A BEME realist synthesis review of the effectiveness of teaching strategies used in the clinical setting on the development of clinical skills among health professionals: BEME Guide No. 61

Abstract

Background: Literature describing the effectiveness of teaching strategies in the clinical setting is limited. This realist synthesis review focuses on understanding the effectiveness of teaching strategies used in the clinical setting.

Methods: We searched ten databases for English language publications between 1 January 1970 and 31 May 2017 reporting effective teaching strategies, used in a clinical setting, of non-procedural skills. After screening, we used consensus to determine inclusion and employed a standardised instrument to capture study populations, methodology, and outcomes. We summarised what strategies worked, for whom, and in what settings.

Results: The initial search netted 53,642 references after de-duplication; 2037 were retained after title and abstract review. Full text review was done on 82 references, with ultimate inclusion of 25 publications. Three specific teaching strategies demonstrated impact on educational outcomes: the One Minute Preceptor (OMP), SNAPPS, and concept mapping. Most of the literature involves physician trainees in an ambulatory environment. All three have been shown to improve skills in the domains of medical knowledge and clinical reasoning.

Discussion/conclusions: Apart from the OMP, SNAPPS, and concept mapping, which target the formation of clinical knowledge and reasoning skills, the literature establishing effective teaching strategies in the clinical setting is sparse.

Keywords:

• Effective clinical teaching
• realist synthesis review
• educational outcomes

Acknowledgments

The authors would like to thank Douglas Myhre, MD, Professor of Medicine, at University of Calgary, Paul Worley, Ph.D., MBBS, MBA and Professor of Medicine at Flinders University, and Jan Illing, Ph.D., MPhil and Professor of Medical Education Research at Newcastle University for their extremely valuable contributions to the development of this review topic, creation of the review protocol, and thoughtful input during the literature search process.

Disclosure statement

Dr. Stickrath and Dr. Aagaard developed the MiPLAN teaching strategy for use in a hospital-based clinical setting. Dr. Pierce and Dr. Stickrath have conducted a study on the use of MiPLAN in the inpatient setting. Dr. Aagaard and Dr. Irby have conducted several studies evaluating the One Minute Preceptor. Dr. Corral and Ben Harnke report no declarations of interest.

Glossary

One Minute Preceptor (OMP): A structured teaching strategy used and studied in the clinical setting based on Neher’s five microskills, employed by the preceptor. The steps are (1) get a commitment, (2) probe for supporting evidence, (3) teach general rules, (4) reinforce what was done right, and (5) correct mistakes.

SNAPPS: A mnemonic outlining a structured teaching strategy used and studied in the clinical setting, employed by the learner. Its 6 steps derive from cognitive activity rating scales and include: (1) summarize information, (2) narrow the differential, (3) analyse the differential through comparing and contrasting, (4) probe the preceptor to clarify uncertainty, (5) plan management for the patient’s medical issues, and (6) select a case for self-directed learning.

Concept mapping: A collaborative strategy, originally developed from the field of cognitive psychology with links to neurobiology. Learners use it to graphically represent and provide structure to distinct, interrelated ideas and overarching concepts. Specifically, learners: (1) cluster information to foster the formation of associations between related concepts, (2) draw directional arrows to demonstrate causality and interdependence, and (3) graphically impose hierarchy to organize information around themes.

Additional information

Notes on contributors

Cason Pierce

Cason Pierce, MD, MA, is a full-time clinician and medical educator. He is a graduate of the Teaching Scholars Program at the University of Colorado Anschutz and has presented workshops at national meetings on curriculum development and published on the teaching of high-value care principles in the inpatient clinical setting.

Janet Corral

Janet Corral has a Ph.D. in Education, has international medical education administrative experience, and brings prior experience with literature reviews, and mixed methods and qualitative analysis skills. She has reviewed one BEME review submission for BEME in 2015.

Eva Aagaard

Eva Aagaard, MD, is a medical education leader and investigator. She developed the Academy of Medical Educators at the University of Colorado, which provides support and faculty development in curriculum, education research, and educational leadership. She is now the Senior Associate Dean at the Washington University School of Medicine in St. Louis.

Ben Harnke

Ben Harnke, MLIS, works in the field of library science and brings the expertise needed to conduct a robust literature search. He has published four systematic reviews, including one involving mixed-methods.

David M. Irby

David M. Irby, PhD, MDiv, is an international leader in medical education, serving many years as Vice Dean of Education and Director of the Office of Medical Education at the University of California, San Francisco. He is an active committee member for the Association for Medical Education in Europe and the Josiah Macy Foundation.

Chad Stickrath

Chad Stickrath, MD, serves as the Assistant Dean for Education at the Colorado Springs Branch of the University of Colorado. He has published an approach to maximizing clinical learning during bedside teaching rounds, has overseen the development of a longitudinal integrated clerkship, and oversees the University of Colorado Academy of Medical Educators curriculum.