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Author: Brian S McGowan, PhD

MANUSCRIPT: General practice training and virtual communities of practice – a review of the literature

Background
Good General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs) in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research.

Methods
Major online databases Scopus, Psychlit and Pubmed were searched for the terms “Community of Practice” (CoP) AND (Online OR Virtual OR Electronic) AND (health OR healthcare OR medicine OR “Allied Health”). Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training.

via BMC Family Practice | Full text | General practice training and virtual communities of practice – a review of the literature.

MANUSCRIPT: Teaching and assessing procedural skills: a qualitative study

Background
Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. Little is known about resident experiences of acquiring procedural skills proficiency, of practicing these techniques, or of being assessed on their proficiency. The purpose of this study was to qualitatively investigate resident 1) experiences of the acquisition of procedural skills and 2) perceptions of procedural skills assessment methods available to them.

Methods
Focus groups were conducted in the weeks following an assessment of procedural skills incorporated into an objective structured clinical examination (OSCE). Using fundamental qualitative description, emergent themes were identified and analyzed.

Results
Residents perceived procedural skills assessment on the OSCE as a useful formative tool for direct observation and immediate feedback. This positive reaction was regularly expressed in conjunction with a frustration with available assessment systems. Participants reported that proficiency was acquired through resident directed learning with no formal mechanism to ensure acquisition or maintenance of skills.

Conclusions
The acquisition and assessment of procedural skills in Internal Medicine programs should move toward a more structured system of teaching, deliberate practice and objective assessment. We propose that directed, self-guided learning might meet these needs.

via BMC Medical Education | Abstract | Teaching and assessing procedural skills: a qualitative study.

Improving Case-Based Learning with Learning Actions Research

One of the most common challenges we get from partners who are integrating our natural learning actions research into their educational plans is whether the model is applicable (or necessary) in case-based or problem-based initiatives.

Before we explore the answer to this question I thought it is worth the time to reflect on one of the key findings of our research to date – clinician learners need structure to support their lifelong learning. The model of planning, developing, packaging, and delivering content is insufficient to have the impact we intend (and need) our programs to achieve. We are learning that despite the fact that clinicians have spent much of their career engaging in continuing education, they very much still struggle with how to absorb and integrate new information into practice (knowledge translation). By providing structure that supports the natural learning actions we can make learning more effective and more efficient.

Now back to the original challenge, “Is the natural learning actions model applicable (or necessary) in case-based or problem-based lessons?”  With a bit of probing it seems that this question is typically rooted in the belief that case-based learning is in-and-of-itself a sufficient model to support knowledge translation and skills development; that since the design is typically more interactive, it is fully-formed. The reality is that, while data do suggest that case-based learning is often a more effective model, there is no data suggesting that it is absent of the same issues that undermine other modes of teaching (ie. live lecture, print-based education, etc.).

Lets use the schematics below to understand how learning actions research may be applied in a common form of case-based education:

Learning Moments and Actions Dual Schematic

In the typical case model (illustrated to the left above) the clinical scenario presents a series of actionable moments in which the learner is expected to make a decision. Once the clinical choice is made new information is presented within the context of feedback. In this way choices/actions are intertwined with information exchange – and as we learned within the learning actions research: providing a structure for information exchange is critical to supporting lifelong learning. To simplify this (illustrated to the right above) each of the learning moments within a typical case model is a critical moment for the application of the learning actions research. Said another way, each learning moment will be an opportunity for note-taking, reminders being set, searching related context, and if possible, social learning.

Surely the more practical nature of case-based learning is an essential reason why, in many settings, it outperforms other educational models, but that does not (in any way) make it fully-formed. The reality is that each of the actionable moments within a case can be used to enable information exchange and knowledge transfer. Mind you that this is just as true for tumor boards and M&M conferences as it is for case-based lectures or even simulations.

What is the takeaway? There is little value in case-based education that is devoid of actual information exchange, and whenever/however there is new information being exchanged we, as educators, must begin to recognize that we have been missing a clear opportunity to support the natural learning actions described in our natural learning actions research.

But wait, there’s more…the flip side of this is that when the learner is actively engaged in case-based learning, they are even more likely to be nudged using the triggers that we believe are essential to effectively leveraging the learning actions, AND the case-based, interactive model itself makes it far simpler to engineer the appropriate nudges and triggers.

So the answer the original challenge, “Is the natural learning actions model applicable (or necessary) in case-based or problem-based lessons?”  Not only is it applicable, it is every bit as essential and in more ways even easier to apply!

 

 

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ABSTRACT: Perceptions of family physician trainees and trainers regarding the usefulness of a virtual community of practice

Abstract
BACKGROUND:
Training for Australian general practice, or family medicine, can be isolating, with registrars (residents or trainees) moving between rural and urban environments, and between hospital and community clinic posts. Virtual communities of practice (VCoPs), groups of people sharing knowledge about their domain of practice online and face-to-face, may have a role in overcoming the isolation associated with general practice training.
OBJECTIVE:
This study explored whether Australian general practice registrars and their supervisors (trainers) would be able to use, and would be interested in using, a VCoP in the form of a private online network for work and training purposes. It also sought to understand the facilitators and barriers to intention to use such a community, and considers whether any of these factors may be modifiable.
METHODS:
A survey was developed assessing computer, Internet, and social media access and usage, confidence, perceived usefulness, and barriers, facilitators, and intentions to use a private online network for training purposes. The survey was sent by email link to all 139 registrars and 224 supervisors in one of Australia’s 17 general practice training regions. Complete and usable responses were received from 131 participants (response rate=0.4).
RESULTS:
Most respondents had access to broadband at home (125/131, 95.4%) and at work (130/131, 99.2%). Registrars were more likely to spend more than 2 hours on the Internet (P=.03), and to use social media sites for nonwork purposes (P=.01). On a 5-point Likert scale, confidence was high (mean 3.93, SD 0.63) and was negatively associated with higher age (P=.04), but not associated with training stage. Social media confidence was lower, with registrars more confident than supervisors for almost all social media activities. On a 5-point Likert scale, overall usefulness was scored positively (n=123, mean 3.63, SD 0.74), and was not significantly associated with age or training level. The main concerns of respondents were worries about privacy (registrar: 61/81, 75.3%; supervisor: 30/50, 60.0%) and insufficient time (registrar: 41/81, 50.6%; supervisor: 36/50, 72.0%). Using a multivariate generalized linear regression model, training stage and perceived usefulness were positively predictive, and concerns about privacy and time were negatively predictive of intention to use a private online network.
CONCLUSIONS:
General practice registrars and supervisors are interested in using a private online network, or VCoP, for work and training purposes. Important considerations are the extent to which concerns such as privacy and usefulness may be overcome by training and support to offset some other concerns, such as time barriers. Participants at an early stage in their training are more receptive to using an online network. More senior registrars and supervisors may benefit from more training and promotion of the online network to improve their receptiveness.

via Perceptions of family physician trainees … [J Med Internet Res. 2013] – PubMed – NCBI.

ABSTRACT: Perceptions of family physician trainees and trainers regarding the usefulness of a virtual community of practice

Abstract
OBJECTIVE:
To map the state of the existing literature evaluating the use of social media in patient and caregiver populations.
DESIGN:
Scoping review.
DATA SOURCES:
Medline, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge and ProQuest (2000-2012).
STUDY SELECTION:
Studies reporting primary research on the use of social media (collaborative projects, blogs/microblogs, content communities, social networking sites, virtual worlds) by patients or caregivers.
DATA EXTRACTION:
Two reviewers screened studies for eligibility; one reviewer extracted data from relevant studies and a second performed verification for accuracy and completeness on a 10% sample. Data were analysed to describe which social media tools are being used, by whom, for what purpose and how they are being evaluated.
RESULTS:
Two hundred eighty-four studies were included. Discussion forums were highly prevalent and constitute 66.6% of the sample. Social networking sites (14.8%) and blogs/microblogs (14.1%) were the next most commonly used tools. The intended purpose of the tool was to facilitate self-care in 77.1% of studies. While there were clusters of studies that focused on similar conditions (eg, lifestyle/weight loss (12.7%), cancer (11.3%)), there were no patterns in the objectives or tools used. A large proportion of the studies were descriptive (42.3%); however, there were also 48 (16.9%) randomised controlled trials (RCTs). Among the RCTs, 35.4% reported statistically significant results favouring the social media intervention being evaluated; however, 72.9% presented positive conclusions regarding the use of social media.
CONCLUSIONS:
There is an extensive body of literature examining the use of social media in patient and caregiver populations. Much of this work is descriptive; however, with such widespread use, evaluations of effectiveness are required. In studies that have examined effectiveness, positive conclusions are often reported, despite non-significant findings.

via Social media use among patients and caregivers: a s… [BMJ Open. 2013] – PubMed – NCBI.

ABSTRACT: Understanding the Group Size Effect in Electronic Brainstorming

A number of studies on electronic brainstorming have found that large electronic groups can facilitate the number of ideas generated relative to control groups of similar numbers of solitary performers (nominal groups). Thus far there is no clear evidence for the basis of this facilitative effect. The most likely explanation is that group members benefit from exposure to the wide range of ideas in large groups. Since most electronic brainstorming studies appear to divide the presented ideas into subfolders to avoid overloading participants with too many ideas, this practice may be important for demonstration of a benefit of exposure to a large number of ideas. The present study was designed to assess the role of number of ideas and number of folders on individual idea generation and to eliminate some alternative interpretations for the group size effect. Participants performed an idea generation task on computers while being exposed to either no ideas, 28 ideas, or 112 ideas. The 28 and 112 ideas were presented in either one, four, or eight folders. The results indicated that only the number of ideas factor was important for facilitating idea generation.

via Understanding the Group Size Effect in Electronic Brainstorming.

ABSTRACT: The Role of Feeling Known for Team Member Outcomes in Project Teams

This research introduces the concept of feeling known—or the belief that others have developed accurate opinions of one’s traits and characteristics—to the team literature. Various theoretical streams posit that acquiring a sense of being known and understood is a central human motivation that leads to positive outcomes for individuals. The present research links team member’s sense of feeling known with team member’s reports of interpersonal trust, personal learning, and project satisfaction in a large sample of project teams. Using a longitudinal study design, this research finds that feeling known is indeed a strong predictor of proximal and distal team member outcomes. Additional analyses reveal that team members’ sense of feeling known plays a role in predicting outcomes for both face-to-face and virtual team members, despite the fact that virtual team members report feeling less known than face-to-face team members. The practical significance of these results is discussed.

via The Role of Feeling Known for Team Member Outcomes in Project Teams.

ABSTRACT: The Effects of Group Factors on Deception Detection Performance

Deception has been an important problem in interactive groups, impeding effective group communication and group work, yet deception detection in such a context remains understudied. Extrapolated from the interpersonal deception theory (IDT) and group composition research in cooperative contexts, this research proposes that group factors, including diversity and familiarity, have influence on the performance of deception detection. The measurement of group performance was not limited to success, as previous deception studies did, but included efficiency as well because it is fundamental to the effectiveness of deception detection. An analysis of data collected from a real-world online community found that behavioral familiarity had a positive effect, and gender diversity had a negative effect, on group success in deception detection. In addition, behavioral familiarity had a negative effect and functional diversity had a positive effect on the group efficiency of deception detection. The findings not only extend IDT in several important ways but also suggest the need to distinguish between noncooperative and cooperative groups, an important theoretical implication for group composition research.

via The Effects of Group Factors on Deception Detection Performance.

ABSTRACT: Social Validation of Shared and Nonvalidation of Unshared Information in Group Discussions

Research on information sharing within groups confirms a favoring of shared compared to unshared information. Social validation is considered to be the primary psychological mechanism explaining this group bias (Wittenbaum, Hubbell, & Zuckerman, 1999). Our focus here is on a process-related measurement of the social validation of shared information, as well as the social nonvalidation of unshared information in the discussion protocols of 31 decision-making groups. Results confirmed that mentioning shared information evoked social validations, whereas mentioning unshared information evoked nonvalidations (H1). Contrary to our expectation that social validation would encourage the repetition of shared information and social nonvalidation would discourage the repetition of nonshared information (H2), we found that nonvalidation of information enhanced the probability of repetition. We conclude that the need for social validation found in face-to-face groups can be overcome in a more task-oriented, goal-focused, and depersonalized media-based communication setting such as the one in this study.

via Social Validation of Shared and Nonvalidation of Unshared Information in Group Discussions.

ABSTRACT: Goal Instructions, Response Format, and Idea Generation in Groups

This study examined the separate and joint impact of two standard, but seemingly conflicting brainstorming rules on idea generation in interacting and nominal groups: the free-wheeeling rule, which calls for the production of dissimilar ideas, and the build-on rule, which encourages idea combination and improvement. We also tested whether the superior performance of interacting groups found in several previous studies using a brainwriting technique may have been due to the different response formats employed by groups and individuals. Interacting groups and individuals generated ideas for improving their university under one of three sets of instructions. In one condition, participants were given the build-on rule, but not the free-wheeling rule, and in another condition, the reverse was true. In the third condition, both rules were provided. When the two rules were presented separately, interacting and nominal groups responded similarly, generating ideas from more semantic categories in response to the free-wheeling rule, and generating more practical ideas in response to the build-on rule. But when those rules were presented simultaneously, interacting groups generated ideas from fewer semantic categories than did nominal groups. In addition, interacting groups produced more ideas overall than nominal groups, but only when the two used different response formats.

via Goal Instructions, Response Format, and Idea Generation in Groups.