Summary
Background
No scientific assessment of the theoretical teaching of cardiology in France is available.
Aim
To analyse the impact of the available teaching modalities on the theoretical knowledge of French residents in cardiology.
Methods
Electronic questionnaires were returned by 283 residents. In the first part, an inventory of the teaching/learning methods was taken, using 21 questions (Yes/No format). The second part was a knowledge test, comprising 15 multiple-choice questions, exploring the core curriculum.
Results
Of the 21 variables tested, four emerged as independent predictors of the score obtained in the knowledge test: access to self-assessment ( P = 0.0093); access to teaching methods other than lectures ( P = 0.036); systematic discussion about clinical decisions ( P = 0.013); and the opportunity to prepare and give lectures ( P = 0.039). The fifth variable was seniority in residency ( P = 0.0003). Each item of the knowledge test was analysed independently: the score was higher when teaching the item was driven by reading guidelines and was lower if the item had not been covered by the programme ( P < 0.001). Finally, 91% of students would find it useful to have a national source for each topic of the curriculum; 76% of them would often connect to an e-learning platform if available.
Conclusions
It is necessary to rethink teaching in cardiology by involving students in the training, by using teaching methods other than lectures and by facilitating access to self-assessment. The use of digital tools may be a particularly effective approach.
Résumé
Contexte
Aucune évaluation scientifique de l’enseignement théorique de la cardiologie en France n’est disponible.
Objectif
Notre but était d’analyser l’impact des méthodes d’enseignement sur les connaissances théoriques des internes et assistants en cardiologie.
Méthodes
Deux cent quatre-vingt-trois internes et assistants ont répondu à un questionnaire électronique envoyé à l’ensemble des internes et résidents français. La première partie était un inventaire des différentes méthodes d’enseignement sous la forme de 21 questions Oui/Non. La seconde partie était une évaluation des connaissances théoriques sous la forme de 15 questions à choix multiples couvrant l’ensemble du programme.
Résultats
Parmi les 21 variables testées, 4 sont ressorties comme étant associées au score obtenu à l’évaluation des connaissances : l’accès à une auto-évaluation ( p = 0,0093), l’accès à d’autres méthodes pédagogiques que les cours magistraux ( p = 0,036), la discussion systématique avec un senior des décisions cliniques ( p = 0,013) et la possibilité pour les internes de préparer et donner eux-mêmes les cours théoriques ( p = 0,039). La cinquième variable était l’ancienneté ( p = 0,0003). Pour chaque QCM pris indépendamment, la note est plus élevée si l’information est tirée des recommandations et plus basse si aucune formation n’a été dispensée sur l’item testé par le QCM ( p < 0,001). Enfin, 91 % des étudiants trouveraient utile d’avoir une référence nationale pour chaque item du programme ; 76 % se connecteraient souvent à une plateforme de e-learning si elle était disponible.
Conclusions
Il est nécessaire de repenser l’enseignement en cardiologie en impliquant les étudiants dans l’enseignement, en utilisant des méthodes pédagogiques différentes du cours magistral et en facilitant l’accès à l’auto-évaluation. L’outil numérique semble être une approche adaptée à cet effet.
Background
The digital revolution leads us to rethink medical education. Diversification of educational facilities and new technologies are already part of the educational arsenal in the world’s largest universities. Technological innovations in e-learning help to individualize education (adaptive learning) and improve student/student and student/teacher interactions (collaborative learning). The European Society of Cardiology is currently involved in developing an extensive training programme integrating self-assessment modules .
It is intuitive to think that a medical doctor’s knowledge is one of the major determinants of quality of care. Thus, the scientific community has a duty to provide evidence-based education to medical residents, as it is currently the standard for medication evaluation.
In France, after the first 6 years of medical school, students have a national examination. According to their ranking, students can choose their specialization. The cardiology residency lasts for 4 years and consists of eight 6-month internships: four in various subspecialties of cardiology; one in vascular medicine or surgery; and three outside the discipline (preferably in internal medicine and intensive care). Conforming to the regulations, the courses represent 250 hours of training, which take place during the 4 years of residency. An exit examination is not needed, but a programme with the educational objectives is offered to students and teachers. The theoretical training of specialized medical residents is based mainly on local, regional or national lectures. Education at the regional level is based on clusters of three to six neighbouring universities, called ‘inter-regional areas’. In these areas, residents share lectures, workshops or seminars on a regular basis. National seminars consist of organized meetings for residents in cardiology, during which a major cardiology theme is approached tackled either by a lecture or by a more interactive approach. As showed in unpublished surveys by Moubarak et al., on behalf of the Group of Young Cardiologists appointed by the French Society of Cardiology, satisfaction with education remains low, at around 25–40%.
In this context, the assessment of the impact of teaching methods on residents’ expertise is a prerequisite for the evolution of medical education. We are therefore committed to understanding how residents have been trained since 2007, and to assessing the effect of each of these learning methods on residents’ knowledge.
Methods
Study population
A total of 780 electronic questionnaires were sent in June 2013 to residents and assistants affiliated to the French Society of Cardiology. Questionnaires were sent to all 28 French universities. Fifty email addresses were not functional. The electronic questionnaires were anonymous and were built using the ‘Google forms’ open source and secure software.
Composition of the questionnaire
The questionnaire consisted of two parts: an assessment of teaching methods followed by a knowledge test.
First part
Questions regarding teaching methods and satisfaction are summarized in Table 1 . Ten Yes/No questions described the implicit or explicit theoretical academic organization of their curriculum. Ten Yes/No questions described the context of the education, as well as the personal and studying resources used. Three scales from 1 to 10 assessed residents’ feelings about theoretical education, practical (bedside) education, and the usefulness of the available educational resources on the web. The use of Likert scale questions, multiple-choice questions (MCQs) and the opportunity to give suggestions allowed the residents to communicate the reasons for their dissatisfaction.
| Grouping | Question | Question format | Response | Abbreviation |
|---|---|---|---|---|
| Local training | In MY LAST INTERNSHIP, courses were organized at least once a month (excluding training by pharmaceutical companies) | Yes/No | 76% yes | 1. Intradepartment lessons |
| In MY LAST INTERNSHIP, staff meetings were held at least once a week | Yes/No | 82% yes | 2. Staff meetings | |
| In MY LAST INTERNSHIP, teaching during rounds by an MD or an MD/PhD took place at least once a week | Yes/No | 52% yes | 3. Training during rounds | |
| In MY LAST INTERNSHIP, all decisions that were problematic for me were discussed with a senior doctor | Yes/No | 86% yes | 4. Decisions discussed | |
| Academic training | Courses are held regularly at my academic hospital (at least 30 weeks per year) | Yes/No | 34% yes | 5. Frequent lectures |
| A quota is required for course attendance | Yes/No | 39% yes | 6. Quota for attendance at lectures | |
| The courses are usually prepared by residents rather than by senior doctors | Yes/No | 47% yes | 7. Lectures prepared by residents | |
| Teaching methods other than lectures are used (simulation exercises, workshops, etc.) | Yes/No | 18% yes | 8. Other teaching methods | |
| Regional and national training | A seminar takes place at least once a year in my academic (inter-regional) area (seven areas throughout the country) | Yes/No | 84% yes | 9. Inter-regional seminar |
| I have already attended at least two national seminars dedicated to residents | Yes/No | 50% yes | 10. National seminar | |
| Context | In MY LAST INTERNSHIP, I managed to spare time for myself during my working day (at least 1 hour per week) for self-instruction | Yes/No | 37% yes | 11. Spare time for self-instruction |
| In MY LAST INTERNSHIP, I spent more than 11 hours a day on average in hospital | Yes/No | 63% yes | 12. Hospital >11 hours per day | |
| I have the opportunity to take a self-assessment test (ECG analysis quiz, etc.) at least once per semester | Yes/No | 16% yes | 13. Self-assessment | |
| I provide more than 1 hour of instruction per week (to medical students, residents, etc.) | Yes/No | 32% yes | 14. Residents teaching others | |
| Personal training | I am enrolled in or have obtained at least two supplementary (optional) medical diplomas | Yes/No | 41% yes | 15. Supplementary medical diplomas >2 |
| I have read at least two of the six ESC full text guidelines published in 2012 | Yes/No | 73% yes | 16. ESC guidelines | |
| I read other international guidelines | Yes/No | 57% yes | 17. International guidelines | |
| I read a reference text book on a regular basis (e.g. Braunwald) | Yes/No | 32% yes | 18. Reference book | |
| I visit PubMed (or equivalent on the web) at least once a week | Yes/No | 39% yes | 19. Medical article database website | |
| I take the time, at least once a week, to read about cardiology (e.g. heart.org) | Yes/No | 59% yes | 20. Reading cardiology more than once/week | |
| In my education, I feel active | Yes/No | 65% yes | 21. Feeling active | |
| Personal impression | I think the quality of THEORETICAL TRAINING in my specialized degree in cardiology is/was | 1 to 10 | 4.3 ± 2 | |
| I think the quality of PRACTICAL TRAINING in my specialized degree in cardiology is/was | 1 to 10 | 6.3 ± 2.2 | ||
| I think the usefulness of the available educational resources on the web is/was | 1 to 10 | 5.2 ± 2 | ||
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
