Papers by Barry Issenberg
Medical Science Educator, 2020
Despite calls from educators to re-engineer how faculty deliver medical student curricula with in... more Despite calls from educators to re-engineer how faculty deliver medical student curricula with integrated basic science concepts, this content is still frequently disarticulated from other curricular components. We renewed our curriculum using evidence-based pedagogical and cognitive learning strategies to interleave basic science across the 4-year curriculum.
Background The Accreditation Council for Graduate Medical Education (ACGME) Internal Medicine Res... more Background The Accreditation Council for Graduate Medical Education (ACGME) Internal Medicine Residency Program Guidelines identifies leadership as a core competency. The definition of strong resident leadership is not clearly defined. Prior studies have identified characteristics of resident leadership from the perspective of residency program leaders with little emphasis on the resident point of view. Objective This study aims to identify qualities of effective resident leadership from the perspective of Internal Medicine (IM) residents. Methods Participants were recruited through email invitations. An online focus group with five IM residents was conducted in September 2020. The transcribed discussion was inductively analyzed using thematic data analysis.Results Analysis resulted in four main themes of strong resident leadership: mentorship, team ownership, communication, and emotional intelligence. All four themes were further characterized by subthemes. Being a mentor as a resi...
Medical Education, 2008
High-stakes assessments of doctors&am... more High-stakes assessments of doctors' physical examination skills often employ standardised patients (SPs) who lack physical abnormalities. Simulation technology provides additional opportunities to assess these skills by mimicking physical abnormalities. The current study examined the relationship between internists' cardiac physical examination competence as assessed with simulation technology compared with that assessed with real patients (RPs). The cardiac physical examination skills and bedside diagnostic accuracy of 28 internists were assessed during an objective structured clinical examination (OSCE). The OSCE included 3 modalities of cardiac patients: RPs with cardiac abnormalities; SPs combined with computer-based, audio-video simulations of auscultatory abnormalities, and a cardiac patient simulator (CPS) manikin. Four cardiac diagnoses and their associated cardiac findings were matched across modalities. At each station, 2 examiners independently rated a participant's physical examination technique and global clinical competence. Two investigators separately scored diagnostic accuracy. Inter-rater reliability between examiners for global ratings (GRs) ranged from 0.75-0.78 for the different modalities. Although there was no significant difference between participants' mean GRs for each modality, the correlations between participants' performances on each modality were low to modest: RP versus SP, r = 0.19; RP versus CPS, r = 0.22; SP versus CPS, r = 0.57 (P < 0.01). Methodological limitations included variability between modalities in the components contributing to examiners' GRs, a paucity of objective outcome measures and restricted case sampling. No modality provided a clear 'gold standard' for the assessment of cardiac physical examination competence. These limitations need to be addressed before determining the optimal patient modality for high-stakes assessment purposes.
Medical Education, 2014
This article has two objectives. Firstly, we critically review simulation-based mastery learning ... more This article has two objectives. Firstly, we critically review simulation-based mastery learning (SBML) research in medical education, evaluate its implementation and immediate results, and document measured downstream translational outcomes in terms of improved patient care practices, better patient outcomes and collateral effects. Secondly, we briefly address implementation science and its importance in the dissemination of innovations in medical education and health care. This is a qualitative synthesis of SBML with translational (T) science research reports spanning a period of 7 years (2006-2013). We use the 'critical review' approach proposed by Norman and Eva to synthesise findings from 23 medical education studies that employ the mastery learning model and measure downstream translational outcomes. Research in SBML in medical education has addressed a range of interpersonal and technical skills. Measured outcomes have been achieved in educational laboratories (T1), and as improved patient care practices (T2), patient outcomes (T3) and collateral effects (T4). Simulation-based mastery learning in medical education can produce downstream results. Such results derive from integrated education and health services research programmes that are thematic, sustained and cumulative. The new discipline of implementation science holds promise to explain why medical education innovations are adopted slowly and how to accelerate innovation dissemination.
Medical Education, 2003
Context At a time of significant changes in medical education world-wide, the international dimen... more Context At a time of significant changes in medical education world-wide, the international dimensions and global issues relating to the application of new learning technologies have been recognised.
Journal of Veterinary Medical Education, 2005
Simulation technology will feature prominently in this exciting, yet challenging, time for veteri... more Simulation technology will feature prominently in this exciting, yet challenging, time for veterinary medicine. The profession is evolving to keep pace with rapid changes in clinical practice, scientific discovery, and educational strategy, while ensuring that it follows the public mandate to produce competent veterinarians. Among the challenges to meeting this educational goal are limitations-due to important issues such as animal welfare-on the availability of real patients for training. Drawing chiefly on the experience in human medicine, this article explores the use of simulations in veterinary medical education to provide safe and ethical alternative opportunities for learners to practice essential clinical and professional skills.
Journal of the American Geriatrics Society, 2010
Despite extensive educational efforts, many medical students still have negative attitudes toward... more Despite extensive educational efforts, many medical students still have negative attitudes toward the field of geriatric medicine and the care of older adult patients. This article describes a fourth-year geriatric clerkship that addressed this issue by providing opportunities for students to actively discuss many of the negative stereotypes that exist regarding geriatric medicine. Emphasis was also placed on personalizing the course content to show the relevance of geriatric medicine to all medical students. During the 2008/09 academic year, 150 students completed the rotation. Although no students expressed an interest in pursuing a career as a geriatrician, they expressed a highly favorable evaluation of this personalized geriatric clerkship and voted this clerkship ''the most outstanding clinical course'' at the medical school. J Am Geriatr Soc 58:746-750, 2010.
Journal of General Internal Medicine, 2008
Medical education during the past decade has witnessed a significant increase in the use of simul... more Medical education during the past decade has witnessed a significant increase in the use of simulation technology for teaching and assessment. Contributing factors include: changes in health care delivery and academic environments that limit patient availability as educational opportunities; worldwide attention focused on the problem of medical errors and the need to improve patient safety; and the paradigm shift to outcomes-based education with its requirements for assessment and demonstration of competence. The use of simulators addresses many of these issues: they can be readily available at any time and can reproduce a wide variety of clinical conditions on demand. In lieu of the customary (and arguably unethical) system, whereby novices carry out the practice required to master various techniques-including invasive procedures-on real patients, simulation-based education allows trainees to hone their skills in a risk-free environment. Evaluators can also use simulators for reliable assessments of competence in multiple domains. For those readers less familiar with medical simulators, this article aims to provide a brief overview of these educational innovations and their uses; for decision makers in medical education, we hope to broaden awareness of the significant potential of these new technologies for improving physician training and assessment, with a resultant positive impact on patient safety and health care outcomes.
The Journal of Continuing Education in Nursing, 2013
Effective training is needed for high-quality performance of staff nurses, who are often the firs... more Effective training is needed for high-quality performance of staff nurses, who are often the first responders in initiating resuscitation. There is insufficient evidence to identify specific educational strategies that improve outcomes, including early recognition and rescue of the critical patient. This study was conducted to identify perceived competence and educational needs as well as to examine factors influencing perceived competence in resuscitation among staff nurses to build a resuscitation training curriculum. A convenience sample of 502 staff nurses was recruited from 11 hospitals in a single city. Staff nurses were asked to complete a self-administered questionnaire. On a five-point scale, chest compression was the lowest-rated technical skill (M = 3.33, SD = 0.80), whereas staying calm and focusing on required tasks was the lowest-rated non-technical skill (M = 3.30, SD = 0.80). Work duration, the usefulness of simulation, recent code experience, and recent simulation-based training were significant factors in perceived competence, F(4, 496) = 45.94, p < .001. Simulation-based resuscitation training was the most preferred training modality, and cardiac arrest was the most preferred training topic. Based on this needs assessment, a simulation-based resuscitation training curriculum with cardiac arrest scenarios is suggested to improve the resuscitation skills of staff nurses.
JAMA, 1999
Changes in medical practice that limit instruction time and patient availability, the expanding o... more Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, casebased programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.
JAMA: The Journal of the American Medical Association, 1997
Cardiac Auscultation Skills of Physicians in Training To the Editor.\p=m-\WhileI strongly believe... more Cardiac Auscultation Skills of Physicians in Training To the Editor.\p=m-\WhileI strongly believe that cardiac auscul-tation is a skill worth honing, I disagree with the conclusions of Drs Mangione and Nieman1 that a deficiency in the skills they tested might be a serious problem and ...
Evaluation & the Health Professions, 2012
Little is known about the current training and barriers in resuscitation skills among practicing ... more Little is known about the current training and barriers in resuscitation skills among practicing ward nurses. A convenience sample of 459 ward nurses, recruited from 11 academic teaching hospitals in Korea, were surveyed to assess current training and barriers to optimal resuscitation performance on the wards. The Perceived Barriers scale was developed, refined, and its psychometric properties were assessed. Approximately 36% of nurses had received simulation-based resuscitation skills training. Exploratory factor analysis identified four barriers accounting for 58.4% of the variance: insufficient training (37.7%), lack of competence (9.8%), lack of self-confidence (5.9%), and workload and tension (5.1%). Strategic planning and resuscitation skills training should be incorporated into staff development programs to reduce barriers to optimal resuscitation performance and cope with work demands for ward nurses.
Educational and Psychological Measurement, 2005
... obtained from 965 graduate and undergraduate students yielded a well-differentiated 11-factor... more ... obtained from 965 graduate and undergraduate students yielded a well-differentiated 11-factor solution of internally consistent and stable scores. The 57-item instrument distinguished betweenstudents with high and low stress and was unrelated to students' perceptions of their ...
British Journal of Anaesthesia, 2001
1 Byrne AJ, Greaves JD. Assessment instruments used during anaesthetic simulation: review of publ... more 1 Byrne AJ, Greaves JD. Assessment instruments used during anaesthetic simulation: review of published studies. Br J Anaesth 2001; 86: 445±50 2 Issenberg SB, McGaghie WC, Hart IR, et al. Simulation technology for health care professional skills training and assessment.
Archives of Internal Medicine, 1995
Medical education faces problems caused by increasing restraints on resources. A multicenter cons... more Medical education faces problems caused by increasing restraints on resources. A multicenter consortium combined simulation and multimedia computer-assisted instruction (MCAI) to develop unique interactive teaching programs that can address a number of these problems. We describe the consortium, the MCAI system, the programs, and a multicenter evaluation of technical and educational performance. The MCAI system uses computer-controlled access to full-screen, full-motion, and full-color laser disc video in combination with digitized sound, images, and graphics stored on removable media. The Socratic teaching method enhances interaction and guides learners through the patient's history, cardiovascular physical examination, laboratory evaluation, and therapy. Self-instruction and instructor-led modes of function are possible. The first five programs, based on simulations of specific cardiology problems, were distributed to four medical centers. Questionnaires evaluated technical function and medical student opinions, while behaviors and scores were automatically tracked and tabulated by program administration software. The MCAI system functioned reliably and accurately in all modes and at all sites. The programs were highly rated. Student ratings, scores, and behaviors were independent of institution and mode of use. A multicenter educational consortium developed a system to produce unique, sophisticated MCAI programs in cardiology. Both system and programs functioned reliably at four institutions and were highly rated by fourth-year medical students. With this enthusiastic reception, the economies and strengths associated with MCAI make it an attractive solution to a number of problem areas, and it will likely play an increasingly important role.
Annals of Internal Medicine, 1999
... Advantages of computer-based methods include uniformity in assessment; opportunity to assess ... more ... Advantages of computer-based methods include uniformity in assessment; opportunity to assess skills without possible harm to live patients ... the cost of computer simulation by eliminating the need for the mainframe computers that were necessary for initial simulation efforts (2). ...
Annals of Emergency Medicine, 2012
Academic Medicine, 2005
Using computer-based simulation to assess clinical skill-a key competence for medical trainees-en... more Using computer-based simulation to assess clinical skill-a key competence for medical trainees-enables standardization and exposure to a broad sample of physical findings. The purpose of this study is to provide evidence of construct validity for a computer-based outcome measure of neurology clinical skills. A total of 128 medical students and neurology residents at four institutions volunteered to take a 34-question computer-based test designed to measure neurology clinical skills. Subjects were classified into three groups based on level of training: novice, intermediate, and experienced. Overall performance increased with level of training. Question difficulty discriminated between groups as predicted. Twenty-six of 34 individual items discriminated between novices and more advanced learners. This test separated learners at different levels of training with a consistency of .92. This study provided evidence of construct validity for a computer-based outcome measure of neurology clinical skills.
Academic Medicine, 1999
The pressures of a changing health care system are making inroads on the commitment and effort th... more The pressures of a changing health care system are making inroads on the commitment and effort that both basic science and clinical faculty can give to medical education. A tool that has the potential to compensate for decreased faculty time and thereby to improve medical education is multimedia computer instruction that is applicable at all levels of medical education, developed according to instructional design principles, and supported by evidence of effectiveness. The authors describe the experiences of six medical schools in implementing a comprehensive computer-based four-year curriculum in bedside cardiology developed by a consortium of university cardiologists and educational professionals. The curriculum consisted of ten interactive, patient-centered, case-based modules focused on the history, physical examination, laboratory data, diagnosis, and treatment. While an optimal implementation plan was recommended, each institution determined its own strategy. Major goals of the project, which took place from July 1996 to June 1997, were to identify and solve problems of implementation and to assess learners' and instructors' acceptance of the system and their views of its value. A total of 1,586 students used individual modules of the curriculum 6,131 times. Over 80% of students rated all aspects of the system highly, especially its clarity and educational value compared with traditional lectures. The authors discuss the aspects of the curriculum that worked, problems that occurred (such as difficulties in scheduling use of the modules in the third year), barriers to change and ways to overcome them (such as the type of team needed to win acceptance for and oversee implementation of this type of curriculum), and the need in succeeding years to formally assess the educational effectiveness of this and similar kinds of computer-based curricula.
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Papers by Barry Issenberg