Skip to Main Content
Follow us

Medical Education Research Grant — Recipients

2018

Elif Bilgic, PhD

Development of a curriculum to teach and assess advanced laparoscopic suturing skills: taking first steps in the development of an advanced laparoscopic surgery program

Elif Bilgic, PhD
Elif Bilgic, PhD
Postdoctoral Fellow, Department of Surgery, McGill University

Abstract

Objectives: (1) collect validity evidence for advanced laparoscopic suturing tasks and their metrics using an automated suturing device, and evaluate the perceived educational value of the tasks; (2) investigate whether training with both the free-needle and device-assisted suturing tasks improves suturing skills in the operating room.

Design: This study will include (a) development of new simulation tasks and metrics for device-assisted laparoscopic suturing; (b) providing validity evidence for the tasks as measures of device-assisted suturing skills; and (c) determining whether training with these tasks, and previously developed tasks for free-needle, improve skill in the operating room.

Setting: The primary institution for these studies will be McGill University; studies will include participation from various university-affiliated hospitals across Canada and the United States of America.

Statistical analysis: Data will be analyzed using descriptive and inferential statistical methods.

Conclusion: This research program will develop a simulation program aimed at improving the advanced laparoscopic suturing skills of trainees, which is a first step for the development of an advanced laparoscopic surgery program.

How this work will inform research in medical education
Laparoscopic suturing is an advanced skill that is essential for a wide range of procedures but it is also one of the most challenging skills to master. Evidence supports the use of low-fidelity bench-top simulation to develop basic laparoscopic suturing skills; however, needs assessments identified that there is a gap between the skills targeted by the current simulation platforms versus the complex laparoscopic skills needed in the clinical setting (one of the identified skills being laparoscopic suturing). The available laparoscopic suturing models have several limitations in terms of cost-effectiveness and validity-evidence to support them as measures of laparoscopic suturing skills. By developing models for advanced laparoscopic suturing and providing evidence in the context of assessment and training, we are taking the first steps in developing an advanced laparoscopic surgery program that will include other advanced skills that were identified by needs assessments to be lacking in representation within simulation training.

Tristen Gilchrist, MD, FRCPC (MHPE Student, Maastricht University)

Residents’ recognition and disclosure of limitations: how it impacts entrustment decisions on the clinical teaching unit

Tristen Gilchrist
Tristen Gilchrist, MD, FRCPC (MHPE Student, Maastricht University)
Clinical Educator Fellow, Centre for Health Education Scholarship, University of British Columbia

Abstract

Canadian residency training is undergoing a shift toward competency-based medical education (CBME). Competency assessments for ward-based medicine have some reliance on residents recognizing and disclosing their limitations to attending physicians, who subsequently make additional entrustment decisions; however, residents struggle with deciding when and if to disclose limitations and ask for help. As we quickly move into an era where more emphasis is placed on Entrustable Professional Activities (EPAs) for tracking resident competence, residents’ strategies for disclosing limitations and how disclosure of limitations by residents affects attending physicians’ entrustment decisions and assessment judgements, is unclear. We must have a better understanding of the social act of a resident disclosing – or not disclosing – limitations to an attending, and the resulting impact on the attending’s entrustment decisions, to inform the implementation of CBME in ward-based medical learning environments.

Using a constructivist grounded theory approach, we will develop a theory of the social processes involved between a resident and an attending during disclosure (or non-disclosure) of limitations and the resulting implications. We will conduct field research, including non-participatory observation of resident clinical work and interviews with attending-resident dyads in the authentic clinical environment of internal medicine inpatient wards in three tertiary hospitals in Vancouver. We will collect data in detailed field notes and audio-recorded interviews. We will transcribe, code and analyze data in a constant comparison and iterative fashion. We anticipate that this work will enable postgraduate programs to strategically implement competence assessments utilizing EPAs in the context of competency-based medical education.

How this work will inform research in medical education
In teaching hospitals, patient care and safety are at least partially based on residents’ appropriately recognizing and disclosing limitations because attending physicians cannot directly observe all of their actions. Even when residents recognize their own limitations, they struggle with deciding when and how to disclose limitations and request clinical support. As we transition to using entrustment decisions as part of competence assessments, it is increasingly important to understand when, how and under what conditions residents disclose limitations and request clinical support. It is equally important to understand how those requests are interpreted and utilized by attending physicians. Our study has the potential to provide a model of the tacit relationship between disclosures of limitations, requests for clinical support, entrustment decisions and assessments within supervisor-resident dyads. It could also deepen our understanding of how clinical faculty interpret the meaning of entrustment and aid, in the design and revision of entrustment scales and workplace-based assessments.

Anna MacLeod, PhD

Cadaver as practice: a sociomaterial ethnography

Anna MacLeod, PhD
Anna MacLeod, PhD
Associate Professor, Faculty of Medicine, Continuing Professional Development & Medical Education, Dalhousie University

Abstract

Introduction: Residency programs across Canada are in the process of adopting competency-based medical education (CBME). High quality simulation for procedural learning will play an important role in CBME. Arguably, no mannequin can offer more fidelity in reproducing the material complexity of the human body than an actual human body. Cadaver-based simulation (CBS) is therefore emerging as a promising method for CBME; however, we lack a rigorous evidence base to inform recommendations about CBS in this context.

Objective: Our objective is to contribute to this evidence base by conducting a sociomaterial ethnography of the CBS program in the Emergency Medicine Residency Program at Dalhousie University.

Design: Our research questions are (1) what is the potential role of CBS in a competency-based postgraduate program and (2) how do social and material dimensions of CBS shape teaching and learning in this context? We will explore these questions through observation and sensory participation in CBS within the Dalhousie Emergency Medicine Residency Program; interviews with residents (n=10) and faculty (n=5), and Clinical Cadaver Program staff (n=3); document analysis of curriculum and policy documents; and material documentation of CBS tools and spaces through photographs, notes and inventories. Data will be analyzed in accordance with Wolcott’s classic three-step approach to the analysis of ethnographic data: description, analysis and interpretation. Each team member will independently review each data source and independently code data. Codes will be thematized first by method and then for the project as a whole. Individual analyses will then be discussed and interpreted by the team.

Conclusion: This work is timely. As programs transition to CBME, simulation will play a greater role. Considering the potential role of CBS in postgraduate education, including its social and material dimensions, has potential to reduce costs and improve learning in Emergency Medicine and other residency programs across the country.

How this work will inform research in medical education
As residency programs adopt CBD, there are significant challenges to address; these include ensuring residents have sufficient opportunity to learn, see, practice, prove, do and maintain their skills. Simulation will therefore play a key role in the successful implementation of CBD. Providing high quality, high-fidelity simulation experiences will be particularly important. Arguably, no mannequin can offer more fidelity in reproducing the complexity, variability and particularity of the human body than an actual human body; thus, cadaver-based simulation (CBS) is emerging as a promising approach. As advances in cadaveric preservation arise, the potential use of clinical cadavers for simulation is growing. Yet, there are certainly complex questions that have yet to be considered with respect to practising skills and procedures on clinical cadavers. We believe CBS has tremendous potential in the context of CBD. Our objective is to conduct a sociomaterial ethnography of the CBS program in the Emergency Medicine Residency Program at Dalhousie University. We believe our ethnographic work will advance our understanding of CBS and translate into real world implications about its possible use in CBD programs.

Tracy Moniz, PhD

How are postgraduate medical educators using reflective writing to remediate professionalism?

Tracy Moniz, PhD
Tracy Moniz, PhD
Associate Professor, Department of Communication Studies, Mount Saint Vincent University

Abstract

Underperformance in the “Professional” Role is a high stakes situation for learners and educators alike. Problems with professionalism, unless appropriately and effectively remediated, portend serious problems in practice; however, remediation for unprofessional behaviour is particularly challenging. Increasingly, educators are turning to reflective writing as a remediation strategy in residency, yet little is known about what educators expect reflective writing to accomplish, how they choose reflective writing tasks, why they use reflective writing, or how they evaluate whether or not a learner has met expectations in a reflective writing assignment.

We will use a constructivist grounded theory approach to explore the use of reflective writing as an educational intervention to remediate professionalism in postgraduate training programs at two medical schools in Canada. Through semi-structured interviews, we will engage a broad community of medical educators to (1) identify how they integrate reflective writing as an educational strategy to remediate professionalism, to (2) determine why they use reflective writing as a window onto professionalism underperformance and a trigger for performance improvement, and to (3) understand how educators evaluate and perceive the effectiveness of reflective writing as a strategy to remediate unprofessional behaviour and promote resilience.

This project represents an important step in medical education research towards apprehending how medical educators navigate remediation around the “Professional” Role when challenges arise in residency. We anticipate that our enhanced understanding of the potential and pitfalls of reflective writing may inform more tailored and effective approaches to professionalism remediation.

How this work will inform research in medical education
A lack of professionalism in medicine impedes the delivery of quality patient care and compromises physician wellness; however, remediating professionalism is among the most challenging educational interventions. This project aims to critically explore current practices of using reflective writing as a tool to remedy underperformance in the “Professional” Role at the postgraduate level. Our research will provide medical educators with an understanding of the current state of professionalism remediation across multiple residency programs at two Canadian medical schools, focusing on how and why reflective writing is used as a tool to nurture and strengthen professional values. This research will inform the use of reflective writing as a remediation strategy. Our work aims to elucidate both the successes and the cautionary tales related to the use of reflective writing for remediation of professionalism problems, enabling faculty development to occur that positions educators to use this strategy to maximum effect.

Heather Waters, MD, CCFP, FCFP

Optimizing feedback from direct observation of clinical performance: learner feedback-seeking and avoidance behaviour in four clinical settings

Heather Waters, MD, CCFP, FCFP
Heather Waters, MD, CCFP, FCFP
Associate Professor, Department of Family Medicine, McMaster University, Hamilton Site Director for Postgraduate Family Medicine

Abstract

Objectives: Medical education literature is clear on the importance of feedback for the development of competency. What is less well understood is how learners navigate opportunities for feedback involving direct observation. We seek to understand how to motivate learners to use direct observation for feedback in a way that supports a low stakes, formative, learner-centered culture of feedback. Our research question is: How do learners navigate opportunities for direct observation and feedback?

Design and setting: We will conduct a three-phase qualitative study using constructivist grounded theory at one institution. Participants will be any resident working in the following academic teaching units: Emergency Medicine, Pediatric Emergency Medicine, Pediatrics or Family Medicine. The first phase will consist of a non-physician research assistant observing how a resident negotiates feedback and direct observation in the clinical workplace. After observation, each participant will be interviewed. We will use data from Phase 1 to inform semi-structured interviews with a broader sample of residents in Phase 2. Phase 3 consists of a small number of focus groups to expand and elaborate on our emerging theory, confirm data sufficiency and ensure that our findings are resonant with the experiences of residents.

Analysis: There will be iterative movement between data collection and analysis, with initial analysis informing future data collection both within and across phases. Multiple analysts with diverse perspectives will engage in a staged coding process.

Conclusion: The pedagogic potential of direct observation has been recognized by a number of medical education licensure bodies, including the Royal College of Physicians and Surgeons of Canada. Understanding how to optimize feedback from direct observation is essential, given medical education’s move towards competency-based, outcomes-oriented training with an explicit mandate that direct observation be used to both assess performance and offer feedback. This study will produce evidence about effective educational practices to support clinical preceptors and learners during this transition.

How this work will inform research in medical education
Understanding how to optimize feedback from direct observation is essential, given medical education's move towards competency-based, outcomes-oriented training with an explicit mandate that direct observation be used to both assess performance and offer formative feedback. In Canada, the approaching shift to Competence by Design across Royal College specialties will place an increased onus on learners to request and use direct observation for feedback and coaching. Our research will illuminate how and why they may choose to do this, and guide preceptors in how to enhance its effectiveness. By developing our understanding of the factors that impact medical learners’ behaviours and perceptions related to feedback from direct observation, we will be able to make suggestions to medical teachers, programs and learners to assist each party in using direct observation to its highest potential.

Timothy J. Wood, PhD

Implicit versus explicit first impressions in the workplace: will raters overcome their first impressions when learner performance changes?

Timothy J. Wood, PhD
Timothy J. Wood, PhD
Professor, Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa

Abstract

Background: To ensure raters are accurate in their ratings, it is important to understand how various factors influence them. One factor is a first impression. A rating should reflect a learner’s overall abilities and not just the first few seconds with a patient; therefore, it is important to understand the degree to which raters are influenced by their first impression, especially if performance of the learner changes during the course of the assessment.

Objectives: The purpose of this study is to determine to what degree raters are influenced by their first impression when performance changes in a workplace setting.

Design: Participants will view a set of videos in which learner performance changes partway through (strong to weak, weak to strong). There will be two conditions: raters make a first impression rating (explicit) and then score a learner, or raters score a learner without a first impression rating (implicit).

Setting: All videos will be dramatized representations of a learner interacting with a patient.

Analysis: Mini-CEX ratings will be analyzed using a 2 x 2 ANOVA with first impression condition (explicit, implicit) treated as a between subject variable and video (strong to weak, weak to strong) as a within subject variable. For the “explicit” condition only, ratings will be analyzed using a 2 x 2 ANOVA with video (strong to weak, weak to strong) and measure (first impression rating, final Mini-CEX rating) as repeated measures factors.

Conclusion: Previous research has shown that raters will adjust ratings based on the performance of the learners. This research introduces a degree of artificiality because raters do not make their first impression explicit in the real world. By comparing results to a condition that mimics real life, we will be able to determine if prior results can be generalized to real world performance.

How this work will inform research in medical education
Direct observation of learners by raters is increasingly important. Unfortunately, raters often demonstrate unwanted variability in their judgments. Much of the work on rater variability has occurred in laboratory settings and the degree these findings generalize to real world settings (i.e. the workplace) is unknown. If we want to generalize laboratory results to the real world, we need to ensure our manipulations do not unduly influence raters. This study is a first step toward moving from the laboratory to the real world. Previous work around first impressions has demonstrated that raters form first impressions of learners but it has been demonstrated by asking raters to make their judgments explicit. Forming a first impression reflects an unconscious process; therefore, making these judgments explicit introduces a level of artificiality. The goal of this study is to examine first impressions in a more naturalistic task in order to determine the degree a first impression influences raters.

2017

Ryan Brydges, PhD and Jeffrey J.H. Cheung, PhD(c)

Vicki Leblanc, PhD

Carmen L. Mueller, BSc(H) MD FRCSC MEd FACS

Geoffrey Norman, PhD

Nha Voduc, MD, FRCPC

2016

Joanna Bates, MDCM, CCFP, FCFP

Gisèle Bourgeois-Law, MD, FRCSC, MEd (PhD student, Maastricht University)

Kathy Boutis, MD, MSc, FRCPC

Kevin Eva, PhD

Joanne Goldman, PhD

Sandra Monteiro, PhD

Dominique Piquette, MD, MSc, MEd, PhD

Akshay (Shay) Seth, MD MAEd(c)

Kong Eric You-Ten, MD, PhD, FRCPC and Sev Perelman, MD, CCFP-EM

Bin Zheng, MD, PhD