Enhancing interprofessional collaboration in paediatric training: Insights from profession-specific experiences and implications for future education.

AIM: There is limited evidence on trainees' and instructors' needs and perspectives concerning interprofessional simulation-based trainings. We aimed to study task distribution among team members, profession-specific learning effects and enhancing collaboration and competencies within medical teams. METHODS: This prospective study examined expectations and experiences of medical and nursing students during paediatric emergency training in a tertiary care centre with questionnaires before and after a training. Further, expert interviews were conducted to identify the needs for interprofessional training. Results were used to design a standardised checklist for structured preparation of interprofessional paediatric emergency management training. RESULTS: Of the nursing students, 82% initially intended to assume the role of the team leader, but only 5.8% did so during training. Both professions emphasised the significance of effective communication and transparent task distribution for successful collaboration. Experts highlighted the importance of proficiency in basic technical skills and identified non-technical skills such as closed-loop communication and the 10-4-10 principle as crucial for both professions. CONCLUSION: The study revealed profession-specific variations in the intention of acquiring the team leader or member role. Interprofessional training emerges as a potential strategy to dismantle these structures and promote shared responsibilities. The checklist aims to facilitate structured preparation of a training.

Mentally Demanding Work and Strain: Effects of Study Duration on Fatigue, Vigor, and Distress in Undergraduate Medical Students.

AIMS: The impact of the extent of mentally demanding work on the next-day's strain is largely unknown, as existing studies generally investigate consequences of extended versus normal workdays. The present study sought to fill this gap by investigating how short work periods of mentally demanding academic work impact strain reactions in medical students preparing for an exam, using days of no work as reference category. METHOD: The observational design involved students repeatedly self-reporting fatigue, vigor, distress, and the preceding day's study duration. Hours of nocturnal sleep, attending paid work and compulsory classes, gender, and proximity to the exam were controls in the linear model (generalized estimating equations). Forty-nine students provided 411 self-reports (M = 8.6, SD = 7.0 self-reports/student). RESULTS: Engaging in mentally demanding work was associated with increased distress and work periods > 4 h with increased fatigue. Distress, vigor loss, and fatigue increased in proximity to the exam. CONCLUSION: Despite students' high control of their schedule, even short periods of mentally highly demanding work may impair next-day's well-being when task motivation is high. Freelancers and students might require health-promoting scheduling of work and leisure to avoid an accumulation of strain.

Designing virtual patient based self-study quizzes covering learning goals in clinical diagnostic sciences for undergraduate medical students - the radiology example.

Background: Diagnostic tests and examinations inform clinical decision making. Thus, an essential part of medical students' workplace-based training is dedicated to core skills in clinical diagnostic sciences. Due to a reduction of clinical internships for fifth-year students in the wake of COVID-19 learning activities replacing this aspect of training were needed. Project description: Virtual Patient online learning materials addressing clinical diagnostic sciences, specifically, radiology, were developed to prepare students for the transition to workplace-based learning. Three types of activities related to interprofessional patient treatment, showing how radiology knowledge improves the diagnosing and treatment of patients, were used to design the narrative of each virtual patient. The materials also showed students "how to learn" in the clinical workplace while showing "what to learn". Students complete relevant tasks and compare their approach with experts' approach in a self-directed way. Results: Twenty self-study quizzes, accompanied by nine interactive Webinars were developed, providing 13% of the overall available replacement learning materials for the summer term 2020. In June 2020, 486 students completed the program and collected a mean share of 16% (SD=10) of their required credits by choosing to learn with these materials. Conclusion: Developing virtual patients based on three types of clinical activities to prepare students for the transition to workplace based learning proved successful and allowed rapid development of learning materials. The presented online quiz format and webinar format showed high acceptance and interest among students.

Communication skills supervisors' monitoring of history-taking performance: an observational study on how doctors and non-doctors use cues to prepare feedback.

BACKGROUND: Medical students need feedback to improve their patient-interviewing skills because self-monitoring is often inaccurate. Effective feedback should reveal any discrepancies between desired and observed performance (cognitive feedback) and indicate metacognitive cues which are diagnostic of performance (metacognitive feedback). We adapted a cue-utilization model to studying supervisors' cue-usage when preparing feedback and compared doctors' and non-doctors' cue usage. METHOD: Twenty-one supervisors watched a video of a patient interview, choose scenes for feedback, and explained their selection. We applied content analysis to categorize and count cue-use frequency per communication pattern (structuring/facilitating) and scene performance rating (positive/negative) for both doctors and non-doctors. RESULTS: Both groups used cognitive cues more often than metacognitive cues to explain their scene selection. Both groups also used metacognitive cues such as subjective feelings and mentalizing cues, but mainly the doctors mentioned 'missing information' as a cue. Compared to non-doctors, the doctors described more scenes showing negative performance and fewer scenes showing positive narrative-facilitating performance. CONCLUSIONS: Both groups are well able to communicate their observations and provide cognitive feedback on undergraduates' interviewing skills. To improve their feedback, supervisors should be trained to also recognize metacognitive cues, such as subjective feelings and mentalizing cues, and learn how to convert both into metacognitive feedback.

Student Perceptions of Instructional Ultrasound Videos as Preparation for a Practical Assessment.

BACKGROUND: Learning ultrasound early in the medical school curriculum helps students to understand anatomy and pathology and to perform defined ultrasound standard views. Instructional videos are a potentially valuable tool for improving the process of learning ultrasound skills. It was the aim of the present study to investigate how students perceived instructional videos as a learning aid, compared to other learning opportunities, in preparation for an Objective Structured Clinical Examination (OSCE). MATERIALS AND METHODS: Eleven concise ultrasound videos were created and implemented in the 4 th year at the Medical University of Vienna. The videos illustrate the predefined examination process, image optimization, and nine standardized ultrasound views. The videos were available to be used in preparation for the practical ultrasound examination, which was part of the objective structured clinical examination. The students' perceptions of the instructional videos and other learning methods were surveyed using an online questionnaire. RESULTS: In total, 445 of 640 students (69.5% of the cohort) used the instructional videos. Of those students, 134 (30%) answered the questionnaire. Of this group, 88.9% rated the instructional videos as very helpful (49.6% as extremely helpful). An ANOVA revealed a significant difference between various learning materials in terms of helpfulness. Post hoc analysis showed that instructional videos were perceived as the second most helpful learning material after "self-execution and feedback." CONCLUSION: The study revealed that students use instructional videos frequently and appreciate them as an extra tool for effective studying.

[Doctor-Patient Communication Training in Simulated Situations: Emotions and Perceptions of Simulated Patients during Patient-Centered Conversations]. / Ärztliches Gesprächsführungstraining in simulierten Situationen: Wahrnehmungen und Empfindungen von Simulationspatienten bei patientenzentrierter Gesprächsführung.

INTRODUCTION: The use of simulated patients (SPs) for doctor-patient communication training has been established in medical curricula as an important didactic method. The study addresses the question, if patients' emotions and perceptions are represented adequately in patient-centered communication. MATERIALS AND METHODS: 22 of 37 SPs of the Medical University of Vienna (12 women, 10 men) were asked openly about their feelings after having acted as an SP in a semi-structured interview, which employed the Critical Incident Technique. The interviews were recorded, transcribed, separated into situational analysis units und analyzed deductively; we used the evidence based qualities of patient-centered communication and the "Nationaler Kompetenzbasierter Lernzielkatalog Medizin" as a guideline. RESULTS: Out of 192 analysis units, 67 were evaluated as positive and 125 as negative. The SPs reported positive feelings, such as perceiving "stability and trust in relationships" (22%), perception of congruence (15%), acceptance (27%) and empathy (36%). As to negative feelings, SPs reported "perceiving instability" (18%), "incongruence" (11%), "lack of acceptance" (40%) and "lack of empathy" (30%). Additionally, 50% of SPs were positively affected when observing students' learning success. DISCUSSION: When SPs perceived patient-centered communication, they reported positive emotions. A lack of patient centeredness, on the contrary, provoked negative emotions. An empathic attitude, as well as a "lack of acceptance" with contrary effects had the strongest influence on the SPs' mental state. The reaction of SPs to patient centeredness is sufficiently authentic to reach learning objectives, however it is also affected by reactions of SPs to the learning success of students, which is irrelevant for the real-life doctor-patient interaction. CONCLUSION: SP reactions are affected by students' attitudes. Students should therefore be prepared well before interacting with SPs in a roleplay setting. While SPs' behavior is authentic in patient-centered communication in general, SPs should be trained to hide their positive emotions concerning students' learning success during roleplay.

Comparison of rest-break interventions during a mentally demanding task.

Research is scarce on ways to enhance the effect of rest breaks during mentally demanding tasks. The present study investigated the effectiveness of two rest-break interventions on well-being during an academic lecture. Sixty-six students (53 females, mean age 22.5 years) enrolled in two different university classes of 4-hr duration participated in the study. Two measures of well-being (fatigue and vigor) were assessed immediately before, after, and 20 minutes after the break. A control condition without a break as well as an unstructured break was compared with breaks either encompassing physical activity or a relaxation exercise. Compared with the nonbreak condition, the unstructured rest break led to an increase in vigor, the exercise break as well as the relaxation break both to an increase in vigor and a decrease in fatigue at 20-min post break. Compared with the unstructured break, exercise led to an (additional) increase in vigor and relaxation to an (additional) decrease in fatigue at 20-min post break. Thus, the effects of rest breaks during mentally demanding tasks can be enhanced by engaging in physical activity or relaxation exercises, with effects lasting at least as long as 20 min into the continuation of the task.

Using patient cases to educate health professionals, patients, institutions, and society: the swallowing disorder example.

The problems and symptoms of patients are at the heart of medicine and pertinent to information, communication, and education. Patients present their problems to health professionals looking for relief and a cure, while institutions collect data about symptoms of patients and the way health professionals treated them to support society's care providers in administrating and managing care. The information on the problems of patients and the way health professionals treated them, which is gathered and stored in patient files, is valuable as educational material in the field of medicine. Driven by the fast developments of new technical tools case-based information, communication and education starts to enter educational domains beyond the field of medicine, such as school systems and public health services. In our discussion we seek to understand and outline how to use the material gathered and stored in patient files to educate health professionals. Additionally, this paper gives examples of case-based education for all members of society.

Publication activity in medical education research: A descriptive analysis of submissions to the GMS Zeitschrift für Medizinische Ausbildung in 2007-2015.

Objectives: The significance of medical education research has increased internationally. In this context we investigated whether, and if so, how the quantity and quality of scientific papers reviewed and/or published by the GMS Zeitschrift für Medizinische Ausbildung (GMS Z Med Ausbild) changed. Methods: The quantity and ratio of original papers, project reports and reviews submitted to or published in the GMS Z Med Ausbild were analysed. Published scientific articles were investigated in regard to the quality features "study type" and "mode of data collection" as well as the background (university affiliation) of the last authors. The citation frequency within the first five years after PubMed listing was compared to the one of BMC Medical Education in the corresponding period. Results: The number of submitted scientific manuscripts increased steadily. Most of the submissions and publications are original papers. For publications explorative studies and prospective data collection are most common. A shift over time is not observed. 16% of the published works come from one and 36% from four of the in total 39 universities represented by the last authors. The development of the citation frequency of articles published in GMS Z Med Ausbild is similar to that of BMC Medical Education. Conclusion: The rising number of submissions indicates an increasing significance of medical education research in German-speaking countries. The development of the number of citations reflects the growing appreciation of GMS Z Med Ausbild also indicated by the increasing number of online accesses. Our findings that study type and mode of data collection did not change has to be interpreted with caution since among other things choice and correct application of adequate methods are crucial regarding a scientific work's quality, too. These aspects, however, were not investigated in this paper.

Taking the history in patients with swallowing disorders: an international multidisciplinary survey.

PURPOSE: Clinical assessment of swallowing disorders (dysphagia) requires accurate and comprehensive medical history-taking to further tailor the diagnostic work-up, but functional health care questionnaires show a large variability and various limitations. The aim of this study was to assess the way in which international swallowing experts from various disciplines asses swallowing problems in order to improve the radiologist´s ability to take a thorough medical history in this specific patient group. METHODS: A two-step Delphi method was used to collect swallowing experts' ways of taking the medical history in patients with swallowing disorders. The questions obtained in a first interview round were pooled and structured by dividing them into general and specific questions, including several subcategories, and these were scored by the experts in a second step based on to their clinical relevance. RESULTS: Eighteen experts provided 25 different questions categorized as general questions and 34 dimension-specific questions (eight attributed to 'suspicion of aspiration,' 13 to 'dysphagia,' six to 'globus sensation,' four to 'non-cardiac chest pain,' and three to 'effect of life.') In the second interview round, the experts´ average predictive values attributed to those questions showed the varying importance of the presented items. Seven general and 13 specific questions (six of them attributed to 'effect on life' and seven 'others') were also added. CONCLUSIONS: This collection of questions reflects the fact that a multidisciplinary approach when obtaining the medical history in patients with swallowing disorders may contribute to an improved technique for performing a symptom-oriented medical history-taking for radiologists of all training levels.

Information technology and social sciences: how can health IT be used to support the health professional?

Keeping up to date with the increasing amount of health-related knowledge and managing the increasing numbers of patients with more complex clinical problems is a challenge for healthcare professionals and healthcare systems. Health IT applications, such as electronic health records or decision-support systems, are meant to support both professionals and their support systems. However, for physicians using these applications, the applications often cause new problems, such as the impracticality of their use in clinical practice. This review adopts a social sciences perspective to understand these problems and derive suggestions for further development. Indeed, humans use tools to remediate the brain's weaknesses and enhance thinking. Available health IT tools have been shaped to fit administrative needs rather than physicians' needs. To increase the beneficial effect of health IT applications in health care, clinicians' style of thinking and their learning needs must be considered when designing and implementing such systems. New health IT tools must be shaped to fit health professionals' needs. To further ease the integration of new health IT tools into clinical practice, we must also consider the effects of implementing new tools on the wider social framework.

Monitoring communication with patients: analyzing judgments of satisfaction (JOS).

Medical students struggle to put into practice communication skills learned in medical school. In order to improve our instructional designs, better insight into the cause of this lack of transfer is foundational. We therefore explored students' cognitions by soliciting self-evaluations of their history-taking skills, coined 'judgments of satisfaction (JOSs)'. Our cognitive-psychological approach was guided by Koriat's cue-utilization framework (J Exp Psychol Gen 126:349-370. doi: 10.1037/0096-3445.126.4.349 , 1997) which rests on the assumption that internal and external cues inform learners' metacognitive judgments, which, in turn, steer their actions. Judgments based on unsuitable cues will cause ineffective behavior. Consequently, students are unable to adequately master these skills or properly apply them in similar situations. For the analysis, we had 524 medical undergraduates select scenes they were satisfied or dissatisfied with from their video-recorded simulated-patient encounters and explain why. Twenty transcripts were sampled for directed content analysis. We found that approximately one-third of students' judgments focused on content (JOS-type-a); about half on the quality of the communication skills (JOS-type-b); and about ten percent targeted the appropriateness of the skills harnessed (JOS-type-c). This lack of reflection on appropriateness may explain why students experience problems adapting to new situations. It was primarily high-performance students who formed type-c judgments; poor performers tended to give type-a and type-b judgments. Future research would benefit from the use of our modified version of Koriat's framework in order to further explore how high and poor performing medical students differ in the way they form JOSs during communications skills training.

Desire and reality--teaching and assessing communicative competencies in undergraduate medical education in German-speaking Europe--a survey.

OBJECTIVES: Increasingly, communicative competencies are becoming a permanent feature of training and assessment in German-speaking medical schools (n=43; Germany, Austria, Switzerland - "D-A-CH"). In support of further curricular development of communicative competencies, the survey by the "Communicative and Social Competencies" (KusK) committee of the German Society for Medical Education (GMA) systematically appraises the scope of and form in which teaching and assessment take place. METHODS: The iterative online questionnaire, developed in cooperation with KusK, comprises 70 questions regarding instruction (n=14), assessment (n=48), local conditions (n=5), with three fields for further remarks. Per location, two to three individuals who were familiar with the respective institute's curriculum were invited to take part in the survey. RESULTS: Thirty-nine medical schools (40 degree programmes) took part in the survey. Communicative competencies are taught in all of the programmes. Ten degree programmes have a longitudinal curriculum for communicative competencies; 25 programmes offer this in part. Sixteen of the 40 programmes use the Basler Consensus Statement for orientation. In over 80% of the degree programmes, communicative competencies are taught in the second and third year of studies. Almost all of the programmes work with simulated patients (n=38) and feedback (n=37). Exams are exclusively summative (n=11), exclusively formative (n=3), or both summative and formative (n=16) and usually take place in the fifth or sixth year of studies (n=22 and n=20). Apart from written examinations (n=15) and presentations (n=9), practical examinations are primarily administered (OSCE, n=31); WPA (n=8), usually with self-developed scales (OSCE, n=19). With regards to the examiners' training and the manner of results-reporting to the students, there is a high variance. CONCLUSIONS: Instruction in communicative competencies has been implemented at all 39 of the participating medical schools. For the most part, communicative competencies instruction in the D-A-C-H region takes place in small groups and is tested using the OSCE. The challenges for further curricular development lie in the expansion of feedback, the critical evaluation of appropriate assessment strategies, and in the quality assurance of exams.

Practical clinical skills assessment for a cohort of 680 2nd year human medicine students. Is it feasible?

In clinical skills training objective structured clinical examinations (OSCEs) are the method of choice to foster learning. Hence, implementing them is challenging and expensive. Thus it is investigated how an alternative procedure that keeps OSCE's essential elements, but assigns less stations to each student, works in terms of validity and justifiability.Data of n = 694 students, each taking five tasks drawn semi-randomized out of a pool of 26 tasks, strictly aligned with learning objectives, are analyzed. Despite unsurprisingly low overall reliability, a justifiable pass/fail decision is possible for 480 students (69 %). The remaining group (n = 210, 30 %) is indeed larger than with longer OSCEs, and would need ongoing assessment. The tasks' psychometric quality contributes to exams construct validity. Resource preserving short practical skills assessment is educationally valid and feasible with MedUniVienna's human medicine cohorts of n = 680.

Adaptive testing for psychological assessment: how many items are enough to run an adaptive testing algorithm?

Although the principles of adaptive testing were established in the psychometric literature many years ago (e.g., Weiss, 1977), and practice of adaptive testing is established in educational assessment, it not yet widespread in psychological assessment. One obstacle to adaptive psychological testing is a lack of clarity about the necessary number of items to run an adaptive algorithm. The study explores the relationship between item bank size, test length and measurement precision. Simulated adaptive test runs (allowing a maximum of 30 items per person) out of an item bank with 10 items per ability level (covering .5 logits, 150 items total) yield a standard error of measurement (SEM) of .47 (.39) after an average of 20 (29) items for 85-93% (64-82%) of the simulated rectangular sample. Expanding the bank to 20 items per level (300 items total) did not improve the algorithm's performance significantly. With a small item bank (5 items per ability level, 75 items total) it is possible to reach the same SEM as with a conventional test, but with fewer items or a better SEM with the same number of items.

Rising to the challenge: cross-cultural adaptation and psychometric evaluation of the adapted German version of the Jefferson Scale of Physician Empathy for Students (JSPE-S).

Assessment of students' attitudes towards physicians' empathy is essential in medical education and in practice because empathy is vital in physician-patient communication. To cross-culturally adapt the Jefferson Scale of Physician Empathy (S-version, JSPE-S) into a German version, examine its psychometric properties in comparison to the original US version (psychometric equivalence), and to compare the level of attitude towards empathy to the original US version and to other cultural adaptations. The German version was administered to the 2010 2nd year medical students cohort at the Medical University of Vienna, Austria (n = 516). Item-total score correlations were all positive. Reliability was high (Cronbach's alpha = .82); a 6-7 weeks test-retest correlation for a subsample was .45. In an explanatory factor analysis, a four-factor solution emerged and is akin to published results of the original JSPE-S. This study provides an example of successful cross-cultural adaptation of an assessment instrument. The German adaptation of the JSPE at hand will pave the way for future international research regarding the concept of empathy and its outcomes.

Twelve tips for designing and implementing a structured rater training in OSCEs.

BACKGROUND: Observation, rating, and grading are parts of the routine of the faculty when in contact with medical students. Most interestingly, there is a dearth of proper instructions on rater training for objective structured clinical examinations (OSCEs) in medical education literature. AIMS: We assembled 12 tips for implementing a structured rater training program. To highlight these tips, we provided examples of our implementation of rater training for an OSCE in 2009. METHODS: We developed a tailored rater training program by compiling information from medical education and other related research disciplines. RESULTS: The structured rater training at hand proved feasible, and the acceptance rate of this training by examiners was high.

Research in assessment: consensus statement and recommendations from the Ottawa 2010 Conference.

Medical education research in general is a young scientific discipline which is still finding its own position in the scientific range. It is rooted in both the biomedical sciences and the social sciences, each with their own scientific language. A more unique feature of medical education (and assessment) research is that it has to be both locally and internationally relevant. This is not always easy and sometimes leads to purely ideographic descriptions of an assessment procedure with insufficient general lessons or generalised scientific knowledge being generated or vice versa. For medical educational research, a plethora of methodologies is available to cater to many different research questions. This article contains consensus positions and suggestions on various elements of medical education (assessment) research. Overarching is the position that without a good theoretical underpinning and good knowledge of the existing literature, good research and sound conclusions are impossible to produce, and that there is no inherently superior methodology, but that the best methodology is the one most suited to answer the research question unambiguously. Although the positions should not be perceived as dogmas, they should be taken as very serious recommendations. Topics covered are: types of research, theoretical frameworks, designs and methodologies, instrument properties or psychometrics, costs/acceptability, ethics, infrastructure and support.

Conception and construction of a Rasch-scaled measure for self-confidence in one's vocabulary ability.

Although different theoretical approaches indicate the importance of self-confidence in one's ability in educational or counselling psychology, there are only a few standardized psychological instruments, these being mainly questionnaires, that focus on this construct. The idea pursued is to expand a traditional ability test and create an objective personality measure for self-confidence in one's ability. Empirical evidence will be provided as to whether it is possible to construct and cross validate this measure using the Rasch model. A two step procedure allowing for a self rating of one's knowledge of words was designed using 25 items from a general knowledge - vocabulary test. The results indicate that it is possible to construct and cross validate a measure for self-confidence in one's ability using the Rasch model. Additionally, it is shown that the measure for self-confidence in one's ability is independent from the general knowledge.