Review article: Closing the research gap at the interface of learning and clinical practice

Abstract

Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

Review article: Leading the future: guiding two predominant paradigm shifts in medical education through scholarship

“…Challenges for competency-based education As Philibert points out, the two obvious challenges to a competency-based approach are: 1) to define the outcome abilities for competencies and 2) to create valid and reliable assessment tools. 11 Until the 1980s, society expressed the main requirements of physicians in terms of medical knowledge and technical expertise. The 21 st century has seen the demand for a more holistic physician who embodies a broader set of competencies to address both patients' needs and societal needs.…”

Postgraduate anaesthesiology education: protocol for a scoping review

“…Although the link between education and practice is crucial for patient safety and quality of care, it has been noted that a gap between education and clinical practice exists in the field of anaesthesiology 1. A paucity of literature has comprehensively surveyed what is currently known, and what is currently unknown from anaesthesiology education research.…”

“…A paucity of literature has comprehensively surveyed what is currently known, and what is currently unknown from anaesthesiology education research. Philibert1 suggests that important topics in anaesthesiology that should be studied in more detail include issues surrounding transitions within anaesthesiology training, duty hour limits, and teaching and evaluating competencies (eg, the CanMEDS framework), and importantly, suggests that although important to knowledge and innovation, commentaries and editorials are often employed as an evidence base, ahead of alternative methodologies or article types. This concern is echoed by other researchers, who have noted a number of potential concerns with the current research, such as methodological issues (eg, small sample sizes, brief follow-up, threats to validity),1 lack of conceptual frameworks,2 and a preponderance of descriptive or justification studies (ie, those that focus on only the beginning or end of the scientific method, rather than employing all of the steps from making predictions through to testing them) 3…”

Special theme issue on advances in education in anesthesiology

“…7 Drilling downwards, three factors are identified as being important in influencing the quality of patient care following residency. The first important factor is the extent of preparation for all aspects of independent practice ''to meet society's expectations for person-centred, prevention-focused and costeffective care''.…”

“…7 En approfondissant, trois facteurs importants sont identifiés pour leur influence sur la qualité des soins aux patients après l'obtention du diplôme. Le premier facteur est le niveau de préparation face à tous les aspects de l'exercice indépendant de la profession pour « répondre aux attentes de la société concernant des soins centrés sur la personne, axés sur la prévention et ayant un bon rapport efficacité-coût ».…”