We conducted a scoping review of the extant literature of AHD to map available literature and to highlight knowledge gaps about this educational strategy in post-graduate medical education. Scoping reviews are commonly used as a tool to synthesize emerging research evidence.14,15 According to Peters and colleagues, scoping reviews are useful when attempting to (1) map existing literature in terms of attributes and quantity; (2) clarify working definitions and conceptual boundaries of a topic or field; and, (3) identify gaps in existing literature and research.15 Scoping reviews are useful when considering a research area that has emerging evidence but a limited number of randomized controlled trials, making a systematic review unfeasible.14,15 Our goal was to describe the characteristics of AHD as a teaching method in post-graduate medical education, including the extent of use, content, and range of learner outcomes applying the Kirkpatrick model of learning evaluation.16
The Arksey and O’Malley methodological framework for scoping reviews ensures an orderly approach to mapping the existing evidence on what is known broadly about an area of interest.17 We employed the five stages of the Arksey and O’Malley framework to describe the use of the AHD in post-graduate medical training, and to identify any potential gaps in knowledge. These stages include: (1) identifying the research question; (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; and (5) collating, summarizing, and reporting the results.
Stage 1. Identifying the Research Question
This scoping review asked two research questions:
1. What are the key characteristics of the AHD teaching method used in post-graduate medical education curricula?
2. What is known about effects of the AHD on post-graduate medical trainees (i.e., learner outcomes)?
Stage 2. Identifying Relevant Studies
We consulted with an experienced medical librarian to establish key information sources and identify available studies. We selected relevant electronic databases (PubMed, Web of Science, ERIC, MedEdPORTAL) to be searched from their respective inceptions to September 13, 2019. We also selected Google and Google Scholar to take advantage of the search engines’ full-text search capability, something not available in some bibliographic databases. We then identified appropriate search terms: academic half-day, noon conference, didactic session, medical education, internship, residency, fellowship, and graduate. We identified the initial study count of 735 references that were imported into Covidence, a primary screening and data extraction tool.18 See Additional File 1 for electronic database search strategies.
Stage 3. Selecting Studies
Among those initially imported 735 references, we excluded 272 duplicated studies. Next, we established eligibility criteria for study selection to identify all studies describing the AHD as a teaching method in post-graduate medical education. Inclusion criteria were: (1) Teaching was delivered to, or described for implementation with, post-graduate medical trainees (MD/DO/residents/fellows), (2) Teaching was integrated into the general trainee curriculum, and (3) Teaching was described as a single intensive learning event (i.e., more than a single-hour didactic lecture), or self-described as a paper about AHD. Exclusion criteria were: (1) Papers written in a language other than English, (2) Teaching was provided during a workshop or other training opportunity not within the general residency or fellowship educational training program, (3) On-line curriculum solely, (4) Abstract not from peer-reviewed paper, (5) Review papers, (6) Teaching event covered only a single skill or procedure (e.g., surgical simulation of a single skill), and (7) Full day or multi-day lectures/trainings. Using these defined eligibility criteria, two authors (MSC and LMH) completed initial screening of the remaining 463 papers using the title and abstract. After title and abstract review, we excluded 385 papers. We then assessed 78 papers for full-text eligibility, at which point, we excluded 40 papers which resulted in 38 papers eligible for data charting and analysis. Through discussion with a third author (LCH), we resolved disagreements about study inclusion or exclusion at each step. See Figure 1 for summary.
Stage 4. Charting Data
We employed Arksey and O’Malley’s “descriptive-analysis” method of data extraction, summarizing information from the selected studies. Two authors (MSC and LMH) collectively developed a data-charting form using Microsoft® Excel for Mac (version 16.41, 2020) to create a common framework. Each author then recorded the data independently on the data-charting form. The data-charting form included demographic data (e.g., title of article, name of author, year of publication, name of journal, country of publication, discipline), teaching characteristics (e.g., self-description as AHD, rationale, structure, teaching modality, delivery time), resources (e.g., number of faculty, space, money, teaching equipment, use of standardized patient), learner characteristics (e.g. target audience, number of participants), and study characteristics (e.g., evaluation design, method). The form also included information about any measurement of AHD effect (e.g., learner outcomes); this information was organized using the Kirkpatrick Model of Training Evaluation 16, as a framework for relating learner outcomes. Kirkpatrick model is classified into four levels: reaction, learning, behavior, and results. As applied to medical education evaluation, Level 1, reaction, assesses learner’s reaction to the educational experience (e.g., learner attendance, interruption, or satisfaction). Level 2, learning, explores the degree of actual acquirement in intended knowledge, skill, and/or attitude, based on the participation in the educational experience. Level 3, behavior, looks into the degree of application of the educational experience to clinical practice on the job. Level 4, results, measures the effect of the educational experience on targeted goals such as patient outcome. See Additional File 2 for a selective summary of information collected with this data charting form.
Stage 5. Reporting Results
After independent completion of the data-charting form, we aggregated the information in a master Excel spreadsheet. All data disagreements were noted. The two authors (MSC and LMH) then collaboratively reviewed the aggregated data in the master spreadsheet and reconciled data differences, returning to the study in question if needed to re-assess, with input from third author (LCH) to resolve any disagreements.