An Innovative Simulation-based Community-engaged Intervention for Training Research Assistants in Culturally Appropriate Informed Consent.

BACKGROUND: Enrolling under-represented groups in biomedical research remains challenging owing to limited health literacy, historic medical abuses, and mistrust. Addressing such barriers requires scrutiny of informed consent processes and training of research assistants (RAs). Applying simulation methods that are well-established in medical education, Simulation-based Community-engaged Research Intervention for Informed Consent Protocol Testing and Training (SCRIIPTT) engages community members as community advisors (CAs) to train RAs in implementing culturally appropriate approaches, such as addressing difficult issues related to race and power dynamics, into the informed consent training process. OBJECTIVES: To present SCRIIPTT's development, implementation, and preliminary findings. METHODS: Over 12 months, our community-academic partnership 1) introduced SCRIIPTT to the greater community using the Truth & Reconciliation Model, which acknowledges the wrongs of research and offers an apology; 2) deepened understanding of community concerns; 3) developed the intervention; 4) conducted a pilot; and 5) disseminated findings. RESULTS: SCRIIPTT included a comprehensive training manual, scenarios for simulated informed consent encounters, and a 37-item checklist to measure performance. Outcomes include CA and RA satisfaction surveys, and RA performance rating. The checklist adequately measured observable behaviors. RAs reported important gains in knowledge, self-confidence, and cultural competence in conducting informed consent. CAs reported positive experiences, being fully engaged and valued as members of the research team and participants during simulation encounters. CONCLUSIONS: This pilot study demonstrated the feasibility of SCRIIPTT, with preliminary evidence of effectiveness and acceptability. SCRIIPTT offers an innovative approach for community engagement in research training and advancing the skills of RAs in culturally appropriate informed consent.

A human factors curriculum for surgical clerkship students.

HYPOTHESIS: Early introduction of a full-day human factors training experience into the surgical clerkship curriculum will teach effective communication skills and strategies to gain professional satisfaction from a career in surgery. DESIGN: In pilot 1, which took place between July 1, 2007, and December 31, 2008, 50 students received training and 50 did not; all received testing at the end of the rotation for comparison of control vs intervention group performance. In pilot 2, a total of 50 students were trained and received testing before and after rotation to examine individual change over time. SETTING: University of Massachusetts Medical School. PARTICIPANTS: A total of 148 third-year medical students in required 12-week surgical clerkship rotations. INTERVENTIONS: Full-day training with lecture and small-group exercises, cotaught by surgeons and educators, with focus on empathetic communication, time management, and teamwork skills. MAIN OUTCOME MEASURES: Empathetic communication skill, teamwork, and patient safety attitudes and self-reported use of time management strategies. RESULTS: Empathy scores were not higher for trained vs untrained groups in pilot 1 but improved from 2.32 to 3.45 on a 5-point scale (P < .001) in pilot 2. Students also were more likely to ask for the nurse's perspective and to seek agreement on an action plan after team communication training (pilot 1, f = 7.52, P = .007; pilot 2, t = 2.65, P = .01). Results were mixed for work-life balance, with some trained groups scoring significantly lower than untrained groups in pilot 1 and no significant improvement shown in pilot 2. CONCLUSIONS: The significant increase in student-patient communication scores suggests that a brief focused presentation followed by simulation of difficult patient encounters can be successful. A video demonstration can improve interdisciplinary teamwork.

Reliability and validity of checklists and global ratings by standardized students, trained raters, and faculty raters in an objective structured teaching environment.

BACKGROUND: Objective structured teaching exercises (OSTEs) are relatively new in medical education, with few studies that have reported reliability and validity. PURPOSE: To systematically examine the impact of OSTE design decisions, including number of cases, choice of raters, and type of scoring systems used. METHODS: We examined the impact of number of cases and raters using generalizability theory. We also compared scores from standardized students (SS), faculty raters (FR) and trained graduate student raters (TR), and examined the relation between behavior checklist ratings and global perception scores. RESULTS: Generalizability (g) coefficients for checklist scores were higher for SSs than TRs. The g estimates based on SSs' global scores were higher than g estimates for FRs. SSs' checklist scores were higher than TRs' checklist scores, and SSs' global evaluations were higher than FRs' and TRs' global scores. TRs' relative to SSs' global perceptions correlated more highly with checklist scores. CONCLUSIONS: SSs provide more generalizable checklist scores than TRs. Generalizability estimates for global scores from SSs and FRs were comparable. SSs are lenient raters compared to TRs and FRs.

Development and implementation of an objective structured teaching exercise (OSTE) to evaluate improvement in feedback skills following a faculty development workshop.

BACKGROUND: Faculty development programs focusing on teaching have become widespread. PURPOSE: Despite the popularity of such programs, evidence as to their effectiveness is limited. This article reports on the development of an objective structured teaching exercise (OSTE) and its pilot implementation in an evaluation of a faculty development program module. A written test intended to measure feedback skills was also developed and pilot tested. METHODS: A separate-sample, pretest-posttest design was used to pilot test both instruments. RESULTS: The results showed some evidence of significant differences between groups tested preworkshop and postworkshop. Higher scores were observed for the posttest group compared to the pretest group only for OSTE items focusing on prioritizing and limiting the amount of feedback given at one time and on action planning. CONCLUSIONS: Results suggest that an OSTE may be sensitive to changes in preceptor skill level for skills that are relatively easy to incorporate immediately into practice. Lack of differences in other skill areas may be due to lack of sensitivity of the measure or to need for practice and reflection before changes in performance on other feedback skills are evident.