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Licensed Unlicensed Requires Authentication Published by De Gruyter February 3, 2021

Improving diagnosis by feedback and deliberate practice: one-on-one coaching for diagnostic maturation

Pranay Sinha ORCID logo, Lauren Pischel ORCID logo and André N. Sofair
From the journal Diagnosis

Abstract

Reflective practice is essential for the ongoing maturation of clinicians and requires regular self-evaluation in association with ongoing mentoring and feedback. Currently, most resident physicians do not have access to educational experiences that fulfill these needs. We present a novel model for structured one-on-one longitudinal coaching using the principles of deliberate practice to improve diagnostic skills. This is an easily implementable educational model that can be replicated in residencies across the country to improve clinical reasoning. Skills learned through this program have the potential not only to bolster the academic approach to patients but to also directly improve the clinical assessment and care of patients under the trainee’s care.


Corresponding author: Pranay Sinha, MD, Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Ave, Crosstown Center, 2021A, Boston, MA, 02118, USA, Phone: +1 (516) 633 9920, E-mail:

Funding source: National Institutes of Health

Award Identifier / Grant number: 5T32 AI-052074-13

  1. Research funding: PS was supported by a grant from the NIH (5T32 AI-052074-13).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

References

1. Ericsson, KA, Krampe, RT, Tesch-Römer, C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993;100:363. https://doi.org/10.1037/0033-295x.100.3.363.Search in Google Scholar

2. McGaghie, WC, Issenberg, SB, Cohen, ER, Barsuk, JH, Wayne, DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011;86:706–11. https://doi.org/10.1097/acm.0b013e318217e119.Search in Google Scholar PubMed PubMed Central

3. Ericsson, A, Pool, R. Peak: secrets from the new science of expertise. New York: Houghton Mifflin Harcourt; 2016.Search in Google Scholar

4. Ericsson, KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med 2015;90:1471–86. https://doi.org/10.1097/acm.0000000000000939.Search in Google Scholar

5. Pradarelli, JC, Yule, S, Panda, N, Lowery, KW, Lagoo, J, Gee, DW, et al.. Surgeons’ coaching techniques in the Surgical Coaching for Operative Performance Enhancement (SCOPE) program. Ann Surg 2020 Jul 24. https://doi.org/10.1097/sla.0000000000004323 [Epub ahead of print].Search in Google Scholar

6. Siddaiah-Subramanya, M, Smith, S, Lonie, J. Mastery learning: how is it helpful? An analytical review. Adv Med Educ Pract 2017;8:269. https://doi.org/10.2147/amep.s131638.Search in Google Scholar PubMed PubMed Central

7. Petrosoniak, A, Lu, M, Gray, S, Hicks, C, Sherbino, J, McGowan, M, et al.. Perfecting practice: a protocol for assessing simulation-based mastery learning and deliberate practice versus self-guided practice for bougie-assisted cricothyroidotomy performance. BMC Med Educ 2019;19:100. https://doi.org/10.1186/s12909-019-1537-7.Search in Google Scholar PubMed PubMed Central

8. Waechter, J, Reading, D, Lee, CH, Walker, M. Quantifying the medical student learning curve for ECG rhythm strip interpretation using deliberate practice. GMS J Med Educ 2019;36:1–21. https://doi.org/10.3205/zma001248.Search in Google Scholar PubMed PubMed Central

9. Wells, J, Cronk, NJ. Practice makes perfect: training residents in difficult encounters. PRiMER 2020;4:2. https://doi.org/10.22454/primer.2020.924066.Search in Google Scholar PubMed PubMed Central

10. Green, W, Shahzad, MW, Wood, S, Martinez Martinez, M, Baines, A, Navid, A, et al.. Improving junior doctor medicine prescribing and patient safety: an intervention using personalised, structured, video-enhanced feedback and deliberate practice. Br J Clin Pharmacol 2020;86:2234–46. https://doi.org/10.1111/bcp.14325.Search in Google Scholar PubMed PubMed Central

11. Wenrich, MD, Jackson, MB, Maestas, RR, Wolfhagen, IH, Scherpbier, AJ. From cheerleader to coach: the developmental progression of bedside teachers in giving feedback to early learners. Acad Med 2015;90(11 Suppl):S91–7. https://doi.org/10.1097/acm.0000000000000901.Search in Google Scholar

12. McMurray, L, Hall, AK, Rich, J, Merchant, S, Chaplin, T. The nightmares course: a longitudinal, multidisciplinary, simulation-based curriculum to train and assess resident competence in resuscitation. J Grad Med Educ 2017;9:503–8. https://doi.org/10.4300/jgme-d-16-00462.1.Search in Google Scholar

13. Graddy, R, Reynolds, SS, Wright, SM. Longitudinal resident coaching in the outpatient setting: a novel intervention to improve ambulatory consultation skills. Perspect Med Educ 2020;9:186–90. https://doi.org/10.1007/s40037-020-00573-5.Search in Google Scholar PubMed PubMed Central

14. Epstein, RM. Assessment in medical education. N Engl J Med 2007;356:387–96. https://doi.org/10.1056/nejmra054784.Search in Google Scholar

15. Powell, DE, Carraccio, C. Toward competency-based medical education. N Engl J Med 2018;378:3–5. https://doi.org/10.1056/nejmp1712900.Search in Google Scholar PubMed

16. Chatterjee, S, Desai, S, Manesh, R, Sun, J, Nundy, S, Wright, SM. Assessment of a simulated case-based measurement of physician diagnostic performance. JAMA Netw Open 2019;2: e187006. https://doi.org/10.1001/jamanetworkopen.2018.7006.Search in Google Scholar PubMed PubMed Central

17. Kahneman, D. Thinking, fast and slow. New York: Macmillan; 2011.Search in Google Scholar

18. Balogh, EP, Miller, BT, Ball, JR. Improving diagnosis in health care. Washington, DC: National Academies Press; 2015.10.17226/21794Search in Google Scholar PubMed

19. Sinha, P. Don’t just do something, stand there! JAMA Intern Med 2017;177:1420–1. https://doi.org/10.1001/jamainternmed.2017.3628.Search in Google Scholar PubMed

Received: 2020-09-27
Accepted: 2020-12-27
Published Online: 2021-02-03
Published in Print: 2021-05-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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