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Biomedical subjects

William C McGaghie

Publications and source records attributed to William C McGaghie.

At least 19 recordsLinked to original sources
PubMed2006

Graduating internal medicine residents' self-assessment and performance of advanced cardiac life support skills.

Internal medicine residents in the US must be competent to perform procedures including Advanced Cardiac Life Support (ACLS) to become board-eligible. Our aim was to determine if residents near graduation could assess their skills in ACLS procedures accurately. Participants were 40 residents in a university-based training program. Self-assessments of confidence in managing six ACLS scenarios were measured on a 0 (very low) to 100 (very high) scale. These were compared to reliable observational ratings of residents' performance on a high-fidelity simulator using published treatment protocols. Residents expressed strong self-confidence about managing the scenarios. Residents' simulator performance varied widely (range from 45% to 94%). Self-confidence assessments correlated poorly with performance (median r = 0.075). Self-assessment of performance by graduating internal medicine residents was not accurate in this study. The use of self-assessment to document resident competence in procedures such as ACLS is not a proxy for objective evaluation.

Advanced Cardiac Life Support↗
PubMed2006

A longitudinal study of internal medicine residents' retention of advanced cardiac life support skills.

BACKGROUND: Internal medicine residents must be competent in Advanced Cardiac Life Support (ACLS) for board certification. Traditional ACLS courses have limited ability to enable residents to achieve and maintain skills. Educational programs featuring reliable measurements and improved retention of skills would be useful for residency education. METHOD: We developed a training program using a medical simulator, small-group teaching and deliberate practice. Residents received traditional ACLS education and subsequently participated in four two-hour educational sessions using the simulator. Resident performance in six simulated ACLS scenarios was assessed using a standardized checklist. RESULTS: After the program, resident ACLS skill improved significantly. The cohort was followed prospectively for 14 months and the skills did not decay. CONCLUSIONS: Use of a simulation-based educational program enabled us to achieve and maintain high levels of resident performance in simulated ACLS events. Given the limitations of traditional methods to train, assess and maintain competence, simulation technology can be a useful adjunct in high-quality ACLS education.

Advanced Cardiac Life Support↗
PubMed2006

Emergency and critical care pediatrics: use of medical simulation for training in acute pediatric emergencies.

PURPOSE OF THE REVIEW: Recent data suggest that pediatric trainees receive insufficient training to manage acute pediatric emergencies. This review addresses the use of medical simulation as a way for medical learners to acquire and maintain skills needed to manage pediatric resuscitations. RECENT FINDINGS: Recent work highlights the value of deliberate practice in the context of simulated medical environments to promote development of medical expertise. Several studies demonstrate the benefit of simulation-based training for improved skill acquisition in advanced life support, emergency airway management, and nontechnical skills. Work in other fields of medicine supports the integration of simulation into pediatric training programs. SUMMARY: Medical simulation holds great promise to enhance existing pediatric training curricula by increasing skills and expertise in resuscitation. Future research is needed to identify best methods of pediatric simulation-based training.

Acute Disease↗
PubMed2006

Effect of practice on standardised learning outcomes in simulation-based medical education.

OBJECTIVES: This report synthesises a subset of 31 journal articles on high-fidelity simulation-based medical education containing 32 research studies drawn from a larger qualitative review published previously. These studies were selected because they present adequate data to allow for quantitative synthesis. We hypothesised an association between hours of practice in simulation-based medical education and standardised learning outcomes measured as weighted effect sizes. METHODS: Journal articles were screened using 5 exclusion and inclusion criteria. Response data were extracted and 3 judges independently coded each study. Learning outcomes were standardised using a common metric, the average weighted effect size (AWES), due to the heterogeneity of response measures in individual studies. anova was used to evaluate AWES differences due to hours of practice on a high-fidelity medical simulator cast in 5 categories. The eta squared (eta2) statistic was used to assess the association between AWES and simulator practice hours. RESULTS: There is a strong association (eta2=0.46) between hours of practice on high-fidelity medical simulators and standardised learning outcomes. The association approximates a dose-response relationship. CONCLUSIONS: Hours of high-fidelity simulator practice have a positive, functional relationship with standardised learning outcomes in medical education. More rigorous research methods and more stringent journal editorial policies are needed to advance this field of medical education research.

Analysis of Variance↗
PubMed2006

Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice.

BACKGROUND: Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification. OBJECTIVE: To use a medical simulator to assess postgraduate year 2 (PGY-2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. DESIGN: Pretest-posttest design without control group. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research-derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached. PARTICIPANTS: Forty-one PGY-2 internal medicine residents in a university-affiliated program. MEASUREMENTS: Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility. RESULTS: Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly. CONCLUSIONS: A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency-based efforts illustrate outcome-based medical education that is now prominent in accreditation reform of residency education.

Adult↗
PubMed2005

Stroke training of prehospital providers: an example of simulation-enhanced blended learning and evaluation.

Since appropriate treatment of patients in the first few hours of ischemic stroke may decrease the risk of long-term disability, prehospital providers should recognize, assess, manage and communicate about stroke patients in an effective and time-efficient manner. This requires the instruction and evaluation of a wide range of competencies including clinical skills, patient investigation and management and communication skills. The authors developed and assessed the effectiveness of a simulation-enhanced stroke course that incorporates several different learning strategies to evaluate competencies in the care of acute stroke patients. The one-day, interactive, emergency stroke course features a simulation-enhanced, blended-learning approach that includes didactic lectures, tabletop exercises, and focused-examination training and small-group sessions led by paramedic instructors as standardized patients portraying five key neurological syndromes. From January to October 2000, 345 learners were assessed using multiple-choice tests as were randomly selected group of 73 learners using skills' checklists during two pre- and two post-course simulated patient encounters. Among all learners there was a significant gain in knowledge (pre: 53.9%+/-13.9 and post: 85.4%+/-8.5; p<0.001), and for the 73 learners a significant improvement in their clinical and communication skills (p<0.0001 for all). By using a simulation-enhanced, blended-learning approach, pre-hospital paraprofessionals were successfully trained and evaluated in a wide range of competences that will lead to the more improved recognition and management of acute stroke patients.

Brain Ischemia↗
PubMed2005

Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.

REVIEW DATE: 1969 to 2003, 34 years. BACKGROUND AND CONTEXT: Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. OBJECTIVES: Review and synthesize existing evidence in educational science that addresses the question, 'What are the features and uses of high-fidelity medical simulations that lead to most effective learning?'. SEARCH STRATEGY: The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the 'grey literature' were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. INCLUSION AND EXCLUSION CRITERIA: Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. DATA EXTRACTION: Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. DATA SYNTHESIS: Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. HEADLINE RESULTS: Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following: providing feedback--51 (47%) journal articles reported that educational feedback is the most important feature of simulation-based medical education; repetitive practice--43 (39%) journal articles identified repetitive practice as a key feature involving the use of high-fidelity simulations in medical education; curriculum integration--27 (25%) journal articles cited integration of simulation-based exercises into the standard medical school or postgraduate educational curriculum as an essential feature of their effective use; range of difficulty level--15 (14%) journal articles address the importance of the range of task difficulty level as an important variable in simulation-based medical education; multiple learning strategies--11 (10%) journal articles identified the adaptability of high-fidelity simulations to multiple learning strategies as an important factor in their educational effectiveness; capture clinical variation--11 (10%) journal articles cited simulators that capture a wide variety of clinical conditions as more useful than those with a narrow range; controlled environment--10 (9%) journal articles emphasized the importance of using high-fidelity simulations in a controlled environment where learners can make, detect and correct errors without adverse consequences; individualized learning--10 (9%) journal articles highlighted the importance of having reproducible, standardized educational experiences where learners are active participants, not passive bystanders; defined outcomes--seven (6%) journal articles cited the importance of having clearly stated goals with tangible outcome measures that will more likely lead to learners mastering skills; simulator validity--four (3%) journal articles provided evidence for the direct correlation of simulation validity with effective learning. CONCLUSIONS: While research in this field needs improvement in terms of rigor and quality, high-fidelity medical simulations are educationally effective and simulation-based education complements medical education in patient care settings.

Clinical Competence↗
PubMed2005

Teaching pediatrics residents how to obtain informed consent.

BACKGROUND: Few physicians view informed consent as a critical component of the physician-patient relationship or as a way to improve individual and population health. We hypothesized that formal education about informed consent would affect first-year pediatrics residents' knowledge and attitudes. METHOD: Twenty-seven first-year pediatrics residents participated in a randomized controlled trial with a wait-list control group. The one-hour interactive intervention consisted of a lecture, video, and small-group discussion. Outcomes were measured after randomization at baseline and after the intervention group received the intervention. Data were analyzed using multivariate analysis and between and within group t tests. Qualitative data were obtained after the wait-list control group's exposure to the intervention. RESULTS: The quantitative analyses demonstrated that the intervention yielded statistically significant improvements in the measured outcomes. The qualitative analyses confirm the quantitative findings. CONCLUSION: A formal session on informed consent in the pediatrics residency educational program positively affects residents' knowledge and attitudes about informed consent.

Adult↗
PubMed2005

Comparison of two standard-setting methods for advanced cardiac life support training.

BACKGROUND: This study used the Angoff and Hofstee standard-setting methods to derive minimum passing scores for six advanced cardiac life support (ACLS) procedures. METHOD: An expert panel provided item-based (Angoff) and group-based (Hofstee) judgments about six ACLS performance checklists on two occasions separated by ten weeks. Interrater reliabilities and test-retest reliability (stability) of the judgments were calculated. Derived ACLS passing standards are compared to historical ACLS performance data from two groups of ACLS-trained internal medicine residents. RESULTS: Both the Angoff and Hofstee standard-setting methods produced reliable and stable data. Hofstee minimum passing scores (MPSs) were uniformly more stringent than Angoff MPSs. Interpretation of historical ACLS performance data from medical residents shows the MPSs derived in this study would yield higher-than-expected failure rates. CONCLUSION: Systematic standard setting for ACLS procedures is a necessary step toward the creation of mastery learning educational programs.

Advanced Cardiac Life Support↗
PubMed2005

Holistic versus actuarial student selection.

BACKGROUND: The U.S. Supreme Court ruled in 2003 in the Gratz et al. v. Bollinger et al. and the Grutter v. Bollinger et al. cases that affirmative action selection policies aimed at student diversity in higher and professional education are acceptable on constitutional grounds. The court also ruled that "holistic," "individualized" selection procedures, not "mechanical" methods, must be used to achieve student diversity goals. SUMMARY: This brief essay reviews and critiques professional and academic literature that addresses the two court cases and their likely sequelae. The weight of scientific evidence dating from at least 1954 shows that actuarial procedures are superior to holistic, individualized procedures to fulfill a priori student selection policy goals fairly and consistently. CONCLUSIONS: The higher and professional education community, including medicine, should support the Supreme Court's student diversity policy but should insist the court change its reliance on holistic, individualized decision making.

Education, Graduate↗
PubMed2005

Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial.

BACKGROUND: Internal medicine residents must be competent in Advanced Cardiac Life Support (ACLS) for board certification. PURPOSE: The purpose was to use a medical simulator to assess baseline proficiency in ACLS and determine the impact of an intervention on skill development. METHOD: This was a randomized trial with wait-list controls. After baseline evaluation in all residents, the intervention group received 4 education sessions using a medical simulator. All residents were then retested. After crossover, the wait-list group received the intervention, and residents were tested again. Performance was assessed by comparison to American Heart Association guidelines for treatment of ACLS conditions with interrater and internal consistency reliability estimates. RESULTS: Performance improved significantly after simulator training. No improvement was detected as a function of clinical experience alone. The educational program was rated highly.

Academic Medical Centers↗
PubMed2004

Concept mapping in pulmonary physiology using pathfinder scaling.

This three-part article begins with a brief presentation of a framework that describes different approaches to conduct and report research on expert knowledge. The framework contrasts direct vs. indirect approaches and provides examples of each. Second, the article gives a detailed description of the methods and results of three concept mapping studies in pulmonary physiology that employ Pathfinder scaling, an indirect approach. The studies derive concepts maps for a variety of faculty experts individually and in groups. Two of the studies focus on changes in students' concept maps of the pulmonary physiology concepts as a result of instruction. Changes are gauged in terms of the degree to which students' concept maps approximate instructors' concept maps due to educational interventions. An index of student-instructor concept map similarity is also correlated with student performance on final examinations. The article concludes by articulating several "next steps" in the Feinberg Northwestern and Wisconsin program of health sciences education research on concept mapping using Pathfinder scaling.

Adult↗
PubMed2004

What is the impact of commercial test preparation courses on medical examination performance?

BACKGROUND: Commercial test preparation courses are part of the fabric of U.S. medical education. They are also big business with 2,000 sales for 1 firm listed at nearly $250 million. This article systematically reviews and evaluates research published in peer-reviewed journals and in the "grey literature" that addresses the impact of commercial test preparation courses on standardized, undergraduate medical examinations. SUMMARY: Thirteen computerized English language databases were searched using 29 search terms and search concepts from their onset to October 1, 2002. Also manually searched was medical education conference proceedings and publications after the end date; and medical education journal editors were contacted about articles accepted for publication, but not yet in print, that were deemed pertinent to this review. Studies that met three criteria were selected: (a) a commercial test preparation course or service was an educational intervention, (b) the outcome variable was one of several standardized medical examinations, and (c) results are published in a peer-reviewed journal or another outlet that insures scholarly scrutiny. The criteria were applied and data extracted by consensus of 2 reviewers. The search identified 11 empirical studies, of which 10 (8 journal articles, 2 unpublished reports) are included in this review. Qualitative data synthesis and tabular presentation of research methods and outcomes are used. CONCLUSION: The articles and unpublished reports reveal that current research lacks control and rigor; the incremental validity of the commercial courses on medical examination performance, if any, is extremely small; and evidence in support of the courses is weak or nonexistent; almost no details are given about the form and conduct of the commercial test preparation courses; studies are confined to courses in preparation for the Medical College Admission Test, the former National Board of Medical Examiners Part 1, and the United States Medical Licensing Examination Step 1, not tests of clinical science; and that cost-benefit analyses of the test preparation courses have not been done. It is concluded that the utility and value of commercial test preparation courses in medicine have not been demonstrated, and that evaluation apprehension in the medical profession and aggressive marketing practices are most likely responsible for commercial course prosperity.

Advertising↗
PubMed2003

Development of a reliable multimedia, computer-based measure of clinical skills in bedside neurology.

PURPOSE: This study reports the development of reliable multimedia, computer-based measures of bedside neurology skills. METHOD: A consortium of neurologists and medical educators (1) identified bedside skills and (2) created a computer-based test. Test-item stems were multimedia clips of standardized patients. Options appeared as text. Sixty-one junior medical students responded to these items. RESULTS: The 77-item test yielded a reliability coefficient of 0.85. Subgroup item analysis resulted in reliability coefficients of 0.73 for the 20-question "pretest" (Test A) and 0.75 for the 20-question "posttest" (Test B). CONCLUSION: Two sets of test items were developed that can be used as outcome measures in studies that assess the effectiveness of educational interventions in bedside neurology.

Clinical Competence↗
PubMed2003

Cognitive, social and environmental sources of bias in clinical performance ratings.

BACKGROUND: Global ratings based on observing convenience samples of clinical performance form the primary basis for appraising the clinical competence of medical students, residents, and practicing physicians. This review explores cognitive, social, and environmental factors that contribute unwanted sources of score variation (bias) to clinical performance evaluations. SUMMARY: Raters have a 1 or 2-dimensional conception of clinical performance and do not recall details. Good news is reported more quickly and fully than bad news, leading to overly generous performance evaluations. Training has little impact on accuracy and reproducibility of clinical performance ratings. CONCLUSIONS: Clinical performance evaluation systems should assure broad, systematic sampling of clinical situations; keep rating instruments short; encourage immediate feedback for teaching and learning purposes; encourage maintenance of written performance notes to support delayed clinical performance ratings; give raters feedback about their ratings; supplement formal with unobtrusive observation; make promotion decisions via group review; supplement traditional observation with other clinical skills measures (e.g., Objective Structured Clinical Examination); encourage rating of specific performances rather than global ratings; and establish the meaning of ratings in the manner used to set normal limits for clinical diagnostic investigations.

Clinical Competence↗
PubMed2002

Assessing readiness for medical education: evolution of the medical college admission test.

The attrition rate of 5% to 50% from US medical schools in the 1920s propelled the development of a test that would measure aptitude for medical studies. Since its development in 1928, the Medical College Admission Test (MCAT) has undergone 5 revisions. The first version was divided into 6 to 8 subtests that focused on memory, knowledge of scientific terminology, reading and comprehension, and logic. The second, which appeared in 1946, was reduced to 4 categories: verbal and quantitative skills, science knowledge, and added a category called understanding modern society. The major difference in the third version, launched in 1962, expanded the test's understanding modern society section to a broader test of general information. In 1977, the MCAT underwent its fourth change: its science section, reading and quantitative skill assessment sections were expanded; its general liberal arts knowledge section was eliminated; its scoring report structure and scoring range were altered; and its cultural and social bias was minimized. The current version, beginning in 1991, has undergone another significant change. Although it does not contain independent measures of either liberal arts or numeracy as separate categories, quantitative skills are needed to solve some of the problems in biological and physical sciences. However, its principal innovation is the writing sample section. Through its 74-year history, the various renditions of the MCAT demonstrate that the definition of aptitude for medical education reflects the professional and social mores and values of the time.

College Admission Test↗