Mapping the complexity of task demands during constant observation of patients with complex health behaviors.

Unlicensed patient care assistants (PCAs) are often tasked with providing constant observation (CO) of patients with complex health behaviors. The unique demands of CO are poorly understood, making it challenging to design effective training. Four-component instructional design theory suggests the tasks associated with CO feature non-recurrent challenges, such that effective, simulation-based deliberate practice must reflect real-life variability.

The red hat - designating leadership using visual and verbal cues: a mixed-methods study.

Background: During a critical event in the labor and delivery operating room, it is crucial for team members responding to the situation to be aware of the designated leaders. Visual and verbal cues have been utilized to designate leadership in various healthcare settings; however, previous research has indicated mixed results using visual cues for role designation.

Methods: The purpose of this study was to explore the use of the red surgical hat as a visual cue of leadership during obstetric emergency simulation training.

Putting the "learning" in "pre-learning": effects of a self-directed study hall on skill acquisition in a simulation-based central line insertion course.

Background: Opportunities to practice procedural skills in the clinical learning environment are decreasing, and faculty time to coach skills is limited, even in simulation-based training. Self-directed learning with hands-on practice early in a procedural skill course might help maximize the benefit of later faculty coaching and clinical experience. However, it may also lead to well-learned errors if learners lack critical guidance.

Integrative Literature Review on Cognitive Science to Reconsider Failure to Rescue in Nursing: A Call to Action.

Background: When current workload demands exceed the cognitive capacity of nurses, tasks that are critical to early detection of clinical deterioration may be omitted. In many high-risk industries that require vigilance over sustained periods, such as the military, the cognitive resource theory of vigilance heavily guides systematic approaches. Yet, in research and policy on nursing failure to rescue, that same application of a cognitive science framework has been overlooked.

Integrating simulation and interpretive description to explore operating room leadership: critical event continuing education.

In Obstetrics and Gynecologic operating room emergencies, the surgeon cannot both operate and lead a suddenly expanded and redirected team response. However, one of the most often used approaches to interprofessional continuing education designed to improve teams' ability to respond to unanticipated critical events still emphasizes surgeon leadership. We developed Explicit Anesthesia and Nurse Distributed (EXPAND) Leadership to imagine a workflow that might better distribute emergency leadership task responsibilities and practices.

Modeling Diagnostic Expertise in Cases of Irreducible Uncertainty: The Decision-Aligned Response Model.

Purpose: Assessing expertise using psychometric models usually yields a measure of ability that is difficult to generalize to the complexity of diagnoses in clinical practice. However, using an item response modeling framework, it is possible to create a decision-aligned response model that captures a clinician's decision-making behavior on a continuous scale that fully represents competing diagnostic possibilities. In this proof-of-concept study, the authors demonstrate the necessary statistical conceptualization of this model using a specific electrocardiogram (ECG) example.

The Purpose, Design, and Promise of Medical Education Research Labs.

Medical education researchers are often subject to challenges that include lack of funding, collaborators, study subjects, and departmental support. The construct of a research lab provides a framework that can be employed to overcome these challenges and effectively support the work of medical education researchers; however, labs are relatively uncommon in the medical education field. Using case examples, the authors describe the organization and mission of medical education research labs contrasted with those of larger research team configurations, such as research centers, collaboratives, and networks.

Publication Inaccuracies Listed in General Surgery Residency Training Program Applications.

Background: Professionalism is a core competency that is difficult to assess. We examined the incidence of publication inaccuracies in Electronic Residency Application Service applications to our training program as potential indicators of unprofessional behavior.

Study Design: We reviewed all 2019-2020 National Resident Matching Program applicants being considered for interview.

Multi-level longitudinal learning curve regression models integrated with item difficulty metrics for deliberate practice of visual diagnosis: groundwork for adaptive learning.

Visual diagnosis of radiographs, histology and electrocardiograms lends itself to deliberate practice, facilitated by large online banks of cases. Which cases to supply to which learners in which order is still to be worked out, with there being considerable potential for adapting the learning. Advances in statistical modeling, based on an accumulating learning curve, offer methods for more effectively pairing learners with cases of known calibrations.

Medical student perspectives on conducting patient experience debrief interviews with hospitalized children and their families.

Purpose: To explore how medical students completing a pediatric clerkship viewed the benefits and barriers of debrief interviews with hospitalized patients and families.

Methods: In this study, focus groups were conducted with pediatric clerkship students after completion of a debrief interview. The constant comparative method was used with Mezirow's transformative learning theory as a lens to explore perceptions of the benefits and challenges of performing the interview.

The Fundamentals of Endoscopic Surgery (FES) skills test: factors associated with first-attempt scores and pass rate.

Background: The Fundamentals of Endoscopic Surgery (FES) program became required for American Board of Surgery certification as part of the Flexible Endoscopy Curriculum (FEC) for residents graduating in 2018. This study expands prior psychometric investigation of the FES skills test.

Methods: We analyzed de-identified first-attempt skills test scores and self-reported demographic characteristics of 2023 general surgery residents who were required to pass FES.

The Patient Experience Debrief Interview: How Conversations With Hospitalized Families Influence Medical Student Learning and Reflection.

Purpose: To determine the effect of patient debrief interviews on pediatric clerkship student depth of reflection and learning.

Method: The authors conducted a multi-institutional, mixed-methods, cluster randomized trial among pediatric clerkship students from May 2016 to February 2017. Intervention students completed a debrief interview with a patient-caregiver, followed by a written reflection on the experience.

Balancing Deliberate Practice and Reflection: A Randomized Comparison Trial of Instructional Designs for Simulation-Based Training in Cardiopulmonary Resuscitation Skills.

Introduction: A key question in simulation-based education is how to maximize learning within time and resource limits, including how best to balance hands-on practice versus reflective debriefing. Several instructional design frameworks suggest setting the balance according to the type of learning objective(s); however, broad professional activities such as team-based cardiopulmonary resuscitation include several interrelated component skills. This study experimentally manipulated hands-on practice versus reflective debriefing for cardiopulmonary resuscitation skills, hypothesizing that the former best supports learning taskwork (eg, compression quality), whereas the latter best supports learning teamwork.

Coaching for Chaos: A Qualitative Study of Instructional Methods for Multipatient Management in the Emergency Department.

Background: Busy environments, like the emergency department (ED), require teachers to develop instructional strategies for coaching trainees to function within these same environments. Few studies have documented the strategies used by emergency physician (EP)-teachers within these busy, chaotic environments, instead emphasizing teaching in more predictable environments such as the outpatient clinic, hospital wards, or operating room. The authors sought to discover what strategies EP-teachers were using and what trainees recalled experiencing when learning to handle these unpredictable, overcrowded, complex, multipatient environments.

Experts' responses in script concordance tests: a response process validity investigation.

Context: The script concordance test (SCT), designed to measure clinical reasoning in complex cases, has recently been the subject of several critical research studies. Amongst other issues, response process validity evidence remains lacking. We explored the response processes of experts on an SCT scoring panel to better understand their seemingly divergent beliefs about how new clinical data alter the suitability of proposed actions within simulated patient cases.

Geriatrics Curriculum Needs Assessment for Dermatology Residency Programs.

Background: Geriatric patients account for a growing proportion of dermatology clinic visits. Although their biopsychosocial needs differ from those of younger adults, there are no geriatrics training requirements for dermatology residency programs.

Objective: This study explored the state of geriatrics education in dermatology programs in 2016.

Influencing Mindsets and Motivation in Procedural Skills Learning: Two Randomized Studies.

Objectives: An incremental (growth) theory of intelligence (mindset), compared with an entity (fixed) mindset, has been associated with improved motivation and performance. Interventions to induce incremental beliefs have improved performance on non-surgical motor tasks. We sought to evaluate the impact of 2 brief interventions to induce incremental beliefs in the context of learning a surgical task.

Simulation as More Than a Treatment-Planning Tool: A Systematic Review of the Literature on Radiation Oncology Simulation-Based Medical Education.

Purpose: Simulation-based medical education (SBME) is gaining prominence as a tool to meet Accreditation Council for Graduate Medical Education-mandated competency-based assessment educational goals. SBME is used in radiation oncology, although the type and extent are not clear. This study reports a systematic literature review designed to clarify the type and extent of radiation oncology SBME.

How well is each learner learning? Validity investigation of a learning curve-based assessment approach for ECG interpretation.

Learning curves can support a competency-based approach to assessment for learning. When interpreting repeated assessment data displayed as learning curves, a key assessment question is: "How well is each learner learning?" We outline the validity argument and investigation relevant to this question, for a computer-based repeated assessment of competence in electrocardiogram (ECG) interpretation. We developed an on-line ECG learning program based on 292 anonymized ECGs collected from an electronic patient database.

Development, administration, and validity evidence of a subspecialty preparatory test toward licensure: a pilot study.

Background: Trainees in medical subspecialties lack validated assessment scores that can be used to prepare for their licensing examination. This paper presents the development, administration, and validity evidence of a constructed-response preparatory test (CRPT) administered to meet the needs of nephrology trainees.

Methods: Learning objectives from the licensing examination were used to develop a test blueprint for the preparatory test.

Simulation-based mastery learning significantly reduces gender differences on the Fundamentals of Endoscopic Surgery performance exam.

Background: Analysis of the Fundamentals of Endoscopic Surgery (FES) performance exam showed higher scores for men than women. Gender differences have been reduced with task-specific practice. We assessed the effect of simulation-based mastery learning (SBML) on FES performance exam differences by gender.

Pretest Scores Uniquely Predict 1-Year-Delayed Performance in a Simulation-Based Mastery Course for Central Line Insertion.

Introduction: Within simulation-based mastery learning (SBML) courses, there is inconsistent inclusion of learner pretesting, which requires considerable resources and is contrary to popular instructional frameworks. However, it may have several benefits, including its direct benefit as a form of deliberate practice and its facilitation of more learner-specific subsequent deliberate practice. We consider an unexplored potential benefit of pretesting: its ability to predict variable long-term learner performance.

Learner-Adaptive Educational Technology for Simulation in Healthcare: Foundations and Opportunities.

Despite evidence that learners vary greatly in their learning needs, practical constraints tend to favor ''one-size-fits-all'' educational approaches, in simulation-based education as elsewhere. Adaptive educational technologies - devices and/or software applications that capture and analyze relevant data about learners to select and present individually tailored learning stimuli - are a promising aid in learners' and educators' efforts to provide learning experiences that meet individual needs. In this article, we summarize and build upon the 2017 Society for Simulation in Healthcare Research Summit panel discussion on adaptive learning.

Development and Evaluation of a Student-Initiated Test Preparation Program for the USMLE Step 1 Examination.

Problem: Studies have documented performance on the United States Medical Licensing Examination® (USMLE) Step 1 exam as an important factor that residency program directors consider when deciding which applicants to interview and rank. Therefore, success on this exam, though only one aspect of applicant evaluation, is important in determining future career prospects for medical students. Unfortunately, mean test scores at the University of Illinois College of Medicine at Chicago (UIC) have historically been below the national average.

Managing Multiplicity: Conceptualizing Physician Cognition in Multipatient Environments.

Purpose: Emergency physicians (EPs) regularly manage multiple patients simultaneously, often making time-sensitive decisions around priorities for multiple patients. Few studies have explored physician cognition in multipatient scenarios. The authors sought to develop a conceptual framework to describe how EPs think in busy, multipatient environments.