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Author: Brian S McGowan, PhD

ABSTRACT: How cognitive engagement fluctuates during a team-based learning session and how it predicts academic achievement.

The objective of the paper is to report findings of two studies that attempted to find answers to the following questions: (1) What are the levels of cognitive engagement in TBL? (2) Are there differences between students who were more exposed to TBL than students who were less exposed to TBL? (3) To which extent does cognitive engagement fluctuate as a function of the different activities involved in TBL? And (4) How do cognitive engagement scores collected over time correlate with each other and with academic achievement? The studies were conducted with Year-1 and -2 medical students enrolled in a TBL curriculum (N = 175, 62 female). In both studies, six measurements of cognitive engagement were taken during the distinct TBL activities (preparation phase, individual/team readiness assurance test, burning questions, and application exercises). Data were analysed by means of one-way repeated-measures ANOVAs and path modelling. The results of the repeated-measures ANOVA revealed that cognitive engagement systematically fluctuated as a function of the distinct TBL activities. In addition, Year-1 students reported significantly higher levels of cognitive engagement compared to Year-2 students. Finally, cognitive engagement was a significant predictor of performance (β = .35). The studies presented in this paper are a first attempt to relate the different activities undertaken in TBL with the extent to which they arouse cognitive engagement with the task at hand. Implications of these findings for TBL are discussed.

via How cognitive engagement fluctuates during a team-based learning session and how it predicts academic achievement. – PubMed – NCBI.

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MANUSCRIPT: Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study

Background: Mobile technology ownership in the general US population and medical professionals is increasing, leading to increased use in clinical settings. However, data on use of mobile technology by psychiatry residents remain unclear.
Objective: In this study, our aim was to provide data on how psychiatric residents use mobile phones in their clinical education as well as barriers relating to technology use.
Methods: An anonymous, multisite survey was given to psychiatry residents in 2 regions in the United States, including New Orleans and Boston, to understand their technology use.
Results: All participants owned mobile phones, and 79% (54/68) used them to access patient information. The majority do not use mobile phones to implement pharmacotherapy (62%, 42/68) or psychotherapy plans (90%, 61/68). The top 3 barriers to using mobile technology in clinical care were privacy concerns (56%, 38/68), lack of clinical guidance (40%, 27/68), and lack of evidence (29%, 20/68).
Conclusions: We conclude that developing a technology curriculum and engaging in research could address these barriers to using mobile phones in clinical practice.

via JMU-Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study | Gipson | JMIR mHealth and uHealth.

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MANUSCRIPT: Comparison of the Impact of Wikipedia, UpToDate, and a Digital Textbook on Short-Term Knowledge Acquisition Among Medical Students

BACKGROUND:
Web-based resources are commonly used by medical students to supplement curricular material. Three commonly used resources are UpToDate (Wolters Kluwer Inc), digital textbooks, and Wikipedia; there are concerns, however, regarding Wikipedia’s reliability and accuracy.
OBJECTIVE:
The aim of this study was to evaluate the impact of Wikipedia use on medical students’ short-term knowledge acquisition compared with UpToDate and a digital textbook.
METHODS:
This was a prospective, nonblinded, three-arm randomized trial. The study was conducted from April 2014 to December 2016. Preclerkship medical students were recruited from four Canadian medical schools. Convenience sampling was used to recruit participants through word of mouth, social media, and email. Participants must have been enrolled in their first or second year of medical school at a Canadian medical school. After recruitment, participants were randomized to one of the three Web-based resources: Wikipedia, UpToDate, or a digital textbook. During testing, participants first completed a multiple-choice questionnaire (MCQ) of 25 questions emulating a Canadian medical licensing examination. During the MCQ, participants took notes on topics to research. Then, participants researched topics and took written notes using their assigned resource. They completed the same MCQ again while referencing their notes. Participants also rated the importance and availability of five factors pertinent to Web-based resources. The primary outcome measure was knowledge acquisition as measured by posttest scores. The secondary outcome measures were participants’ perceptions of importance and availability of each resource factor.
RESULTS:
A total of 116 medical students were recruited. Analysis of variance of the MCQ scores demonstrated a significant interaction between time and group effects (P<.001, ηg2=0.03), with the Wikipedia group scoring higher on the MCQ posttest compared with the textbook group (P<.001, d=0.86). Access to hyperlinks, search functions, and open-source editing were rated significantly higher by the Wikipedia group compared with the textbook group (P<.001). Additionally, the Wikipedia group rated open access editing significantly higher than the UpToDate group; expert editing and references were rated significantly higher by the UpToDate group compared with the Wikipedia group (P<.001).
CONCLUSIONS:
Medical students who used Wikipedia had superior short-term knowledge acquisition compared with those who used a digital textbook. Additionally, the Wikipedia group trended toward better posttest performance compared with the UpToDate group, though this difference was not significant. There were no significant differences between the UpToDate group and the digital textbook group. This study challenges the view that Wikipedia should be discouraged among medical students, instead suggesting a potential role in medical education.

via Comparison of the Impact of Wikipedia, UpToDate, and a Digital Textbook on Short-Term Knowledge Acquisition Among Medical Students: Randomized Cont… – PubMed – NCBI.

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ABSTRACT: Learner, Patient, and Supervisor Features Are Associated With Different Types of Cognitive Load During Procedural Skills Training

PURPOSE:
Cognitive load theory, focusing on limits of the working memory, is relevant to medical education; however, factors associated with cognitive load during procedural skills training are not well characterized. The authors sought to determine how features of learners, patients/tasks, settings, and supervisors were associated with three types of cognitive load among learners performing a specific procedure, colonoscopy, to identify implications for procedural teaching.
METHOD:
Data were collected through an electronically administered survey sent to 1,061 U.S. gastroenterology fellows during the 2014-2015 academic year; 477 (45.0%) participated. Participants completed the survey immediately following a colonoscopy. Using multivariable linear regression analyses, the authors identified sets of features associated with intrinsic, extraneous, and germane loads.
RESULTS:
Features associated with intrinsic load included learners (prior experience and year in training negatively associated, fatigue positively associated) and patient/tasks (procedural complexity positively associated, better patient tolerance negatively associated). Features associated with extraneous load included learners (fatigue positively associated), setting (queue order positively associated), and supervisors (supervisor engagement and confidence negatively associated). Only one feature, supervisor engagement, was (positively) associated with germane load.
CONCLUSIONS:
These data support practical recommendations for teaching procedural skills through the lens of cognitive load theory. To optimize intrinsic load, level of experience and competence of learners should be balanced with procedural complexity; part-task approaches and scaffolding may be beneficial. To reduce extraneous load, teachers should remain engaged, and factors within the procedural setting that may interfere with learning should be minimized. To optimize germane load, teachers should remain engaged.

via Learner, Patient, and Supervisor Features Are Associated With Different Types of Cognitive Load During Procedural Skills Training: Implications for… – PubMed – NCBI.

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MANUSCRIPT: Behavior change interventions and policies influencing primary healthcare professionals’ practice-an overview of reviews.

BACKGROUND:There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers.METHODS:Study design: overview of reviews.DATA SOURCE:MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015).STUDY SELECTION:two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language.DATA EXTRACTION AND SYNTHESIS:two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors’ conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.).RESULTS:Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change.CONCLUSIONS:Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.

via Behavior change interventions and policies influencing primary healthcare professionals’ practice-an overview of reviews. – PubMed – NCBI.

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Nudging his way to a Nobel Prize

For nearly 5 years ArcheMedX has been working to “nudge” learners to learn more effectively. The simple idea is that learners rely on a largely unevolved set of learning actions, or behaviors, and that by architecting learning experiences that optimize these behaviors, learners learn better. We validated this approach years ago, demonstrating that nudging learners within the ArcheViewer leads to learning experiences that are 4-6 times more effective!

Yesterday morning (October 9th, 2017) I awoke to the news that Rich Thaler, the pioneering behavioral economist and the man whose research serves as the foundation of Nudge Science was awarded the Nobel Prize in Economics. 

From the Team at ArcheMedX, we would like to share the heartiest of congratulations for this recognition!!

For those unfamiliar with Nudge Science, it is grounded in the awareness that humans struggle balancing long-term and short-term benefits, that we struggle to balance fear of loss with joy of gains, that we believe in hindsight though evidence demonstrates it is rarely 20/20. In short, Nudge Science tells us that humans are irrational and often fail to make the decisions that are empirically in our best interest….time after time after time.

Thaler’s work provides us practical guidance for addressing and overcoming these short-comings. To learn how we, at ArcheMedX, have been evolving this science and connecting Rich’s work to learning science, check out some of the posts we have shared:

To learn much more about Thaler’s recognition and the 2017 Nobel prize, here is just a small snapshot of yesterday’s media coverage:

 

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ABSTRACT: Use of the pause procedure in continuing medical education: A randomized controlled intervention study.

During lectures, a pause procedure (the presenter pauses so students can discuss content) can improve educational outcomes. We aimed to determine whether (1) continuing medical education (CME) presentations with a pause procedure were evaluated more favorably and (2) a pause procedure improved recall. In this randomized controlled intervention study of all participants (N = 214) at the Mayo Clinic Internal Medicine Board Review course, 48 lectures were randomly assigned to an intervention (pause procedure) or control (traditional lecture) group. The pause procedure was a 1-min pause at the middle and end of the presentation. Study outcomes were (1) presentation evaluation instrument scores and (2) number of recalled items per lecture. A total of 214 participants returned 145 surveys (response rate, 68%). Mean presentation evaluation scores were significantly higher for pause procedure than for traditional presentations (70.9% vs 65.8%; 95%CI for the difference, 3.5-6.7; p < .0001). Mean number of rapid recall items was higher for pause procedure presentations (0.68 vs 0.59; 95%CI for the difference, 0.02-0.14; p = .01). In a traditional CME course, presentations with a pause procedure had higher evaluation scores and more content was recalled. The pause procedure could arm CME presenters with an easy technique to improve educational content delivery.

via Use of the pause procedure in continuing medical education: A randomized controlled intervention study. – PubMed – NCBI.

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ABSTRACT: Medical education of attention: A qualitative study of learning to listen to sound.

INTRODUCTION:
There has been little qualitative research examining how physical examination skills are learned, particularly the sensory and subjective aspects of learning. The authors set out to study how medical students are taught and learn the skills of listening to sound.
METHODS:
As part of an ethnographic study in Melbourne, 15 semi-structured in-depth interviews were conducted with students and teachers as a way to reflect explicitly on their learning and teaching.
RESULTS:
From these interviews, we found that learning the skills of listening to lung sounds was frequently difficult for students, with many experiencing awkwardness, uncertainty, pressure, and intimidation. However not everyone found this process difficult. Often those who had studied music reported finding it easier to be attentive to the frequency and rhythm of body sounds and find ways to describe them.
CONCLUSIONS:
By incorporating, distinctively in medical education, theoretical insights into “attentiveness” from anthropology and science and technology studies, the article suggests that musical education provides medical students with skills in sensory awareness. Training the senses is a critical aspect of diagnosis that needs to be better addressed in medical education. Practical approaches for improving students’ education of attention are proposed.

via Medical education of attention: A qualitative study of learning to listen to sound. – PubMed – NCBI.

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ABSTRACT: Creating a longitudinal database in medical education: Perspectives from the pioneers.

The Jefferson Longitudinal Study of Medical Education (JLSME) is the longest running database in medical education and covers the collection and measurement of background, learning, performance, and psychosocial variables before, during, and after medical school. Recently, our research group at VU University Medical Center School of Medical Sciences launched a longitudinal study in medical education, called the “Student Motivation and Success Study.” While setting up this study, we faced many challenges and learning about the JLSME helped us gain a fresh perspective on our work. We interviewed Drs. Joseph Gonnella and Mohammadreza Hojat, the leaders of the JLSME, and present their experiences verbatim in this article and summarize the lessons we learned as tips for others. We conclude that by establishing a longitudinal database, medical educators can test and ensure the quality of the doctors they produce, justify curricular reforms, participate in a continuing inquiry into their educational practices, and produce more generalizable research findings.

via Creating a longitudinal database in medical education: Perspectives from the pioneers. – PubMed – NCBI.

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ABSTRACT: A Plea for MERSQI: The Medical Education Research Study Quality Instrument.

OBJECTIVE:
To describe the quality of educational scholarship presented at a large national conference of obstetrics and gynecology educators.
METHODS:
We reviewed Council on Resident Education in Obstetrics and Gynecology-Association of Professors of Gynecology and Obstetrics annual meeting abstracts from 2015 and 2016, published as supplements to Obstetrics & Gynecology. For this uncontrolled observational study, abstracts were reviewed and scored using the Medical Education Research Study Quality Instrument (MERSQI). Comparisons between types of submissions (oral presentations or posters), origin of the report (academic or community), setting (undergraduate, graduate, postgraduate), and focus of the study (tool development or evaluation) were made. Abstracts from award-winning presentations and full manuscripts were compared with the remaining abstracts. One- and two-tailed Student t tests with a two-sample unequal variance (heteroscedastic) test were performed with a significance threshold of P≤.05.
RESULTS:
One hundred eighty-six abstracts and articles were available, with 101 posters and 77 oral presentations that could be scored in all six of the MERSQI domains. The average MERSQI score was 9.05 (±1.90) with scores ranging from 5 to 13.5 (median 9). Abstracts from full-text articles scored more than 1 point higher than other abstracts (10.2 compared with 9.0, P<.001, Cohen’s d=0.72). Statistically significant smaller magnitude differences were found comparing tool development with evaluation, academic with community studies, and for award with nonaward winners. No differences were found comparing oral and poster presentations.
CONCLUSION:
The quality of educational scholarship presented at a national meeting of obstetrics and gynecology educators falls within the published range for other specialties. The MERSQI scoring system is a useful method for tracking and benchmarking the quality of medical education scholarship in obstetrics and gynecology.

via A Plea for MERSQI: The Medical Education Research Study Quality Instrument. – PubMed – NCBI.

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