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Introduction: Implementation of evidence-informed educational interventions (EEI) involves applying and adapting theoretical and scientific knowledge to a specific context. Knowledge translation (KT) approaches can both facilitate and structure the process. The purpose of this paper is to describe lessons learned from applying a KT approach to help implement an EEI for clinical reasoning in medical students. Methods: Using the Knowledge to Action framework, we designed and implemented an EEI intended to support the development of students' clinical reasoning skills in a renewed medical curriculum. Using mixed-methods design, we monitored students' engagement with the EEI longitudinally through a platform log; we conducted focus groups with students and stakeholders, and observed the unfolding of the implementation and its continuation. Data are reported according to six implementation outcomes: Fidelity, Feasibility, Appropriateness, Acceptability, Adoption, and Penetration. Results: Students spent a mean of 24 min on the activity (fidelity outcome) with a high completion rate (between 75% and 95%; feasibility outcome) of the entire activity each time it was done. Focus group data from students and stakeholders suggest that the activity was acceptable, appropriate, feasible, adopted and well-integrated into the curriculum. Discussion: Through the process we observed the importance of having a structuring framework, of working closely and deliberatively with stakeholders and students, of building upon concurrent evaluations in order to adapt iteratively the EEI to the local context and, while taking students' needs into consideration, of upholding the EEI's core educational principles. [ABSTRACT FROM AUTHOR]

Self-explanation and structured reflection have been studied independently with results suggesting that both learning interventions can effectively support medical students' clinical reasoning development. Given this evidence, medical schools may want/begin to implement these interventions in their curricula. Implementing educational interventions requires educators to maintain the core philosophy and principles of the interventions intact while adjusting implementation techniques to the specificities of individual learning contexts. Educational scholars have yet to explicitly articulate the philosophy, principles and techniques of self-explanation and structured reflection. Without such descriptions, educators risk failing to realize self-explanation's and structured reflection's effect to support students' clinical reasoning skill development in their implementations. Relying on the layered analysis approach, we articulate the philosophy, principles and techniques of self-explanation and structured reflection. This description is framed within the context of an actual implementation to illustrate the philosophies underpinning self-explanation and structured reflection, the principles that realize those philosophies, and the techniques that can be used to enact those principles. Building on the similarities between self-explanation and structured reflection, while also harnessing their differences, we identify why and how these interventions can be combined in a single implementation, while preserving their philosophies and principles. The layered analysis of self-explanation and structured reflection offers essential insights into the underpinnings of these interventions. They are articulated in this manuscript in hopes that other scholars will continue to refine these descriptions thereby facilitating effective use of self-explanation and structured reflection for clinical reasoning development. [ABSTRACT FROM AUTHOR]

Testing is used in various contexts and with different populations. However, its effect has never been studied in continuing professional development. As testing can induce some stress, it seems necessary to ascertain the acceptability of this strategy with professionals that engage in continuing education. Purpose: The primary purpose of this study was to evaluate the acceptability of testing as an inherent part of a continuing professional development activity for physicians and residents. Subject/Material/Methods: The study was conducted with Quebec-based family physicians and residents. Participants had to solve 20 clinical cases in 45 min. Feedback (right answer) was provided afterwards. For a group of participants, the activity was followed by a discussion about the cases with an expert physician. The acceptability expressed by participants was documented. Results: In general, participants appreciated the activity, but even more so when followed by a discussion about the cases. Conclusion: Results show the acceptability of testing as an inherent part of a continuing professional development activity thereby suggesting a potential for more widespread integration of this strategy in continuing professional development. [ABSTRACT FROM AUTHOR]

Contexte: Les directeurs des programmes d'externat et les étudiants eux-mêmes sont préoccupés par la maîtrise insuffisante de l'examen physique (EP) des étudiants à leur entrée en stages, alors que l'EP est un élément essentiel du diagnostic pour les médecins. La plupart des écoles de médecine utilisent des activités d'apprentissages en petits groupes pour enseigner l'EP lors de la formation pré-doctorale. On sait peu de choses sur les facteurs qui affectent l'apprentissage de l'EP dans les environnements en petits groupes, en particulier en ce qui concerne l'influence des pairs lors de ces activités. Objectifs: Cette thèse comprend une série d'études menées auprès d'étudiants en médecine de deuxième année de l'université de Sherbrooke qui visait à vérifier si l'observation de pairs, le feedback des pairs et l'ordre de pratique influençaient l'acquisition des compétences psychomotrices nécessaires à la maîtrise de l'EP. Résultats: Une première étude a démontré que les étudiants ayant la possibilité d'observer un pair performant mieux que ceux qui n'ont pas eu cette possibilité (83,9% vs. 75,9 %, p<.001). Il n'y avait pas d'avantage significatif à observer plus d'un pair (83,7% vs. 84,1 %, p>.05). Une deuxième étude a démontré que l'observation d'une bonne performance d'un pair influence positivement l'acquisition de l'EP (81,1% vs. 68,3 %, p>.002.). L'observation d'un pair semble aider, en donnant aux étudiants une image mentale de la performance à apprendre qui est plus proche qui est plus proche de leur capacité à reproduire les gestes enseignés. Le feedback des pairs passe par les commentaires sur la performance de leurs collègues lors des séances de formation en petits groupes. Une troisième étude a montré que les commentaires des pairs contribuent positivement à la maîtrise de l'EP (89,5% vs. 86,2%, p =.02). Les étudiants qui reçoivent des commentaires par les pairs apprennent davantage. Cependant, cette influence, étudiée dans une étude subséquente, demeure complexe. Aucune caractéristique de la rétroaction par les pairs, que ce soit la quantité ou la spécificité, ne semble expliquer l'effet positif du feedback des pairs lors de l'apprentissage de l'EP. Beaucoup d'étudiants étant généralement réticents à être les premiers à pratiquer dans un petit groupe, nous avons vérifié dans deux autres études si l'ordre de pratique dans un petit groupe fait la différence. Les données montrent qu'à la fin de la séance de formation, les étudiants ont une performance semblable (quel que soit l'ordre qu'ils pratiquent [p = 0,706] ou la quantité de feedback reçus [p = 0,096]). Conclusion: En conclusion, il semble que la formation en petits groupes de l'EP est utile pour les étudiants, car l'apprentissage est influencé positivement par l'observation et le feedback des pairs. L'utilisation de petits groupes pour apprendre l'examen physique dans les programmes de formation en sciences de la santé est une méthode de choix, non seulement pour des raisons logistiques, mais aussi pour la contribution des pairs à la maîtrise de l'EP de leurs collègues. [ABSTRACT FROM AUTHOR]

Context Recent studies suggest that self-explanation ( SE) while diagnosing cases fosters the development of clinical reasoning in medical students; however, the conditions that optimise the impact of SE remain unknown. The example-based learning framework justifies an exploration of students' use of their own SEs combined with the study of examples. This study aimed to assess the impact on medical students' diagnostic performance of: (i) combining students' SEs with their listening to examples of residents' SEs, and (ii) the addition of prompts (specific questions) while working with examples. Methods This study consisted of a training phase and an assessment phase conducted 1 week later. In the training phase, 54 Year 3 medical students were randomly assigned to one of three groups. In all groups, students first solved four clinical cases using SE. Subsequently, Group 1 listened to examples of residents' SEs with prompts; Group 2 listened to examples of residents' SEs without prompts, and the control group solved word puzzles. Then, all students again solved the same four cases. One week later, all students solved four similar and four different cases. Students' diagnostic performance and diagnostic accuracy scores were assessed for each case at each time-point. Results Although all groups' diagnostic accuracy scores on similar cases improved significantly between the training and the assessment phase, Group 1 showed a significantly higher diagnostic performance score after 1 week than the control group (p = 0.037). On different cases, Group 1 obtained significantly higher diagnostic accuracy (p = 0.011) and diagnostic performance (p < 0.001) scores than the control group and a significantly higher diagnostic performance score than Group 2 (p = 0.018). Conclusions Self-explanation seems to be an effective technique to help medical students learn clinical reasoning. Its impact is increased significantly by combining it with examples of residents' SEs and prompts. Although students' exposure to examples of clinical reasoning is important, their 'active processing' of these examples appears to be critical to their learning from them. [ABSTRACT FROM AUTHOR]

Contexte/problématique : Les séances d'apprentissage en petits groupes permettent l'acquisition d'habiletés psychomotrices en combinant pratique et observation ; chaque étudiant pratique à tour de rôle pendant que les autres observent ce collègue qui pratique. Cependant, lors de ces séances d'apprentissage, les premiers étudiants à pratiquer peuvent être désavantagés, puisqu'ils n'ont pas la chance d'observer avant de pratiquer. Jusqu'à maintenant, les études qui ont porté sur l'impact de la combinaison pratique/observation dans l'apprentissage d'habiletés psychomotrices, ont investigué l'inluence d'observer un pair avant ou pendant la pratique, sans toutefois s'intéresser à l'inluence de l'observation d'autres pairs après avoir pratiqué. Objectifs/questions : La présente étude avait pour objectif d'étudier l'impact du moment de l'observation d'un pair sur l'acquisition, par des étudiants en médecine, des habiletés psychomotrices nécessaires à conduire un examen neurolocomoteur (ENL) intégré pour lombalgie. Méthodes : 130 étudiants de deuxième année en médecine ont participé à une activité d'apprentissage de l'ENL. Les étudiants pratiquaient en petits groupes de trois avec un patient formateur. Chaque étudiant pratiquait l'ENL à tour de rôle et pendant ce temps, les deux autres étudiants observaient. Cette manière de faire créait trois combinaisons observation/pratique différentes : 1) deux observations après la pratique (pour le premier étudiant qui pratique) ; 2) une observation avant et une observation après la pratique (pour le deuxième étudiant) ; et 3) deux observations avant la pratique (pour le troisième étudiant). Après la séance de pratique, une phase d'évaluation suivait lors de laquelle chaque étudiant exécutait l'ENL, seul avec le patient formateur. Cette performance était enregistrée sur bande vidéo pour être analysée à l'aide d'une grille d'évaluation des habiletés psychomotrices préalablement validée dans des études précédentes. Résultats : Une ANOVA à mesures répétées a été utilisée pour évaluer les différences de performance selon le moment où l'observation d'un pair était faite. Les résultats ne montrent aucune différence signiicative entre les trois groupes (moyennes : groupe 1 - 88,3 % ; groupe 2 - 88,3 % ; groupe 3 - 86,4 % ; p < 0,05). Discussion/conclusion : L'acquisition des habiletés psychomotrices nécessaires pour faire un ENL ne semble pas être inluencée par l'ordre de passage dans une session d'apprentissage combinant pratique et observation. Les résultats suggèrent que les étudiants continuent à apprendre par l'observation, même après avoir pratiqué l'habileté à acquérir. [ABSTRACT FROM AUTHOR]

Background: Learning and mastering the skills required to execute physical exams is of great importance and should be fostered early during medical training. Observing peers has been shown to positively influence the acquisition of psychomotor skills.Purpose: The current study investigated the influence of peer observation on the acquisition of psychomotor skills required to execute a physical examination.Methods: Second-year medical students (N= 194) learned the neurological physical examination for low back pain in groups of three. Each student learned and performed the physical examination while the other students observed. Analyses compared the impact of the quantity and the quality of observed performances on students’ learning of the physical examination skills.Results: Students benefited from observing peers while they executed their examination. Moreover, observing a high-performing peer increased the acquisition of physical examination skills.Conclusions: Results suggest that group learning activities that allow students to observe their peers during physical examination should be favored. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 688-695 Skill in clinical reasoning is a highly valued attribute of doctors, but instructional approaches to foster medical students' clinical reasoning skills remain scarce. Self-explanation is an instructional procedure, the positive effects of which on learning have been demonstrated in a variety of domains, but which remain largely unexplored in medical education. The purpose of this study was to investigate the effects of self-explanation on students' learning of clinical reasoning during clerkships and to examine whether these effects are affected by topic familiarity. An experimental study with a training phase and an assessment phase was conducted with 36 Year 3 medical students, randomly assigned to one of two groups. In the training phase, students solved 12 clinical cases (four cases on a less familiar topic; four on a more familiar topic; four on filler topics), either generating self-explanations ( n = 18) or not ( n = 18). The self-explanations were generated after minimal instructions and no feedback was provided to students. One week later, in the assessment phase, students were requested to diagnose 12 different, more difficult cases, similarly distributed among the same more familiar topic, less familiar topic and filler topics, and their diagnostic performance was assessed. In the training phase the performance of the two groups did not differ. However, in the assessment phase 1 week later, a significant interaction was found between self-explanation and case topic familiarity ( F = 6.18, p < 0.05). Students in the self-explanation condition, compared with those in the control condition, demonstrated better diagnostic performance on subsequent clinical cases, but this effect emerged only for cases concerning the less familiar topic. The present study shows the beneficial influence of generating self-explanations when dealing with less familiar clinical contexts. Generating self-explanations without feedback resulted in better diagnostic performance than in the control group at 1 week after the intervention. [ABSTRACT FROM AUTHOR]