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Background: Advanced nursing practice and education with a Master's degree as the necessary preparation, is viewed as a major strategy to cultivate senior nursing talents. Competencies are central to advanced nursing practice and education, but how can competencies be measured? Entrustable professional activities (EPAs) have been used widely in medicine as a practical approach for bridging the gaps between competency and clinical practice. Considering the paucity of research in EPAs for nursing graduates in China, it is needed to develop EPAs specifically for Chinese Master of Nursing Specialist (MNS) graduates to improve patient safety and quality patient care. Objectives: To develop and evaluate a core competency-based EPAs framework for Chinese MNS graduates. Methods: A four-stage approach was adopted for the EPAs development, including: (1) forming a research team, (2) drafting an initial EPAs framework, (3) reviewing EPAs framework, and (4) conducting EPAs consensus assessment. Results: A framework containing twelve EPAs was developed, including: 1) perform health assessments, 2) identify and prioritize nursing diagnoses, 3) formulate and implement care plan, 4) perform basic and specialized care operations, 5) recognize and manage medication needs of patients, 6) assess and manage patients with mental health problems, 7) recognize and assist in rescuing critically ill patients, 8) perform transition and handover, 9) participate in multidisciplinary team collaborative care, 10) provide health education and nursing consultation, 11) formulate and implement discharge plans, and 12) instruct nursing students in a clinical setting. The I-CVI score for the two rounds of Delphi ranged from 0.92 ∼ 1.00 and 0.96 ∼ 1.00, respectively. The mean of Equal's score for the three domains ranged from 4.20 ∼ 4.47, 4.25 ∼ 4.51, and 4.23 ∼ 4.37, respectively. Conclusion: The developed EPAs framework in this study is a reliable tool to assess the core competencies of Chinese MNS graduates in clinical practice and assist with their curricula design. [ABSTRACT FROM AUTHOR]

The transition towards Competency-Based Medical Education at the Cumming School of Medicine was accelerated by the reduced clinical time caused by the COVID-19 pandemic. The purpose of this study was to define a standard protocol for setting Entrustable Professional Activity (EPA) achievement thresholds and examine their feasibility within the clinical clerkship. Achievement thresholds for each of the 12 AFMC EPAs for graduating Canadian medical students were set by using sequential rounds of revision by three consecutive groups of stakeholders and evaluation experts. Structured communication was guided by a modified Delphi technique. The feasibility/consequence models of these EPAs were then assessed by tracking their completion by the graduating class of 2021. The threshold-setting process resulted in set EPA achievement levels ranging from 1 to 8 across the 12 AFMC EPAs. Estimates were stable after the first round for 9 of 12 EPAs. 96.27% of EPAs were successfully completed by clerkship students despite the shortened clinical period. Feasibility was predicted by the slowing rate of EPA accumulation overtime during the clerkship. The process described led to consensus on EPA achievement thresholds. Successful completion of the assigned thresholds was feasible within the shortened clerkship. Practice points The modified Delphi technique is a feasible methodology that can be used to propose achievement thresholds for all 12 EPAs for graduating undergraduate medical students. Recommended achievement thresholds for each EPA ranged from 1 (e.g. 'Participate in health quality improvement initiatives') to 8 (e.g. 'Obtain a history and perform a physical examination adapted to the patient's clinical situation'). [ABSTRACT FROM AUTHOR]

Entrustable professional activities (EPAs), units of professional practice that require proficient integration of multiple competencies and can be entrusted to a sufficiently competent learner, are increasingly being used to define and inform curricula of health care professionals. The process of developing EPAs can be challenging and requires a deep yet pragmatic understanding of the concepts underlying EPA construction. Based on recent literature and the authors' lessons learned, this article provides the following practical and more or less sequential recommendations for developing EPAs: [1] Assemble a core team; [2] Build up expertise; [3] Establish a shared understanding of the purpose of EPAs; [4] Draft preliminary EPAs; [5] Elaborate EPAs; [6] Adopt a framework of supervision; [7] Perform a structured quality check; [8] Use a Delphi approach for refinement and/or consensus; [9] Pilot test EPAs; [10] Attune EPAs to their feasibility in assessment; [11] Map EPAs to existing curriculum; [12] Build a revision plan. [ABSTRACT FROM AUTHOR]

Although evidence supports diverse assessment strategies, including patient/caregiver involvement in Competency-Based Medical Education (CBME), few residency programs formally include patients/caregivers in assessment. We aimed to determine the milestones for which patient/caregiver inclusion would be valuable in the Canadian Pediatric Competence By Design (CBD) curriculum. Program directors from 17 Canadian pediatric residency programs were invited to participate in a Delphi study. This Delphi included 209 milestones selected by the study team from the 320 milestones of the draft pediatric CBD curriculum available at the time of the study. In round 1, 16 participants representing 13 institutions rated the value of including patients/caregivers in the assessment of each milestone using a 4-point scale. We obtained consensus for 150 milestones, leaving 59 for re-exposure. In round 2, 14/16 participants rated remaining items without consensus. Overall, 67 milestones met consensus for 'valuable,' of which 11 met consensus for 'extremely valuable.' The majority of these milestones related to communication skills. Patient/caregiver assessment is valuable for 21% of milestones in the draft pediatric CBD curriculum, predominantly those relating to communication skills. This confirms the perceived importance of patient/caregiver assessment of trainees in CBME curricula; formal inclusion may be considered. Future directions could include exploring patients/caregivers' perspectives of their roles in assessment in CBD. [ABSTRACT FROM AUTHOR]

These authors sought to define the new roles and competencies required of administrative staff and faculty in the age of CBME. A modified Delphi process was used to define the new CBME roles and competencies needed by faculty and administrative staff. We invited international experts in CBME (volunteers from the ICBME Collaborative email list), as well as faculty members and trainees identified via social media to help us determine the new competencies required of faculty and administrative staff in the CBME era. Thirteen new roles were identified. The faculty-specific roles were: National Leader/Facilitator in CBME; Institutional/University lead for CBME; Assessment Process & Systems Designer; Local CBME Leads; CBME-specific Faculty Developers or Trainers; Competence Committee Chair; Competence Committee Faculty Member; Faculty Academic Coach/Advisor or Support Person; Frontline Assessor; Frontline Coach. The staff-specific roles were: Information Technology Lead; CBME Analytics/Data Support; Competence Committee Administrative Assistant. The authors present a new set of faculty and staff roles that are relevant to the CBME context. While some of these new roles may be incorporated into existing roles, it may be prudent to examine how best to ensure that all of them are supported within all CBME contexts in some manner. [ABSTRACT FROM AUTHOR]

Assessing competency in surgical procedures is key for instructors to distinguish whether a resident is qualified to perform them on patients. Currently, assessment techniques do not always focus on providing feedback about the order in which the activities need to be performed. In this research, using a Process Mining approach, process-oriented metrics are proposed to assess the training of residents in a Percutaneous Dilatational Tracheostomy (PDT) simulator, identifying the critical points in the execution of the surgical process. A reference process model of the procedure was defined, and video recordings of student training sessions in the PDT simulator were collected and tagged to generate event logs. Three process-oriented metrics were proposed to assess the performance of the residents in training. Although the students were proficient in classic metrics, they did not reach the optimum in process-oriented metrics. Only in 25% of the stages the optimum was achieved in the last session. In these stages, the four more challenging activities were also identified, which account for 32% of the process-oriented metrics errors. Process-oriented metrics offer a new perspective on surgical procedures performance, providing a more granular perspective, which enables a more specific and actionable feedback for both students and instructors. [ABSTRACT FROM AUTHOR]

The acquisition of skills in patient-centered communication is a critical aspect of medical education which demands both resource-intensive instruction and longitudinal opportunities for learning. Significant variation currently exists in the content and timing of communication education. The aim of this study was to establish consensus regarding communication curriculum content for undergraduate medical education (UME) within the country of Denmark. This study employed a Delphi process which is a widely accepted method for establishing consensus among experts and can be utilized to guide planning and decision-making in education. For this study, consensus was based on greater than 60% agreement between participants. Diverse stakeholders, representing all four universities with medical schools in Denmark, participated in an iterative three-round Delphi process which involved: (1) identifying key curricular elements for medical student education, (2) rating the importance of each item, and (3) prioritizing items relative to one another and rating each item based on the level of mastery that was expected for each skill (i.e. knowledge, performance with supervision, or performance independently). A national sample of 149 stakeholders participated with a 70% response rate for round 1, 81% for round 2, and 86% for round 3. The completed Delphi process yielded 56 content items which were prioritized in rank order lists within five categories: (1) establishing rapport, engaging patient perspectives and responding to needs; (2) basic communication skills and techniques; (3) phases and structure of the encounter; (4) personal characteristics and skills of the student; (5) specific challenging patient groups and context-dependent situations. Using a Delphi process, it was possible to achieve consensus regarding communication curriculum content for UME. These findings provide an important foundation for ensuring greater uniformity in UME, as well as supporting the important longitudinal goals of communication skill development across medical training. [ABSTRACT FROM AUTHOR]

There is a widely recognized need to improve teacher professional development as well as recognition of teaching expertise in health professions education (HPE). This study aimed to develop Entrustable Professional Activities (EPAs) for university teachers in HPE as foundations for systems of training, certification, and career opportunities. A local expert consultation using a two-round Delphi study at a Dutch academic medical center (round 1: n = 23; round 2: n = 13) was conducted to reach a consensus on an initial set of EPAs developed by the researchers. Subsequently, an international expert consultation was conducted using a survey (n = 21) and a focus group discussion (n = 7) to explore their international value. Local consensus for all nine EPAs was reached in the second round of the Delphi study. The international survey showed a consensus for relevance and usefulness of all but one EPA but not for clarity and comprehensiveness of the EPAs. The international expert consultation revealed a need to tailor the EPA specifications to local contexts. We found international consensus for the relevance and usefulness of EPAs for university teachers in HPE but local tailoring for each EPA is needed to acknowledge contextual differences. [ABSTRACT FROM AUTHOR]

Coaching supports academic goals, professional development and wellbeing in medical education. Scant literature exists on training and assessing coaches and evaluating coaching programs. To begin filling this gap, we created a set of coach competencies for medical education using a modified Delphi approach. An expert team assembled, comprised of seven experts in the field of coaching. A modified Delphi approach was utilized to develop competencies. Fifteen competencies in five domains resulted: coaching process and structure, relational skills, coaching skills, coaching theories and models, and coach development. These competencies delineate essential features of a coach in medical education. Next steps include creating faculty development and assessment tools for coaching. [ABSTRACT FROM AUTHOR]

To define recommendations to the medical schools in Turkey about social accountability which meets the local needs. The Association of Evaluation and Accreditation of Medical Education Programs (TEPDAD-Turkey) Social Accountability working group planned a study to determine national recommendations for social accountability of medical schools in two-stages. Delphi technique was used to develop the recommendations and finalize the recommendations in the first stage in which 61 members from 30 different institutions participated. Qualitative analysis was used for open questions in the first round and quantitative analysis for the data which is collected with a rating scale in the second and third rounds of the Delphi study. In the second stage, the recommendations were reviewed and finalized in a consensus workshop in which 68 members from 39 different institutions participated. In the Delphi study 63 recommendations were classified under five themes: the health needs of the society, health service delivery, institutional structure and management, educational program and implementation and development and evaluation of social accountability. In the consensus workshop, the 63 recommendations were evaluated and of which 54 of 63 recommendations were agreed upon. A national framework has been developed by including a wide range of experts from different institutions for the social accountability of medical schools in Turkey. Developing recommendations in a local context will enhance the conceptualization of the recommendations of social accountability in the medical schools. As an accreditation body embedding the principles in the national standards will have a further impact on this process. [ABSTRACT FROM AUTHOR]

Context: Social accountability of medical schools has emerged as a standard of excellence in medical education during the last decade. However, the lack of valid and reliable instruments to estimate social accountability has limited the possibility of measuring the impact that medical schools have in society. Our aim was to develop an instrument and validate its use for assessing social accountability in Latin American countries. Methods: We used a three–phase mixed methods research design to develop, validate and estimate social accountability in a diverse convenient sample of 49 medical schools from 16 Latin American countries. We used a qualitative framework approach and a Delphi consensus method to design an instrument with high content validity. Finally, we assessed the psychometric properties of the instrument. Results: The Social Accountability Instrument for Latin America (SAIL) contained 21 items in four domains: mission and quality improvement, public policy, community engagement, and professional integrity. Its reliability index, estimated using Cronbach's alpha, was very high (0.96). Most of the medical schools that had ranked over the 80th percentile on traditional national academic estimates did not reach the 80th percentile using SAIL. Conclusions: There are validity arguments (content and reliability) to support the measurement of social accountability using the SAIL instrument. Its application showed that it provides a complementary dimension to that traditionally obtained when estimating quality in medical schools. [ABSTRACT FROM AUTHOR]

Background: The Delphi method is a demonstrated way to gather structured expert opinions to forecast, plan, and prioritize around a given topic. It builds consensus through iterative rounds. Aims: The goal of this study was to build consensus-based predictions for the year 2022 about: future trends in surgeon continuing medical education (CME); the role of technology in learning for surgeons of different experience levels (trainee/resident, practicing, expert); and CME funding models. Methods: A three round e-Delphi method was employed for this study. Panelist identities were anonymized, and controlled feedback and consensus rules were employed. Fifteen international expert panelists' input was collected via electronically distributed, open-ended questionnaire (Round 1) and 5-point Likert scale ranking surveys (Rounds 2 and 3), in a series of nine questions (Round 1) and 26 and 25 summary statements (Rounds 2 and 3, respectively). Summary statements were collated via key words and ideas collected from panelist's input. Mean, median, standard deviation, and 95% confidence intervals were calculated. Results: Response rate was 100% for each round. Consensus in Round 2 was 61% and 88% in Round 3. Seven key finding statements with supporting background information was the result. Discussion: Reliable, affordable internet access was identified as a likely barrier to education for certain regions, even in 5 years' time. The use of similar educational resources were identified for all levels of surgeon, what varied was the reliance on a particular resource by each level of surgeon. Conclusion: Institutes of employment were predicted to have ended CME funding for expert surgeons by 2022. Industry sponsored CME was predicted to have a continued role for trainee/residents and practicing surgeons. [ABSTRACT FROM AUTHOR]

Background: A standard undergraduate radiology education is essential to prepare graduates for multidisciplinary clinical practice yet the literature lacks clear guidelines or consensus about the learning objectives of an optimal radiology clerkship. Aim: To define a competency-based framework for undergraduate radiology education by using language of Entrustable Professional Activities (EPAs). Methods: A modified Delphi method with three iterative rounds was used as an expert consensus approach. An online questionnaire with Likert scale was formulated incorporating EPAs and their components (competencies, assessment strategies, and supervision level) and distributed to 45 consultant radiologists following pilot study. Items reaching consensus were accepted and rest were resent in round 2. In round 3, a dichotomous scale was used for final approval and to see response stability. Results: A final set of six EPAs with 87 competencies and respective assessment strategies, all aiming for 'level 3a' of supervision was identified. These include recommending cost effective appropriate imaging tests for common pathologies, obtaining informed consent for diagnostic contrast studies, basic interpretation and communication of common pathologies/emergencies on radiographs (chest, abdominal, and skeletal) and on CT brain. Conclusion: This EPA framework for radiology clerkship is a first step towards a competency-based approach to undergraduate radiology training and assessment. [ABSTRACT FROM AUTHOR]

Background: Medical students need to be trained in delivering diversity-responsive health care but unknown is what competencies teachers need. The aim of this study was to devise a framework of competencies for diversity teaching. Methods: An open-ended questionnaire about essential diversity teaching competencies was sent to a panel. This resulted in a list of 74 teaching competencies, which was sent in a second round to the panel for rating. The final framework of competencies was approved by the panel. Results: Thirty-four experts participated. The final framework consisted of 10 competencies that were seen as essential for all medical teachers: (1) ability to critically reflect on own values and beliefs; (2) ability to communicate about individuals in a nondiscriminatory, nonstereotyping way; (3) empathy for patients regardless of ethnicity, race or nationality; (4) awareness of intersectionality; (5) awareness of own ethnic and cultural background; (6) knowledge of ethnic and social determinants of physical and mental health of migrants; (7) ability to reflect with students on the social or cultural context of the patient relevant to the medical encounter; (8) awareness that teachers are role models in the way they talk about patients from different ethnic, cultural and social backgrounds; (9) empathy for students of diverse ethnic, cultural and social background; (10) ability to engage, motivate and let all students participate. Conclusions: This framework of teaching competencies can be used in faculty development programs to adequately train all medical teachers. [ABSTRACT FROM AUTHOR]

Simulation-based training (SBT) is a revolutionary addition to the education of residents in different specialties. However, the selection of training programs is often reliant on commercially available equipment or on experiential notions, local interests or coincidence. The first step to developing training programs should be problem identification and general needs assessment to ensure that these are aligned with current trainee needs. We describe a stepwise approach to performing a needs assessment following the Delphi process and using a needs assessment formula (NAF) to prioritize technical procedures for simulation training. This technique relies on a panel of experts to gather information and achieve a convergence of opinion. We used three rounds of survey iterations. Round 1: A brainstorming phase to gather all procedures that a newly qualified resident should be able to perform. Round 2: Rating and preliminary prioritization with a NAF including frequency of the procedure, number of doctors, impact, and feasibility. Round 3: Elimination and final prioritization of procedures. The needs assessment identifies and prioritizes procedures for simulation training. It can guide medical educators in the planning of SBT programs to address current trainee needs with the aim of improving the education and training of future doctors. [ABSTRACT FROM AUTHOR]

Background: “Student-as-Teacher” (SaT) programs have been growing in number to prepare medical students for their teaching roles in residency and beyond, but it remains unknown what content areas should be covered in SaT curricula. Aim: To determine five to ten “essential” content areas for inclusion in SaT curricula using expert opinion. Methods: Using a three-round Delphi process, moderators iteratively surveyed a panel of 28 medical educators (25 academy directors and three individuals identified as having expertise in undergraduate medical education) representing 25 medical schools in the United States. This “SaT Delphi Working Group” was tasked with rating topics for inclusion in SaT curricula on a 3-point scale (i.e. 1. “essential,” 2. “important, but not essential” 3. “not important”). Topics achieving ≥70% consensus as “essential,” “important” or “not important” were accepted by the moderators and removed from subsequent rounds. Results: Hundred per cent response rate (n = 28) was achieved for all survey rounds. Five content areas reached consensus as “essential” for inclusion in a SaT curriculum: feedback, bedside teaching and clinical precepting, small-group teaching, case-based teaching and professionalism as a medical educator. Conclusion: This consensus from a group of leaders in medical education is a first step toward the implementation of more developmentally-appropriate SaT competencies. [ABSTRACT FROM AUTHOR]

Purpose: To better understand the steps undertaken by medical specialties to develop and implement undergraduate national, and international, educational guidelines for use in medical schools, and to find what makes them successful in terms of uptake and knowledge. Methods: Systematic review of databases to find inter- and nationally-created undergraduate medical specialty guidelines, and descriptions of development and analysis, from 1998 to January 2015. Results: Ninety six eligible papers were found, covering 59 different guidelines in 32 specialties. Five documented from development to revision. Development often required multiple stages and methods, 10 using the Delphi technique. Twenty two guidelines mapped to recommended government standards. Twenty papers analyzed curricula. No guideline was used in every relevant medical school. Conclusions: This is a comprehensive review of the processes involved in creating international and national guidelines, with emphasis of key points for those considering similar undertakings. These include thorough needs analysis of multiple groups involved in the delivery of the curriculum; and engagement of relevant parties throughout development, to ensure relevance and increase buy-in. Flexibility is important, to allow use in medical schools with different methods of teaching. Ongoing evaluation and update are also critical steps that must not be forgotten. [ABSTRACT FROM AUTHOR]

Consensus group methods are widely used in research to identify and measure areas where incomplete evidence exists for decision-making. Despite their widespread use, these methods are often inconsistently used and reported. Using examples from the three most commonly used methods, the Delphi, Nominal Group and RAND/UCLA; this paper and associated Guide aim to describe these methods and to highlight common weaknesses in methodology and reporting. The paper outlines a series of recommendations to assist researchers using consensus group methods in providing a comprehensive description and justification of the steps taken in their study. [ABSTRACT FROM PUBLISHER]

We developed, through a three-round modified Delphi technique, an inventory [Assessment of Medical Education Environment by Teachers (AMEET)] to assess viewpoints of medical faculty on educational environment experienced by teachers. In Round 1, 16 members from international settings graded (0–3) and modified an initial list of statements, or suggested new statements for inclusion. In Round 2, the new statements were graded and previous responses reconsidered. Subsequently, statements with median scores ≤1 were excluded. The questionnaire was compiled following reconsideration of responses to new statements in Round 3. A pilot test enabled assessment of the validity and reliability of the instrument. The panel members modified and graded the initial 50 statements of the preliminary inventory and suggested five new statements. The new statements were graded, responses to previous 50 statements were reconsidered, and three statements with median scores <1 were removed following Round 2. On review of the 52 statements by panel, two statements (each with agreement of <75%) were deleted. The final 50-item inventory comprising six domains was piloted with 62 faculty. Cronbach’s alpha of 0.94 was obtained. The AMEET inventory is valid, highly reliable and practically useful to assess medical faculty members’ perceptions of educational environment. [ABSTRACT FROM PUBLISHER]

Background: Non-technical skills are a subset of human factors that focus on the individual and promote safety through teamwork and awareness. There is no widely adopted competency- or outcome-based framework for non-technical skills training in healthcare. The authors set out to devise such a framework using a modified Delphi approach. Methods: An exhaustive list of published and team suggested items was presented to the expert panel for ranking and to propose a definition. In the second round, a focused list was presented, as well as the proposed definition elements. The finalised framework was sent to the panel for review. Results: Sixteen experts participated. The final framework consists of 16 competencies for all and eight specific competencies for team leaders. The consensus definition describes non-technical skills as 'a set of social (communication and team work) and cognitive (analytical and personal behaviour) skills that support high quality, safe, effective and efficient inter-professional care within the complex healthcare system'. Conclusions: The authors have produced a new competency framework, through the works of an International expert panel, which is not discipline specific that can be used by curriculum developers, educational innovators and clinical teachers to support developments in the field. [ABSTRACT FROM AUTHOR]

Background: The importance of medical education research in Saudi Arabia has been acknowledged increasingly and a lot of concepts used have been derived from the Western world. The question arises, however, whether Western concepts and questionnaires are transferable to societies with different cultures. The aim of this study was to investigate the instrument structure and the reliability of the Arabic version of the Zuckerman-Kuhlman Personality Questionnaire-medium (ZKPQ-m). Methods: Three statistical methods with decreased amount of strictness were used to analyse our data: Confirmatory Factor Analysis, Procrustes rotation and Principal Component Analysis. Results: Our outcomes did not confirm the original instrument structure. Instead, we found four interpretable components: Emotional Instability, Impulse-seeking, Activeness and Self-Control. However, the amount of explained variance was not very high and the internal consistencies ranged from unsatisfactory to only moderate. The data showed a high percentage of respondents agreeing with more than three items of the Infrequency scale, which may be attributable to the collectivistic culture in Saudi Arabia. Conclusion: We did not succeed in replicating the ZKPQ structure in the Arabic context. Social desirability, a common characteristic in collectivistic cultures, may have reduced the replicability of the internal structure of the ZKPQ-m. Different methods to measure concepts in collectivistic cultures may help to get round social desirability. [ABSTRACT FROM AUTHOR]

Objective: Medical education and teaching skills are core competencies included in the generic curriculum for specialty training. To support the development of these skills, there is need for a validated instrument. This study aims to develop and test an instrument to measure the attributes of specialty trainees as effective teachers. Methods: The study was conducted in two phases. In first phase, the content of the instrument was generated from the literature and tested using the Delphi technique. In second phase, the instrument was field tested for validity and reliability using factor analysis and generalizability study. Feasibility was calculated by the time taken to complete the instrument. Acceptability and educational impact were determined by qualitative analysis of written feedback. Attributes of specialty trainees were assessed by clinical supervisors, peers, and students. Results: The Delphi study produced consensus on 15 statements which formed the basis of the instrument. In field study, a total of 415 instruments were completed. Factor analysis demonstrated a three-factor solution ('learning-teaching milieu', 'teaching skills', and 'learner-orientated'). A generalizability coefficient was 0.92. Mean time to complete the instrument was five minutes. Feedback indicated that it was an acceptable and useful method of assessment. Conclusion: This new instrument provides valid, reliable, feasible, and acceptable assessment of clinical teaching. [ABSTRACT FROM AUTHOR]

Background: Needs assessment should be the starting point for curriculum development. In medical education, expert opinion and consensus methods are commonly employed. Aim: This paper showcases a more practice-grounded needs assessment approach. Methods: A mixed-methods approach, incorporating a national survey, practice audit, and expert consensus, was developed and piloted in thrombosis medicine; Phase 1: National survey of practicing consultants, Phase 2: Practice audit of consult service at a large academic centre and Phase 3: Focus group and modified Delphi techniques vetting Phase 1 and 2 findings. Results: Phase 1 provided information on active curricula, training and practice patterns of consultants, and volume and variety of thrombosis consults. Phase 2's practice audit provided empirical data on the characteristics of thrombosis consults and their associated learning issues. Phase 3 generated consensus on a final curricular topic list and explored issues regarding curriculum delivery and accreditation. Conclusions: This approach offered a means of validating expert and consensus derived curricular content by incorporating a novel practice audit. By using this approach we were able to identify gaps in training programs and barriers to curriculum development. This approach to curriculum development can be applied to other postgraduate programs. [ABSTRACT FROM AUTHOR]

Background: Medical professionalism has been described as a set of attributes and behaviors, yet the Western frameworks of medical professionalism may not resonate with the cultural values of non-Western countries. Aim: This study aims to formulate a professionalism framework for healthcare providers as interpreted by local medical professionals in Arabian countries. Methods: A purposive sample of 17 experts from diverse disciplines participated in a Delphi study in three rounds. Consensus was identified by content analysis and by numerical analysis of responses on the basic attributes of medical professionalism in Arabian context. Results: Eight professional traits were shortlisted and coupled in four themes (Gates): dealing with self, dealing with tasks, dealing with others and dealing with God. Self-accountability and self-motivation were interpreted from a faithful viewpoint as ' taqwa' and ' ehtesab', respectively, in Arabic. Discussion: The Four-Gates Model helps in better understanding of medical professionalism as grounded in the minds and culture of Arabs. The model may act as a genuine framework for teaching and learning of medical professionalism in Arab medical schools. Conclusion: The study highlights the divergent interpretation of medical professionalism between Western and Arabian contexts. The Four-Gates Model may work for faith-driven societies, but not for non-Muslims Arabs students or teachers or in institutions with humanistic values. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to examine the impact of subjective and physiological stress responses on medical students' diagnostic reasoning and communication skills. Method: A prospective randomized quantitative study was undertaken, looking at ambulatory consultations in internal medicine. On the first day (baseline day), volunteer year 6 students (n=41) participated in a simulated ambulatory consultation with standardized patients (SPs). On the second day (study day), one week later, they were randomly assigned to two groups: a low stress (n = 20) and a high stress (n = 21) simulated ambulatory consultation. Stress was measured using validated questionnaires and salivary cortisol. The SPs assessed the students' reasoning and communication. The students completed assessments of their clinical reasoning after the consultations. Results: Although stress measures were all significantly higher in the high-stress condition (all p < 0.05), no differences were found in diagnostic accuracy and justification scores. However, correlational analyses revealed a negative correlation between multiple-stress measures and the students' ability to generate arguments for differential diagnoses. Conclusion: Stress was associated with impairments in clinical reasoning, of a nature typically suggestive of premature closure. [ABSTRACT FROM AUTHOR]

Background: Students' perceptions of their educational environment (EE) have been studied in undergraduate and postgraduate curricula. Postgraduate EE has been measured in hospital settings. However, there are no instruments available to measure the EE in postgraduate ambulatory settings. Aim: The aim of this study was to develop the 'Ambulatory Care Learning Education Environment Measure' (ACLEEM). Methods: A mixed methodology was used including three stages: (1) Grounded theory (focus groups); (2) Delphi technique to identify consensus; and (3) Pilot study. Results: Three quota samples of approximately 60 stakeholders were formed, one as Focus Groups and two as Delphi panels. Eight focus groups were carried out including 58 residents (Latin-American Spanish speakers). The results were analysed and 173 items were offered to a National Delphi panel (61 residents and teachers). They reduced in two rounds the number of important items to 54. The 54-item questionnaire was then piloted with 63 residents and refined to the final version of the ACLEEM with 50 items and three domains. Conclusions: The 50-item inventory is a valid instrument to measure the EE in postgraduate ambulatory setting in Chile. Large-scale administration of the ACLEEM questionnaire to evaluate its construct validity and reliability are the next steps to test the psychometric properties of the instrument. [ABSTRACT FROM AUTHOR]

Background: Providing clinical teachers in postgraduate medical education with feedback about their teaching skills is a powerful tool to improve clinical teaching. A systematic review showed that available instruments do not comprehensively cover all domains of clinical teaching. We developed and empirically test a comprehensive instrument for assessing clinical teachers in the setting of workplace learning and linked to the CanMEDS roles. Methods: In a Delphi study, the content validity of a preliminary instrument with 88 items was studied, leading to the construction of the EFFECT (evaluation and feedback for effective clinical teaching) instrument. The response process was explored in a pilot test and focus group research with 18 residents of 6 different disciplines. A confirmatory factor analyses (CFA) and reliability analyses were performed on 407 evaluations of 117 supervisors, collected in 3 medical disciplines (paediatrics, pulmonary diseases and surgery) of 6 departments in 4 different hospitals. Results: CFA yielded an 11 factor model with a good to excellent fit and internal consistencies ranged from 0.740 to 0.940 per domain; 7 items could be deleted. Conclusion: The model of workplace learning showed to be a useful framework for developing EFFECT, which incorporates the CanMEDS competencies and proved to be valid and reliable. [ABSTRACT FROM AUTHOR]

Background: Everybody seems to know what a clinical skill (CS) is but closer consideration shows that the concept of a CS is not as clear as might be assumed. Some seem to use 'CSs' when just referring to physical examination skills, whereas others use the term to also include diagnostic, communication and practical skills. CSs are more than a simple performance, but clinicians are often not consciously aware of the complex interplay of different components of a CS that they are practicing and accordingly do not teach all these aspects to students. Methods: A modified Delphi research was designed to explore concepts around the definition of a CS and its components for learning and teaching. The panel consisted of a group of British doctors, all involved in teaching CSs. Results: One hundred and twenty-two items were identified and ranked through two rounds of a Delphi process, coded into thirty-seven codes and clustered into six principle themes: professional roles; components of CSs; performance; psychomotor aspects; educational environment; and teacher versus student centeredness. Conclusions: A CS may contain one or several different domains such as: physical examination skills, practical procedure, communication skills, and management. Acquiring CSs includes three components: learning how to perform certain movements (procedural knowledge), why one should do so (underlying basic science knowledge), and what the findings might mean (clinical reasoning). If we are to teach CSs for clinical practice, we must take these three different components into account in our instructional design. [ABSTRACT FROM AUTHOR]

In this article, we outline an innovative and comprehensive approach to the development by consensus of curriculum content guidelines for a medical specialty. We initially delineated the content domain by triangulation of sources, validated a curriculum blueprint by both quantitative and qualitative methodology, and finally reached consensus on content by Delphi methodology. Development of curricular objectives is an important step in curriculum development. Content definition or 'blueprinting' refers to the systematic definition of content from a specified domain for the purpose of creating test items with validity evidence. Content definition can be achieved in a number of ways and we demonstrate how the concepts of content definition or validation can be transferred beyond assessment, to other steps in curriculum development and instructional design. Validity in Education refers to the multiple sources of evidence to support the use or interpretation of different aspects of a curriculum. In this approach, there are multiple sources of content-related validity evidence which, when accumulated, give credibility and strength to curriculum consensus guidelines. [ABSTRACT FROM AUTHOR]

Background: Measurement of learning climates can serve as an indicator of a department's educational functioning. Aim: This article describes the development and psychometric qualities of an instrument to measure learning climates in postgraduate specialist training: the Dutch Residency Educational Climate Test (D-RECT). Method: A preliminary questionnaire was evaluated in a modified Delphi procedure. Simultaneously, all residents in the Netherlands were invited to fill out the preliminary questionnaire. We used exploratory factor analysis to analyze the outcomes and construct the definitive D-RECT. Confirmatory factor analysis tested the questionnaire's goodness of fit. Generalizability studies tested the number of residents needed for a reliable outcome. Results: In two rounds, the Delphi panel reached consensus. In addition, 1278 residents representing 26 specialties completed the questionnaire. The Delphi panel's input in combination with the exploratory factor analysis of 600 completed surveys led to the definitive D-RECT, consisting of 50 items and 11 subscales (e.g., feedback, supervision, patient handover and professional relations between attendings). Confirmatory factor analyses of the remaining surveys confirmed the construct. The results showed that a feasible number of residents is needed for a reliable outcome. Conclusion: D-RECT appears to be a valid, reliable and feasible tool to measure the quality of clinical learning climates. [ABSTRACT FROM AUTHOR]

Background: Currently, there is no consensus on the core competencies required for emergency medicine (EM) clerkships in Canada. Existing EM curricula have been developed through informal consensus or local efforts. The Delphi process has been used extensively as a means for establishing consensus. Aim: The purpose of this project was to define core competencies for EM clerkships in Canada, to validate a Delphi process in the context of national curriculum development, and to demonstrate the adoption of the CanMEDS physician competency paradigm in the undergraduate medical education realm. Methods: Using a modified Delphi process, we developed a consensus amongst a panel of expert emergency physicians from across Canada utilizing the CanMEDS 2005 Physician Competency Framework. Results: Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59%% reduction). Conclusion: This study demonstrated that a modified Delphi process can result in a strong consensus around a realistic number of core competencies for EM clerkships. We propose that such a method could be used by other medical specialties and health professions to develop rotation-specific core competencies. [ABSTRACT FROM AUTHOR]

Purpose: To develop components of a curriculum for teaching and evaluating Residents as health advocates. Method: Modeled on the Delphi technique, the first step involved a multidisciplinary panel of 10 Queen's University health care providers with expertize in education and patient advocacy. In the context of four Advocacy questions: What is it?, Who does it?, How to teach it?, and How to evaluate it?, they discussed a curriculum framework including graded education, scholarly activity, role modeling, and case examples. In the second step, 24 faculty experts addressed two goals: (1) to identify attributes discussed by the expert panel in step 1 and corresponding measurable behaviours and (2) to refine the curriculum framework proposed in step 1 with emphasis on content and evaluation. Results: Six attributes of a health advocate were identified; knowledgeable, altruistic, honest, assertive, resourceful, and up-to date. Behaviours that reflect these attributes were identified as desirable or undesirable and means of teaching were matched to the attributes. For most residents, skills would be developed in a graded fashion, progressing from advocating for the individual to society as a whole. Conclusions: This study provides a general framework from which specialty-specific curriculums for training health advocates can be developed. [ABSTRACT FROM AUTHOR]

Investigates the activities of radiographers who supervise students in the clinical environment. Role of clinical supervisors in clinical education; Research questions; Delphi technique; Critical incident technique method; Analysis of incidents.