforms building on two decades of concerted efforts by medical educators to move from traditional teacher and subject-centred degree programmes to integrated student-centred curricula. European higher education policies have helped drive this process. A challenge in these developments is that the adoption of integrated and outcomes-based curricula in medicine requires a discursive shift in teaching practices. While investment in teacher training is essential, it is also important for educational leaders in medicine to communicate a compelling vision of the type of health professional medical schools are aiming to produce. Systematic educational research should accompany this transition to evaluate the process and gauge sustainability. Investigation should also examine how external influences and pressures are calibrated and adapted to the national context and epistemology. The adoption of a common international vocabulary to describe educational processes means Italy will be able to participate more fully in the European medical education debate in future.