Résumés
Abstract
Introduction: The progression from preclinical medical training to clerkship is a pivotal yet steep transition for medical students. Effective feedback on clinical skills during preclinical training can better equip students for clerkship and allows time for them to address difficulties promptly. The goal of this study was to explore whether and how narrative comments at this stage were being leveraged to achieve this transition.
Methods: We conducted a content analysis to categorize narrative comments on the clinical skills of two cohorts of third-year preclinical students at one academic institution.
Results: Teachers made narrative comments for 272 students. Each comment was divided into analysis units (n = 1,314 units). Comments were either general (n = 187) or focused on attitude (n = 628), knowledge and cognitive processes (n = 357), or clinical reasoning (n = 142). They were abundantly positive (n = 1,190) and marginally negative (n = 39). Few (6%) contained suggestions for improvement.
Discussion: In this study, narrative comments on clinical skills before clerkship seemed minimally helpful, as they were overwhelmingly positive and seldom offered suggestions. This could suggest missed opportunities for early interventions. Pre-clerkship narrative comments could potentially be optimized by increasing emphasis on clinical reasoning, addressing challenges early and providing actionable steps for improvement.
Résumé
Introduction : Le passage de la formation médicale préclinique à l'externat est une transition cruciale mais abrupte pour les étudiants en médecine. Une rétroaction efficace sur les compétences cliniques au cours de la formation préclinique peut mieux préparer les étudiants à l'externat et leur donner le temps de remédier rapidement aux difficultés rencontrées. L'objectif de cette étude était d'explorer si et comment les commentaires narratifs à ce stade étaient mis à profit pour réaliser cette transition.
Méthodes : Nous avons effectué une analyse de contenu pour catégoriser les commentaires narratifs sur les compétences cliniques de deux cohortes d'étudiants précliniques de troisième année dans un établissement universitaire.
Résultats : Les enseignants ont fait des commentaires narratifs pour 272 étudiants. Chaque commentaire a été divisé en unités d'analyse (n = 1 314 unités). Les commentaires étaient soit généraux (n = 187), soit axés sur l'attitude (n = 628), les connaissances et les processus cognitifs (n = 357), ou le raisonnement clinique (n = 142). Ils étaient en général positifs (n = 1 190) et rarement négatifs (n = 39). Peu d'entre eux (6 %) contenaient des suggestions d'amélioration.
Discussion : Dans cette étude, les commentaires narratifs sur les compétences cliniques avant l'externat ont semblé peu utiles, car ils étaient en grande majorité positifs et offraient rarement des suggestions. Cela donne à penser que des occasions d’intervention précoce ont pu être perdues. Les commentaires narratifs avant l'externat pourraient être optimisés en mettant davantage l'accent sur le raisonnement clinique, en abordant rapidement les défis rencontrés et en proposant des mesures d'amélioration réalisables.
Veuillez télécharger l’article en PDF pour le lire.
Télécharger
Parties annexes
Bibliography
- Prince KJAH, Boshuizen HPA, van der Vleuten CPM, Scherpbier AJJA. Students' opinions about their preparation for clinical practice. Med Educ. 2005;39(7):704-12. https://doi.org/10.1111/j.1365-2929.2005.02207.x
- Boileau É, Talbot-Lemaire M, Bélanger M, St-Onge C. "Playing in the big leagues now": exploring feedback receptivity during the transition to residency. Health Prof Educ. 2019;5(4):303-12. https://doi.org/10.1016/j.hpe.2018.09.003
- Young JQ, Ranji SR, Wachter RM, Lee CM, Niehaus B, Auerbach AD. "July effect": impact of the academic year-end changeover on patient outcomes: a systematic review. Annals intern med. 2011;155(5):309-15. https://doi.org/10.7326/0003-4819-155-5-201109060-00354
- Guerrasio J, Garrity MJ, Aagaard EM. Learner deficits and academic outcomes of medical students, residents, fellows, and attending physicians referred to a remediation program, 2006-2012. Acad Med. 2014;89(2):352-8. https://doi.org/10.1097/ACM.0000000000000122
- Boud D. Feedback: ensuring that it leads to enhanced learning. Clin Teach. 2015;12(1):3-7. https://doi.org/10.1111/tct.12345
- Boileau E, St-Onge C, Audétat MC. Is there a way for clinical teachers to assist struggling learners? A synthetic review of the literature. Adv Med Educ Pract. 2017;8:89-97. https://doi.org/10.2147/AMEP.S123410
- Steinert Y. The "problem" learner: Whose problem is it? AMEE Guide No. 76. Med Teach. 2013;35(4):e1035-45. https://doi.org/10.3109/0142159X.2013.774082
- Challis AF Gifford Batstone, Maggie. An accident waiting to happen? A case for medical education. Med Teach. 1999;21(6):582-5. https://doi.org/10.1080/01421599979004
- Coombes I, Donovan P, Bullock B, Mitchell C, Noble C. Can a novel Constructivist theory-informed feedback intervention reduce prescribing errors? A pre-post study. BMC Med Educ. 2023;23(1):150. https://doi.org/10.1186/s12909-023-04095-6
- Hayes V, Bing-You R, Varaklis K, Trowbridge R, Kemp H, McKelvy D. Is feedback to medical learners associated with characteristics of improved patient care? Perspect Med Educ. 2017;6(5):319-24. https://doi.org/10.1007/S40037-017-0375-8
- Kluger AN, DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol bulletin. 1996;119(2):254. https://doi.org/10.1037/0033-2909.119.2.254
- van de Ridder JMM, Peters CMM, Stokking KM, de Ru JA, ten Cate OThJ. Framing of feedback impacts student's satisfaction, self-efficacy and performance. Adv Health Sci Ed. 2015;20(3):803-16. https://doi.org/10.1007/s10459-014-9567-8
- Chakroun M, Dion VR, Ouellet K, et al. Narrative assessments in higher education: a scoping review to identify evidence-based quality indicators. Acad Med. 2022;97(11):1699-1706. https://doi.org/10.1097/ACM.0000000000004755
- Holmboe ES, Yepes M, Williams F, Huot SJ. Feedback and the mini clinical evaluation exercise. J Gen Inter Med. 2004;19(5 Pt 2):558-61. https://doi.org/10.1111/j.1525-1497.2004.30134.x
- Dudek N, Cook D. Narrative assessment. In: Yudkowsky R, Park YS, Downing SM, editors. Assessment in health professions education. New York (NY): Routledge; 2019. p. 173-80. https://doi.org/10.4324/9781315166902-11
- Kelleher M, Kinnear B, Sall DR, et al. Warnings in early narrative assessment that might predict performance in residency: signal from an internal medicine residency program. Perspect Medl Educ. 2021;10(6):334-40. https://doi.org/10.1007/S40037-021-00681-W
- Ginsburg S, Gold W, Cavalcanti RB, Kurabi B, McDonald-Blumer H. Competencies "plus": the nature of written comments on internal medicine residents' evaluation forms. Acad Med. 2011;86(10):S30-4. https://doi.org/10.1097/ACM.0b013e31822a6d92
- Jackson JL, Kay C, Jackson WC, Frank M. The quality of written feedback by attendings of internal medicine residents. J Gen Intern Med 2015;30(7):973-8. https://doi.org/10.1007/s11606-015-3237-2
- White JS, Sharma N. "Who writes what?" Using written comments in team-based assessment to better understand medical student performance: a mixed-methods study. BMC Med Ed. 2012;12(1):123. https://doi.org/10.1186/1472-6920-12-123
- Chakroun M, Dion VR, Ouellet K, et al. Quality of narratives in assessment: piloting a list of evidence-based quality indicators. Perspect Med Educ. 2023;12(1):XX. https://doi.org/10.5334/pme.925
- Hodges B. Assessment in the post-psychometric era: Learning to love the subjective and collective. Med Teach. 2013;35(7):564-8. https://doi.org/10.3109/0142159X.2013.789134
- Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-15. https://doi.org/10.1111/j.1365-2648.2007.04569.x
- Pintoi AJ, Zeitz HJ. Concept mapping: a strategy for promoting meaningful learning in medical education. Med Teach. 1997;19(2):114-21. https://doi.org/10.3109/01421599709019363
- Boileau E, Audétat MC, St-Onge C. Just-in-time faculty development: a mobile application helps clinical teachers verify and describe clinical reasoning difficulties. BMC Med Educ. 2019;19(1):120. https://doi.org/10.1186/s12909-019-1558-2
- Evans DE, Alstead EM, Brown J. Applying your clinical skills to students and trainees in academic difficulty. Clinic Teach. 2010;7(4):230-5. https://doi.org/10.1111/j.1743-498X.2010.00411.x
- Hauer KE, Ciccone A, Henzel TR, et al. Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature. Acad Med. 2009;84(12):1822-32. https://doi.org/10.1097/ACM.0b013e3181bf3170
- Torre DM, Treat R, Durning S, Elnicki DM. Comparing PDA- and paper-based evaluation of the clinical skills of third-year students. WMJ. 2011;110(1):9-13. https://wmjonline.org/wp-content/uploads/2011/110/1/9.pdf
- Murdoch‐Eaton D, Sargeant J. Maturational differences in undergraduate medical students' perceptions about feedback. Med Educ. 2012;46(7):711-21. https://doi.org/10.1111/j.1365-2923.2012.04291.x
- Tekian A, Borhani M, Tilton S, Abasolo E, Park YS. What do quantitative ratings and qualitative comments tell us about general surgery residents' progress toward independent practice? Evidence from a 5-year longitudinal cohort. Amer J Surg. 2019;217(2):288-95. https://doi.org/10.1016/j.amjsurg.2018.09.031
- Hatala R, Sawatsky AP, Dudek N, Ginsburg S, Cook DA. Using In-Training Evaluation Report (ITER) qualitative comments to assess medical students and residents: a systematic review. Acad Med. 2017;92(6):868-79. https://doi.org/10.1097/ACM.0000000000001506