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Author: Brian S McGowan, PhD

ABSTRACT: A retrospective and prospective look at medical education in the United States: trends shaping anatomical sciences education

Abstract
During the last decade of the 20th century and the first decade of the 21st century, curricular reform has been a popular theme. In fact, reform on the current scale has not occurred since the early 1900s, when Abraham Flexner released his landmark report ‘Medical Education in the United States and Canada’. His report, suggesting major changes in how physicians were educated, became the norm and few changes occurred until the last quarter of the 20th century. During this period increased demands on medical school curriculums due to the explosion of knowledge in biomedical sciences and the pressure to add additional clinical experiences increased the momentum for curriculum reform. In 1984 an Association of American Medical Colleges (AAMC) report, ‘Physicians for the Twenty-First Century: The Report of the Panel on the General Professional Education of the Physician (GPEP) and College Preparation for Medicine’, discussed many items related to reforming medical education including the value of integration, increased use of active learning formats, more self-directed learning, improved communication skills and increased problem-solving activities. This was followed by a report released in 1993 entitled ‘Educating Medical Students: Assessing Change in Medical Education – The Road to Implementation’ (ACME-TRI), which identified educational problems by surveying medical school deans, suggested ways to deal with these issues and presented a plan of action. Recently, the Carnegie Foundation for the Advancement of Teaching released ‘Education Physicians: A Call for Reform of Medical School and Residency’ with additional suggestions. At this point the question that might be asked is – Where is all this going and how is it going to affect anatomy education?

via A retrospective and prospective look at medical educa… [J Anat. 2013] – PubMed – NCBI.

ABSTRACT: Evaluation of GPs diagnostic knowledge and treatment practice in detection and treatment of early schizophrenia: a French postal survey in Brittany.

Abstract
AIMS:
Evaluating French general practitioners (GPs) diagnostic knowledge and practice in the detection and treatment of early schizophrenia as well as needs and preferences with specialist services.
METHODS:
A postal survey comprising 27 questions was conducted among 2,039 GPs from three counties of Western France. Composite scores were calculated to determine a level of diagnostic knowledge.
RESULTS:
A total of 515 GPs (25.3 %) responded to the survey. The mean score to determine a level of knowledge on the most important aspects in detecting early stages of schizophrenia was 5.3 ± 2.50 [median = 6 (range 0-10)]. The mean score to determine the overall knowledge of schizophrenia was 8.1 ± 2.98 [median = 8 (range 1-16)]. The majority of surveyed GPs (76.1 %) would treat early schizophrenia pharmacologically. A majority of GPs (53.9 %) advise an insufficient duration of anti-psychotic treatment for first episode psychosis. The vast majority (90.8 %) were in favour of a specialized outpatient service.
CONCLUSIONS:
French GPs tend to have a deficit in diagnostic knowledge and practice in detection and treatment of early schizophrenia. It seems important to provide GPs with continuing medical education (CME) on detection and management of early schizophrenia and to set up relevant specialized outpatient services.

via Evaluation of GPs diagnos… [Soc Psychiatry Psychiatr Epidemiol. 2013] – PubMed – NCBI.

ABSTRACT: 50 years of publication in the field of medical education.

Abstract
Background: The advent of new medical education (ME) journals makes evident the growth of the field of ME. However, the nature and context of growth is undefined. Aim: To analyze the evolution of publication in ME. Methods: MEDLINE retrieval using medical subject headings was used to analyze patterns of ME publications from 1960-2010: changes in number of ME publications; number of journals publishing ME articles; co-topics occurring frequently in ME articles; differences among journals’ publication of co-topics. Results: Annual publication of ME articles increased from 279 in 1960 to 3760 in 2010. 81 531 articles were published in 4208 different journals. 104 journals published ME articles in 1960, 855 in 2010. Despite an increase in journals in all fields, ME journals now account for a larger proportion of all journals indexed in MEDLINE than in 1960. One-quarter of all ME articles were indexed as internship/residency; 16% as graduate ME; 15% as undergraduate ME; and 14% as continuing ME. The five journals that published the most ME articles distinguished themselves by publishing some topics with greater or less frequency. Conclusions: The increase in the number of ME publications and in the number of journals publishing ME articles suggests a supportive environment for a growing field; but variation in journals’ foci has implications for readers, editors and authors.

via 50 years of publication in the field of medical ed… [Med Teach. 2013] – PubMed – NCBI.

ABSTRACT: Enhancing Quality Improvements in Cancer Care Through CME Activities at a Nationally Recognized Cancer Center.

Abstract
Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal.

via Enhancing Quality Improvements in Cancer Care … [J Cancer Educ. 2013] – PubMed – NCBI.

ABSTRACT: InsuOnline, a Serious Game to Teach Insulin Therapy to Primary Care Physicians: Design of the Game and a Randomized Controlled Trial for Educational Validation.

Abstract
BACKGROUND:
Physicians´ lack of knowledge contributes to underuse of insulin and poor glycemic control in adults with diabetes mellitus (DM). Traditional continuing medical education have limited efficacy, and new approaches are required.
OBJECTIVE:
We report the design of a trial to assess the educational efficacy of InsuOnline, a game for education of primary care physicians (PCPs). The goal of InsuOnline was to improve appropriate initiation and adjustment of insulin for the treatment of DM. InsuOnline was designed to be educationally adequate, self-motivating, and attractive.
METHODS:
A multidisciplinary team of endocrinologists, experts in medical education, and programmers, was assembled for the design and development of InsuOnline. Currently, we are conducting usability and playability tests, with PCPs and medical students playing the game on a desktop computer. Adjustments will be made based on these results. An unblinded randomized controlled trial with PCPs who work in the city of Londrina, Brazil, will be conducted to assess the educational validity of InsuOnline on the Web. In this trial, 64 PCPs will play InsuOnline, and 64 PCPs will undergo traditional instructional activities (lecture and group discussion). Knowledge on how to initiate and adjust insulin will be assessed by a Web-based multiple choice questionnaire, and attitudes regarding diabetes/insulin will be assessed by Diabetes Attitude Scale 3 at 3 time points-before, immediately after, and 6 months after the intervention. Subjects´ general impressions on the interventions will be assessed by a questionnaire. Software logs will be reviewed.
RESULTS:
To our knowledge, this is the first research with the aim of assessing the educational efficacy of a computer game for teaching PCPs about insulin therapy in DM. We describe the development criteria used for creating InsuOnline. Evaluation of the game using a randomized controlled trial design will be done in future studies.
CONCLUSIONS:
We demonstrated that the design and development of a game for PCPs education on insulin is possible with a multidisciplinary team. InsuOnline can be an attractive option for large-scale continuous medical education to help improving PCPs´ knowledge on insulin therapy and potentially improving DM patients´ care.

via InsuOnline, a Serious Game to Teach Insulin … [JMIR Res Protoc. 2013] – PubMed – NCBI.

ABSTRACT: Development of National Competency-based Learning Objectives “Medical Informatics” for Undergraduate Medical Education.

Abstract
Objectives: The aim of this project is to develop a catalogue of competency-based learning objectives “Medical Informatics” for undergraduate medical education (abbreviated NKLM-MI in German). Methods: The development followed a multi-levelannotation andconsensus process. For each learning objective a reason why a physician needs this competence was required. In addition, each objective was categorized according to the competence context (A = covered by medical informatics, B = core subject of medical informatics, C = optional subject of medical informatics), the competence level (1 = referenced knowledge, 2 = applied knowledge, 3 = routine knowledge) and a CanMEDS competence role (medical expert, communicator, collaborator, manager, health advocate, professional, scholar). Results: Overall 42 objectives in seven areas (medical documentation and information processing, medical classifications and terminologies, information systems in healthcare, health telematics and telemedicine, data protection and security, access to medical knowledge and medical signal-/image processing) were identified, defined and consented. Conclusion: With the NKLM-MI the competences in the field of medical informatics vital to a first year resident physician are identified, defined and operationalized. These competencies are consistent with the recommendations of the International Medical Informatics Association (IMIA). The NKLM-MI will be submitted to the National Competence-Based Learning Objectives for Undergraduate Medical Education. The next step is implementation of these objectives by the faculties.

via Development of National Competency-based Lea… [Methods Inf Med. 2013] – PubMed – NCBI.

ABSTRACT: eLearning among Canadian anesthesia residents: a survey of podcast use and content needs.

Abstract
BACKGROUND:
Podcasts are increasingly being used in medical education. In this study, we conducted a survey of Canadian anesthesia residents to better delineate the content needs, format preferences, and usage patterns among anesthesia residents METHODS: 10/16 Canadian anesthesia program directors, representing 443/659 Canadian anesthesia residents, allowed their residents to be included in the study. 169/659 (24%) residents responded to our survey. A 17-item survey tool developed by the investigators was distributed by email eliciting information on patterns of podcast use, preferred content, preferred format, and podcast adjuncts perceived to increase knowledge retention.
RESULTS:
60% (91/151) had used medical podcasts with 67% of these users spending up to 1 hour per week on podcasts. 72.3% of respondents selected ‘ability to review materials whenever I want’ was selected by the majority of respondents (72%) as the reason they found podcasts to be valuable. No clear preference was shown for audio, video, or slidecast podcasts. Physiology (88%) and pharmacology (87%) were the most requested basic science topics while regional anesthesia (84%), intensive care (79%) and crisis resource management (86%) were the most requested for procedural, clinical and professional topics respectively. Respondents stated they would most likely view podcasts that contained procedural skills, journal article summaries and case presentations and that were between 5-15 minutes in duration A significantly greater proportion of senior residents (81%) requested podcasts on ‘pediatric anesthesia’ compared to junior residents 57% (P = 0.007).
CONCLUSIONS:
The majority of respondents are using podcasts. Anesthesia residents have preferred podcast content, types, length and format that educators should be cognizant of when developing and providing podcasts.

via eLearning among Canadian anesthesia residents: … [BMC Med Educ. 2013] – PubMed – NCBI.

ABSTRACT: A Crowdsourcing Model for Creating Preclinical Medical Education Study Tools.

Abstract
During their preclinical course work, medical students must memorize and recall substantial amounts of information. Recent trends in medical education emphasize collaboration through team-based learning. In the technology world, the trend toward collaboration has been characterized by the crowdsourcing movement. In 2011, the authors developed an innovative approach to team-based learning that combined students’ use of flashcards to master large volumes of content with a crowdsourcing model, using a simple informatics system to enable those students to share in the effort of generating concise, high-yield study materials. The authors used Google Drive and developed a simple Java software program that enabled students to simultaneously access and edit sets of questions and answers in the form of flashcards. Through this crowdsourcing model, medical students in the class of 2014 at the Johns Hopkins University School of Medicine created a database of over 16,000 questions that corresponded to the Genes to Society basic science curriculum. An analysis of exam scores revealed that students in the class of 2014 outperformed those in the class of 2013, who did not have access to the flashcard system, and a survey of students demonstrated that users were generally satisfied with the system and found it a valuable study tool. In this article, the authors describe the development and implementation of their crowdsourcing model for creating study materials, emphasize its simplicity and user-friendliness, describe its impact on students’ exam performance, and discuss how students in any educational discipline could implement a similar model of collaborative learning.

via A Crowdsourcing Model for Creating Preclinical Medi… [Acad Med. 2013] – PubMed – NCBI.

ABSTRACT: I’m Clear, You’re Clear, We’re All Clear: Improving Consultation Communication Skills in Undergraduate Medical Education.

Abstract
Requesting and providing consultations are daily occurrences in most teaching hospitals. With increased attention on transitions of care in light of the recent scrutiny of duty hours, consultations and other interphysician interactions, such as handoffs, are becoming increasingly important. As modern medicine increases in complexity, the skill of communicating with medical colleagues throughout the continuum of care becomes more challenging. Like many of the other skills acquired by medical students, consultation communication is often learned by casual observation and through trial and error. Without formal training, however, miscommunications will continue to occur, nearly ensuring that medical errors happen. Interphysician communication skills, therefore, need to be emphasized in undergraduate and graduate medical education instead of being left to happenstance or hit-or-miss practice. In this article, the authors review two models for understanding and teaching the consultation process-5Cs and PIQUED-both of which were developed for specific subsets of learners. They then combine the two to create a consultation model that may be more widely applied.

via I’m Clear, You’re Clear, We’re All Clear: Improving… [Acad Med. 2013] – PubMed – NCBI.

ABSTRACT: Technology-Enhanced Simulation to Assess Health Professionals: A Systematic Review of Validity Evidence, Research Methods, and Reporting Quality.

Abstract
PURPOSE:
To summarize the tool characteristics, sources of validity evidence, methodological quality, and reporting quality for studies of technology-enhanced simulation-based assessments for health professions learners.
METHOD:
The authors conducted a systematic review, searching MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous reviews through May 2011. They selected original research in any language evaluating simulation-based assessment of practicing and student physicians, nurses, and other health professionals. Reviewers working in duplicate evaluated validity evidence using Messick’s five-source framework; methodological quality using the Medical Education Research Study Quality Instrument and the revised Quality Assessment of Diagnostic Accuracy Studies; and reporting quality using the Standards for Reporting Diagnostic Accuracy and Guidelines for Reporting Reliability and Agreement Studies.
RESULTS:
Of 417 studies, 350 (84%) involved physicians at some stage in training. Most focused on procedural skills, including minimally invasive surgery (N = 142), open surgery (81), and endoscopy (67). Common elements of validity evidence included relations with trainee experience (N = 306), content (142), relations with other measures (128), and interrater reliability (124). Of the 217 studies reporting more than one element of evidence, most were judged as having high or unclear risk of bias due to selective sampling (N = 192) or test procedures (132). Only 64% proposed a plan for interpreting the evidence to be presented (validity argument).
CONCLUSIONS:
Validity evidence for simulation-based assessments is sparse and is concentrated within specific specialties, tools, and sources of validity evidence. The methodological and reporting quality of assessment studies leaves much room for improvement.

via Technology-Enhanced Simulation to Assess Health Pro… [Acad Med. 2013] – PubMed – NCBI.