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      Using Gagné's “Instructional Design” to teach clinically applicable knowledge in small groups

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          Abstract

          Background

          Anesthesia trainees are expected to perform tasks under non-direct supervision as soon as possible in their clinical training. Often they rely on only superficial rote learning, which might lead to medical errors. We have developed a lesson plan that is based on this educational need using Gagné's Instructional Design for the example of teaching the complex preoperative management of diabetic patients. Our aim was to use Gagne's approach successfully for the teaching of non-procedural skills.

          Methods

          We implemented a comprehensive lesson plan that was developed on the example of a clinical pattern – the preoperative assessment of diabetic patients - using Gagné's systematic nine-step model of instruction design. After the lesson, we analysed the trainees' opinions with the use of a standardized questionnaire.

          Results

          Nine trainees with 2.1 ± 0.8 years of anesthesia experience attended the lesson. The assessment of knowledge revealed in 82% the correct answers to the treatment options, and the residents' overall view on the lecture concept were 4.8 ± 0.3 for lecture concept and realization and 4.7 ± 0.5 regarding motivation, participation and climate.

          Conclusions

          Applying Gagné's Instructional Design model guides seems to effectively guide the development of a comprehensive lesson plan to teach non-procedural skills in a small group setting.

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          Most cited references22

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          When do supervising physicians decide to entrust residents with unsupervised tasks?

          Patient-care responsibilities stimulate trainee learning but training may compromise patient safety. The authors investigated factors guiding clinical supervisors' decisions to trust residents with critical patient-care tasks. In a mixed quantitative and qualitative descriptive study carried out at University Medical Center Utrecht, Utrecht, the Netherlands, from March to September 2008, the authors surveyed attending anesthetists and resident anesthetists regarding when attendings should entrust each of six selected critical tasks to residents. The authors conducted structured interviews with both groups, using trigger case vignettes to solicit opinions on factors that affect entrustment decisions. Thirty-two attending anesthetists and 31 residents answered the questionnaire (response rate 58%), and 10 participants from each group were interviewed. Attendings varied in their opinions regarding how much independence to give residents, particularly postgraduate year (PGY) 2, 3, and 4 residents. PGY1 residents reported working above their expected level of competence but estimate their own ability as sufficient, whereas PGY5 residents reported working below their expected level of competence. The authors classified factors that determine entrustment into four groups: characteristics of the resident, the attending, the clinical context, and the critical task. Residents' and attendings' opinions and impressions differ regarding what is expected from residents, what residents actually do, and what residents think they can do safely. The authors list factors affecting why and when supervisors trust residents to proceed without supervision. Future studies should address drivers behind entrustment decisions, correlations with patient outcomes, and tools that enable faculty to justify their entrustment decisions.
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            Perioperative Hyperglycemia Management

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              Is Open Access

              Role-play for medical students learning about communication: Guidelines for maximising benefits

              Background Role-play is widely used as an educational method for learning about communication in medical education. Although educational theory provides a sound rationale for using this form of simulation, there is little published evidence for its effectiveness. Students' prior experiences of role-play may influence the way in which they engage in this method. This paper explores students' experiences with the aim of producing guidelines for maximising the benefits of role-play within this learning context. Methods First-year undergraduate medical students participated in a role-play session as part of their communication programme. Before and after the session, students completed questionnaires. In the pre-session questionnaire, students were asked about their experiences of role-play and asked to identify helpful and unhelpful elements. Immediately after the session, students answered similar questions in relation to the role-play activity they had just completed. Descriptive statistics were used to analyse quantitative data and qualitative data was thematically analysed. Results 284 students completed evaluation forms. Although 63 (22.2%) had prior unhelpful experiences, most students (n = 274; 96.5%) found this experience helpful. Summary findings were that students reported the key aspects of helpful role-play were opportunities for observation, rehearsal and discussion, realistic roles and alignment of roles with other aspects of the curriculum. Unhelpful aspects were those that evoked strong negative emotional responses and factors that contributed to a lack of realism. Conclusion Role-play was valued by students in the acquisition of communication skills even though some had prior unhelpful experiences. Guidelines for effective role-play include adequate preparation, alignment of roles and tasks with level of practice, structured feedback guidelines and acknowledgment of the importance of social interactions for learning.
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                Author and article information

                Contributors
                Journal
                Trends in Anaesthesia & Critical Care
                The Authors. Published by Elsevier Ltd.
                2210-8440
                2210-8467
                18 August 2020
                18 August 2020
                Affiliations
                [1]Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland
                Author notes
                []Corresponding author. joana.berger-estilita@ 123456insel.ch
                Article
                S2210-8440(20)30115-5
                10.1016/j.tacc.2020.08.002
                7431410
                38620668
                6f32941b-7a98-4562-b3ee-0e189c117d5e
                © 2020 The Authors. Published by Elsevier Ltd.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 25 May 2020
                : 18 July 2020
                : 6 August 2020
                Categories
                Article

                gagne's theory of instruction,instructional design model,medical education,preoperative care,diabetes mellitus,anesthesia

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