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      A CanMEDS Competency-Based Assessment Tool for High-Fidelity Simulation in Internal Medicine: The Montreal Internal Medicine Evaluation Scale (MIMES)

      , , , ,
      Canadian Journal of General Internal Medicine
      Dougmar Publishing Group, Inc.

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          Abstract

          Introduction: High-fidelity simulation is an efficient and holistic teaching method. However, assessing simulation performances remains a challenge. We aimed to develop a CanMEDS competency-based global rating scale for internal medicine trainees during simulated acute care scenarios. Methods: Our scale was developed using a formal Delphi process. Validity was tested using six videotaped scenarios of two residents managing unstable atrial fibrillation, rated by 6 experts. Psychometric properties were determined using a G-study and a satisfaction questionnaire.Results: Most evaluators favorably rated the usability of our scale, and attested that the tool fully covered CanMEDS competencies. The scale showed low to intermediate generalization validity.Conclusions: This study demonstrated some validity arguments for our scale. The best assessed aspect of performance was communication; further studies are planned to gather further validity arguments for our scale and to compare assessment of teamwork and communication during scenarios with multiple versus single residents.

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          Most cited references20

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          Anaesthetists' non-technical skills.

          This review presents the background to the development of the anaesthetists' non-technical skills (ANTS) taxonomy and behaviour rating tool, which is the first non-technical skills framework specifically designed for anaesthetists. We share the experience of the anaesthetists who designed ANTS in relation to applying it in a department of anaesthesia, using it in a simulation centre, and the process of introducing it to the profession on a national basis. We also consider how ANTS is being applied in relation to training and research in other countries and finally, we discuss emerging issues in relation to the introduction of a non-technical skills approach in anaesthesia.
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            Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education.

            Critical incident reporting and observational studies have identified nontechnical skills that are vital to successful anesthesia crisis management. Examples of such skills include task management, team working, situation awareness, and decision making. These skills are not necessarily acquired through clinical experience and may need to be specifically taught. This study uses a high-fidelity patient simulator to assess the effect of repeated exposure to simulated anesthesia crises on the nontechnical skills of anesthesia residents. After institutional research board approval and informed consent, 20 anesthesia residents were recruited. Each resident was randomized to participate as the primary anesthesiologist in the management of three different simulated anesthesia crises using a high-fidelity patient simulator. After each session, videotaped footage was used to facilitate debriefing of their nontechnical skills. The videotapes were later reviewed by two expert blinded independent assessors who rated each resident's nontechnical skills by using a previously validated and reliable marking system. : A significant improvement in the nontechnical skills of residents was demonstrated from their first to second session and from their first to third session (both P < 0.005). However from their second to third session, no significant improvement was observed. Interrater reliability between assessors was modest (single rater intraclass correlation = 0.53). A single exposure to anesthesia crises using a high-fidelity patient simulator can improve the nontechnical skills of anesthesia residents. However, an additional simulation session may confer little or no additional benefit.
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              Analytic global OSCE ratings are sensitive to level of training.

              There are several reasons for using global ratings in addition to checklists for scoring objective structured clinical examination (OSCE) stations. However, there has been little evidence collected regarding the validity of these scales. This study assessed the construct validity of an analytic global rating with 4 component subscales: empathy, coherence, verbal and non-verbal expression. A total of 19 Year 3 and 38 Year 4 clinical clerks were scored on content checklists and these global ratings during a 10-station OSCE. T-tests were used to assess differences between groups for overall checklist and global scores, and for each of the 4 subscales. The mean global rating was significantly higher for senior clerks (75.5% versus 71.3%, t55 = 2.12, P < 0.05) and there were significant differences by level of training for the coherence (t55 = 3.33, P < 0.01) and verbal communication (t55 = 2.33, P < 0.05) subscales. Interstation reliability was 0.70 for the global rating and ranged from 0.58 to 0.65 for the subscales. Checklist reliability was 0.54. In this study, a summated analytic global rating demonstrated construct validity, as did 2 of the 4 scales measuring specific traits. In addition, the analytic global rating showed substantially higher internal consistency than did the checklists, a finding consistent with that seen in previous studies cited in the literature. Global ratings are an important element of OSCE measurement and can have good psychometric properties. However, OSCE researchers should clearly describe the type of global ratings they use. Further research is needed to define the most effective global rating scales.
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                Author and article information

                Journal
                Canadian Journal of General Internal Medicine
                Can Journ Gen Int Med
                Dougmar Publishing Group, Inc.
                2369-1778
                1911-1606
                November 13 2018
                October 12 2018
                : 13
                : 4
                : e10-e16
                Article
                10.22374/cjgim.v13i4.280
                c52b66b8-241c-4842-83ec-43f7ebba2183
                © 2018

                Copyright of articles published in all DPG titles is retained by the author. The author grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any non-commercial third party the rights to use the article freely provided original author(s) and citation details are cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/


                General medicine,Geriatric medicine,Neurology,Internal medicine
                General medicine, Geriatric medicine, Neurology, Internal medicine

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