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Author: Brian S McGowan, PhD

ABSTRACT: Communication Challenges for Chronic Metastatic Cancer in an Era of Novel Therapeutics

Advances in the production of novel therapies for cancer management are creating new challenges for the support of increasing numbers of persons surviving for extended periods with advanced disease. Despite incurable and life-limiting metastatic conditions, these patients are living longer with serious disease, pushing the boundaries of what science explains and clinicians can confidently interpret using available evidence. Here we report findings from an early subset of such individuals within a longitudinal qualitative cancer cohort study on clinician–patient communication across the cancer trajectory. In these findings, we contextualize experiential accounts of communication in a changing environment of the costs and uncertainties of personalized medicine, and examine the complex psychosocial circumstances of this rapidly growing patient population. Interpretation of these findings illustrates how emerging issues in cancer treatment influence the experience of these patients, their social and support networks, their cancer care specialists, and the multidisciplinary teams charged with coordinating their care.

via Communication Challenges for Chronic Metastatic Cancer in an Era of Novel Therapeutics.

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ABSTRACT: UUnderstanding the Etiology of Prescription Opioid Abuse Implications for Prevention and Treatment

Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse (POA) etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.

via Understanding the Etiology of Prescription Opioid Abuse.

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ABSTRACT: Medical student perspectives of what makes a high-quality teaching practice

Abstract
Primary care has seen increasing involvement in undergraduate medical education following recommendation from the GMC in Tomorrow’s Doctors. This is also influenced by an increasing number of medical students and changing patterns of health care. The variety of practices involved in delivering undergraduate primary care placements poses a challenge for the quality of these placements. The variety of learners in primary care may also affect this. To reflect this, Cotton et al in 2009 produced a national consensus list of quality criteria for community-based education using a variety of medical education stakeholders. This paper seeks to explore the medical student perspective of what makes a high-quality teaching practice. This study uses focus group interviewing to explore student perspectives of the range of factors that can contribute towards the quality of a primary care placement. Previous research into student perspectives of teaching in primary care has revealed a strong focus on tutor quality. Students in this study again highlighted the important of good GP tutors and organisation of placements. However, one novel finding was the emphasis that students placed on involving patients in teaching and the vital role that they play in this.

via Medical student perspectives of what makes a … [Educ Prim Care. 2013] – PubMed – NCBI.

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ABSTRACT: Do residents need end-of-life care training?

Abstract
Objective: As medical education evolves, emphasis on chronic care management within the medical curriculum becomes essential. Because of the consistent lack of appropriate end-of-life care training, far too many patients die without the benefits of hospice care. This study explores the association between physician knowledge, training status, and level of comfort with hospice care referral of terminally ill patients. Method: In 2011, anonymous surveys were distributed to physicians in postgraduate years 1, 2, and 3; fellows; hospital attending physicians; specialists; and other healthcare professionals in five hospitals of a large health system in New York. Demographic comparisons were performed using χ2 and Fisher’s exact tests. Spearman correlations were calculated to determine if professional status and experience were associated with comfort and knowledge discussing end-of-life topics with terminal patients. Results: The sample consisted of 280 participants (46.7% response rate). Almost a quarter (22%) did not know key hospice referral criteria. Although 88% of respondents felt that knowledge of hospice care is an important competence, 53.2% still relinquished advance directives discussion to emergency room (ER) physicians. Fear of patient/family anger was the most frequently reported hospice referral barrier, although 96% of physicians rarely experienced reprisals. Physician comfort level discussing end-of-life issues and hospice referral was significantly associated with the number of years practicing medicine and professional status. Significance of results: Physicians continue to relinquish end-of-life care to ER staff and palliative care consultants. Exploring unfounded and preconceived fears associated with hospice referral needs to be integrated into the curriculum, to prepare future generations of physicians. Medical education should focus on delivering the right amount of end-of-life care training, at the right time, within the medical school and residency curriculum.

via Do residents need end-of-life care trai… [Palliat Support Care. 2013] – PubMed – NCBI.

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ABSTRACT: Virtual patient design: exploring what works and why. A grounded theory study.

Abstract
OBJECTIVES:
Virtual patients (VPs) are online representations of clinical cases used in medical education. Widely adopted, they are well placed to teach clinical reasoning skills. International technology standards mean VPs can be created, shared and repurposed between institutions. A systematic review has highlighted the lack of evidence to support which of the numerous VP designs may be effective, and why. We set out to research the influence of VP design on medical undergraduates.
METHODS:
This is a grounded theory study into the influence of VP design on undergraduate medical students. Following a review of the literature and publicly available VP cases, we identified important design properties. We integrated them into two substantial VPs produced for this research. Using purposeful iterative sampling, 46 medical undergraduates were recruited to participate in six focus groups. Participants completed both VPs, an evaluation and a 1-hour focus group discussion. These were digitally recorded, transcribed and analysed using grounded theory, supported by computer-assisted analysis. Following open, axial and selective coding, we produced a theoretical model describing how students learn from VPs.
RESULTS:
We identified a central core phenomenon designated ‘learning from the VP’. This had four categories: VP Construction; External Preconditions; Student-VP Interaction, and Consequences. From these, we constructed a three-layer model describing the interactions of students with VPs. The inner layer consists of the student’s cognitive and behavioural preconditions prior to sitting a case. The middle layer considers the VP as an ‘encoded object’, an e-learning artefact and as a ‘constructed activity’, with associated pedagogic and organisational elements. The outer layer describes cognitive and behavioural change.
CONCLUSIONS:
This is the first grounded theory study to explore VP design. This original research has produced a model which enhances understanding of how and why the delivery and design of VPs influence learning. The model may be of practical use to authors, institutions and researchers.

via Virtual patient design: exploring what works and wh… [Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Beyond individualism: professional culture and its influence on feedback.

Abstract
CONTEXT:
Although feedback is widely considered essential to learning, its actual influence on learners is variable. Research on responsivity to feedback has tended to focus on individual rather than social or cultural influences on learning. In this study, we explored how feedback is handled within different professional cultures, and how the characteristics and values of a profession shape learners’ responses to feedback.
METHODS:
Using a constructivist grounded theory approach, we conducted 12 focus groups and nine individual interviews (with a total of 50 participants) across three cultures of professional training in, respectively, music, teacher training and medicine. Constant comparative analysis for recurring themes was conducted iteratively.
RESULTS:
Each of the three professional cultures created a distinct context for learning that influenced how feedback was handled. Despite these contextual differences, credibility and constructiveness emerged as critical constants, identified by learners across cultures as essential for feedback to be perceived as meaningful. However, the definitions of credibility and constructiveness were distinct to each professional culture and the cultures varied considerably in how effectively they supported the occurrence of feedback with these critical characteristics.
CONCLUSIONS:
Professions define credibility and constructiveness in culturally specific ways and create contexts for learning that may either facilitate or constrain the provision of meaningful feedback. Comparison with other professional cultures may offer strategies for creating a productive feedback culture within medical education.

via Beyond individualism: professional culture and its … [Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: The current and future state of pharmacogenomics medical education in the USA.

Abstract
Healthcare professionals (e.g., physicians, physician assistants, pharmacists, nurses and genetic counselors) believe pharmacogenomics (PGx) is essential to personalized medicine; however, they still lack confidence prescribing, dosing, interacting with other healthcare professionals and counseling patients with regard to PGx. This is due to the inadequate incorporation of PGx content into professional curricula. Compared with other health professions, Doctor of Pharmacy programs have integrated more PGx content. Unlike other healthcare professionals, pharmacists have extensive training in pharmacology, drug selection, drug dosage, drug-drug interactions and are uniquely accessible to patients. We suggest pharmacists are the best poised to facilitate incorporating PGx into therapeutic decision-making. Based on our experience as undergraduate and pharmacy PGx educators, we further reflect on our experience educating future healthcare professionals on PGx.

via The current and future state of pharmacogen… [Pharmacogenomics. 2012] – PubMed – NCBI.

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MANUSCRIPT: Concussion guidelines need to move from only expert content to also include implementation and dissemination strategies — Finch et al. 47 1: 12 — British Journal of Sports Medicine

Sport-related head injuries place a significant burden on the health service delivery systems needed to treat and assess them; the sport delivery systems responsible for providing safe sporting opportunities; and personally on the individuals who sustain them. The number of head injury occurrences, the anecdotally high levels of public concern about the risk of head injury in sport and the fact that there is so much public misinformation about their assessment, management and prevention1–3 make the prevention of sport-related head injury a health priority. The most recent international consensus statement on the management of concussion in sport stated that there is a need to develop guidelines, education resources and other health promotion approaches for the prevention of head injury and its adverse outcomes across all sports with a risk of serious head injury.4 However, while there is evidence that some educational resources and guidelines have been developed, these have had varying success because they have not incorporated social marketing approaches.2 ,3 ,5

via Concussion guidelines need to move from only expert content to also include implementation and dissemination strategies — Finch et al. 47 1: 12 — British Journal of Sports Medicine.

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ABSTRACT: Development of a Method to Measure and Compare Hospital Waste

Abstract

The authors developed 15 measures and a comparative index to assist acute care facilities in identifying and monitoring clinical and administrative functions for health care waste reduction. Primary clinical and administrative data were collected from 261 acute care facilities contained within a database maintained by Premier Inc, spanning October 1, 2010, to September 30, 2011. The measures and 4 index models were tested using the Cronbach α coefficient and item-to-total and Spearman rank correlations. The final index model was validated using 52 facilities that had complete data. Analysis of the waste measures showed good internal reliability (α = .85) with some overlap. Index modeling found that data transformation using the standard deviation and adjusting for the proportional contribution of each measure normalized the distribution and produced a Spearman rank correlation of 0.95. The waste measures and index methodology provide a simple and reliable means to identify and reduce waste and compare and monitor facility performance.

via Development of a Method to Measure and Compare Hospital Waste.

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ABSTRACT: YouTube: An emerging tool in anatomy education.

Abstract
The use of online social networks in medical education can remodel and enhance anatomy teaching and learning; one such network is the video-sharing site YouTube. Limited research in the literature exists on the use of YouTube as a platform for anatomy education. The aim of this study is to assess student’s perceptions and patterns of usage of this resource, as well as the effectiveness of YouTube videos within a problem-based learning (PBL) curriculum. The study was conducted on 91 second-year medical students for whom video links were suggested throughout the academic year. In addition, the Human Anatomy Education (HAE) Channel was launched on YouTube to support classroom teaching with videos that emphasized applied aspects of anatomy. The results demonstrated that 98% of the students used YouTube as an online information resource, albeit in different frequencies. Out of the 86% who have been to the HAE Channel, 92% agreed/strongly agreed that the channel helped them learn anatomy. The study also reports the popularity of and awareness about using YouTube as a social network as well as in learning. Based on these findings, YouTube can be considered as an effective tool to enhance anatomy instruction if the videos are scrutinized, diversified, and aimed toward course objectives. Faculty of average computer literacy should be enabled to produce videos on their own YouTube channels to support independent learning and integration in a PBL curriculum. The methods described for capturing and editing the videos can be used as a prototype.

via YouTube: An emerging tool in anatomy e… [Anat Sci Educ. 2012 May-Jun] – PubMed – NCBI.

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