Corneal Laser Refractive Surgery Curriculum Development in the Military: Using the Nominal Group Technique.

INTRODUCTION: Corneal laser refractive surgery (CRS) has emerged over the past three decades as a surgical method for correcting or improving vision. In the military, CRS helps warfighters achieve weapon grade vision, which offers a tactical advantage in the deployed environment. As refractive surgery has become more prevalent in both the military and civilian sector, more ophthalmologists need to learn about treatment options as well as management of complications in order to meet increasing patient demand. Currently, little is known about the most effective curriculum for teaching refractive surgery in training programs, and a standardized curriculum does not exist. Since unification of training programs is a Defense Health Agency priority, this study aimed to collect expert consensus on a standardized curriculum for CRS training in the military. MATERIALS AND METHODS: To achieve this goal, the Nominal Group Technique (NGT) was used wherein a panel of experts, currently practicing refractive surgeons involved in military refractive surgery training programs, arrived at consensus on a standardized CRS curriculum. The framework for developing this curriculum is based on Kern's Six-Step Approach to Curriculum Development. The International Council of Ophthalmology refractive surgery curriculum, National Curriculum for Ophthalmology Residency Training, Accreditation Council for Graduate Medical Education competencies and surgical minimums, and American Academy of Ophthalmology Refractive Surgery Preferred Practice Guidelines were used as the starting materials from which panelists' consensus was drawn. This consensus-building method allowed for equal representation of experts' ideas and fostered collaboration to aid in the creation of a robust and standardized curriculum for refractive surgery training programs in the military. RESULTS: The panelist experts from this NGT were able to reach consensus on the components of a standardized military refractive surgery curriculum to include generalized and targeted needs assessment, goals and objectives, educational strategies, and curriculum implementation. CONCLUSION: A standardized CRS curriculum is warranted in military training programs. This NGT achieved expert consensus on the goals, objectives, educational methods, and implementation strategies for a standardized CRS curriculum in military ophthalmology residency.

Teaching Medical Students How to Teach: A Scoping Review.

PHENOMENON: Teaching medical students how to teach is a growing and essential focus of medical education, which has given rise to student teaching programs. Educating medical students on how to teach can improve their own learning and lay the foundation for a professional identity rooted in teaching. Still, medical student-as-teacher (MSAT) programs face numerous obstacles including time constraints, prioritizing curriculum, and determining effective evaluation techniques. The purpose of this scoping review is to map the current landscape of the literature on medical school initiatives designed to train students to teach to describe why medical student teaching programs are started; the benefits and barriers; who teaches them; what content is taught; and how content is delivered. With this new map, the authors aimed to facilitate the growth of new programs and provide a shared knowledge of practices derived from existing programs. APPROACH: The authors conducted a scoping review, guided by Arksey and O'Malley's framework, to map the literature of MSAT training programs. Six databases were searched using combinations of keywords and controlled vocabulary terms. Data were charted in duplicate using a collaboratively designed data charting tool. This review builds on the Marton et al. review and includes articles published from 2014 to 2020. FINDINGS: Of the 1,644 manuscripts identified, the full-text of 57 were reviewed, and ultimately 27 were included. Articles included empirical research, synthetic reviews, opinion pieces, and a descriptive study. Analysis focused on modalities for teaching medical students how to teach; content to teach medical students about teaching; benefits and barriers to starting teaching programs; and the value of teaching programs for medical students. INSIGHTS: The rapid growth of MSAT programs suggests that this curricular offering is of great interest to the field. Literature shows an increase in evaluative efforts among programs, benefits for students beyond learning to teach, and evidence of effective engagement in medical students' designing and implementing programs.

Leaders' Windows of Tolerance for Affect Arousal-and Their Effects on Political Decision-making During COVID-19.

The recent 'affect revolution' in strategic decision-making research has placed greater emphasis on the role of stress and emotions in decision-making, with new theorizing to highlight how leader decisions often differ from rational choice expectations. However, while existing theories add to our understanding of the interplay between affect and cognition, they have not yet explained why affect drives decisions in some situations and not others. Undertheorized connections between leaders' neurobiological windows of tolerance to affect arousal and their self-regulatory capacity-their capacity to regulate stress and emotions so that these phenomena do not drive resulting decisions-may hold the key to explaining this variation in affect's influence on decision-making. Furthermore, this article considers how leaders' windows of tolerance have unique ripple effects in their social environments, thereby affecting their groups' collective window of tolerance. While regulated leaders can convey a calming and creative influence in their organizations that helps the group access strategic decision-making, dysregulated leaders are likely to convey stress and emotion contagion-which may erode the group's ability to cooperate, adapt, and learn. It illustrates this argument using evidence from the upper echelons of governmental decision-making, comparing New Zealand Prime Minister Jacinda Ardern's and US President Donald Trump's responses to the coronavirus pandemic in their respective nations. It concludes by offering hypotheses for testing the argument in future empirical research.

Developing Academic Leadership From a Distance: A Health Professions Education Practicum Course.

PROBLEM: Leadership skills are fundamental to the successful practice of health professions education (HPE), but HPE degree programs struggle with providing meaningful leadership instruction from a distance. APPROACH: The leaders of the HPE program at the Uniformed Services University of the Health Sciences developed a practicum course to give learners guided experiences in their daily leadership roles and responsibilities from a distance. The ongoing practicum course, started in fall 2018 and broadly framed by the principles of deliberate practice and self-directed learning, involves a 6-step process where learners: (1) identify leadership competency/ies to develop, (2) identify roles and responsibilities in their own work settings that involve elements of leadership, (3) develop a learning agreement that identifies personal leadership goals for the practicum activity, (4) are assigned expert preceptors by practicum directors, (5) initiate regular meetings with their preceptors to receive feedback and expert advice, and (6) end the practicum activity with a debriefing reflection between themselves and their preceptors. Practicum activity timelines are flexible and preceptors work with learners through the lifespan of the project. Learners can participate in multiple practicum activities as they improve different leadership competencies. OUTCOMES: Since fall 2018, 36 learners have participated in 83 practicum activities, 45 (54%) of which have been completed. The practicum activities show that leadership competencies are most often embedded within other activities and are unique to every situation. Reflecting on practice, collaborating in teams, and negotiating and resolving conflict are the most commonly identified leadership competencies learners want to improve. Feedback on the practicum from learners has been positive. NEXT STEPS: This practicum course provides a model that can be applied in various organizational contexts. In the future, the authors plan to collect data from both learners and preceptors about their experiences and solicit feedback from learners' employers and supervisors.

Scoping reviews in medical education: A scoping review.

OBJECTIVES: Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities. METHOD: The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review. RESULTS: One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal. CONCLUSIONS: Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.

Trust in Group Decisions: a scoping review.

BACKGROUND: Trust is a critical component of competency committees given their high-stakes decisions. Research from outside of medicine on group trust has not focused on trust in group decisions, and "group trust" has not been clearly defined. The purpose was twofold: to examine the definition of trust in the context of group decisions and to explore what factors may influence trust from the perspective of those who rely on competency committees through a proposed group trust model. METHODS: The authors conducted a literature search of four online databases, seeking articles published on trust in group settings. Reviewers extracted, coded, and analyzed key data including definitions of trust and factors pertaining to group trust. RESULTS: The authors selected 42 articles for full text review. Although reviewers found multiple general definitions of trust, they were unable to find a clear definition of group trust and propose the following: a group-directed willingness to accept vulnerability to actions of the members based on the expectation that members will perform a particular action important to the group, encompassing social exchange, collective perceptions, and interpersonal trust. Additionally, the authors propose a model encompassing individual level factors (trustor and trustee), interpersonal interactions, group level factors (structure and processes), and environmental factors. CONCLUSIONS: Higher degrees of trust at the individual and group levels have been associated with attitudinal and performance outcomes, such as quality of group decisions. Developing a deeper understanding of trust in competency committees may help these committees implement more effective and meaningful processes to make collective decisions.