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Lessons learned through innovation in medical education

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... 40 Eva suggested the problem that we fool ourselves, because we believe to have a privileged insight into our own capacities but maybe are not able to perceive our own deficits for a performance improvement. 37,41 Poor self-assessment not only seems to be a problem of medical students, it impacts on all health professions 42 -which consequently underlines the significance of RNAs' poor self-assessment skills. ...
... 44 In extreme cases, others or "bad conditions" are blamed for their inadequate performance. 41 Going a closer look at the research details on self-assessment reveals its weak sides and therefore forced Eva and Regehr to query how this concept could be improved. 37,41 But how could this be realised? ...
... 41 Going a closer look at the research details on self-assessment reveals its weak sides and therefore forced Eva and Regehr to query how this concept could be improved. 37,41 But how could this be realised? ...
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Background: Anaesthesiologists and Registered Nurse Anaesthetists (RNA) are providing anaesthesia in closed collaboration in Switzerland. Since 1968, a two-year educational program for RNAs exists and it was renewed in 2009 towards a “postgraduate study of higher degree”. Continuing Education (CE) of RNAs after graduation is not regulated, but there are vigorous efforts for national recognition. The evidence about effective Continuing Professional Development (CPD) in Health Profession Education (HPE) and its application on the high professional competencies of RNAs is unknown. This thesis will investigate that and focus on a practical example of effective educational strategies specifically for the management of Difficult Airway (DA) situations. DA management is representative as one of the various responsible core competencies of RNAs in anaesthesia and pre-hospital emergency medicine at the Cantonal Hospital Aarau (Kantonsspital Aarau - KSA). Methods: A review of the literature was conducted to gain an insight of the following relevant topics: a) CPD in Health Profession Education b) self-assessment c) DA management in anaesthesia d) pre-hospital DA management e) general principles for airway management training and f) educational strategies for DA management (e.g. simulation and workplace-based learning) Results: In total 131 studies, textbooks, book chapters and websites were reviewed. David Davis’ best practice1-5 served as an effective conceptual framework for CPD in HPE underlining the importance of providing feedback. Feedback, as the literature talking about self-assessment clearly summarises, is essential to compensate the known weaknesses of the “self-assessment concept”. The literature on DA management reveals the effectiveness of predictive tests and its positive impact on RNAs’ training, the training of algorithms, and especially the non-technical skills in team trainings. Simulation training and workplace-based learning are reviewed as educational strategies to improve RNAs’ DA management as part of anaesthesia teams. Issenberg’s6 recommendations on simulation training and Norcini’s7 recommendations on workplace-based learning are highly overlapping with Davis’ best practice for effective CPD. Those may be indicators for appropriate educational strategies to improve the DA management competencies of RNAs. Discussion: Attempts to regulate Swiss RNAs CPD provide the chance for educational changes. That may be the way for structured and consistent realisation in the Swiss anaesthesia departments. Davis’ seven operational elements provide a useful conceptual framework for CPD that could guide curriculum planers to develop suitable CPD programs. This master thesis clarifies problems and provides examples how to improve one of RNAs’ core competencies: the Difficult Airway management, in anaesthesia and pre-hospital emergency care specifically at the KSA.
... Ainsi, la même recherche documentaire sur le site de la revue anglophone Medical Education, dont la parution est mensuelle, dénombre un peu plus de 700 références incluant ce terme, soit sous sa forme substantive innovationsoit sous sa forme adjectivaleinnovative -, pendant la même décennie. La visibilité du terme est en l'occurrence fortement renforcée puisqu'on le retrouve dans une quarantaine de titres, concernant pour la plupart les communications brèves publiées dans la rubrique semestrielle "Really good stuff" », dont il faut noter avec intérêt que le sous-titre initial, choisi lors du lancement de la formule en 1999 -New ideas in medical education -, avait été modifié à partir de 2011 au profit de Lessons learned through innovation in medical education [1]. ...
... Le statut d'innovation ne peut en effet, le plus souvent, être attribué que de façon rétrospective. Un certain nombre d'idées ou d'intuitions ne tiennent pas toutes leurs promesses lorsqu'elles sont expérimentées et, à cet égard, il est tout aussi important d'analyser les succès que les échecs pour contribuer à mettre au jour les conditions de viabilité favorables à la réussite d'un nouveau dispositif, appelé à devenir alors une authentique innovation [1]. ...
... Goals and need for innovation -There is a thorough description of the scope of the problem and need for innovation. 13,16,17 -There is a statement about the degree to which the problem is generalizable. 13 -There is a clear statement of the research question and goals. ...
... 10 -There is a description of the barriers and challenges experienced. 13,16 Evaluation of innovation -There is a description of the metrics used to evaluate the innovation. 11,13,17 -Complete results of the statistical analysis are reported, distinguishing between the statistical and practical/ education significance. ...
Article
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Objective: The scholarly dissemination of innovative medical education practices helps broaden the reach of this type of work, allowing scholarship to have an impact beyond a single institution. There is little guidance in the literature for those seeking to publish program evaluation studies and innovation papers. This study aims to derive a set of evidence-based features of high-quality reports on innovations in emergency medicine (EM) education. Methods: We conducted a scoping review and thematic analysis to determine quality markers for medical education innovation reports, with a focus on EM. A search of MEDLINE, EMBASE, ERIC, and Google Scholar was augmented by a hand search of relevant publication guidelines, guidelines for authors, and website submission portals from medical education and EM journals. Study investigators reviewed the selected articles, and a thematic analysis was conducted. Results: Our search strategy identified 14 relevant articles from which 34 quality markers were extracted. These markers were grouped into seven important themes: goals and need for innovation, preparation, innovation development, innovation implementation, evaluation of innovation, evidence of reflective practice, and reporting and dissemination. In addition, multiple outlets for the publication of EM education innovations were identified and compiled. Conclusion: The publication and dissemination of innovations are critical for the EM education community and the training of health professionals. We anticipate that our list of innovation report quality markers will be used by EM education innovators to support the dissemination of novel educational practices.
... Aspects of learning environments that program participants have reported to have provided the highest impact include mentoring, high challenge assignments paired with high support, and approval of innovation (permission to fail!) by institutional leadership (Bogo, 2007;Gusic et al., 2010). Field mentors have been reported as a best practice to teach any behavioral competency, as students accept feedback more readily when the instructor has observed their practice as the instructor is seen as knowledgeable and hence credible creating a relationship between student and field instructor that includes trust and support (Bogo, 2007;Eva & Anderson, 2011;Miehls et al., 2013). Both student feedback and empirical data have demonstrated educators make a large impact on learning when they are both highly proficient in professional practice and teaching (Rhodes et al., 1999). ...
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ABSTRACT To date, less than 20 publications describe leadership development programs that demonstrate quantitative influence on team effectiveness or objective improvement in learned leadership competencies. More research is required to seek education strategies able to demonstrate measurable outcomes. This mixed-methods study evaluated the outcomes of an adaption of Social Work’s Field Education pedagogy to develop leadership competencies for front line managers in a healthcare company (N=56). This mixed methods study evaluated a participant survey, two group interviews, related company records and three culture surveys. Linear regression analysis was conducted on voluntary turnover trendlines. The results of the research survey confirmed front line leaders with adequate conceptual knowledge and high motivation retain an ongoing need for procedural and metacognitive knowledge to consistently deploy EI-SI in their roles. Study survey revealed that participants perceived their personal effectiveness to have improved an average of 3.2 areas post LFE program participation. The most commonly named areas of improvement included meeting daily expectations, operational quality, and managing relationships. Interview trends also revealed perceptions of enhanced organizational effectiveness in direct-report teams following leaders’ participation in the LFE program. Company records during the intervention period confirmed improved report submission compliance and higher cooperation levels in these teams. Linear regression analysis of turnover records revealed a statistically significant drop in voluntary turnover (p = .001) following initiation of the LFE program. Study trends suggest the LFE framework has promise as an effective pedagogy to develop SI behavioral competencies in leaders and effectiveness in their teams. The dissertation concludes with recommendations on how to implement and evaluate an LFE workforce program.
... I hope you had the opportunity to read the editorial in the May 2011 issue of Medical Education that outlined the changes we will implement for future contributions to 'Really Good Stuff'. 1 As we look forward to an evolution in the submissions to this section of the journal, I believe you will learn a great deal from the reports published here. ...
Article
2020 marks the 20th anniversary of the publication of "Really Good Stuff" reports in Medical Education and an opportunity to explore the evolution of the "Really Good Stuff" (RGS) section of the journal as well as what is meant by "really good"?
Article
The Duke Medicine Graduate Medical Education Quasi-Endowment, established in 2006, provides infrastructure support and encourages educational innovation. The authors describe Duke's experience with the "grassroots innovation" part of the fund, the Duke Innovation Fund, and discuss the Innovation Fund's processes for application, review, and implementation, and also outcomes, impact, and intended and unintended consequences.In the five years of the Innovation Fund described (2007-2011), 105 projects have been submitted, and 78 have been funded. Thirty-seven projects have been completed. Approved funding ranged from $2,363 to $348,750, with an average award of $66,391. This represents 42% of funding originally requested. Funding could be requested for a period of 6 months to 3 years. The average duration of projects was 27 months, with a range from 6 months to 36 months. Eighty percent of projects were completed on time. Two projects were closed because of lack of progress and failure to adhere to reporting requirements. Thirty-nine are ongoing.Program directors report great success in meeting project outcomes and concrete impacts on resident and faculty attitudes and performance. Ninety-two percent report that their projects would have never been accomplished without this funding. Projects have resulted in at least 68 posters, abstracts, and peer-reviewed presentations. At least 12 peer-reviewed manuscripts were published.There has been tremendous diversity of projects; all 13 clinical departments have been represented. Interdepartmental and intradepartmental program cooperation has increased. This modest seed money has resulted in demonstrable sustainable impacts on teaching and learning, and increased morale and scholarly recognition.