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Author: Brian S McGowan, PhD

RESOURCE: 300 Years of Distance Learning Evolution [INFOGRAPHIC]

If you thought that distance learning was a product of today, then you would be mistaken. In fact, the first distance learning program on record took place in 1728, when a local teacher by the name of Caleb Phillips advertised shorthand correspondence lessons offered by mail! By 1800, the growth of the U.S. Postal Service brought about an increase in the number of distance learning correspondence courses in the country. Remember, mail back then was like email is today – “fast”, convenient, and nearly everyone had access. Heck, by 1873, the University of the Cape of Good Hope (South Africa) founded a distance learning facility.

Times sure have changed, in particular because of accessible and advanced technology. But it never hurts to take a look back in time to see how distance learning has evolved. As expected, once technology started to become more developed in the last century, we have seen a rapid growth in the number of distance learning offerings. Starting with radio and television, and naturally with the computer, when BlackBoard entered the market (1999) to help lead the charge into the new millennium. Today, roughly 60% of four-year U.S. private colleges and universities offer online classes.

via 300 Years of Distance Learning Evolution [INFOGRAPHIC] | WPLMS.

Nudging learners to effectively learn

For as long as I have been teaching, creating medical education, or even funding education there has always been one assumption that has bothered me about what we broadly refer to as ‘adult learning,’ and that is the assumption that adults KNOW how to learn. This assumption is all the more critical when we move from a singular focus on adult learning theory and begin to focus the more practical learning actions.

To put the critical reality of this assumption in context using just a small example of physician education: Each year in the US there are more than 100,000 different activities planned and implemented by ACCME-accredited providers totaling nearly 1,000,000 hours of medical education. The costs in terms of finances and energies is nearly impossible to calculate. And, in what may be the understatement of the year, this is a pretty weighty model to base on an assumption.

Now, if the assumption is valid, then ‘no harm done’ and we might just as well be content with the efficiency and effectiveness of the existing model of lifelong learning in the health professions. But if the assumption is invalid, well then this one issue (do clinicians really know how to learn) might go a long way to explaining why we continue to hear about a ‘broken and fragmented‘ system of lifelong learning and why CME in particular has been referred to as ‘minimally’ or ‘generally’ effective.

So as we began our recent research into clinician lifelong learning – the same research that lead to what we have come to call the Natural Learning Actions – we began to ask clinicians how efficiently and effectively they leveraged each of these actions.

Here are the average grades that the clinician learners gave themselves:

C- grade F grade

Note-taking:   C-

Setting Reminders/
Reflection:   F

Search:   C-

Social Learning:   C-

 

Read through those grades one more time! As clinicians began to reflect on how critical the learning actions were to their ability to efficiently and effectively absorb and take action on new information, they just as quickly came to the realization that they hadn’t spent much time honing these learning actions. Not one clinician in our interviews had ever taken a course on note-taking. Fewer than 1 in 20 had ever taken a course in ‘search’. Here we are assuming for as long as I can tell that learners – especially learners with the intelligence and passion of physicians – know how to learn when by the own volition, this is far from the reality.

I have been chewing on this new view of lifelong learning in the healthcare professions for several months now and these findings are in no way a condemnation of clinician learners or medical educators – it is simply a logical, but faulty, assumption that we now know has long been undermining our educational models. Surely clinicians have learned through existing undergraduate and lifelong learning opportunities. Surely some of the most critical lessons stick. But what we have come to learn is that by nudging our learners to take notes, set reminders, search for related context, and engage with other learners we may make learning much more efficient and effective.

Over the coming months our research will undoubtedly bear this out. But in the meantime I continue to look for other evidence to support (or refute) our new model, which leads me to my final thought. With this new context in mind, go ahead and read this statement recently published in Medical Teacher by faculty at Johns Hopkins:

Reflection is a skill that requires teaching and practice. It is within the explicit process of teaching reflection in medical education that reflective learners can be developed.

It may come as no surprise but I support this notion whole-heartily. Note-taking is a skill. Setting reminders and reflection systems is a skill. Searching for related context is a skill. And engaging effectively with other learners to co-create knowledge is a skill. Each of these learning actions is a skill that must be trained, honed, refined, and occasionally nudged. And in a lifelong learning system where these skills can be optimized, so to will be learning.

 

 

MANUSCRIPT: Experience with using second life for medical education in a family and community medicine education unit.

Abstract
BACKGROUND:
The application of new technologies to the education of health professionals is both a challenge and a necessity. Virtual worlds are increasingly being explored as a support for education. Aim: The aim of this work is to study the suitability of Second Life (SL) as an educational tool for primary healthcare professionals.
METHODS:
Design: Qualitative study of accredited clinical sessions in SL included in a continuing professional development (CPD) programme for primary healthcare professionals. Location: Zaragoza I Zone Family and Community Medicine Education Unit (EU) and 9 health centres operated by the Aragonese Health Service, Aragon, Spain. Method: The EU held two training workshops in SL for 16 healthcare professionals from 9 health centres by means of two workshops, and requested them to facilitate clinical sessions in SL. Attendance was open to all personnel from the EU and the 9 health centres. After a trail period of clinical sessions held at 5 health centres between May and November 2010, the CPD-accredited clinical sessions were held at 9 health centres between February and April 2011. Participants: 76 healthcare professionals attended the CPD-accredited clinical sessions in SL. Main measurements: Questionnaire on completion of the clinical sessions.
RESULTS:
Response rate: 42-100%. Questionnaire completed by each health centre on completion of the CPD-accredited clinical sessions: Access to SL: 2 centres were unable to gain access. Sound problems: 0% (0/9). Image problems: 0% (0/9). Voice/text chat: used in 100% (10/9); 0 incidents. Questionnaire completed by participants in the CPD-accredited clinical sessions: Preference for SL as a tool: 100% (76/76). Strengths of this method: 74% (56/76) considered it eliminated the need to travel; 68% (52/76) believed it made more effective use of educational resources; and 47% (36/76) considered it improved accessibility. Weaknesses: 91% (69/76) experienced technical problems, while; 9% (7/76) thought it was impersonal and with little interaction. 65.79% (50/76) believed it was better than other distance learning methods and 38.16% (29/76) believed it was better than face-to-face learning.
CONCLUSIONS:
SL is a tool that allows educational activities to be designed that involve a number of health centres in different geographical locations, consequently eliminating the need to travel and making more effective use of educational resources.

via Experience with using second life for medical e… [BMC Med Educ. 2012] – PubMed – NCBI.

ABSTRACT: An evaluation of the ‘5 Minute Medicine’ video podcast series compared to conventional medical resources for the internal medicine clerkship.

Abstract
BACKGROUND:
‘5 Minute Medicine’ (5MM) is a series of video podcasts, that in approximately 5 min, each explain a core objective of the internal medicine clerkship that all clinical clerks should understand. Video podcasts are accessible at www.5minutemedicine.com
AIM:
The aim of this study was to investigate how well received 5MM video podcasts are as an educational tool for clinical clerks to use while on call.
METHODS:
Clinical clerks rotating through their internal medicine clerkship rotation were asked to use the 5MM video podcasts or conventional resources to prepare themselves prior to seeing patients. Questionnaires were distributed to students to determine effectiveness, appropriateness and time-efficiency of the resources students used.
RESULTS:
Students almost unanimously strongly agreed or agreed that the 5MM video podcasts were effective learning tools, appropriate for clinical clerks and time-efficient, more so than conventionally used resources. The vast majority of clerks selected the 5MM videos as their preferred resource of all resources available to them. Most clerks felt the 5MM videos were better than textbooks and conventional online resources.
CONCLUSION:
Video podcasts such as the 5MM videos are welcomed as educational tools and may have a role in the future of undergraduate medical education.

via An evaluation of the ‘5 Minute Medicine’ video pod… [Med Teach. 2012] – PubMed – NCBI.

MANUSCRIPT: Medical student education program in Alzheimer’s disease: the PAIRS Program.

Abstract
BACKGROUND:
As life expectancy increases, dementia incidence will also increase, creating a greater need for physicians well-trained to provide integrated geriatric care. However, research suggests medical students have limited knowledge or interest in pursuing geriatric or dementia care. The purpose of this study is to evaluate the PAIRS Program and its effectiveness in enhancing medical education as a service-learning activity and replication model for the Buddy ProgramTM.
METHODS:
Between 2007 and 2011, four consecutive classes of first year Boston University School of Medicine students (n = 45; 24 ± 3 years, 58% female, 53% White) participated in a year-long program in which they were paired with a patient with early-stage Alzheimer’s disease (AD). Assessments included pre- and post-program dementia knowledge tests and a post-program reflective essay.
RESULTS:
Program completion was 100% (n = 45). A paired-sample t-test revealed a modest improvement in dementia knowledge post-program (p < 0.001). Using qualitative coding methods, 12 overarching themes emerged from the students’ reflective essays, such as observing care partner burden, reporting a human side to AD, reporting experiences from the program that will impact future clinical practice, and obtaining a greater understanding of AD.
CONCLUSIONS:
Quantitative and qualitative findings suggest that the PAIRS Program can enhance the acquisition of knowledge, skills, and positive attitudes regarding geriatric healthcare in future generations of physicians, a skill set that is becoming increasingly relevant in light of the rapidly aging population. Furthermore, results suggest that The Buddy ProgramTM model can be successfully replicated.

via Medical student education program in Alzheimer’… [BMC Med Educ. 2012] – PubMed – NCBI.

ABSTRACT: Reflective writing in medical education.

Abstract
BACKGROUND:
The teaching of reflection and the use of reflective writing assignments is commonplace in medical school education. There is a preponderance of research in medical education, which appraises and discusses new ways of teaching reflection.
AIMS:
Students often complain about having to write about their experience with that patient. This work explores some of the reasoning between the variability of student acceptance of reflection in medical education.
METHODS:
The method is based on available literature as well as a personal perspective regarding reflective writing in medical education.
RESULTS:
Reflection is a skill that requires teaching and practice. It is within the explicit process of teaching reflection in medical education that reflective learners can be developed.
CONCLUSIONS:
Reflection includes the take-home lesson from patient encounters. Its use can help learners become better physicians in terms of medical and humanistic effectiveness and support personal growth.

via Reflective writing in medical education. [Med Teach. 2012] – PubMed – NCBI.

MANUSCRIPT: Teacher-made models: the answer for medical skills training in developing countries?

Abstract
BACKGROUND:
The advantages of using simulators in skills training are generally recognized, but simulators are often too expensive for medical schools in developing countries. Cheaper locally-made models (or part-task trainers) could be the answer, especially when teachers are involved in design and production (teacher-made models, TM).
METHODS:
We evaluated the effectiveness of a TM in training and assessing intravenous injection skills in comparison to an available commercial model (CM) in a randomized, blind, pretest-posttest study with 144 undergraduate nursing students. All students were assessed on both the TM and the CM in the pre-test and post-test. After the post-test the students were also assessed while performing the skill on real patients.
RESULTS:
Differences in the mean scores pre- and post-test were marked in all groups. Training with TM or CM improved student scores substantially but there was no significant difference in mean scores whether students had practiced on TM or CM. Students who practiced on TM performed better on communication with the patient than did students who practiced on CM. Decreasing the ratio of students per TM model helped to increase practice opportunities but did not improve student’s mean scores. The result of the assessment on both the TM and the CM had a low correlation with the results of the assessment on real persons.
CONCLUSIONS:
The TM appears to be an effective alternative to CM for training students on basic IV skills, as students showed similar increases in performance scores after training on models that cost considerably less than commercially available models. These models could be produced using locally available materials in most countries, including those with limited resources to invest in medical education and skills laboratories.

via Teacher-made models: the answer for medical ski… [BMC Med Educ. 2012] – PubMed – NCBI.

MANUSCRIPT: Wanted: role models–medical students’ perceptions of professionalism

Abstract
BACKGROUND:
Transformation of medical students to become medical professionals is a core competency required for physicians in the 21st century. Role modeling was traditionally the key method of transmitting this skill. Medical schools are developing medical curricula which are explicit in ensuring students develop the professional competency and understand the values and attributes of this role. The purpose of this study was to determine student perception of professionalism at the University of Ottawa and gain insights for improvement in promotion of professionalism in undergraduate medical education.
METHODS:
Survey on student perception of professionalism in general, the curriculum and learning environment at the University of Ottawa, and the perception of student behaviors, was developed by faculty and students and sent electronically to all University of Ottawa medical students. The survey included both quantitative items including an adapted Pritzker list and qualitative responses to eight open ended questions on professionalism at the Faculty of Medicine, University of Ottawa. All analyses were performed using SAS version 9.1 (SAS Institute Inc. Cary, NC, USA). Chi-square and Fischer’s exact test (for cell count less than 5) were used to derive p-values for categorical variables by level of student learning.
RESULTS:
The response rate was 45.6% (255 of 559 students) for all four years of the curriculum. 63% of the responses were from students in years 1 and 2 (preclerkship). Students identified role modeling as the single most important aspect of professionalism. The strongest curricular recommendations included faculty-led case scenario sessions, enhancing interprofessional interactions and the creation of special awards to staff and students to “celebrate” professionalism. Current evaluation systems were considered least effective. The importance of role modeling and information on how to report lapses and breaches was highlighted in the answers to the open ended questions.
CONCLUSIONS:
Students identify the need for strong positive role models in their learning environment, and for effective evaluation of the professionalism of students and teachers. Medical school leaders must facilitate development of these components within the MD education and faculty development programs as well as in clinical milieus where student learning occurs.

via Wanted: role models–medical students’ percepti… [BMC Med Educ. 2012] – PubMed – NCBI.

ABSTRACT: Improving child and adolescent psychiatry education for medical students: an inter-organizational collaborative action plan.

Abstract
OBJECTIVE:
A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the long-standing dearth of CAP training for medical students.
METHOD:
The CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP’s CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies.
RESULTS/CONCLUSION:
The authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

via Improving child and adolescent psychiatry ed… [Acad Psychiatry. 2012] – PubMed – NCBI.

ABSTRACT: Design, Dissemination, and Evaluation of an Advanced Communication Elective at Seven U.S. Medical Schools

Abstract
PURPOSE:
To test educational methods that continue communication training into the fourth year of medical school.
METHOD:
The authors disseminated and evaluated an advanced communication elective in seven U.S. medical schools between 2007 and 2009; a total of 9 faculty and 22 fourth-year students participated. The elective emphasized peer learning, practice with real patients, direct observation, and applications of video technology. The authors used qualitative and quantitative survey methods and video review to evaluate the experience of students and faculty.
RESULTS:
Students reported that the elective was better than most medical school clerkships they had experienced. Their self-confidence in time management and in the use of nine communication skills improved significantly. The most valued course components were video review, repeated practice with real patients, and peer observation. Analysis of student videos with real patients and in role-plays showed that some skills (e.g., agenda setting, understanding the patient perspective) were more frequently demonstrated than others (e.g., exploring family and cultural values, communication while using the electronic health record). Faculty highly valued this learner-centered model and reported that their self-awareness and communication skills grew as teachers and as clinicians.
CONCLUSIONS:
Learner-centered methods such as peer observation and video review and editing may strengthen communication training and reinforce skills introduced earlier in medical education. The course design may counteract a “hidden curriculum” that devalues respectful interactions with trainees and patients. Future research should assess the impact of course elements on skill retention, attitudes for lifelong learning, and patients’ health outcomes.

via Design, Dissemination, and Evaluation of an Advance… [Acad Med. 2013] – PubMed – NCBI.