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Author: Brian S McGowan, PhD

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.

MANUSCRIPT: Planning an objective and need based curriculum: the logistics with reference to the undergraduate medical education in biochemistry.

Abstract
Purpose: The medical education is recently being transformed into several domains in order to adapt to the need and the value based academics which is required for the quality doctors who serve the community. Presently, the biochemistry curricula for the graduate students of medicine have been questioned by as many experts, because of their multiple lacunae. In this review, we would like to highlight the scenario which is related to the existing biochemistry curricula for graduate medical students, which have been followed in several medical schools and universities and we also hope to share our ideas for implementing objective and pragmatic curricula. Evidence based research, wherein the articles which are related to innovative teaching-learning tools are collected and the pros and cons which are related to the different methods analyzed in biochemistry point of view. Conclusion: Rapid changes in the content of the curriculum may not be required, but a gradual introduction of the novel approach and the methods of teaching biochemistry can be adopted into the curriculum.

via Planning an objective and need based curric… [J Clin Diagn Res. 2013] – PubMed – NCBI.

MANUSCRIPT: Delivery and use of individualised feedback in large class medical teaching

Abstract (provisional)
Background
Formative feedback that encourages self-directed learning in large class medical teaching is difficult to deliver. This study describes a new method, blueprinted feedback, and explores learner’s responses to assess its appropriate use within medical science teaching.

Methods
Mapping summative assessment items to their relevant learning objectives creates a blueprint which can be used on completion of the assessment to automatically create a list of objectives ranked by the attainment of the individual student. Two surveys targeted medical students in years 1, 2 and 3. The behaviour-based survey was released online several times, with 215 and 22 responses from year 2, and 187, 180 and 21 responses from year 3. The attitude-based survey was interviewer-administered and released once, with 22 responses from year 2 and 3, and 20 responses from year 1.

Results
88-96% of learners viewed the blueprinted feedback report, whilst 39% used the learning objectives to guide further learning. Females were significantly more likely to revisit learning objectives than males (p = 0.012). The most common reason for not continuing learning was a ‘hurdle mentality’ of focusing learning elsewhere once a module had been assessed.

Conclusions
Blueprinted feedback contains the key characteristics required for effective feedback so that with further education and support concerning its use, it could become a highly useful tool for the individual and teacher.

via BMC Medical Education | Abstract | Delivery and use of individualised feedback in large class medical teaching.

ABSTRACT: Preferred sources of health information in persons with multiple sclerosis: degree of trust and information sought.

Abstract
BACKGROUND:
Effective health communication is important for informed decision-making, yet little is known about the range of information sources used by persons with multiple sclerosis (MS), the perceived trust in those information sources, or how this might vary according to patient characteristics.
OBJECTIVE:
We aimed to investigate the sources of health information used by persons with MS, their preferences for the source of health information, and levels of trust in those information sources. We also aimed to evaluate how these findings varied according to participant characteristics.
METHODS:
In 2011, participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry were asked about their sources of health information using selected questions adapted from the 2007 Health Information National Trends (HINTS) survey.
RESULTS:
Of 12,974 eligible participants, 66.18% (8586/12,974) completed the questionnaire. Mass media sources, rather than interpersonal information sources, were the first sources used by 83.22% (5953/7153) of participants for general health topics and by 68.31% (5026/7357) of participants for MS concerns. Specifically, the Internet was the first source of health information for general health issues (5332/7267, 73.40%) and MS (4369/7376, 59.23%). In a logistic regression model, younger age, less disability, and higher annual income were independently associated with increased odds of use of mass media rather than interpersonal sources of information first. The most trusted information source was a physician, with 97.94% (8318/8493) reporting that they trusted a physician some or a lot. Information sought included treatment for MS (4470/5663, 78.93%), general information about MS (3378/5405, 62.50%), paying for medical care (1096/4282, 25.59%), where to get medical care (787/4282, 18.38%), and supports for coping with MS (2775/5031, 55.16%). Nearly 40% (2998/7521) of participants had concerns about the quality of the information they gathered.
CONCLUSIONS:
Although physicians remain the most trusted source of health information for people with MS, the Internet is the first source of health information for most of them. This has important implications for the dissemination of health information.

via Preferred sources of health information i… [J Med Internet Res. 2013] – PubMed – NCBI.

RESOURCE: Five Best Practices for the Flipped Classroom

Ok, I’ll be honest. I get very nervous when I hear education reformists and politicians tout how “incredible” the flipped classroom model, or how it will “solve” many of the problems of education. It doesn’t solve anything. It is a great first step in reframing the role of the teacher in the classroom.

It fosters the “guide on the side” mentality and role, rather than that of the “sage of the stage.” It helps move a classroom culture towards student construction of knowledge rather than the teacher having to tell the knowledge to students. Even Salman Khan says that the teacher is now “liberated to communicate with [their students].”

It also creates the opportunity for differentiated roles to meet the needs of students through a variety of instructional activities. But again, just because I “free” someone, doesn’t mean that he/she will know what to do next, nor how to do it effectively. This is where the work must occur as the conversation of the flipped classroom moves forward and becomes more mainstream in public and private education. We must first focus on creating the engagement and then look at structures, like the flipped classroom, that can support. So educators, here are some things to think about and consider if you are thinking about or already using the flipped classroom model.

via Five Best Practices for the Flipped Classroom | Edutopia.

MANUSCRIPT: Vodcasts and Active-Learning Exercises in a “Flipped Classroom” Model of a Renal Pharmacotherapy Module

Abstract
Objective. To implement a “flipped classroom” model for a renal pharmacotherapy topic module and assess the impact on pharmacy students’ performance and attitudes.

Design. Students viewed vodcasts (video podcasts) of lectures prior to the scheduled class and then discussed interactive cases of patients with end-stage renal disease in class. A process-oriented guided inquiry learning (POGIL) activity was developed and implemented that complemented, summarized, and allowed for application of the material contained in the previously viewed lectures.

Assessment. Students’ performance on the final examination significantly improved compared to performance of students the previous year who completed the same module in a traditional classroom setting. Students’ opinions of the POGIL activity and the flipped classroom instructional model were mostly positive.

Conclusion. Implementing a flipped classroom model to teach a renal pharmacotherapy module resulted in improved student performance and favorable student perceptions about the instructional approach. Some of the factors that may have contributed to students’ improved scores included: student mediated contact with the course material prior to classes, benchmark and formative assessments administered during the module, and the interactive class activities.

via Vodcasts and Active-Learning Exercises in a “Flipped Classroom” Model of a Renal Pharmacotherapy Module.