Feedback on role model behaviour: effective for clinical trainers?

AIM: The aim of this study was to assess changes in role model behaviour of clinical trainers after giving personal feedback. METHODS: First-year general practitioner (GP) trainees at two institutes for GP speciality training in the Netherlands were asked to complete an assessment of their clinical trainers: the Role Model Apperception Tool (RoMAT). The RoMAT consists of attributes of positive role modelling divided into two components (Caring Attitude and Effectiveness) and was scored on a 5-point Likert scale twice. After the first assessment moment, the trainers received their personal scores combined with the mean score of their peers. The trainers were divided into three performance groups: below average, average and above average. RESULTS: Only the group with the lowest scores showed an improvement on the Effectiveness component of the RoMAT from 3.89 to 4.08 (p = 0.04) with an effect size of.52, showing a large effect. This pattern is confirmed by the number of trainers shifting from the below average performance group to the average (7) and above average (5) performance groups. CONCLUSION: Giving feedback to clinical trainers resulted in better scores on the Effectiveness characteristics. This indicates that role model behaviour of clinical trainers can be improved.

Learning from a role model: A cascade or whirlpool effect?

BACKGROUND: Continuing Professional Development (CPD) and Faculty Development (FD) courses have been designed in the expectation that a cascade effect will occur, consisting of a conveyance of information from the courses to clinical trainers to daily practice and/or to trainees by means of role modeling. PURPOSE: The aims of this study were to gain insight into factors that encourage clinical trainers to incorporate what they have learned in CPD/FD into their role model function and the factors that influence conveyance from master to apprentice. METHOD: We conducted a qualitative study using semi-structured interviews with GP trainers and their trainees. RESULTS: Twenty-four GP trainers who completed a CPD/FD course and sixteen of their trainees participated in the study. Analysis of their statements enabled the identification of factors that affect the amplification of the competences of clinical trainers and their awareness of being a role model, the applicability in training practice and conveyance to the trainee. CONCLUSIONS: As a result of interactions between the trainer, trainee and patient, it seems more accurate to represent the conveyance of competences from master to apprentice using the image of a whirlpool rather than a cascade, with the influential factors and interactions functioning as filters, causing a decline in the effectiveness of CPD/FD. Using the filters as a basis for turning-points for improvements around the whirlpool could increase the effectiveness of CPD/FD.

Educating the clinical trainer: professional gain for the trainee? A controlled intervention study in general practice.

The aim of this study was to establish whether a 'teach-the-trainer' course leads to improvements in, firstly, the knowledge and attitude of clinical trainers and their trainees, and, secondly, the role model behaviour of the clinical trainers. A controlled intervention study was performed with GP trainers and GP trainees from four training institutes in the Netherlands. Clinical trainers in the two intervention institutes received two 3-h training sessions on weight management, focusing on knowledge and attitudes towards obesity, and on conveying the correct professional competency as a positive role model for trainees. This was measured using questionnaires on knowledge, attitude, and role model behaviour (the role model apperception tool; RoMAT). GP trainers showed an increase in knowledge and several characteristics could be identified as being related to positive role model behaviour. A small correlation was found between the trainer's score on the RoMAT and the attitude of the trainee. A teach-the-trainer course in which knowledge, attitudes, and role modelling are integrated proved to be a first step toward improving the knowledge of clinical trainers, but did not result in a measurably better professional outcome for the trainee, maybe due to a more objective level of assessment.

Assessment of the clinical trainer as a role model: a Role Model Apperception Tool (RoMAT).

PURPOSE: Positive role modeling by clinical trainers is important for helping trainees learn professional and competent behavior. The authors developed and validated an instrument to assess clinical trainers as role models: the Role Model Apperception Tool (RoMAT). METHOD: On the basis of a 2011 systematic review of the literature and through consultation with medical education experts and with clinical trainers and trainees, the authors developed 17 attributes characterizing a role model, to be assessed using a Likert scale. In 2012, general practice (GP) trainees, in their first or third year of postgraduate training, who attended a curriculum day at four institutes in different parts of the Netherlands, completed the RoMAT. The authors performed a principal component analysis on the data that were generated, and they tested the instrument's validity and reliability. RESULTS: Of 328 potential GP trainees, 279 (85%) participated. Of these, 202 (72%) were female, and 154 (55%) were first-year trainees. The RoMAT demonstrated both content and convergent validity. Two components were extracted: "Caring Attitude" and "Effectiveness." Both components had high reliability scores (0.92 and 0.84, respectively). Less experienced trainees scored their trainers significantly higher on the Caring Attitude component. CONCLUSIONS: The RoMAT proved to be a valid, reliable instrument for assessing clinical trainers' role-modeling behavior. Both components include an equal number of items addressing personal (Heart), teaching (Head), and clinical (Hands-on) qualities, thus demonstrating that competence in the "3Hs" is a condition for positive role modeling. Educational managers (residency directors) and trainees alike can use the RoMAT.

The attributes of the clinical trainer as a role model: a systematic review.

PURPOSE: Medical trainees (interns and residents) and their clinical trainers need to be aware of the differences between positive and negative role modeling to ensure that trainees imitate and that trainers demonstrate the professional behavior required to provide high-quality patient care. The authors systematically reviewed the medical and medical education literature to identify the attributes characterizing clinical trainers as positive and negative role models for trainees. METHOD: The authors searched the MEDLINE, EMBASE, ERIC, and PsycINFO databases from their earliest dates until May 2011. They included quantitative and qualitative original studies, published in any language, on role modeling by clinical trainers for trainees in graduate medical education. They assessed the methodological quality of and extracted data from the included studies, using predefined forms. RESULTS: Seventeen articles met inclusion criteria. The authors divided attributes of role models into three categories: patient care qualities, teaching qualities, and personal qualities. Positive role models were frequently described as excellent clinicians who were invested in the doctor-patient relationship. They inspired and taught trainees while carrying out other tasks, were patient, and had integrity. These findings confirm the implicit nature of role modeling. Positive role models' appearance and scientific achievements were among their least important attributes. Negative role models were described as uncaring toward patients, unsupportive of trainees, cynical, and impatient. CONCLUSIONS: The identified attributes may help trainees recognize which aspects of the clinical trainer's professional behavior to imitate, by adding the important step of apperception to the process of learning professional competencies through observation.

Attitudes towards obesity treatment in GP training practices: a focus group study.

BACKGROUND: Both patients and government expect the GP to treat obesity. Previous studies reported a negative attitude of GPs towards this task. Little is known about the attitude of GP trainees. OBJECTIVES: To assess the attitude and other factors that influence the willingness and ability of GP trainees to provide lifestyle interventions for overweight patients. METHODS: A qualitative study was performed using focus groups, consisting of first- and third-year trainees, GP trainers and teachers. Two researchers analysed the data independently. RESULTS: First-year trainees lack knowledge and a positive attitude. Third-year trainees, although trained in motivational interviewing techniques, lack specific knowledge and feel cheated when discussing eating habits. Trainers are despondent as they rarely observe long-lasting results. Teachers warn the trainees not to have high hopes. The trainers and trainees fear ruining the relationship with their patient, and all make a request for evidence-based multidisciplinary treatment programmes, joint responsibility and an image change in society to stop the epidemic. CONCLUSIONS: Trainees do not feel more competent in treating overweight patients successfully over the course of their GP specialty training and GP trainers are not convinced of the success of the treatment of overweight patients. Therefore, it could be equally important to reflect on the GP trainer as a role model as to concentrate on the education of the trainee. Both need a revived attitude and evidence-based treatment programmes, help from policy makers and an attitude change in society are desired.

Epidemiology of inclusion body myositis in the Netherlands: a nationwide study.

Epidemiologic data on inclusion body myositis (IBM) are scarce, and possibly biased, because they are derived from larger neuromuscular centers. The present nationwide collaborative cross-sectional study, which culminated on July 1, 1999, resulted in identification of 76 patients with IBM and the establishment of a prevalence of 4.9 patients with IBM per million inhabitants in the Netherlands. Several discrepancies suggest that this may be an underestimation. The most frequently identified pitfall in diagnosing IBM was an erroneous diagnosis of polymyositis or motor neuron disease.

[Somatosensory chronotopography: normative data]. / Somatosensorische Chronotopographie: Normative Daten.

Somatosensory chronotopography of a limited number of components gives a simple representation of the potential distribution of evoked potentials over the skull. Components of individual somatosensory evoked potentials over 16 equally distributed electrodes were analysed in 10 healthy volunteers. The distribution of some specific and non-specific components, as found near the somatosensory cortex is defined and the distribution in relation to the individual traces plotted, resulting in seven normative topogramms with 90% appearance area of maxima of the seven different components. Dipoles are often present.