SaT 프로그램을 위한 교육과정 우선순위: 전국 델파이 연구(Med Teach, 2017)

SaT 프로그램을 위한 교육과정 우선순위: 전국 델파이 연구(Med Teach, 2017)

Defining curricular priorities for student-as-teacher programs: A National Delphi Study

Jasmine Ranaa , Amy Sullivanb , Molly Brettb , Amy R. Weinsteina,b and Katharyn M. Atkinsa,c and the SaT Delphi Working Group

aHarvard Medical School, Boston, MA, USA; bDepartment of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; cDepartment of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

도입

Introduction

레지던트는 의대생의 상당수에 대한 교육을 책임지고 있지만, 상충하는 임상 요구로 인해 레지던트 프로그램 (Bing-You and Sproul 1992)에서는 RaT프로그램에서조차 가르치는 기술을 배울 수 없습니다. Haber et al., 2006; Dandavino et al., 2007; Snell 2011).

Residents are responsible for a significant proportion of medical student and peer teaching, but competing clinical demands make it difficult for teaching skills to be learned Teacher solely (RaT) during residency, even in Resident-as-programs (Bing-You and Sproul 1992; Haber et al. 2006; Dandavino et al. 2007; Snell 2011).

일반적으로 대부분의 SaT 프로그램은 공식 교육을 동료 학습 (일반적으로 "동료 보조 학습"이라고도 함) 기회와 쌍을 이룰 수 있도록 고안되었지만, 교육 주제와 학습 목표는 프로그램마다 다양합니다 (Ross and Cameron 2007; Yu et al 2011).

Typically, most SaT programs are designed to pair formal instruction in teaching with peer-teaching (also commonly referred to as “peer assisted learning”) opportunities, but teaching topics and learning goals vary widely among programs (Ross and Cameron 2007; Yu et al. 2011).

방법Methods

The delphi method

The Delphi method is to one of three main consensus methodologies used generate empirical expert evidence. agreement in areas with inadequate 

• Unlike other popular consensus methods (i.e. nominal group process,consensus development panel), the Delphi method does not require face-to-face contact, making it a popular choice for national and international consensus studies (Waggoner et al. 2016).

• Consensus in the Delphi method is achieved by iterative rating of items in successive survey rounds (typically two to four rounds) by an expert panel (Waggoner et al.2016). 

• Panelists are unaware of the identities of other panelists, which has been proposed to be one strength of the Delphi method over other consensus methods because it may help eliminate bias from dominant group member(s). 

• Recommended size of the expert panel is at least six members and panels that exceed 12 members have not been shown to confer an increase in reliability(Nair et al. 2011). 

• Limitations include the absence of interactive collaboration and possible survey increasing participant burnout with increasing rounds (Waggoneret al. 2016). 

Importantly, because the Delphi method has under-gone convergent evolution in multiple fields, there is no clearly prescribed length, format or consensus criteria for Delphi techniques. 

• Delphi studies generally conform to the core criteria discussed above, but they are modified in various ways according to goals of each expert panel(Diamond et al. 2014; Waggoner et al. 2016). 

• Although heterogeneity in the Delphi process is inevitable, rigor is ensured by clearly defining consensus criteria and number of survey rounds a priori and reporting a reproducible method for recruiting panelists (Diamond et al. 2014).

전문가 패널

Delphi expert panel

Delphi 전문가 패널 멤버 선정 기준은 다음과 같습니다.

• 문제에 대한 지식과 경험,

• 능력 및 참여 의향,

• 참여하기에 충분한 시간과

• 효과적인 의사 소통 기술 (Skulmoskiet al. 2007)

The suggested criteria for selecting members of a Delphi expert panel are: 

• knowledge and experience with issues, 

• capacity and willingness to participate, 

• sufficient time to participate and 

• effective communication skills (Skulmoskiet al. 2007)

설문 개발

Delphi survey development

원형 델파이 설문 조사를 개발하기 위해 연구 진행자는 문헌 검색을 수행하여 SaT, RaT 및 CME 커리큘럼에서 기존 주제를 파악했습니다. PubMed와 Google에서 기본 검색 용어 (예 : "거주자로서 교사"및 "교사로서 학생")를 사용하여 포스터 / 하드 카피 커리큘럼 작성자가 이전에 큐 레이션 한 것을 검토하는 것 외에도 커리큘럼을 SaT, 10 RaT, 4 CME, 보충 부록 1 참조)

To develop the round one Delphi survey, study moderators performed a literature search to identify preexisting topics in SaT, RaT and CME curricula. Using basic search terms(e.g. “resident as teacher” and “student as teacher”) in PubMed and Google, in addition to reviewing posters/hard-copy curricula authors had previously curated, curricula from (9 23 institutions SaT, 10 RaT, 4 CME; see Supplementary Appendix 1) were identified

주제와 하위 주제의 명확한 표현을 보장하기 위해 의학 교육 프로그램의 하버드 의과 대학 석사 과정에 등록 된 두 명의 의사와 교육의 석사 학위를 추구하는 하버드 의대 의과 대학생 4 명을 대상으로 설문 조사를 실시했습니다. 이 개인들은 의학 교육 주제의 표현과 명확성에 대한 피드백을 제공했습니다.

To ensure clear phrasing of topics and subtopic examples, the round one survey was piloted with two physicians who were enrolled in the Harvard Medical School masters in medical education program and one fourth-year Harvard medical student also pursuing a master’s in education. These individuals gave feedback about the phrasing and clarity of medical education topics. 

설문 수행

Delphi survey administration

SaT Delphi surveys were administered anonymously using the online survey software Qualtrics (Qualtrics, Provo, UT).

• In the round one survey, 28 finalized topics were presented in eight blocks (i.e. pages). 

• Each block corresponded to a thematic domain. Blocks and the topics within them were presented to panelists in random order to minimize bias due to ordering effects. 

• Each block had an optional free response textbox for panelists to comment on their rationale for their ratings.

Panelists were asked to rate topics on a 3-point scale (1- “essential,” 2- “important but not essential,” 3- “not important”). 

Instructions were given to guide panelists in rating of topics:

Our goal is to identify 5-10 core ‘essential’ topics to prepare ALL medical students for their roles as teachers. Topics that are ‘important, but not essential’ may be considered for further study by students with a particular interest in medical education. Topics that are ‘not important’ do not belong in a SaT curriculum for medical students.

At the top of each page in the survey, the cumulative number of topics each panelist had selected as “essential” was displayed. 

• Panelists were encouraged not to select more than five to ten topics as “essential” - a range chosen by moderators based on the number of content areas that could be feasibly covered in a two-to-four-week elective or longitudinally over an academic year, which are commonly cited formats of SaT programs (Soriano et al. 2010). 

• As described below, new and modified topics were included in subsequent survey rounds. 

• Presentation of the topics described above (i.e. organized by domain and in random order) was the same for each round.

델파이 프로세스와 분석

Delphi process and analysis

사회자는 대부분의 델파이 연구 (Wagoner et al., 2016)에서 전형적으로 최소 2 회의 최대 3 회의 조사 라운드가 선행 결정되었다. 2016 년 6 월부터 2016 년 6 월까지 3 차례의 설문 조사가 매월 실시되었다. 많은 델파이 연구들이 합의 합의를위한 비율 합의를 사용하기 때문에 (Diamond et al. 2014), 문턱 이 연구에서 3 점 척도에 대한 70 % 합의가 "합의"를 정의하는 데 사용되었습니다.

The moderators decided a priori there would be a minimum of two and maximum of three survey rounds, typical of most Delphi studies (Waggoner et al. 2016). Because consensus on all topics had not been reached at the end of round two, three survey rounds were administered monthly, from April 2016 to June 2016. As many Delphi studies use percentage agreement to define consensus (Diamond et al. 2014), a threshold of  70% agreement on the three-point scale was used to define “consensus” in this study.

각 라운드 후에, 자유 텍스트 주석은 저자 JR과 KA에 의해 검토되었다. 구체적인 문언 수정 및 제안은 각 라운드에서 강조되었습니다. 주제가 학습 목표에 부합하고 다른 참가자의 프리 텍스트 설명과 충돌하지 않으면 주제가 작성, 수정 및 / 또는 결합되었습니다. 문언 수정 및 새로운 주제 창출에 관한 결정은 JR과 KA 간의 토론을 통해 불일치 사항을 해결했습니다.

After each round, free-text comments were reviewed by authors JR and KA. Specific wording modifications and suggestions were highlighted in each round. Topics were created, modified, and/or combined if they aligned with study goals and did not conflict with the other participants’ freetext comments. Decisions about wording modifications and creation of new topics were made after a discussion between JR and KA to resolve any areas of disagreement.

새로 제안 된 주제, 수정 된 주제 및 양적 합의에 도달하지 못한 주제가 패널리스트의 재검토를위한 후속 라운드에 포함되었습니다. 질적 인 의견이 수정을위한 구체적인 제안을 제시하지 않는 한, "필수적", "중요하다"또는 "중요하지 않은 것"으로 70 % 합의에 도달 한 토픽이 나머지 라운드에서 승인되고 제거되었습니다. 수정 제안이 있는 경우 이러한 주제가 수정되어 다음 조사 라운드에 다시 포함되었습니다.

Newly suggested topics, modified topics and those that did not reach quantitative consensus were included in subsequent rounds for panelists’ re-consideration. Topics that reached 70% consensus as “essential,”“important” or “not important” were accepted and removed from remaining rounds unless qualitative comments offered specific suggestions for modification. In the latter case, these topics were modified and re-included in the next survey round.

결과

Results

우리의 전문가 패널리스트는 건강 전문인의 교육 아카데미 및 유사 단체를위한 전국 포럼 인 "Academies Collaborative"(www.acadmiescollaborative.com)의 미국 의과 대학 아카데미 디렉터 (n¼63)에게 스터디 정보를 이메일로 보냈습니다. 28 명의 개인이 패널리스트로서 참여에 관심을 보였다. 원고 검토 및 연구 참여에 대한 대가로 패널 토론자는 공동 저자로 제안되었습니다. 각 라운드에 참여하는 것은 선택 사항이었고 추가적인 인센티브가 제공되지 않았습니다.

Our expert panelists were recruited by emailing study information to US medical school Academy director members (n¼63) of “Academies Collaborative” (www.acadmiescollaborative.com), a national forum for health professions’ teaching academies and similar organizations. Twenty-eight individuals expressed interest in participating as panelists. In exchange for reviewing and contributing to the manuscript and study participation, panelists were offered coauthorship. Participation in each round was optional and no additional incentives were offered.

패널 명단

Delphi expert panel are summarized in Table 1.

The 28 panelists (100%) responded to each survey round. Most of the consensus was achieved in rounds two and three. 

Table 2 summarizes all three rounds of the survey. At the end of the three survey rounds, 19 topics reached consensus as “essential,” “important” or “not important,” (Table 3) and 16 topics did not reach consensus including two topics that, though reaching consensus as “important” in round 2, had qualitative comments necessitating revisions and did not reach consensus with these revisions in round 3 (Table 4). 

In decreasing order of consensus, the five topics that reached consensus as “essential” for inclusion in SaT curricula (Table 3) were: 

• feedback (100% consensus), 

• bedside teaching and clinical precepting (86% consensus), 

• small-group teaching (75% consensus), 

• case-based teaching (71% consensus), and 

• professionalism as a medical educator (71% consensus). 

Thirteen topics achieved consensus as “important” and only one topic (i.e., history of medical education) reached consensus as “not important” for inclusion in a SaT curriculum (Table 3).

Discussion

"필수적"인 것으로 공감대를 얻은 주제가 (이론이나 주제에 기초한 것보다) "실습"과 기술 기반이라는 것은 주목할 만하다 (표 2).

It is notable that topics that achieved consensus as “essential” are arguably more “hands-on” and skill-based than theory-based topics that did not reach consensus as either essential or important (Table 2).

일반적으로 이론보다 기술을 우선시하려는 패널리스트의 경향은 부분적으로 의대생과 그 이상에서의 교수 역할을 위해 의대생을 실질적으로 준비시키는 명시된 연구 목표에 의해 주도되었을 수 있습니다. 그러나 설문의 자유 텍스트 상자에서 특히, 패널리스트는 SaT 교과 과정에서 이론과 기술에 부여해야하는 상대적 비중에 대한 다양한 의견을 표명했습니다.

In general, panelists’ tendency to prioritize skills over theory may have been driven, in part, by the stated study goal to practically prepare medical students for their teaching roles in residency and beyond. Notably, however, in free-textboxes of the survey, panelists expressed varied opinions about the relative weight that should be given to theory versus skill in a SaT curriculum. 

given the task of helping med students “hit the ground running” as teachers, I think conveying much/many theory information should take a distant second to practical and applied information…the “how-to” (Round 3)

반대로 어떤 패널리스트는 

On the other hand, some panelists argued

나는 모든 학습 과학을 배제하는 것에 대해 걱정합니다. 교사가되는 의대생은 사람들이 어떻게 배우는 지 과학이 있다는 것을 이해해야하며, 종종 의학 교육에서 이 과학을 무시합니다 (예 : 교훈 강의에 많이 의존 함) (3 차)

I worry about excluding any learning science at all. Medical students who become teachers must understand that there is a SCIENCE of how people learn, and often we ignore this science in medical education (for example, our heavy reliance on didactic lecture) (Round 3) 

불일치의 일부 영역에도 불구하고, 패널리스트는 "필수"주제에 대한 전반적인 합의는 주로 기존 SaT 프로그램의 추세를 반영합니다

Despite some areas of disagreement, the panelists’ over-all consensus on “essential” topics largely reflects trends in existing SaT programs

SaT Delphi 패널이 "본질적"이라고 평가하지 않은 현재 미국에 기반을 둔 SaT 및 RaT 커리큘럼에서 가장 인기있는 콘텐츠 영역은 "성인 학습 이론"(Soriano 외. 2010)이었습니다.

The only popular content area in cur-rent US-based SaT and RaT curricula that was not rated as“essential” by the SaT Delphi panelists was “adult learning theory” (Soriano et al. 2010). 

합의에 이르지 못했던 일부 주제는 이들 범주의 비율 합의가 합쳐지면 "필수"및 "중요"로 강한 합의를 이룬다는 점에 유의해야합니다 (표 3).

It is important to note that some topics that did not reach consensus as essential have a strong consensus as “essential” and “important” if the percentage agreements in these categories are summed together (Table 3).

따라서 5-10 개의 "필수 주제"를 식별하기위한 노력에서 각 주제 사이의 상대적 중요성은 명확하지 않습니다.

Therefore, in our effort to identify 5–10 “essential topics,”the relative importance of other topics is less clear. 

SaT Delphi 패널 토론자들의 자유 텍스트 주석 중 일부는 의대생 그 자신들이 훈련생이라는 점을 강조합니다. 한 패널 토론가는이를 반영하여,

some of the SaT Delphi panelists’ free text comments underscore the point that medical students are themselves trainees. One panelist reflected that, 

자기 주도적 학습 기술은 학습과 효과적인 교사가 되는 경험의 연결 고리를 제공합니다 (2 라운드) 

self-directed learning skills provide the link between theof learning and of being an effective teacher experiences (Round 2) 

이 정서는 다른 패널 토론자들에 의해 반향을 일으켰으며 "자기 주도적 학습 기술"이라는 주제가 합의에 "중요"하다고 결론 지었다 (71 % 동의). 이 시점에서 "가르치는"기술에만 국한되지 않고 효과적인 평생 학습을위한 전략을 포함하는 SaT 프로그램의 역량 및 이정표를 개발하는 것이 유익 할 수 있습니다.

This sentiment was echoed by other panelists and it is notable that the topic of “self-directed learning skills” did reach consensus as “important” (71% agreement). To this point, it may be beneficial to develop competencies and milestones for SaT programs that are not only limited to“teaching” skills, but that also incorporate strategies for effective lifelong learning. 

Conclusions

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Med Teach. 2018 Mar;40(3):259-266. doi: 10.1080/0142159X.2017.1401216. Epub 2017 Nov 24.

Defining curricular priorities for student-as-teacher programs: A National Delphi Study.

Rana J1, Sullivan A2, Brett M2, Weinstein AR1,2, Atkins KM1,3; SaT Delphi Working Group.

Author information

1

a Harvard Medical School , Boston , MA , USA.

2

b Department of Internal Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA.

3

c Department of Obstetrics and Gynecology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA.

Abstract

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.

PMID:

 

29171329

 

DOI:

 

10.1080/0142159X.2017.1401216