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Author: Brian S McGowan, PhD

ABSTRACT: Resident versus faculty member simulation debriefing

BACKGROUND:
Near-peer teaching is effective in graduate medical education, but it has not been compared with faculty member teaching in resident simulation. In this study, we sought to compare debriefing sessions of internal medicine (IM) intern simulation sessions led by academic faculty doctors with those led by senior IM residents in order to measure the effectiveness of near-peer teaching in this setting. Near-peer teaching is effective in graduate medical education, but has not been compared with faculty member teaching in resident simulation METHOD: Internal medicine interns participated in four simulation cases, two of which were debriefed by faculty members and two of which were debriefed by residents. Pre-simulation knowledge assessment was completed prior to the case. Following each debriefing, interns completed a Debriefing Assessment for Simulation in Healthcare (DASH) survey. Post-simulation knowledge assessments were completed 6 months after simulation. Debriefings were recorded and transcribed. Each statement made during debriefing was classified as either correct or erroneous by blinded reviewers.
RESULTS:
Fifty interns participated in simulation, and the response rate on the DASH survey was 88%. There was no difference between DASH scores (p = 0.13), post-simulation knowledge assessments or error rates during debriefing (p = 0.31) for faculty member and resident instructors.
CONCLUSION:
Our study suggests that residents and faculty members provide a similar quality of simulation instruction based on qualitative and quantitative evaluation.

via Resident versus faculty member simulation debriefing. – PubMed – NCBI.

MANUSCRIPT: Use of dictation as a tool to decrease documentation errors in electronic health records

Background: Use of Electronic Health Records is increasing. Copy-and-paste function is frequently used with higher rates of documentation errors. Studies to determine the nature of such errors are needed.Objectives: Determination of the effect of implementing a dictation system for completing notes on the quality of clinical documentation. We hypothesized that implementation of the dictation system for note writing would decrease the rate of errors in the progress notes as well as decrease the rate of copying and pasting. Design/Methods: A prospective interventional study in inpatient medical service for six months’ duration starting in July 2016. Resident physicians’ charts were reviewed by the attending physician on a daily basis. This study was done in a community based hospital affiliated to a university program. Residents’ physicians included Internal Medicine, Transitional year and Combined Internal Medicine Pediatrics residents. Charts reviewed for hospitalized patients. A total of 54 residents were offered a pre-intervention survey indicating their subjective use of copy/paste function. Response rate of 85.18%. Progress notes were reviewed on a daily basis for residents on their inpatient rotation. A total of 621 notes were reviewed. Results: Percentage of notes copied prior to the intervention was 92.73% which decreased to 49.71% post-intervention (RR of 0.54, 95% CI 0.48 0.60 Z statistic 11.005 with p-value <0.0001). Of the copied notes percentage of errors pre-intervention was 58% with no errors identified post-intervention (RR of 0.005, 95% CI 0.0003 0.0795 Z statistic 3.752 with p-value 0.0002). Most of the errors are from notes copied by the same author (85.8%). The most common documentation error was in the physical examination section. Conclusion: Implementing a dictation system eliminated documentation errors over our six months’ study. Further studies are needed to check long effects of using such systems on documentation errors.

via Use of dictation as a tool to decrease documentation errors in electronic health records. – PubMed – NCBI.

ABSTRACT: Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review

The number of trials assessing Simulation-Based Medical Education (SBME) interventions has rapidly expanded. Many studies show that potential flaws in design, conduct and reporting of randomized controlled trials (RCTs) can bias their results. We conducted a methodological review of RCTs assessing a SBME in Emergency Medicine (EM) and examined their methodological characteristics. We searched MEDLINE via PubMed for RCT that assessed a simulation intervention in EM, published in 6 general and internal medicine and in the top 10 EM journals. The Cochrane Collaboration risk of Bias tool was used to assess risk of bias, intervention reporting was evaluated based on the “template for intervention description and replication” checklist, and methodological quality was evaluated by the Medical Education Research Study Quality Instrument. Reports selection and data extraction was done by 2 independents researchers. From 1394 RCTs screened, 68 trials assessed a SBME intervention. They represent one quarter of our sample. Cardiopulmonary resuscitation (CPR) is the most frequent topic (81%). Random sequence generation and allocation concealment were performed correctly in 66 and 49% of trials. Blinding of participants and assessors was performed correctly in 19 and 68%. Risk of attrition bias was low in three-quarters of the studies (n = 51). Risk of selective reporting bias was unclear in nearly all studies. The mean MERQSI score was of 13.4/18.4% of the reports provided a description allowing the intervention replication. Trials assessing simulation represent one quarter of RCTs in EM. Their quality remains unclear, and reproducing the interventions appears challenging due to reporting issues.

via Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review. – PubMed – NCBI.

MANUSCRIPT: Meta-analysis of faculty’s teaching effectiveness: Student evaluation of teaching ratings and student learning are not related

Student evaluation of teaching (SET) ratings are used to evaluate faculty’s teaching effectiveness based on a widespread belief that students learn more from highly rated professors. The key evidence cited in support of this belief are meta-analyses of multisection studies showing small-to-moderate correlations between SET ratings and student achievement (e.g., Cohen, 1980, 1981; Feldman, 1989). We re-analyzed previously published meta-analyses of the multisection studies and found that their findings were an artifact of small sample sized studies and publication bias. Whereas the small sample sized studies showed large and moderate correlation, the large sample sized studies showed no or only minimal correlation between SET ratings and learning. Our up-to-date meta-analysis of all multisection studies revealed no significant correlations between the SET ratings and learning. These findings suggest that institutions focused on student learning and career success may want to abandon SET ratings as a measure of faculty’s teaching effectiveness

 

Read more: https://ac.els-cdn.com/S0191491X16300323/1-s2.0-S0191491X16300323-main.pdf?_tid=0ead0432-d8f1-11e7-960c-00000aab0f02&acdnat=1512391730_abc7c35ba284e99e4939bac7de4ab9b2

MANUSCRIPT: Computer model for the cardiovascular system: development of an e-learning tool for teaching of medical students

BACKGROUND:
This study combined themes in cardiovascular modelling, clinical cardiology and e-learning to create an on-line environment that would assist undergraduate medical students in understanding key physiological and pathophysiological processes in the cardiovascular system.
METHODS:
An interactive on-line environment was developed incorporating a lumped-parameter mathematical model of the human cardiovascular system. The model outputs were used to characterise the progression of key disease processes and allowed students to classify disease severity with the aim of improving their understanding of abnormal physiology in a clinical context. Access to the on-line environment was offered to students at all stages of undergraduate training as an adjunct to routine lectures and tutorials in cardiac pathophysiology. Student feedback was collected on this novel on-line material in the course of routine audits of teaching delivery.
RESULTS:
Medical students, irrespective of their stage of undergraduate training, reported that they found the models and the environment interesting and a positive experience. After exposure to the environment, there was a statistically significant improvement in student performance on a series of 6 questions based on cardiovascular medicine, with a 33% and 22% increase in the number of questions answered correctly, p < 0.0001 and p < 0.001 respectively.
CONCLUSIONS:
Considerable improvement was found in students’ knowledge and understanding during assessment after exposure to the e-learning environment. Opportunities exist for development of similar environments in other fields of medicine, refinement of the existing environment and further engagement with student cohorts. This work combines some exciting and developing fields in medical education, but routine adoption of these types of tool will be possible only with the engagement of all stake-holders, from educationalists, clinicians, modellers to, most importantly, medical students.

via Computer model for the cardiovascular system: development of an e-learning tool for teaching of medical students. – PubMed – NCBI.

MANUSCRIPT: Is a Three-Dimensional Printing Model Better Than a Traditional Cardiac Model for Medical Education?

BACKGROUND:
Three-dimensional (3D) printing is a newly-emerged technology converting a series of two-dimensional images to a touchable 3D model, but no studies have investigated whether or not a 3D printing model is better than a traditional cardiac model for medical education.
METHODS:
A 3D printing cardiac model was generated using multi-slice computed tomography datasets. Thirty-four medical students were randomized to either the 3D Printing Group taught with the aid of a 3D printing cardiac model or the Traditional Model Group with a commonly used plastic cardiac model. Questionnaires with 10 medical questions and 3 evaluative questions were filled in by the students.
RESULTS:
A 3D printing cardiac model was successfully generated. Students in the 3D Printing Group were slightly quicker to answer all questions when compared with the Traditional Model Group (224.53 ± 44.13 s vs. 238.71 ± 68.46 s, p = 0.09), but the total score was not significantly different (6.24 ± 1.30 vs. 7.18 ± 1.70, p = 0.12). Neither the students’satisfaction (p = 0.48) nor their understanding of cardiac structures (p = 0.24) was significantly different between two groups. More students in the 3D Printing Group believed that they had understood at least 90% of teaching content (6 vs. 1). Both groups had 12 (70.6%) students who preferred a 3D printing model for medical education.
CONCLUSIONS:
A 3D printing model was not significantly superior to a traditional model in teaching cardiac diseases in our pilot randomized controlled study, yet more studies may be conducted to validate the real effect of 3D printing on medical education.

via Is a Three-Dimensional Printing Model Better Than a Traditional Cardiac Model for Medical Education? A Pilot Randomized Controlled Study. – PubMed – NCBI.

ABSTRACT: Structured education to improve primary-care management of headache: how long do the benefits last?

BACKGROUND:
Our earlier study showed that structured education of general practitioners (GPs) improved their practice in headache management. Here we assess duration of this effect.
METHODS:
In a follow-up observational study in Southern Estonia, subjects were the same six GPs as previously, managing patients presenting with headache as the main complaint. Data reflecting their practice were collected prospectively during a 1-year period commencing 2 years after the educational intervention. The primary outcome measure was referral rate (RR) to neurological services. Comparisons were made with baseline and post-intervention data from the earlier study.
RESULTS:
In 366 patients consulting during the follow-up period, RR was 19.9%, lower than at baseline (39.5%; p<0.0001) or post-intervention (34.7%; p<0.0001). RR was diagnosis-dependent: the biggest decline was for migraine. Usage of headache diagnostic terms showed changes generally favouring specific terminology. In particular, the proportion of patients given migraine diagnoses greatly increased while use of the inappropriate M79.1 (Pericranial) myalgia almost disappeared. Requests for investigations, which had fallen from 26% (of patients seen) at baseline to 4% post-intervention [5], resurged to 23% (mostly laboratory investigations: requests for x-rays continued to dwindle). Initiation of treatment by the GPs remained at the post-intervention level of just over 80% (up from baseline 58%).
CONCLUSIONS:
Improvements in GPs’ practice after a structured educational programme mostly last for ≥3 years, some showing further betterment. A few measures suggest the beginnings of decline towards baseline levels. This policy-informing evidence for continuing medical education indicates that the educational programme needs repeating every 2-3 years. This article is protected by copyright. All rights reserved.

via Structured education to improve primary-care management of headache: how long do the benefits last? A follow-up observational study. – PubMed – NCBI.

ABSTRACT: The interrupted learner: How distractions during live and video lectures influence learning outcomes

New instructional technologies have been increasingly incorporated into the medical school learning environment, including lecture video recordings as a substitute for live lecture attendance. The literature presents varying conclusions regarding how this alternative experience impacts students’ academic success. Previously, a multi-year study of the first-year medical histology component at the University of Michigan found that live lecture attendance was positively correlated with learning success, while lecture video use was negatively correlated. Here, three cohorts of first-year medical students (N = 439 respondents, 86.6% response rate) were surveyed in greater detail regarding lecture attendance and video usage, focusing on study behaviors that may influence histology learning outcomes. Students who reported always attending lectures or viewing lecture videos had higher average histology scores than students who employed an inconsistent strategy (i.e., mixing live attendance and video lectures). Several behaviors were negatively associated with histology performance. Students who engaged in “non-lecture activities” (e.g., social media use), students who reported being interrupted while watching the lecture video, or feeling sleepy/losing focus had lower scores than their counterparts not engaging in these behaviors. This study suggests that interruptions and distractions during medical learning activities-whether live or recorded-can have an important impact on learning outcomes.

via The interrupted learner: How distractions during live and video lectures influence learning outcomes. – PubMed – NCBI.

MANUSCRIPT: The impact of web-based and face-to-face simulation on patient deterioration and patient safety: protocol for a multi-site multi-method design

BACKGROUND:
There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the ‘failure to rescue’ literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety.
METHODS/DESIGN:
In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as ‘FIRST(2)ACT’, have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST(2)ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes.
DISCUSSION:
In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards.

via The impact of web-based and face-to-face simulation on patient deterioration and patient safety: protocol for a multi-site multi-method design. – PubMed – NCBI.

RESOURCE: Mental down-time affects memory

Research has shown that recent experiences are reactivated during sleep and wakeful rest. This “downtime” recall of memories is part of the process for consolidating long-term memory and serves as memory rehearsal that can strengthen the memory. Thus, the old saying, “all work and no play makes Jack a dull boy,” might be re-framed, “all work and no rest makes Jack a poor learner.”

To expand on this idea, a study was conducted to test whether this memory enhancing effect of mental downtime applied to new learning of related material. In other words, does downtime help form memories for new experiences as well as it does for recent past experiences? The researchers hypothesized that the degree to which memory processes are engaged during mental downtime determines whether or not prior knowledge promotes or interferes with new learning.

To read the full post: Mental down-time affects memory | npj Science of Learning Community.