http://orcid.org/0000-0001-9175-7479
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Abstract
Background: Current educational interventions and teaching for acute deteriorations seem to address acute care learning in discreet segments. Technology enhanced and team training methodologies are in vogue though well studied in the nursing profession, teaching avenues for junior ‘doctors in training’ seem to be a lacuna.
Aims: The BEME systematic review was designed to (1) appraise the existing published evidence on educational interventions that are intended for ‘doctors in training’ to teach early recognition and prompt escalation in acute clinical deteriorations (2) to synthesise evidence & to evaluate educational effectiveness.
Methodology: The method applied was a descriptive, justification & clarification review. Databases searched included PubMed, PsycINFO, Science Direct and Scopus for original research and grey literature with no restrictions to year or language. Abstract review, full text decisions and data extraction were completed by two primary coders with final consensus by a third reviewer.
Results: 5592 titles and abstracts were chosen after removal of 905 duplications. After exclusion of 5555 studies, 37 full text articles were chosen for coding. 22 studies met final criteria of educational effectiveness, relevance to acute care. Educational platforms varied from didactics to blended learning approaches, small group teaching sessions, simulations, live & cadaveric tissue training, virtual environments and insitu team-based training. Translational outcomes with reduction in long term (up to 3–6 years) morbidity & mortality with financial savings were reported by 18% (4/22) studies. Interprofessional training were reported in 41% (9/22) of studies. Recent evidence demonstrated effectiveness of virtual environment and mobile game-based learning.
Conclusions: There were significant improvements in teaching initiatives with focus on observable behaviours and translational real patient outcomes. Serious game-based learning and virtual multi-user collaborative environments might enhance individual learners’ cognitive deliberate practice. Acute care learning continuum with programmatic acute care portfolios could be a promise of the future.
Acknowledgements
Miss Annelissa Chin, senior librarian at the National University of Singapore Medical Library with her experience in guiding medical research literature reviews provided support with regulating and formalising the search strategies. She continued to support the review team to refine and achieve a comprehensive search of relevant publications.
The review was done with guidance and support from the BEME-BICC team. The lead reviewer received formal training through Practical Skills for Reviewing Evidence in Health Professions Education (PASREV) courses at AMEE 2017. A panel of BEME faculty (Drs Morris Gordon, Madalena Patricio and António Vaz Carneiro) provided active support for protocol development and educational mentoring was provided by Dr Sara Mortaz Hejri. The scoping review was reviewed by the BEME team and amendments were made to improve the breadth and depth of the research to span all possible literature for this topic with removal of restrictions for year and language.
Disclosure statement
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
Glossary
Acute deterioration: Patients who move from one clinical state to a worsening clinical state in a short period of time which dramatically increases their individual risk of morbidity, including organ dysfunction, protracted hospital stay, disability or death.
Teaching intervention: Any educational program or module or teaching methods that are intended to improve the process of imparting acute care knowledge.
Educational Effectiveness: The degree to which intervention is successful in producing a desired result or success. Lower levels of effectiveness data refer to self-reported confidence improvements, participant satisfaction and engagement. Higher level includes clinical practice standard improvements, workplace reviews of better quality of trainee doctors: 360-degree reports and ratings/ impressions of clinical supervisors. Highest of them includes patient management indices such as reduced morbidity and mortality data, better patient satisfaction scores of confidences in junior practicing doctors, overall reductions of preventable errors or reduced events.
Medical students: Includes undergraduate medical students, house officers and interns who are yet to obtain their qualifications as a medical doctor.
Residents, postgraduates, trainees: Are terms used interchangeably in various educational systems. These are doctors who are in structured training program and have not yet obtained specialist qualifications or certification for independent unsupervised specialty practice from the respective medical boards.
Transitional years, senior house officers, medical officers, non-trainees: Are doctors who have obtained their undergraduate medical degree and work as junior medical doctors and have not entered specialty track or a formal structured program of training into specialist accreditation.
Additional information
Notes on contributors
Balakrishnan Ashokka
Dr. Ashokka Balakrishnan, MBBS, MD, FANZCA, EDRA, MHPE, is an anaesthesiologist, medical educationalist and high-end simulation-based educator for undergraduate, postgraduate medical education and multi-disciplinary team-based training. He facilitates simulation support for strategic prevention of untoward outcomes movement of the National University Hospital, Singapore.
Chaoyan Dong
Dr. Chaoyan Dong, PhD, is a medical educator with experience in systematic review. She received her PhD in Educational Communication & Technology from New York University in 2008. Her expertise is in simulation and medical education research.
Lawrence Siu-Chun Law
Dr. Law Lawrence Siu-Chun, BSSc (Psychology), MD, is a transitional year doctor in training who has a degree in psychology and holds a graduate medical degree. He has prior experience with systematic review methodology and coding.
Sok Ying Liaw
A/Prof Liaw Sok Ying, PhD, is nurse educator and academic researcher who has expertise in reviews on teaching intervention in acute deteriorations and has developed a RAPIDS model (Rescuing A Patient in Deteriorating Situations) and has experience with systematic reviews.
Fun Gee Chen
A/Prof Chen Fun Gee, MBBS, MMed, FANZCA, MHPE, is an anaesthesiologist and pioneer in simulation-based undergraduate and postgraduate training in Asia. He is the director of graduate medical services that overseas postgraduate assessments and outcomes of training and is the Co-Chair of specialist accreditation board.
Dujeepa D. Samarasekera
A/Prof Dujeepa D. Samarasekera, MBBS, FAMEE, MHPE, is the Head of the Centre for Medical education (CenMED) at National University of Singapore. His role in quality assurance in assessment at Ministry of Health, curriculum review committee and graduate exit evaluations surveys added strength to the review direction.