Browsing by Author "McLaughlin, Kevin"

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    A Mixed Methods Study on the Effect of Flipping the Undergraduate Medical Classroom
    (2017-11-14) Burak, Kelly W.; Raman, Maitreyi; Paget, Michael; Busche, Kevin; Coderre, Sylvain; McLaughlin, Kevin
    The flipped classroom model is increasingly being adopted in healthcare education, despite the fact that recent systematic reviews in the nursing and medical education literature suggest that this method of instructional design is not inherently better or worse than the traditional classroom. In this study, we used a sequential, explanatory mixed methods design to assess the impact of flipping the hepatology classroom for preclinical medical students. Compared to students in the traditional classroom, students in the flipped classroom had significantly lower mean (SD) ratings of their learning experiences (3.48 (1.10) vs. 4.50 (0.72), p < 0.001, d = 1.10), but better performance on the hepatology content of the end-of-course examination (78.0% (11.7%) vs. 74.2 (15.1%), respectively, p < 0.01, d = 0.3). Based upon our qualitative data analyses, we propose that the flipped classroom induced a change in the learning process of students by requiring increased preparation for classroom learning and promoting greater learner autonomy, which resulted in better retention of learned material, but reduced enjoyment of the learning experience. This dissonance in outcomes is captured in the words of one flipped classroom student: “…I hated it while I was learning it, but boy did I remember it…”. Based upon our dissonant outcomes and the inconsistent findings in the literature, we feel that there is still equipoise regarding the effectiveness of the flipped classroom, and further studies are needed to describe ways of making the flipped classroom a more effective (±more enjoyable) learning experience.
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    A Multifaceted Educational Intervention to Increase Uptake of a Urinary Tract Infection Guideline
    (2016-01-22) Banks, Anke Marie; McLaughlin, Kevin; Samuel, Susan; Johnson, David; Hecker, Kent
    Physicians often fail to implement clinical practice guidelines. Our objective was to evaluate whether a multifaceted educational intervention would increase adherence to the American Academy of Pediatrics guideline regarding voiding cystourethrogram (VCUG) use in young children with a first febrile urinary tract infection. We conducted a prospective interventional study at one centre using a pretest-posttest design. We used a health promotion model to construct a multifaceted intervention that included an interactive lecture, clinical pathway and faxed reminder. Over the study period, pediatricians and non-pediatricians ordered a significantly greater monthly proportion of adherent VCUGs. There was a significant decrease in the pediatrician monthly ordering rate of VCUGs. Utilizing logistic regression, the odds of adherence to the guideline were significantly greater among pediatricians than non-pediatricians. In conclusion, following a multifaceted educational intervention, pediatricians were more likely to adhere to the VCUG guideline recommendation than prior to the intervention and than non-pediatricians.
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    Assessment of Technical Competence for Central Venous Catheterization
    (2014-12-05) Ma, Irene Wai Yan; McLaughlin, Kevin; Beran, Tara
    Purpose Central venous catheterization (CVC) is a commonly performed procedure. Technical competence in its insertion is critical for patient safety reasons. It is unclear how competence should be diagnosed. Using a unified framework of validity that outlines five sources of validity evidence, results from three published studies are presented on the use of a formative simulation-based examination, assessing for technical competence in video-recorded performances of CVC by medical trainees. Methods Validity evidence based on content: study one evaluated all available published assessment tools on CVC performances. Items on each tool were classified into competency themes. Response process: study two compared the reliability measures of assessment data of 18 video-recorded performances with direct observation, rated by two independent, trained raters. Adequacy of video recordings was reviewed qualitatively. Internal structure: study three used principal component analysis to assess for the dimensions assessed by an 8-item global rating scale. Relationship with other variables: scores rated by two checklists were correlated with global assessment, confidence and number of needle attempts. Consequences of testing: the ability of checklists to identify procedural competence was assessed. Results Of the 25 published checklists identified, only six (20%) assessed each of the seven competency domains. The most frequently under-represented domains were “team working” and “communication with the patient.” Assessments between video-recorded performances and direct observations were comparable. However, wire handling was not fully captured in 13 of the 18 videos (72%). Of these, 5 (38%) were considered to have impacted rating. Drape handling was not fully captured in 17 videos (94%) and felt to be consequential to rating in 9 (53%). Two dimensions were identified in the global rating scale: technical ability and procedural safety, accounting for 84.1% of the overall variance. For both checklists, scores correlated positively with weighted factor scores on technical ability, but negatively with scores on safety. Both checklists demonstrated lower specificity than sensitivity in the diagnosis of competence, and high checklist scores did not preclude incompetence. Discussion Together, these three studies presented validity evidence from multiple sources that support the use of the simulation-based examination in identifying trainees who may benefit from further training.
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    Colorectal Endoscopic Mucosal Resection Curriculum Development
    (2021-10-24) Kayal, Ahmed; Heitman, Steven J; Coderre, Sylvain; Raman, Maitreyi; McLaughlin, Kevin
    ABSTRACTBackground and aimsEndoscopic mucosal resection (EMR) is a commonly performed procedure that is not systematically taught during most training programs. The aim of this study was to evaluate the effectiveness of a one-day didactic and simulation-based EMR curriculum for practicing endoscopists without prior formal training in advanced endoscopic tissue resection.MethodsWe designed a one-day lecture and simulation-based EMR course. Twelve participants completed the course. Effectiveness and clinical utility were evaluated using sequential explanatory mixed methods. All participants completed a pre-course multiple-choice-question (MCQ) examination followed by a different, but thematically similar, post-course MCQ examination. A survey was also conducted to assess cognitive fatigue, perceived benefit, and potential for change in EMR practice. Finally, a delayed MCQ examination was administered 10-14 weeks later to assess knowledge retention and qualitative data were sequentially collected from three candidates via semi-structured interviews.ResultsThe mean pre-course score was 47.8% (SD 12.4%). The mean post-course score was 75% (9.9%) and mean delayed score 70.8% (13.6%), both significantly higher than the mean pre-course score (P <0.001; Cohen’s d = 1.86 and P <0.001; Cohen’s d = 1.47, respectively). There was no significant difference between the mean post- and delayed-course test scores (P =130.2). Three themes emerged from the interviews: (1) a need for EMR training, (2) improved knowledge evaluating polyps and (3) changed or refined EMR technique after the course.ConclusionsThis study highlights the need for formal education in EMR and demonstrates significant knowledge acquisition and retention of EMR cognitive skills.
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    Group Conformity in Interprofessional Teams
    (2016) Kaba, Alyshah; Beran, Tanya; White, Deborah; McLaughlin, Kevin
    Within the multidisciplinary team environment, professionals bring varying levels of experience, authority, and responsibility: examining how team members interact is critical to ensure the highest standard of patient care. One type of influence in this environment is peer pressure, whereby an individual changes his or her own behavior to match the responses of others in a group. Known as conformity, this body of research, which spans 60 years since Asch’s (1951) seminal work, has only recently been examined in medical education (Beran et al., 2012). When the individual conforms to an incorrect diagnosis or plan for treatment, the safety of the patient may be compromised, contributing to the burden of adverse events. Given the ubiquity of collaborative practice in healthcare, the research presented in this dissertation is about succumbing to peer pressure - and the greater pressures experienced by nursing as compared to medical students to conform to a procedural task. This thesis is divided into four papers. The first paper is a narrative review, the second paper is a methods paper, the third paper compares the difference between medical and nursing students’ rate of conformity on a vital sign skill task, and the fourth paper examines whether conforming on the vital signs task is related to their clinical interpretations. The study is an adaption of the original Asch design to recreate conformity within an interprofessional simulated environment. The findings from the four papers presented in this dissertation, suggest that social pressure may prevent nursing and medical students from questioning incorrect information within interprofessional environments. If health professional students are making clinical decisions based on the consensus of the group, this is a critical issue for patient safety, as we cannot negate the fact that these students will one day be future doctors and nurses and will be working with real patients. To improve teamwork and collaboration amongst medicine and nursing in practice, Interprofessional Education (IPE) curriculum needs to teach students how to overcome barriers within the medical hierarchy, by encouraging students to question and politely challenge what seems to be incorrect information.
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    The Impact of Content Specific Resident Teaching on the Knowledge and Clinical Skills of Medical Students
    (2021-08) Zondervan, Nathan; McLaughlin, Kevin; Ma, Irene; Harvey, Adrian; Oddone Paolucci, Elizabeth
    Residents are positioned to create safe learning environments where medical students are comfortable asking questions and presenting ideas. However, residents frequently teach without training or confidence in their teaching ability. Resident-as-teacher training improves observed teaching skill, but little is known about their impact on medical student learning. A realist review was conducted to describe the impact of resident-as-teacher training on the knowledge, skills, and perceptions of medical students. Studies reporting medical student outcomes following exposure to trained resident-teachers were identified in five databases and independently reviewed by two investigators. Analysis of contextual factors suggested that longer, dispersed, and mandatory interventions that targeted a larger number of residents with low prior ratings of teaching effectiveness were more likely to show a positive effect on student ratings of resident teaching. The provision of highly rated training sessions that improve residents’ confidence and self-ratings of teaching ability was the proposed mechanism. There were no studies that elicited changes in medical student knowledge or skills, suggesting that improved teaching ability may not translate into improved student performance unless the content of the teaching is congruent with the examination. A sequential explanatory mixed methods study was then completed to explore the impact of introducing a resident-led and content specific curriculum on medical student performance on certifying examinations. Quantitative analysis demonstrated an increased percentage of medical students passing the surgery OSCE station. However, there was no difference in performance on the surgery MCQ or student ratings of resident teaching. Student ratings of the surgery rotation significantly declined. Qualitative analysis of medical student and resident focus groups revealed poor utilization of the curriculum resources designed for knowledge transfer, while the clinical skills elements were readily integrated into clinical activities. Overall, resident-as-teacher training can improve medical student perceptions of resident-led teaching, but independently have little effect on measures of knowledge and skill. Providing residents with learning objectives and teaching resources that are appropriate for the clinical environment can improve medical student performance on standardized examinations. Creating the time required to address the learning needs of medical students remains an ongoing barrier to teaching amid busy clinical rotations.
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    Involvement in teaching improves learning in medical students: a randomized cross-over study
    (BioMed Central, 2009-08-25) Peets, Adam D.; Coderre, Sylvain; Wright, Bruce; Jenkins, Deirdre; Burak, Kelly; Leskosky, Shannon; McLaughlin, Kevin
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    Musculoskeletal Ultrasound in Canadian Rheumatology Training Programs: Towards a National Curriculum
    (2023-08-15) Powell, Maria; Ma, Irene W.Y.; McLaughlin, Kevin; Thomson, Steven; Desy, Janeve
    Introduction: In 2019 the Royal College of Physicians and Surgeons of Canada added educational experiences in MSUS to the core competencies in rheumatology as an optional training experience. Many Canadian rheumatology programs offer MSUS training for residents, but there is currently no national ultrasound curriculum in Canada outside of externally available courses. Objectives: This thesis had two objectives. Objective one was to explore how educators prioritize competencies while developing educational content for a rheumatology MSUS curriculum. Objective two was to define the expert consensus recommendations for MSUS in Canadian post-graduate rheumatology training programs. Methods: To address objective one, we invited educators with rheumatology MSUS expertise to participate in a modified nominal group technique (NGT) with a sequential mixed methods design. For objective two, we assembled a MSUS working group including educators with rheumatology MSUS expertise, rheumatology residents, and rheumatology program directors. We used a three-stage consensus design including a modified NGT, modified Delphi technique, and structured online focus group to establish consensus among the MSUS working group on MSUS competencies that should be included in a national rheumatology resident curriculum. Results: We identified seven themes that represent key elements educators consider when prioritizing competencies during the curriculum development process, which balance two key factors: clinical utility and learnability. We used these themes to develop a conceptual framework that can be used to help guide educators when curricular content must be prioritized. For the consensus recommendations, key rheumatology MSUS stakeholders agreed that it should be mandatory for all Canadian post-graduate rheumatology trainees to learn basic ultrasound skills; how to perform a focused MSUS exam of the hands, wrists, and feet for features of inflammatory arthritis; and perform a limited MSUS exam of the knee and ankle to identify a joint effusion. Conclusion: This thesis used a hybrid of consensus methods to advance MSUS education in Canadian post-graduate rheumatology training programs. We hope that this work can contribute to the goal of a national MSUS curriculum for all Canadian post-graduate rheumatology trainees.
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    A prospective randomized trial of content expertise versus process expertise in small group teaching
    (BioMed Central, 2010-10-14) Peets, Adam D.; Cooke, Lara; Wright, Bruce; Coderre, Sylvain; McLaughlin, Kevin
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    Psychological Distress in Emergency Medical Services Practitioners: Identifying and Measuring the Issues
    (2017) Lefevre, Nicola Louise; Doig, Christopher; Mitchell, Ian; Page, Stacy; Guichon, Juliet; McLaughlin, Kevin
    This thesis investigates psychological distress in Emergency Medical Services practitioners through three pieces of inter-related research. The first examines the prevalence of compassion fatigue in all health care practitioners by systematic review of literature. The second conceptualizes three manifestations of distress (compassion fatigue, burnout, and post-traumatic stress disorder), places them in the context of EMS work by describing practitioners’ experience, and broadly strategizes ways to address them. The third measures the presence of compassion fatigue, burnout, and post-traumatic stress disorder in a sample of EMS practitioners through a survey based study. Overall, the research showed that EMS practitioners are experiencing psychological distress as compassion fatigue, burnout and PTSD, and that compassion fatigue has been identified across diverse practitioner groups in health care. Recommendations are consistently made that further research needs to be conducted to investigate root causes, and that education and support programs would be of benefit to practitioners.
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    The effect of white coats and gender on medical students’ perceptions of physicians
    (2017-05-26) Ladha, Malika; Bharwani, Aleem; McLaughlin, Kevin; Stelfox, Henry T; Bass, Adam
    Abstract Background Despite the fact that medical schools spend a considerable effort to rate clinical instructors, there is limited evidence regarding the effect of physical characteristics on instructor ratings. White coats have been shown to alter patients’ perceptions of physicians although it has not been determined if preceptors who wear white coats are rated differently than their colleagues. Methods Second year medical students were administered a questionnaire with four clinical scenarios depicting medical errors accompanied by a picture of a physician of different sexes and ethnicities. The packages were randomized so that the physicians depicted either had or did not have a white coat. Results White coats did not alter the perception of physicians’ ratings by medical students although sex and ethnicity/case were associated with the perception of trustworthiness, physician management, competence, professionalism and the perception of medical error. Conclusions Physical characteristics may alter students’ ratings of physicians.
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    Visualization of reasoning and clinical diagnostic decision making
    (2013-01-09) Altabbaa, Ghazwan; Ghali, William; McLaughlin, Kevin; Hemmelgarn, Brenda; Flemons, Ward
    Background: There is little evidence regarding the effects of reasoning visualization decision support aids on the quality of clinicians’ diagnostic decisions. Methods: To address this evidence gap, we conducted a randomized-controlled study involving 30 participating clinicians from three levels of experience: medical students, residents, and physicians. Two interventions designed to improve the diagnostic approach to pulmonary embolism were assessed: a visualization reasoning task model vs. more traditional didactic lecture. All participants were requested to solve paper-based clinical scenarios. The primary outcome of diagnostic pathway concordance (derived as a ratio of the number of correct diagnostic decision steps divided by the ideal number of diagnostic decision steps in diagnostic algorithms) was measured at baseline (5 clinical scenarios) and after either intervention. Results: The mean of diagnostic pathway concordance improved in both study groups: baseline mean= 0.73, post mean (scenarios 1-10) for the decision support group = 0.90 (p < 0.001, 95% CI: 0.08-0.24); baseline mean= 0.70, post mean (scenarios 1-10) for didactic review group = 0.85 (p < 0.001, 95% CI: 0.06-0.2). There was no statistically significant difference between the two study groups, or between the three levels of participants. Conclusions: Clinical decision support aids that are designed with an evidence-based visual reasoning interface can improve clinicians’ diagnostic pathway concordance. To the extent that such decision support aids can feasibly be implemented in clinical settings, while didactic lectures at crucial moments in patient care cannot, they have potential advantages over the latter.