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Author: Brian S McGowan, PhD

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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ABSTRACT: Learning and study strategies correlate with medical students’ performance in anatomical sciences.

Much of the content delivered during medical students’ preclinical years is assessed nationally by such testing as the United States Medical Licensing Examination® (USMLE® ) Step 1 and Comprehensive Osteopathic Medical Licensing Examination® (COMPLEX-USA® ) Step 1. Improvement of student study/learning strategies skills is associated with academic success in internal and external (USMLE Step 1) examinations. This research explores the strength of association between the Learning and Study Strategies Inventory (LASSI) scores and student performance in the anatomical sciences and USMLE Step 1 examinations. The LASSI inventory assesses learning and study strategies based on ten subscale measures. These subscales include three components of strategic learning: skill (Information processing, Selecting main ideas, and Test strategies), will (Anxiety, Attitude, and Motivation) and self-regulation (Concentration, Time management, Self-testing, and Study aid). During second year (M2) orientation, 180 students (Classes of 2016, 2017, and 2018) were administered the LASSI survey instrument. Pearson Product-Moment correlation analyses identified significant associations between five of the ten LASSI subscales (Anxiety, Information processing, Motivation, Selecting main idea, and Test strategies) and students’ performance in the anatomical sciences and USMLE Step 1 examinations. Identification of students lacking these skills within the anatomical sciences curriculum allows targeted interventions, which not only maximize academic achievement in an aspect of an institution’s internal examinations, but in the external measure of success represented by USMLE Step 1 scores.

via Learning and study strategies correlate with medical students’ performance in anatomical sciences. – PubMed – NCBI.

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ABSTRACT: Comparison of lecture and team-based learning in medical ethics education.

BACKGROUND:
Medical education literature suggests that ethics education should be learner-centered and problem-based rather than theory-based. Team-based learning is an appropriate method for this suggestion. However, its effectiveness was not investigated enough in medical ethics education.
RESEARCH QUESTION:
Is team-based learning effective in medical ethics education in terms of knowledge retention, in-class learner engagement, and learner reactions?
RESEARCH DESIGN:
This was a prospective controlled follow-up study. We changed lecture with team-based learning method to teach four topics in a 2-week medical ethics clerkship, while the remaining topics were taught by lectures. For comparison, we formed team-based learning and lecture groups, in which the students and instructor are the same, but the topics and teaching methodologies are different. We determined in-class learner engagement by direct observation and student satisfaction by feedback forms. Student success for team-based learning and lecture topics in the end-of-clerkship exam and two retention tests performed 1 year and 2 years later were compared. Ethical considerations: Ethical approval for the study was granted by Akdeniz University Board of Ethics on Noninvasive Clinical Human Studies Ethics committee.
FINDINGS:
Short-term knowledge retention did not differ; however, team-based learning was found superior to lecture at long-term retention tests. Student satisfaction was high with team-based learning and in-class engagement was better in team-based learning sessions.
DISCUSSION:
Our results on learner engagement and satisfaction with team-based learning were similar to those of previous reports. However, knowledge retention results in our study were contrary to literature. The reason might be the fact that students prepared for the end-of-clerkship pass/fail exam (short term) regardless of the teaching method. But, at long-term retention tests, they did not prepare for the exam and answered the questions just using the knowledge retained in their memories.
CONCLUSION:
Our findings suggest that team-based learning is a better alternative to lecture to teach ethics in medical education.

via Comparison of lecture and team-based learning in medical ethics education. – PubMed – NCBI.

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ABSTRACT: Implementing economic evaluation in simulation-based medical education: challenges and opportunities.

CONTEXT:
Simulation-based medical education (SBME) is now ubiquitous at all levels of medical training. Given the substantial resources needed for SBME, economic evaluation of simulation-based programmes or curricula is required to demonstrate whether improvement in trainee performance (knowledge, skills and attitudes) and health outcomes justifies the cost of investment. Current literature evaluating SBME fails to provide consistent and interpretable information on the relative costs and benefits of alternatives.
CONTENT:
Economic evaluation is widely applied in health care, but is relatively scarce in medical education. Therefore, in this paper, using a focus on SBME, we define economic evaluation, describe the key components, and discuss the challenges associated with conducting an economic evaluation of medical education interventions. As a way forward to the rigorous and state of the art application of economic evaluation in medical education, we outline the steps to gather the necessary information to conduct an economic evaluation of simulation-based education programmes and curricula, and describe the main approaches to conducting an economic evaluation.
CONCLUSION:
A properly conducted economic evaluation can help stakeholders (i.e., programme directors, policy makers and curriculum designers) to determine the optimal use of resources in selecting the modality or method of assessment in simulation. It also helps inform broader decision making about allocation of scarce resources within an educational programme, as well as between education and clinical care. Economic evaluation in medical education research is still in its infancy, and there is significant potential for state-of-the-art application of these methods in this area.

via Implementing economic evaluation in simulation-based medical education: challenges and opportunities. – PubMed – NCBI.

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MANUSCRIPT: Repeated testing improves achievement in a blended learning approach for risk competence training of medical students: results of a randomized controlled trial.

BACKGROUND:
Adequate estimation and communication of risks is a critical competence of physicians. Due to an evident lack of these competences, effective training addressing risk competence during medical education is needed. Test-enhanced learning has been shown to produce marked effects on achievements. This study aimed to investigate the effect of repeated tests implemented on top of a blended learning program for risk competence.
METHODS:
We introduced a blended-learning curriculum for risk estimation and risk communication based on a set of operationalized learning objectives, which was integrated into a mandatory course “Evidence-based Medicine” for third-year students. A randomized controlled trial addressed the effect of repeated testing on achievement as measured by the students’ pre- and post-training score (nine multiple-choice items). Basic numeracy and statistical literacy were assessed at baseline. Analysis relied on descriptive statistics (histograms, box plots, scatter plots, and summary of descriptive measures), bootstrapped confidence intervals, analysis of covariance (ANCOVA), and effect sizes (Cohen’s d, r) based on adjusted means and standard deviations.
RESULTS:
All of the 114 students enrolled in the course consented to take part in the study and were assigned to either the intervention or control group (both: n = 57) by balanced randomization. Five participants dropped out due to non-compliance (control: 4, intervention: 1). Both groups profited considerably from the program in general (Cohen’s d for overall pre vs. post scores: 2.61). Repeated testing yielded an additional positive effect: while the covariate (baseline score) exhibits no relation to the post-intervention score, F(1, 106) = 2.88, p > .05, there was a significant effect of the intervention (repeated tests scenario) on learning achievement, F(1106) = 12.72, p < .05, d = .94, r = .42 (95% CI: [.26, .57]). However, in the subgroup of participants with a high initial numeracy score no similar effect could be observed.
CONCLUSION:
Dedicated training can improve relevant components of risk competence of medical students. An already promising overall effect of the blended learning approach can be improved significantly by implementing a test-enhanced learning design, namely repeated testing. As students with a high initial numeracy score did not profit equally from repeated testing, target-group specific opt-out may be offered.

via Repeated testing improves achievement in a blended learning approach for risk competence training of medical students: results of a randomized cont… – PubMed – NCBI.

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