A qualitative study of medical students' perceptions of resident feedback.

CONTEXT: Residents play a pivotal role in medical students' clinical education. From a feedback lens, the near-peer relationship between student and resident holds the potential to foster an educational alliance that could influence learning. We undertook the current qualitative study to explore medical students' perceptions of feedback experiences with residents, addressing when, how and why (and conversely when not and why not) resident feedback plays a role in their clinical education. METHODS: Our methodology was qualitative interpretive description, informed by phenomenology. We conducted 24 semi-structured interviews with third and fourth year medical students at one institution. The interviews aimed to foster rich discussion about students' feedback experiences with residents during clinical rotations. Data collection and analysis proceeded iteratively. Initial interviews were independently open-coded by three investigators and then collaboratively refined. Codes were applied to subsequent interviews, and new codes were developed. During the final stages of analysis, we organised our themes by drawing on a sociocultural perspective to examine students' perceptions of relationship-building with residents and when and how this influenced feedback and learning. RESULTS: From the students' perspectives, when residents contributed to building interpersonal relationships with students, this in turn influenced students' receptivity to both encouraging and constructive feedback conversations. In the context of resident-student relationships that were perceived as supportive, resident feedback influenced how students approached learning and working in the clinical environment, as well as students' visions of their future selves. In unsupportive relationships, students were less inclined to engage in feedback with residents and students noted resident behaviours that they wanted to avoid in themselves. CONCLUSION: Residents are uniquely positioned to create a strong educational alliance with students in which feedback conversations can flourish. Focusing educational efforts on resident feedback conversations has the potential to significantly impact the feedback culture of our clinical environments.

Efficacy and safety of antimicrobial stewardship prospective audit and feedback in patients hospitalized with COVID-19: A protocol for a pragmatic clinical trial.

BACKGROUND: The use of broad-spectrum antibiotics is widespread in patients with COVID-19 despite a low prevalence of bacterial co-infection, raising concerns for the accelerated development of antimicrobial resistance. Antimicrobial stewardship (AMS) is vital but there are limited randomized clinical trial data supporting AMS interventions such as prospective audit and feedback (PAF). High quality data to demonstrate safety and efficacy of AMS PAF in hospitalized COVID-19 patients are needed. METHODS AND DESIGN: This is a prospective, multi-center, non-inferiority, pragmatic randomized clinical trial evaluating AMS PAF intervention plus standard of care (SOC) versus SOC alone. We include patients with microbiologically confirmed SARS-CoV-2 infection requiring hospital admission for severe COVID-19 pneumonia. Eligible ward beds and critical care unit beds will be randomized prior to study commencement at each participating site by computer-generated allocation sequence stratified by intensive care unit versus conventional ward in a 1:1 fashion. PAF intervention consists of real time review of antibacterial prescriptions and immediate written and verbal feedback to attending teams, performed by site-based AMS teams comprised of an AMS pharmacist and physician. The primary outcome is clinical status at post-admission day 15 measured using a 7-point ordinal scale. Patients will be followed for secondary outcomes out to 30 days. A total of 530 patients are needed to show a statistically significant non-inferiority, with 80% power and 2.5% one-sided alpha assuming standard deviation of 2 and the non-inferiority margin of 0.5. DISCUSSION: This study protocol presents a pragmatic clinical trial design with small unit cluster randomization for AMS intervention in hospitalized COVID-19 that will provide high-level evidence and may be adopted in other clinical situations. TRIAL REGISTRATION: This study is being performed at the University of Alberta and is registered at ClinicalTrials.gov (NCT04896866) on May 17, 2021.

Development of a Novel Mentorship Platform to Foster Relational Mentoring, Empowered Vulnerability, and Professional Identity Formation in Undergraduate Medical Education.

PROBLEM: Mentorship is valuable to medical students undergoing professional identity formation. Many institutions lack infrastructure to facilitate the personalized mentoring that supports students' integration of new professional identities with their personal identities and values. APPROACH: The authors developed a novel mentorship platform called Weave via a multistep, iterative design process, incorporating in-person and survey-based student and faculty feedback. Features of Weave include clear communication of mentorship offerings and expectations, plus opportunities to engage mentors based on professional and personal (identity-based) attributes. Faculty at Harvard Medical School who created a mentor profile within the first 3 months of launch and students who visited the website within the same period were invited to complete usability surveys in February 2019; students were invited to complete impact surveys in August 2020. OUTCOMES: Fifty-two of 132 invited faculty members (39.4%) and 80 of 185 students (43.2%) completed the usability surveys. Most of these faculty (86.5%) and students (73.8%) reported navigating the website was easy/very easy; 36 faculty (69.2%) created a mentor profile within 10 minutes. Key innovations highlighted by faculty and students were the listing of personal attributes and identities of diverse faculty; centralized, increased access to faculty mentors; ease of use; and provision of clear expectations. Nearly all students who completed the impact surveys agreed that Weave allowed them to connect with a faculty mentor whom they would not have found through other sources and to learn about the dimensions of diverse faculty. NEXT STEPS: Weave is a customizable online mentorship platform that fosters empowered vulnerability and increases dialogue between medical students and faculty based on professional and personal interests and identities. Weave may be expanded to other mentoring contexts and adapted for implementation at other institutions to help cultivate an institutional culture that values mentoring and to strengthen broader diversity and inclusion efforts.

Authentic SP-based teaching in spite of COVID-19 - is that possible?

Objective: Medical conversation plays a central role in disease management and therapy. In teaching, standardized patients (SPs) are increasingly being used to present conversation situations with students and provide feedback afterwards. In order to maintain this teaching concept under pandemic conditions, a digital model was developed that should offer both high security and high authenticity. Methodology: A total of 176 teaching units of 45 minutes each were conducted digitally from May to August 2020. During the teaching units, medical students conducted interviews with SPs portraying various patients. The online conference software "HeiConf" was used for this purpose. During the teaching units, a total of 354 students were able to practice conversation techniques such as NURSE and SPIKES. After the teaching units, feedback was provided by students and SPs. Results: The digital lessons about medical conversation with SPs received positive feedback from SPs and students. The authenticity of the role portrayal of SPs seemed to be unaffected by the new format. Students were successful in training and observing conversation techniques. However, aspects of non-verbal communication, atmosphere and group dynamics as well as further discussions could not be carried out to the same extent as in the usual classroom teaching. Conclusion: The conversion of SP-based teaching to a digital format was successful in a short period of time and was able to prevent a cancellation of teaching units about medical conversation. Concrete conversation techniques could be tried out digitally by students. Due to the deficits of digital teaching in terms of non-verbal communication and atmosphere, a blended-learning format is planned for the future. In the first instance, concrete conversation techniques will be learned online in order to focus more on profound aspects of communication and discussions in a later physical teaching unit with SPs, thus enabling a learning experience that is as authentic as possible.

[A&F to monitor and promote quality in healthcare during the COVID-19 emergency: the EASY-NET work]. / A&F per il monitoraggio e la promozione della qualità delle cure in emergenza COVID-19: il lavoro di EASY-NET.

We are presenting here the findings of the reaction to the COVID-19 epidemic during the period March to June 2020 of those centres participating in the research EASY-NET which is on-going in Italy, funded by the Ministry of Health and co-founded by the Regional Health Authorities. The objective of EASY-NET is to evaluate the effectiveness of the audit and feedback (A&F) strategies in different clinical and organizational settings in seven regions. As a negative consequence of the COVID-19 epidemic, the activities of the project have suddenly slowed down; nevertheless, the COVID-19 epidemic represented an opportunity to apply the A&F methodology and support the healthcare within the regional authorities in order to manage and monitor the impact of this new disease. The reaction to the crisis on behalf of EASY-NET was inconsistent across the participating regions for various reasons. Factors which influenced the reaction levels in relation to the rapidity and efficiency of the implementation of the A&F strategies were as follows: the varying epidemiological impact of the COVID-19 epidemic in the various territories, the different clinical and organizational context and availability of expert research teams together with A&F procedures which had already been tested before the start of the epidemic.

Self-perceived competency of the medical faculty for E-Teaching during the COVID-19 pandemic.

BACKGROUND: The aim of this study was to evaluate the self-perceived competency (FSPC) of medical faculty in E-Teaching and support received during the COVID-19 pandemic. METHODS: An online well-structured and validated faculty self-perceived competency questionnaire was used to collect responses from medical faculty. The questionnaire consisted of four purposely build sections on competence in student engagement, instructional strategy, technical communication and time management. The responses were recorded using a Likert ordinal scale (1-9). The Questionnaire was uploaded at www.surveys.google.com and the link was distributed through social media outlets and e-mails. Descriptive statistics and Independent paired t-test were used for analysis and comparison of quantitative and qualitative variables. A p-value of ≤0.05 was considered statistically significant. RESULTS: A total of 738 responses were assessed. Nearly 54% (397) participants had less than 5 years of teaching experience, 24.7% (182) had 6-10 years and 11.7% (86) had 11-15 years teaching expertise. 75.6% (558) respondents have delivered online lectures during the pandemic. Asynchronous methods were used by 61% (450) and synchronous by 39% (288) of participants. Moreover, 22.4% (165) participants revealed that their online lectures were evaluated by a structured feedback from experts, while 38.3% participants chose that their lectures were not evaluated. A significant difference (p < 0.01) was found between FSPC scores and online teaching evaluation by experts. The mean score of FSPC scale was 5.62±1.15. The mean score for student's engagement, instructional strategies, technical communication and time management were of 5.18±1.60, 5.67±1.61, 5.49±1.71 and 6.12±1.67 respectively. CONCLUSIONS: Medical faculty members were found somewhat competent in E-teaching for student engagement, instructional strategy, technical communication and time management skills. Faculty receiving feedback was more competent in comparison to peers teaching without feedback.

[A&F in EASY-NET: a bridge between clinicians and epidemiologists for a more virtuous exchange of information.] / A&F in EASY-NET: un ponte tra clinici ed epidemiologi per un più virtuoso scambio informativo.

The first of a series of four online meetings entitled "A&F CONNECTIONS. In practice and in response to Covid-19", as part of the EASY-NET network program on the topic of Audit & Feedback (A&F), was an opportunity to present and discuss the first results of a survey carried out by the area working on A&F, to describe the characteristics of A&F interventions in the EASY-NET context. A reflection on the preliminary results of the investigation and on the cultural dimension of the importance of creating a bridge between the world of clinicians and the world of epidemiology, for a real and virtuous exchange of information.

"I Have a Cough": An Interactive Virtual Respiratory Case-Based Module.

Introduction: The COVID-19 pandemic has radically disrupted traditional models of medical education, forcing rapid evolution in the delivery of clinical training. As a result, clinical educators must quickly transition away from in-person sessions and develop effective virtual learning opportunities instead. This virtual resource was designed to replace a clinical simulation session for the physical examination course for medical students in the preclinical years. Methods: We designed an online interactive module in three sections for preclinical (first- or second-year) medical students who had not yet learned the respiratory physical exam. The first section incorporated demonstration and practice of the components of the respiratory physical exam that could be effectively taught via videoconferencing software. Following this, students conducted a telemedicine encounter with a standardized patient and received patient-centered feedback evaluating their communication skills. The final segment involved a case discussion and clinical reasoning component. Results: These sessions were implemented for 122 first-year medical students. The module was well received by the students. A majority felt that it helped improve their telemedicine communication skills (93%), interpretation of physical exam findings (84%), development of differential diagnosis (95%), and correlation of clinical and basic science content (93%). Discussion: Our pilot educational session demonstrates that this virtual instruction method is an effective tool for teaching basic clinical skills during medical school. Virtual learning resources allow remote instruction to take place and can be a supplement when face-to-face clinical teaching is not possible.

Simulation Innovation: A Novel Simulation Guide for Building Community Simulation Capacity in Pandemic Preparedness.

STATEMENT: The coronavirus disease 19 (COVID-19) pandemic, caused by severe acute respiratory distress syndrome coronavirus 2, has spread globally and requires effective preparedness within healthcare institutions. The British Columbia Simulation Network COVID-19 Simulation Guide was created to disseminate information throughout the province of British Columbia, Canada, and to allow simulation educators, from novice to expert, to participate in COVID-19 simulations. As of July 15, 2020, the guide had been downloaded 465 times from the British Columbia Simulation Network website, with downloads in 41 countries around the world. The guide has been frequently updated and revised to reflect evolving guidelines as new knowledge about COVID-19 was established.