Best evidence medical education

最佳证据医学教育
  • 文章类型: Journal Article
    强制性培训被认为是建立和保持高标准专业实践的基础。然而,几乎没有证据,培训要么实现所需的学习成果,或改善患者的预后。Whist组织可能会达到强制性培训的合规目标,目的是遗漏要点吗?本系统综述旨在综合和评估法定和强制性培训的效力。
    PubMed,EMBASE,CNAHL,于2023年5月23日搜索了ERIC和CochraneCentral登记册。所有研究设计都包括在内,报告的培训必须在医疗保健环境中指定组织任务。使用改进的Kirkpatrick(KP)评级系统对数据进行编码。使用改良的医学教育研究质量工具进行批判性评估,关键评估技能计划定性研究清单和混合方法评估工具。
    纳入了25项研究,对9132名参与者和1348例患者进行了审计。研究描述了根据柯克帕特里克的结果1-4b级对强制性训练的评估,大多数(68%)在英国和急性环境中进行。训练时间从5分钟到3天不等。关于强制性培训的理由缺乏共识,核心议题,持续时间,和最佳的进修训练期。目前,强制性培训并不能始终如一地转化为安全实践的广泛改进或患者预后的改善.
    由于国际上对强制培训的必要性缺乏共识,大多数论文来自拥有中央管理的国家医疗保健系统的国家。强制实施培训方案的理由仍不明确。本综述中包含的研究不支持强制性培训提供安全实践结果的假设。这项审查的结果为进一步的研究提供了基础,以协助设计,促进,以及强制性培训的影响。
    UNASSIGNED: Mandatory training is considered fundamental to establishing and maintaining high standards of professional practice. There is little evidence however, of the training either achieving its required learning outcomes, or delivering improvement in outcomes for patients. Whist organisations may be hitting their compliance target for mandatory training, is the purpose missing the point? This systematic review aims to synthesize and evaluate the efficacy of statutory and mandatory training.
    UNASSIGNED: PubMed, EMBASE, CNAHL, ERIC and Cochrane Central registers were searched on 23rd May 2023. All research designs were included and reported training had to specify an organisational mandate within a healthcare setting. Data was coded using a modified Kirkpatrick (KP) rating system. Critical appraisal was undertaken using the Modified Medical Education Research Study Quality Instrument, Critical Appraisal Skills Programme Qualitative Studies checklist and Mixed Methods Assessment Tool.
    UNASSIGNED: Twenty-five studies were included, featuring 9132 participants and 1348 patient cases audited. Studies described evaluation of mandatory training according to Kirkpatrick\'s outcomes levels 1-4b, with the majority (68%) undertaken in the UK and within acute settings. Training duration varied from 5 min to 3 days. There is a lack of consensus regarding mandatory training rationale, core topics, duration, and optimum refresher training period. Currently, mandatory training does not consistently translate to widescale improvements in safe practice or improved patient outcomes.
    UNASSIGNED: Due to the lack of international consensus regarding the need for mandated training, most papers originated from countries with centrally administered national health care systems. The rationale for mandating training programmes remains undefined. The assumption that mandatory training is delivering safe practice outcomes is not supported by studies included in this review. The findings of this review offer a basis for further research to be undertaken to assist with the design, facilitation, and impact of mandatory training.
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  • 文章类型: Systematic Review
    The COVID-19 pandemic caused graduate medical education (GME) programs to pivot to virtual interviews (VIs) for recruitment and selection. This systematic review synthesizes the rapidly expanding evidence base on VIs, providing insights into preferred formats, strengths, and weaknesses.
    PubMed/MEDLINE, Scopus, ERIC, PsycINFO, MedEdPublish, and Google Scholar were searched from 1 January 2012 to 21 February 2022. Two authors independently screened titles, abstracts, full texts, performed data extraction, and assessed risk of bias using the Medical Education Research Quality Instrument. Findings were reported according to Best Evidence in Medical Education guidance.
    One hundred ten studies were included. The majority (97%) were from North America. Fourteen were conducted before COVID-19 and 96 during the pandemic. Studies involved both medical students applying to residencies (61%) and residents applying to fellowships (39%). Surgical specialties were more represented than other specialties. Applicants preferred VI days that lasted 4-6 h, with three to five individual interviews (15-20 min each), with virtual tours and opportunities to connect with current faculty and trainees. Satisfaction with VIs was high, though both applicants and programs found VIs inferior to in-person interviews for assessing \'fit.\' Confidence in ranking applicants and programs was decreased. Stakeholders universally noted significant cost and time savings with VIs, as well as equity gains and reduced carbon footprint due to eliminating travel.
    The use of VIs for GME recruitment and selection has accelerated rapidly. The findings of this review offer early insights that can guide future practice, policy, and research.
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  • 文章类型: Systematic Review
    UNASSIGNED:尽管气候危机,卫生专业教育仍未能使学生做好实践可持续医疗保健的准备,但迫切需要提供教育机会。本系统综述旨在综合适用于卫生专业课程中可持续医疗保健教育的教育方法,并批判性地评估其影响。
    UNASSIGNED:搜索的数据库:APAPsycInfo,BEI,CINAHL,Embase,ERIC,Medline,Scopus,科克伦图书馆,WebofScience,BASE,DART-Europe,ETHOS和ProQuest还利用了二次搜索技术,与2021年10月进行的搜索。符合条件的研究包括医疗保健专业学生/学员,接触到可持续的医疗保健教育,并通过对知识的影响进行评估,态度或技能。包括任何出版状态的实证研究。非英语语言学习被排除在外。合格的研究使用JBI(2022)关键评估清单进行质量评估,并以叙述方式进行综合。
    未经评估:纳入了23项研究,由3343名参与者和7名卫生专业人员组成。研究主要采用准实验设计,并证明了可变质量。最常见的教育方法是研讨会和临床技能课程,尽管观察到了八种不同的方法。对知识产生了积极影响,态度和技能。
    未经评估:多种方法已被应用于可持续医疗教育,尽管没有明显的优势。相反,概述了许多有效的方法,根据学习成果予以采纳。
    Health professions education is failing to prepare students to practice sustainable healthcare despite the climate crisis an urgent provision of educational opportunities is required. This systematic review aimed to synthesise educational approaches applied to sustainable healthcare education within health professions curricula and critically evaluate their impact.
    Databases searched: APA PsycInfo, BEI, CINAHL, Embase, ERIC, Medline, Scopus, Cochrane Library, Web of Science, BASE, DART-Europe, EThOS and ProQuest. Secondary searching techniques were also utilised, with searching conducted October 2021. Eligible studies included healthcare professional students/trainees, exposed to sustainable healthcare education, and evaluated through impact on knowledge, attitudes or skills. Empirical studies of any publication status were included. Non-English language studies were excluded. Eligible studies were quality assessed using JBI (2022) critical appraisal checklists and synthesised narratively.
    Twenty-three studies were included, comprising 3343 participants and seven health professions. Studies primarily adopted a quasi-experimental design and demonstrated variable quality. Most common educational approaches were workshops and clinical skills sessions, though eight different approaches were observed. Positive impacts were achieved for knowledge, attitudes and skills.
    Diverse approaches have been applied to sustainable healthcare education, though no superior approach is evident. Instead, many effective approaches are outlined, to be adopted in alignment with the learning outcomes.
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  • 文章类型: Journal Article
    先前的评论调查了应对COVID-19的医学教育发展,确定了远程学习的重点是未来调查的关键领域。这篇评论综合了在线学习的发展,旨在取代以前面向研究生的“课堂”活动。
    四个在线数据库(CINAHL,Embase,心理信息,和PubMed)和MedEdPublish在2020年12月21日之前进行了搜索。两位作者独立筛选了标题,摘要和全文,执行数据提取,并评估偏见的风险。PICRAT技术集成框架用于检查教师如何集成和学习者如何参与技术。报告了描述性综合和结果。专题分析探讨了局限性和经验教训。
    包括51种出版物。有15个合作,包括国际合作伙伴关系和国家项目主管网络。39项发展描述了在线现有教育产品的枢纽,12项发展描述了新的发展。大多数干预措施包括同步活动(nFif5)。虚拟参与是通过聊天促进的,虚拟白板,轮询,和突围。教师对技术的运用在很大程度上取代了传统的实践。学生参与很大程度上是互动的。基础理论并不常见。质量评估显示在研究报告和方法中存在中度到高度的偏倚风险。45个事态发展评估了反应;25个态度,知识或技能;和两种行为。结果明显呈阳性。18种出版物报道了社交媒体或其他结果,包括触角,订婚,和参与。限制包括失去社交互动,缺乏实践经验,技术挑战和研究设计问题。经验教训突出了在线学习的灵活性,以及优化在线环境的实用建议。
    这篇综述为试图在大流行后的世界中优化学习的教育工作者提供了指导。未来的发展将受益于利用合作,考虑到技术集成框架,用理论支撑发展,探索额外的结果,并以支持复制的方式设计和报告开发。
    Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face \'classroom\' activities for postgraduate learners.
    Four online databases (CINAHL, Embase, PsychINFO, and PubMed) and MedEdPublish were searched through 21 December 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction, and assessed risk of bias. The PICRAT technology integration framework was applied to examine how teachers integrated and learners engaged with technology. A descriptive synthesis and outcomes were reported. A thematic analysis explored limitations and lessons learned.
    Fifty-one publications were included. Fifteen collaborations were featured, including international partnerships and national networks of program directors. Thirty-nine developments described pivots of existing educational offerings online and twelve described new developments. Most interventions included synchronous activities (n Fif5). Virtual engagement was promoted through chat, virtual whiteboards, polling, and breakouts. Teacher\'s use of technology largely replaced traditional practice. Student engagement was largely interactive. Underpinning theories were uncommon. Quality assessments revealed moderate to high risk of bias in study reporting and methodology. Forty-five developments assessed reaction; twenty-five attitudes, knowledge or skills; and two behavior. Outcomes were markedly positive. Eighteen publications reported social media or other outcomes, including reach, engagement, and participation. Limitations included loss of social interactions, lack of hands-on experiences, challenges with technology and issues with study design. Lessons learned highlighted the flexibility of online learning, as well as practical advice to optimize the online environment.
    This review offers guidance to educators attempting to optimize learning in a post-pandemic world. Future developments would benefit from leveraging collaborations, considering technology integration frameworks, underpinning developments with theory, exploring additional outcomes, and designing and reporting developments in a manner that supports replication.
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  • 文章类型: Journal Article
    UNASSIGNED: The COVID-19 pandemic spurred an abrupt transition away from in-person educational activities. This systematic review investigated the pivot to online learning for nonclinical undergraduate medical education (UGME) activities and explored descriptions of educational offerings deployed, their impact, and lessons learned.
    UNASSIGNED: The authors systematically searched four online databases and conducted a manual electronic search of MedEdPublish up to December 21, 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias. A third author resolved discrepancies. Findings were reported in accordance with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance.
    UNASSIGNED: Fifty-six articles were included. The majority (n = 41) described the rapid transition of existing offerings to online formats, whereas fewer (n = 15) described novel activities. The majority (n = 27) included a combination of synchronous and asynchronous components. Didactics (n = 40) and small groups (n = 26) were the most common instructional methods. Teachers largely integrated technology to replace and amplify rather than transform learning, though learner engagement was often interactive. Thematic analysis revealed unique challenges of online learning, as well as exemplary practices. The quality of study designs and reporting was modest, with underpinning theory at highest risk of bias. Virtually all studies (n = 54) assessed reaction/satisfaction, fewer than half (n = 23) assessed changes in attitudes, knowledge or skills, and none assessed behavioral, organizational or patient outcomes.
    UNASSIGNED: UGME educators successfully transitioned face-to-face instructional methods online and implemented novel solutions during the COVID-19 pandemic. Although technology\'s potential to transform teaching is not yet fully realized, the use of synchronous and asynchronous formats encouraged virtual engagement, while offering flexible, self-directed learning. As we transition from emergency remote learning to a post-pandemic world, educators must underpin new developments with theory, report additional outcomes and provide details that support replication.
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  • 文章类型: Journal Article
    COVID-19 has fundamentally altered how education is delivered. Gordon et al. previously conducted a review of medical education developments in response to COVID-19; however, the field has rapidly evolved in the ensuing months. This scoping review aims to map the extent, range and nature of subsequent developments, summarizing the expanding evidence base and identifying areas for future research.
    The authors followed the five stages of a scoping review outlined by Arskey and O\'Malley. Four online databases and MedEdPublish were searched. Two authors independently screened titles, abstracts and full texts. Included articles described developments in medical education deployed in response to COVID-19 and reported outcomes. Data extraction was completed by two authors and synthesized into a variety of maps and charts.
    One hundred twenty-seven articles were included: 104 were from North America, Asia and Europe; 51 were undergraduate, 41 graduate, 22 continuing medical education, and 13 mixed; 35 were implemented by universities, 75 by academic hospitals, and 17 by organizations or collaborations. The focus of developments included pivoting to online learning (n = 58), simulation (n = 24), assessment (n = 11), well-being (n = 8), telehealth (n = 5), clinical service reconfigurations (n = 4), interviews (n = 4), service provision (n = 2), faculty development (n = 2) and other (n = 9). The most common Kirkpatrick outcome reported was Level 1, however, a number of studies reported 2a or 2b. A few described Levels 3, 4a, 4b or other outcomes (e.g. quality improvement).
    This scoping review mapped the available literature on developments in medical education in response to COVID-19, summarizing developments and outcomes to serve as a guide for future work. The review highlighted areas of relative strength, as well as several gaps. Numerous articles have been written about remote learning and simulation and these areas are ripe for full systematic reviews. Telehealth, interviews and faculty development were lacking and need urgent attention.
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  • 文章类型: Journal Article
    The novel coronavirus disease (COVID-19) was declared a pandemic in March 2020. This rapid systematic review synthesised published reports of medical educational developments in response to the pandemic, considering descriptions of interventions, evaluation data and lessons learned.
    The authors systematically searched four online databases and hand searched MedEdPublish up to 24 May 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias for included articles. Discrepancies were resolved by a third author. A descriptive synthesis and outcomes were reported.
    Forty-nine articles were included. The majority were from North America, Asia and Europe. Sixteen studies described Kirkpatrick\'s outcomes, with one study describing levels 1-3. A few papers were of exceptional quality, though the risk of bias framework generally revealed capricious reporting of underpinning theory, resources, setting, educational methods, and content. Key developments were pivoting educational delivery from classroom-based learning to virtual spaces, replacing clinical placement based learning with alternate approaches, and supporting direct patient contact with mitigated risk. Training for treating patients with COVID-19, service reconfiguration, assessment, well-being, faculty development, and admissions were all addressed, with the latter categories receiving the least attention.
    This review highlights several areas of educational response in the immediate aftermath of the COVID-19 pandemic and identifies a few articles of exceptional quality that can serve as models for future developments and educational reporting. There was often a lack of practical detail to support the educational community in enactment of novel interventions, as well as limited evaluation data. However, the range of options deployed offers much guidance for the medical education community moving forward and there was an indication that outcome data and greater detail will be reported in the future.
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  • 文章类型: Journal Article
    Purpose: The primary objective was to inventory what is currently known about faculty development (FD) for competency-based medical educations (CBME) and identify gaps in the literature.Methods: A scoping review methodology was employed. Inclusion criteria for article selection were established with two reviewers completing a full-text analysis. Quality checks were included, along with iterative consultation on data collection and consensus decision making via a grounded theory approach.Results: The review identified 19 articles published between 2009 and 2018. Most articles (N = 15) offered suggestions as to what should happen with FD in CBME, but few (N = 4) adopted an experimental design. Six main themes were identified with three main features of FD noted across themes: (1) The importance of direct and timely feedback to faculty members on their teaching and assessment skills. (2) The role of establishing shared mental models for CBME curricula. (3) That FD is thought of longitudinally, not as a one-time bolus.Conclusion: This work illustrates that there is limited, high quality research in FD for CBME. Future FD activities should consider employing a longitudinal and multi-modal program format that includes feedback for the faculty participants on their teaching and assessments skills, including the development of faculty coaching skills.
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