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Author: Brian S McGowan, PhD

MANUSCRIPT: Good experiences with an audience response system used in medical education

Abstract
INTRODUCTION:
Audience response systems (ARS) are increasingly being used to heighten participants’ involvement. Knowledge of technical and pedagogical challenges is, however, limited. The purpose of this paper is to evaluate ARS as a tool for 1) evaluation, 2) knowledge testing, 3) attention raising and 4) discussion stimulation.
MATERIAL AND METHODS:
ARS was used 33 times at four different courses. Data include voting results, observations, questionnaires and interviews.
RESULTS:
A total of 215 participants and 12 teachers were included. The majority of the participants found ARS suitable for course evaluation. The teachers found it useful for obtaining the results immediately and thereby for receiving feedback on their own teaching. The participants and the teachers found ARS suitable for knowledge testing. ARS was used as an instrument to increase activity and attention. The system was found to increase the level of concentration and the interactivity. ARS was used to initiate discussions. The participants found that the questions could be a good starting point for discussion. The teachers found it challenging to comment on answers. Our experiences are that thorough planning and preparation is needed for the successful implementation of ARS.
CONCLUSION:
Our experiences indicate that ARS is suitable for course evaluation. Overall, we find ARS a valuable technology that may stimulate discussion and support learning, but teachers need to be technically and pedagogically well prepared to use the tool. The use of ARS does not in itself entail that the quality of the teaching increases.

via Good experiences with an audience response syst… [Dan Med Bull. 2011] – PubMed – NCBI.

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ABSTRACT: Physicians’ self-assessment of cancer pain treatment skills–more training required.

Abstract
PURPOSE:
Adequate pain control is essential in cancer treatment. We surveyed Finnish physicians’ perception on their skills and training needs on palliative pain management.
METHODS:
A structured questionnaire with multiple choices and open ended questions was used for collecting data in 2006-2008. Of 720 physicians participating, 59 were working in oncology and 661 physicians in internal medicine, geriatrics, and primary health care.
RESULTS:
The principles of the WHO guidelines of cancer pain management were not well known. Forty-six percent of oncologists and 32% of other physicians (P < 0.0001) knew the analgesic ladder consisting of three steps. Forty-seven percent of oncologists and 61% of other physicians considered pain treatment of cancer patients being well managed in Finland. Only 24% of oncologists and 5% of other physicians considered the education in palliative care being currently at a satisfactory level. Oncologists reported a need of training in interaction and communication skills, ethical questions, and palliative home care. The other physicians expressed the strongest need for training in pain management and palliative care.
CONCLUSIONS:
To have more confidence in treating cancer, pain physicians would benefit in training and education in palliative care. It should be systematically included both in general and specialist training and continuous medical education.

via Physicians’ self-assessment of cancer pa… [Support Care Cancer. 2012] – PubMed – NCBI.

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ABSTRACT: Creating a virtual pharmacology curriculum in a problem-based learning environment: one medical school’s experience.

Abstract
Integrating pharmacology education into a problem-based learning (PBL) curriculum has proven challenging for many medical schools, including the Pennsylvania State University College of Medicine (Penn State COM). In response to pharmacology content gaps in its PBL-intensive curriculum, Penn State COM in 2003 hired a director of medical pharmacology instruction to oversee efforts to improve the structure of pharmacology education in the absence of a stand-alone course. In this article, the authors describe the ongoing development of the virtual pharmacology curriculum, which weaves pharmacology instruction through the entire medical school curriculum with particular emphasis on the organ-based second year. Pharmacology is taught in a spiraling manner designed to add to and build upon students’ knowledge and competency. Key aspects of the virtual curriculum (as of 2011) include clearly stated and behaviorally oriented pharmacology learning objectives, pharmacology study guides that correspond to each PBL case, pharmacology review sessions that feature discussions of United States Medical Licensing Examination (USMLE)-type questions, and pharmacology questions for each PBL case on course examinations to increase student accountability. The authors report a trend toward improved USMLE Step 1 scores since these initiatives were introduced. Furthermore, graduates’ ratings of their pharmacology education have improved on the Medical School Graduation Questionnaire. The authors suggest that the initiatives they describe for enhancing pharmacology medical education are relevant to other medical schools that are also seeking ways to better integrate pharmacology into PBL-based curricula.

via Creating a virtual pharmacology curriculum in a pro… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Perspective: Reconsidering the focus on “outcomes research” in medical education: a cautionary note.

Abstract
Researchers in medical education have been placing increased emphasis on “outcomes research,” or the observable impact of educational interventions on patient care. However, although patient outcomes are obviously important, they should not be the sole focus of attention in medical education research. The purpose of this perspective is both to highlight the limitations of outcomes research in medical education and to offer suggestions to facilitate a proper balance between learner-centered and patient-centered assessments. The authors cite five challenges to research using patient outcomes in medical education, namely (1) dilution (the progressively attenuated impact of education as filtered through other health care providers and systems), (2) inadequate sample size, (3) failure to establish a causal link, (4) potentially biased outcome selection, and (5) teaching to the test. Additionally, nonpatient outcomes continue to hold value, particularly in theory-building research and in the evaluation of program implementation. To educators selecting outcomes and instruments in medical education research, the authors offer suggestions including to clarify the study objective and conceptual framework before selecting outcomes, and to consider the development and use of behavioral and other intermediary outcomes. Deliberately weighing the available options will facilitate informed choices during the design of research that, in turn, informs the art and science of medical education.

via Perspective: Reconsidering the focus on “outcomes r… [Acad Med. 2013] – PubMed – NCBI.

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MANUSTRIPT: Learning styles and approaches to learning among medical undergraduates and postgraduates

Abstract
BACKGROUND:
The challenge of imparting a large amount of knowledge within a limited time period in a way it is retained, remembered and effectively interpreted by a student is considerable. This has resulted in crucial changes in the field of medical education, with a shift from didactic teacher centered and subject based teaching to the use of interactive, problem based, student centered learning. This study tested the hypothesis that learning styles (visual, auditory, read/write and kinesthetic) and approaches to learning (deep, strategic and superficial) differ among first and final year undergraduate medical students, and postgraduates medical trainees.
METHODS:
We used self administered VARK and ASSIST questionnaires to assess the differences in learning styles and approaches to learning among medical undergraduates of the University of Colombo and postgraduate trainees of the Postgraduate Institute of Medicine, Colombo.
RESULTS:
A total of 147 participated:73 (49.7%) first year students,40 (27.2%) final year students and 34(23.1%) postgraduate students. The majority (69.9%) of first year students had multimodal learning styles. Among final year students, the majority (67.5%) had multimodal learning styles, and among postgraduates, the majority were unimodal (52.9%) learners.Among all three groups, the predominant approach to learning was strategic. Postgraduates had significant higher mean scores for deep and strategic approaches than first years or final years (p < 0.05). Mean scores for the superficial approach did not differ significantly between groups.
CONCLUSIONS:
The learning approach suggest a positive shift towards deep and strategic learning in postgraduate students. However a similar difference was not observed in undergraduate students from first year to final year, suggesting that their curriculum may not have influenced learning methodology over a five year period.

via Learning styles and approaches to learning amon… [BMC Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Pain Education at the University of Washington School of Medicine.

Abstract
Contemporary medical education is inadequate to prepare medical students to competently assess and design care plans for patients with acute and chronic pain. The time devoted to pain education in most medical school curricula is brief and not integrated into case-based clinical experiences, and it is frequently nonexistent during clinical clerkships. Medical student pain curricula have been proposed for over 30 years and are commonly agreed upon, though rarely implemented. As a consequence of poor undergraduate pain education, postgraduate trainees and practicing physicians struggle with both competency and practice satisfaction; their patients are similarly dissatisfied. At the University of Washington School of Medicine, a committee of multidisciplinary pain experts has, between 2009 and 2011, successfully introduced a 4-year integrated pain curriculum that increases required pain education teaching time from 6 to 25 hours, and clinical elective pain courses from 177 to 318 hours. It is expected that increased didactic and case-based multidisciplinary clinical training will increase knowledge and competency in biopsychosocial measurement-based pain narrative and risk assessment, improve understanding of persistent pain as a chronic complex condition, and expand the role of patient-centered interprofessional treatment for medical students, residents, and fellows, leading to better prepared practicing physicians. PERSPECTIVE: Strategies for improving multidisciplinary pain education at the University of Washington School of Medicine are described and the preliminary results demonstrated.

via Pain Education at the University of Washington School… [J Pain. 2013] – PubMed – NCBI.

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ABSTRACT: Preventive intervention in diabetes: a new model for continuing medical education

Abstract
Competence and skills in overcoming clinical inertia for diabetes treatment, and actually supporting and assisting the patient through adherence and compliance (as opposed to just reiterating what they “should” be doing and then assigning them the blame if they fail) is a key component to success in addressing diabetes, and to date it is a component that has received little formal attention. To improve and systematize diabetes care, it is critical to move beyond the “traditional” continuing medical education (CME) model of imparting knowledge as the entirety of the educational effort, and move toward a focus on Performance Improvement CME. This new approach does not just teach new information but also provides support for improvements where needed most within practice systems based on targeted data-based on self-assessments for the entire system of care. Joslin data conclude that this new approach will benefit support, clinical, and office teams as well as the specialist. In short, the Performance Improvement CME structure reflects the needed components of the successful practice today, particularly for chronic conditions such as diabetes, including the focus on interdisciplinary team care and on quality improvement, which is becoming more and more aligned with reimbursement schemes, public and private, in the U.S.

via Preventive intervention in diabetes: a new mod… [Am J Prev Med. 2013] – PubMed – NCBI.

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ABSTRACT: Enhancing medical education by improving statistical methodology in journal articles

Abstract
Background: Medical journal articles often contain imprecise and inaccurate statistical methods and terminology that inhibit effective teaching and learning in medical education. Summary: Examples are used for ten flaws dealing with research design and methods and statistical analysis. Conclusions: If these inaccurate and inappropriate usages are avoided, teaching and learning in medical student and graduate medical education will be enhanced, and subsequently the health care of patients will be improved. The first step toward wisdom is knowing what the words mean.-Aristotle.

via Enhancing medical education by impro… [Teach Learn Med. 2013 Apr-Jun] – PubMed – NCBI.

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ABSTRACT: e-Professionalism: A New Frontier in Medical Education

Abstract
Background: This article, prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, discusses the evolving challenges facing medical educators posed by social media and a new form of professionalism that has been termed e-professionalism. Summary: E-professionalism is defined as the attitudes and behaviors that reflect traditional professionalism paradigms but are manifested through digital media. One of the major functions of medical education is professional identity formation; e-professionalism is an essential and increasingly important element of professional identity formation, because the consequences of violations of e-professionalism have escalated from academic sanctions to revocation of licensure. Conclusion: E-professionalism should be included in the definition, teaching, and evaluation of medical professionalism. Curricula should include a positive approach for the proper professional use of social media for learners.

via e-Professionalism: A New Frontier in… [Teach Learn Med. 2013 Apr-Jun] – PubMed – NCBI.

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ABSTRACT: The Next Generation of Doctoring.

Abstract
The authors reflect on the creation of the Doctoring program at the UCLA School of Medicine two decades ago. Although Doctoring-at UCLA and other institutions where it has been implemented-has successfully taught large numbers of students psychosocial content and communications skills that are often overlooked in traditional medical school curricula and has had an impact on the larger culture of medical education, the authors believe that its full promise remains unfulfilled. Of the many practical difficulties they encountered in creating and implementing this comprehensive program, the greatest barriers, by far, were cultural. The authors argue that the impact of programs like Doctoring-programs that attempt not only to change the content of what students learn but also to encourage students to think critically and to question fundamental aspects of the way medicine is taught, learned, and practiced-cannot grow unless and until the larger culture of medicine also changes. They offer recommendations for overcoming barriers to improve the next generation of Doctoring and similar programs; these include changing the philosophy behind the selection of medical students, providing far greater resources and support for course faculty, and altering incentives for medical school faculty. They conclude that until major cultural and structural barriers are overcome and the values that Doctoring and like programs attempt to engender become the primary values of the larger culture they seek to change, these programs will continue in fundamental ways to function outside the dominant culture of medicine.

via The Next Generation of Doctoring. [Acad Med. 2013] – PubMed – NCBI.

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