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BACKGROUND: Our current understanding of medical team competence is traditionally influenced by an individualistic perspective focusing on individual team members' knowledge, skills as well as on effective communication within the team. However, team dynamics may influence team performance more than previously anticipated. In particular, recent studies in other academic disciplines suggest that social ties between team members may impact team dynamics but this has not been explored for medical teams. We aimed to explore intensive care staff's perceptions about teamwork and performance in clinical emergencies focusing particularly on the teams' social ties.METHODS: Semi-structured interviews were conducted with a purposive sample of intensive care staff. We used a thematic analysis approach to data interpretation.RESULTS: Thematic saturation was achieved after three group interviews and eight individual interviews. Findings demonstrated that social ties influenced teamwork by affecting the teams' ability to co-construct knowledge, coordinate tasks, the need for hierarchy, the degree to which they relied on explicit or implicit communication, as well as their ability to promote adaptive behavior.CONCLUSIONS: Social ties may be an important factor to consider and acknowledge in the design of future team training, as well as for work planning and scheduling of team activities during clinical practice. More research is needed into the causal effect of social ties on team performance and outcome.

Objectives

This study is designed to provide an overview of why, how, when and for whom collaborative learning of clinical skills may work in health professions education.
Why

Collaborative learning of clinical skills may influence learning positively according to the non-medical literature. Training efficiency may therefore be improved if the outcomes of collaborative learning of clinical skills are superior or equivalent to those attained through individual learning.
How

According to a social interaction perspective, collaborative learning of clinical skills mediates its effects through social interaction, motivation, accountability and positive interdependence between learners. Motor skills learning theory suggests that positive effects rely on observational learning and action imitation, and negative effects may include decreased hands-on experience. Finally, a cognitive perspective suggests that learning is dependent on cognitive co-construction, shared knowledge and reduced cognitive load.
When and for whom

The literature on the collaborative learning of clinical skills in health science education is reviewed to support or contradict the hypotheses provided by the theories outlined above. Collaborative learning of clinical skills leads to improvements in self-efficacy, confidence and performance when task processing is observable or communicable. However, the effects of collaborative learning of clinical skills may decrease over time as benefits in terms of shared cognition, scaffolding and cognitive co-construction are outweighed by reductions in hands-on experience and time on task.
Conclusions

Collaborative learning of clinical skills has demonstrated promising results in the simulated setting. However, further researc, Objectives: This study is designed to provide an overview of why, how, when and for whom collaborative learning of clinical skills may work in health professions education. Why: Collaborative learning of clinical skills may influence learning positively according to the non-medical literature. Training efficiency may therefore be improved if the outcomes of collaborative learning of clinical skills are superior or equivalent to those attained through individual learning. How: According to a social interaction perspective, collaborative learning of clinical skills mediates its effects through social interaction, motivation, accountability and positive interdependence between learners. Motor skills learning theory suggests that positive effects rely on observational learning and action imitation, and negative effects may include decreased hands-on experience. Finally, a cognitive perspective suggests that learning is dependent on cognitive co-construction, shared knowledge and reduced cognitive load. When and for whom: The literature on the collaborative learning of clinical skills in health science education is reviewed to support or contradict the hypotheses provided by the theories outlined above. Collaborative learning of clinical skills leads to improvements in self-efficacy, confidence and performance when task processing is observable or communicable. However, the effects of collaborative learning of clinical skills may decrease over time as benefits in terms of shared cognition, scaffolding and cognitive co-construction are outweighed by reductions in hands-on experience and time on task. Conclusions: Collaborative learning of clinical skills has demonstrated promising results in the simulated setting. However, further research into how collaborative learning of clinical skills may work in clinical settings, as well as into the role of social dynamics between learners, is required.

INTRODUCTION: Simulation-based assessment studies have related simulator performance to clinical experience instead of actual clinical performance. This study validates a novel rating scale for coronary angiography (CA) performance and at the same time explores the association between CA performance in a simulated setting and in the catheterization laboratory.METHODS: Ten cardiologists and cardiology residents with varying degrees of CA experience performed 2 CAs in the catheterization laboratory and 2 CAs in a simulated setting. The residents had prior simulator experience opposite cardiologists. Two raters assessed the operators' video-recorded performances using the novel CA rating scale (CARS).RESULTS: The correlation between CARS scores in the catheterization laboratory and the simulated setting was R = 0.20 (P = 0.195). Residents' scores were higher in the simulated setting than in the catheterization laboratory. The correlation between operators' previous clinical experience in CA and CARS scores was R = 0.65 (P = 0.005) in the catheterization laboratory and R = 0.11 (P = 0.353) in the simulated setting.CONCLUSIONS: The association between CA performance in a simulated setting and actual performance in the catheterization laboratory is not linear. The novel rating scale for CA (CARS) seems to be a valid proficiency assessment instrument in the catheterization laboratory. Familiarity with the simulator may overestimate proficiency, which means that simulator performance as a predictor of clinical performance should be interpreted with caution.

Background: Current guidelines in cardiology training programs recommend 100-300 coronary angiography procedures for certification. We aimed to assess the number of procedures needed to reach sufficient proficiency. Methods: Procedure time, fluoroscopy time, dose area product (DAP), and contrast media volume were used as indicators of quality of performance. We analyzed data from 4,200 coronary angiographies. Performance curves of seven trainees were compared with recommended reference levels and to those of seven interventional cardiologists. Results: On average, the number of procedures needed for trainees to reach recommended reference levels was estimated as 226 and 353, for DAP and use of contrast media, respectively. After 300 procedures, trainees' procedure time, fluoroscopy time, DAP, and contrast media volume were significantly higher compared with experts' performance, P <0.001 for all parameters. To approach the experts' level of DAP and contrast media use, trainees need 394 and 588 procedures, respectively. Performance curves showed large individual differences in the development of competence. Conclusion: On average, trainees needed 300 procedures to reach sufficient level of proficiency, and this is in accordance with current guidelines. However, because of large individual differences, performance curves might be useful in monitoring individual trainees' progress and ensure documentation of sufficient competence when dealing with patients at risk. © 2011 Wiley-Liss, Inc.

A questionnaire survey among 8749 Danish physicians about how the CanMEDS roles apply in an international context. Response rate 42.8% (3,476). The mean rating of importance of competence was 4.2 (SD 0.6). Ratings of confidence increased from interns to specialists. Differences between specialty groups' evaluation of importance and confidence were evident. This study provides an outline of the validity of the CanMEDS roles in a non-Canadian setting. More research in how these aspects of competence are best taught across countries and specialties is needed. Udgivelsesdato: 2007-Jun-11

Several stakeholders now request some sort of continuous assessment of physician performance. In the assessment of physicians it must be acknowledged that physicians often work in teams and systems, rendering it impossible to attribute quality of practice to a single person. The challenge is to design a concept that is a meaningful contribution to the development of quality of practice. There is a need to rethink the traditional discourse known from undergraduate and postgraduate specialist educations when applying concepts of assessment to the continuous professional development. Udgivelsesdato: 2007-Aug-20

This study reports on a pilot study of the effect of an inter-professional course for medical and nursing students in how to collaborate in the conduct of a ward round. A mixed group of 13 medical and 12 nursing students attended a one-day course. They worked together in small groups training in communication and collaborative skills using a framework for ward rounds in a simulated clinical ward environment. The course was evaluated on standard evaluation forms and through focus group interviews. The programme was highly rated by both of the groups and considered most relevant, well situated and efficient. Next term the training course will be extended to include twice as many students.

Focused clinical rotations are a new concept introduced in the education of specialists in Denmark. A focused rotation is a short exposure to a subspecialty or a contiguous specialty with the aim of acquiring specific areas of competence. The aim of this study is to report on the extent of focused rotation across specialties and discuss the rationale and possible impact based on a literature search. Udgivelsesdato: 2006-Dec-11