Educators must consider patient outcomes when assessing the impact of clinical training

Dauphinee, W. Dale

doi:10.1111/j.1365-2923.2011.04144.x

Cited by 42 publications

(35 citation statements)

References 36 publications

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“…It is within this environment of proliferating POCUS use and an evolving evidence base for different applications that advocates have promoted the incorporation of ultrasound training into the curricula of medical schools. Curricular changes may be best judged on their ability to influence patient outcomes, but because it is difficult to demonstrate how educational interventions achieve these outcomes, such studies are rare . Educators are left to weigh other sources of evidence as they choose whether to implement curricular changes.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound in undergraduate medical education: a systematic and critical review

et al. 2017

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IntroductionPoint-of-care ultrasound (POCUS) use in clinical care is growing rapidly, and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically. In this study, we conducted a critical and systematic review framed by the rationales enumerated by advocates of ultrasound in UME in academic publications. MethodsThis research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified using techniques from Foucauldian critical discourse analysis (CDA) from an archive of 403 academic publications. We then sought empirical evidence in support of theses rationales, using a critical synthesis methodology also adapted from CDA. ResultsWe identified four dominant discursive rationales, with different levels of evidentiary support. Ultrasound was not demonstrated to improve students' understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent, and rests on minimal evidence. With POCUS, students' diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve quality of patient care was difficult to evaluate. DiscussionOur analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimizes them and may preclude further primary research. Since the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.

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Section: Introductionmentioning

confidence: 99%

Ultrasound in undergraduate medical education: a systematic and critical review

et al. 2017

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“…34 Then, for each feature we conducted a separate meta-analysis pooling the results of studies in which that feature varied between study arms (i.e., if a given feature were present equally in both arms, then that study would 50 Pneumothorax (thoracentesis) 54 Perforation (colonoscopy) 46 Patient discomfort during event (7) Patient discomfort (colonoscopy) 39 Survival (6) Survival to discharge (cardiac resuscitation) 48 Stillbirth (obstetric delivery with umbilical cord prolapse) 57 Duration of stay (2) Duration of hospitalization (cardiac resuscitation) 48 Patient satisfaction (2) Patient satisfaction (intrauterine device insertion) 73 Patient symptoms / quality of life (0) † (none found in this sample) Laboratory test results (0) † (none found in this sample) Patient compliance (0) † (none found in this sample) Patient motivation (0) † (none found in this sample) To-patient outcomes: conditions or events that happen to the patient Procedural success (31) Successful endotracheal intubation 72 Reach cecum (colonoscopy) 44 Successful venous cannulation 83 Evaluation of final product (2) Tissue removed during transurethral resection of prostate 67 Accuracy of diagnosis (1) Major pathology identified (upper gastrointestinal endoscopy) 66 Delay in diagnosis (1) Time to computed tomography (CT) scan (major trauma) 65 Delay in critical action (1) Time to operating room (major trauma) 65 *Number of studies reporting one or more outcomes of this type (many studies reported >1 outcome) † Identified in advance as potential outcomes; none identified in this sample, but included here for completeness of the model not be included in the meta-analysis for that feature). This approach has been described in detail previously.…”

Section: Data Synthesismentioning

confidence: 99%

Patient Outcomes in Simulation-Based Medical Education: A Systematic Review

et al. 2013

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OBJECTIVES:Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction. DATA SOURCES: Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011. STUDY ELIGIBILITY: Original research in any language measuring the direct effects on patients of simulationbased instruction for health professionals, in comparison with no intervention or other instruction. APPRAISAL AND SYNTHESIS: Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects. RESULTS: From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges' g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31-0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, −0.06 to 0.78). LIMITATIONS: Focused field in education; high inconsistency (I 2 >50 % in most analyses). CONCLUSIONS: Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical significance. Unit of analysis errors were common, and validity evidence was infrequently reported.

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“…Apart from longitudinal analyses, ratings by program directors or other staff members have been investigated for reliability and validity in assessing pediatric trainees' clinical performance (Archer et al 2010) and physicians' professionalism (Cruess et al 2006;Tsugawa et al 2011). These methods mainly assess the "process of clinical performance" rather than "patient outcomes," but the importance of patient outcomes has been increasingly recognized in medical education (Dauphinee 2012;Gonnella and Hojat 2012).…”

Section: Introductionmentioning

confidence: 99%

Development of a Peer Review System Using Patient Records for Outcome Evaluation of Medical Education: Reliability Analysis

Kameoka

Okubo

Koguma

et al. 2014

Tohoku J. Exp. Med.

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In addition to input evaluation (education delivered at school) and output evaluation (students' capability at graduation), the methods for outcome evaluation (performance after graduation) of medical education need to be established. One approach is a review of medical records, which, however, has been met with difficulties because of poor inter-rater reliability. Here, we attempted to develop a peer review system of medical records with high inter-rater reliability. We randomly selected 112 patients (and finally selected 110 after removing two ineligible patients) who visited (and were hospitalized in) one of the four general hospitals in the Tohoku region of Japan between 2008 and 2012. Four reviewers, who were well-trained general internists from outside the Tohoku region, visited the hospitals independently and evaluated outpatient medical records based on an evaluation sheet that consisted of 14 items (3-point scale) for record keeping and 15 items (5-point scale) for quality of care. The mean total score was 84.1 ± 7.7. Cronbach's alpha for these items was 0.798. Single measure and average measure intraclass correlations for the reviewers were 0.733 (95% confidence interval: 0.720-0.745) and 0.917 (95% confidence interval: 0.912-0.921), respectively. An exploratory factor analysis revealed six factors: history taking, physical examination, clinical reasoning, management and outcome, rhetoric, and patient relationship. In conclusion, we have developed a peer review system of medical records with high inter-rater reliability, which may enable us, with further validity analysis, to measure quality of patient care as an outcome evaluation of medical education in the future.

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Educators must consider patient outcomes when assessing the impact of clinical training

Cited by 42 publications

References 36 publications

Ultrasound in undergraduate medical education: a systematic and critical review

Ultrasound in undergraduate medical education: a systematic and critical review

Patient Outcomes in Simulation-Based Medical Education: A Systematic Review

Development of a Peer Review System Using Patient Records for Outcome Evaluation of Medical Education: Reliability Analysis

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