We are always looking for ‘proof’ that medical education influences clinical outcomes. On KeyLIME this week, Linda discusses work-based learning and how it enhances professional identity, teamwork, and other learner abilities. Read on, and check out the podcast here (or on iTunes!)
KeyLIME Session 162:
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Vijn TW1, Fluit CRMG2, Kremer JAM1, Beune T1, Faber MJ1, Wollersheim H1. Involving Medical Students in Providing Patient Education for Real Patients: A Scoping Review. J Gen Intern Med. 2017 Sep;32(9):1031-1043 9.
Reviewer: Linda Snell (@LindaSMedED)
We are always looking for ‘proof’ that medical education influences clinical outcomes. Work-based learning enhances professional identity, teamwork, and other learner abilities. Student-provided patient education may benefit both patients and students:
- it is hypothesized that early clinical exposure for students may affect their identity and learning;
- educating patients promotes shared decision-making and empowers them, perhaps improving clinical outcomes.
No reviews have systematically evaluated interventions and outcomes of student-provided patient education.
Literature (scoping) review of interventions and outcomes of student-provided patient education:
- learning yield, impact on quality of care, and practical feasibility of the interventions were rated by patients, care professionals, researchers, and education professionals.
- facilitators of and barriers to educational interventions were assessed.
Type of Paper
Other: scoping review
A side journey: Scoping reviews (Thomas A et al, Acad Med. 92(2), 2017.
- Knowledge syntheses methodology includes systematic reviews, meta-ethnography, rapid reviews, narrative reviews, realist reviews… and scoping reviews.
- ‘Scoping reviews are a KS methodology used to collect, evaluate and present findings – to contextualize and integrate findings – from existing research on a topic’. Useful for a preliminary exam of large body of evidence when unclear what specific questions can be posed.
- Differ from other reviews that address specific outcome based questions.
- Can furnish map of and expose gaps in current knowledge.
- Can address different and varied interventions, participants, methodology; are iterative and flexible; use numerical and thematic analysis; take into account stakeholders outside research team.
- Synthesize evidence from ・methodologically motley literature.
- Do not necessarily report on effectiveness or quality of interventions.
Key Points on Method
- MEDLINE, EMBASE, ERIC, PsycINFO) for studies on student-provided patient education, 1990 – 2015.
- PRISMA guidelines.
- combined themes of patient education/ undergraduate medical students with patient-centered outcomes.
- outcome measures were based on important elements of patient-centered care: patient satisfaction, self-care, health literacy, treatment compliance, and health attitudes, patient empowerment, student communication skills, shared decision-making, and relations between professionals and patients.
- evaluated study quality using the Quality Assessment Tool for Quantitative Studies, a tool aimed at assessing the quality of public health studies.
- the Kirkpatrick model was used to categorize the level of effects (experiences, learning, behavior, and organizational impact) of the interventions on both patients and students.Two expert rating groups:a. impact on care quality and feasibility, included patients and health care prof.
b. learning yield and feasibility, included med educators.
- they also provided an overall score.
- also looked at facilitators and barriers using a customized tool.
Note: no reference to any SR methodological paper nor to SR steps, rationale.
4991 records-3842 titles, abstracts-exclusions-18 studies included.
Geographically varied (mostly USA).
Variable: intervention types, level of student, contexts, diagnoses.
- Patient: satisfaction, knowledge, confidence, communication skills, MD-patient relations.
- Health outcomes: behavior, disease management, adherence.
- Student: satisfaction, self-efficacy, self-reported skills, behaviors.
Study quality: moderate scores = 6; weak scores = 12
Expert ratings: varied impact on quality of care (8/8), learning yield (7/11). Only one rated highly on both and feasibility. Rater consistency reasonable.
Facilitators and barriers were listed.
The authors conclude that involving undergraduate medical students in patient education has the potential to improve the quality of care and medical education.
- student-provided patient education enhanced, patient health or disease knowledge, health attitude, health behavior, medication adherence, disease management, and shared decision-making.
- enabling students to provide patient education was reported to enhance students’ patient education skills, patient education self-efficacy, patient education behavior, relations with patients, and communication skills. Students greatly appreciate and benefit from practice-based patient interaction.
In particular, student-run patient education clinics, student-provided outreach programs, student health coaching, and clerkships on patient education were rated by experts as having a higher-than-average learning yield and impact on quality of care, and recommended to be implemented to improve the quality of care and medical education.
Students can contribute to the highlighted WHO six dimensions of quality of care: effectiveness, efficacy, accessibility, patient-centeredness, equity, and safety.
The authors emphasize that many studies were weak quality, and many not considered feasible, and outline areas for future research:
1) provide high-quality evidence of the effects on both patients and students;
2) further examine effects such as the impact on leadership skills, role independence, and career perspectives among students;
3) investigate the long-term effects on patients and students;
4) examine the impact on clinical and educational practice; and
5) further investigate the effects on health-related outcomes.
Spare Keys – other take home points for clinician educators
If you are doing a study, cite the methodological literature!
Education scientists at McGill’s Centre for Med Ed for helping me understand scoping reviews.
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