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Author: Brian S McGowan, PhD

MANUSCRIPT: A student authored online medical education textbook: editing patterns and content evaluation of a medical student wiki.

Abstract
The University of Minnesota medical student wiki (UMMedWiki) allows students to collaboratively edit classroom notes to support medical education. Since 2007, UMMedWiki has grown to include 1,591 articles that have collectively received 1.2 million pageviews. Although small-scale wikis have become increasingly important, little is known about their dynamics compared to large wikis, such as Wikipedia. To better understand UMMedWiki’s management and its potential reproducibility at other medical schools, we used an edit log with 28,000 entries to evaluate the behavior of its student editors. The development of tools to survey UMMedwiki allows for quality comparisons that improve both the wiki and the curriculum itself. We completed a content survey by comparing the UMMedWiki with two types of rubric data: TIME, a medical education taxonomy consisting of 1500 terms and national epidemiological data on 2,100 diseases.

via A student authored online medical educat… [AMIA Annu Symp Proc. 2011] – PubMed – NCBI.

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ABSTRACT: Surgeons don’t know what they don’t know about the safe use of energy in surgery.

Abstract
BACKGROUND:
Surgeons are not required to train on energy-based devices or document their knowledge of safety issues related to their use. Their understanding of how to safely use the devices has never formally been tested. This study assessed that knowledge in a cohort of gastrointestinal surgeons and determined if key facts could be learned in a half-day course.
METHODS:
SAGES piloted a postgraduate CME course on the Fundamental Use of Surgical Energy™ (FUSE) at the 2011 SAGES meeting. Course faculty prepared an 11-item multiple-choice examination (pretest) of critical knowledge. We administered it to members of the SAGES board; Quality, Outcomes and Safety Committee; and FUSE Task Force. Postgraduate course participants took the pretest, and at the end of the course they took a 10-item post-test that covered the same content. Data are expressed as median (interquartile range, IQR).
RESULTS:
Forty-eight SAGES leaders completed the test: the median percent of correct answers was 59 % (IQR = 55-73 %; range = 0-100 %). Thirty-one percent did not know how to correctly handle a fire on the patient; 31 % could not identify the device least likely to interfere with a pacemaker; 13 % did not know that thermal injury can extend beyond the jaws of a bipolar instrument; and 10 % thought a dispersive pad should be cut to fit a child. Pretest results for 27 participants in the postgraduate course were similar, with a median of 55 % correct (IQR = 46-82 %). Participants were not told the correct answers. At the end of the course, 25 of them completed a different 10-item post-test, with a median of 90 % correct (IQR = 70-90 %).
CONCLUSIONS:
Many surgeons have knowledge gaps in the safe use of widely used energy-based devices. A formal curriculum in this area can address this gap and contribute to increased safety.

via Surgeons don’t know what they don’t know about t… [Surg Endosc. 2012] – PubMed – NCBI.

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MANUSCRIPT: Advancing medicine one research note at a time: the educational value in clinical case reports.

Abstract
A case report–a brief written note that describes unique aspects of a clinical case–provides a significant function in medicine given its rapid, succinct, and educational contributions to scientific literature and clinical practice. Despite the growth of, and emphasis on, randomized clinical trials and evidenced-based medicine, case reports continue to provide novel and exceptional knowledge in medical education. The journal BMC Research Notes introduces a new “case reports” section to provide the busy clinician with a forum in which to document any authentic clinical case that provide educational value to current clinical practice. The aim is for this article type to be reviewed, wherever possible, by specialized Associate Editors for the journal, in order to provide rapid but thorough decision making. New ideas often garnered by and documented in case reports will support the advancement of medical science–one research note at a time.

via Advancing medicine one research note at a time… [BMC Res Notes. 2012] – PubMed – NCBI.

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MANUSCRIPT: Medical students as human subjects in educational research.

Abstract
Introduction: Special concerns often arise when medical students are themselves the subjects of education research. A recently completed large, multi-center randomized controlled trial of computer-assisted learning modules for surgical clerks provided the opportunity to explore the perceived level of risk of studies where medical students serve as human subjects by reporting on: 1) the response of Institutional Review Boards (IRBs) at seven institutions to the same study protocol; and 2) the thoughts and feelings of students across study sites about being research subjects. Methods: From July 2009 to August 2010, all third-year medical students at seven collaborating institutions were eligible to participate. Patterns of IRB review of the same protocol were compared. Participation burden was calculated in terms of the time spent interacting with the modules. Focus groups were conducted with medical students at each site. Transcripts were coded by three independent reviewers and analyzed using Atlas.ti. Results: The IRBs at the seven participating institutions granted full (n=1), expedited (n=4), or exempt (n=2) review of the WISE Trial protocol. 995 (73% of those eligible) consented to participate, and 207 (20%) of these students completed all outcome measures. The average time to complete the computer modules and associated measures was 175 min. Common themes in focus groups with participant students included the desire to contribute to medical education research, the absence of coercion to consent, and the low-risk nature of the research. Discussion: Our findings demonstrate that risk assessment and the extent of review utilized for medical education research vary among IRBs. Despite variability in the perception of risk implied by differing IRB requirements, students themselves felt education research was low risk and did not consider themselves to be vulnerable. The vast majority of eligible medical students were willing to participate as research subjects. Participants acknowledged the time demands of their participation and were readily able to withdraw when those burdens became unsustainable.

via Medical students as human subjects in educat… [Med Educ Online. 2013] – PubMed – NCBI.

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ABSTRACT: Twelve tips for making the best use of feedback.

Abstract
Background: Feedback is generally regarded as crucial for learning. We focus on feedback provided through instruments developed to inform self-assessment and support learners to improve performance. These instruments are being used commonly in medical education, but they are ineffective if the feedback is not well received and put into practice. Methods: The authors formulated twelve tips to make the best use of feedback based on widely cited publications on feedback. To include recent developments and hands-on experiences in the field of medical education, the authors discussed the tips with their research team consisting of experts in the field of medical education and professional performance, to reach agreement on the most practical strategies. Results: When utilizing feedback for performance improvement, medical students, interns, residents, clinical teachers and practicing physicians could make use of the twelve tips to put feedback into practice. The twelve tips provide strategies to reflect, interact and respond to feedback one receives through (validated) feedback instruments. Conclusions: Since the goal of those involved in medical education and patient care is to perform at the highest possible level, we offer twelve practical tips for making the best use of feedback in order to support learners of all levels

via Twelve tips for making the best use of feedback. [Med Teach. 2013] – PubMed – NCBI.

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ABSTRACT: Evidence-based competencies for improving communication skills in graduate medical education: A review with suggestions for implementation

Abstract
Communicating with patients is arguably the most common and important activity in medical practice, but this activity receives relatively little emphasis in graduate medical education. We propose 12 evidence-based communication competencies that program directors can adopt as a framework for teaching and evaluating residents’ communication skills. We review supporting evidence for these competencies and argue that communication should be treated like a procedural skill that must be taught and evaluated by observing real resident-patient interactions. We make practical suggestions for implementing these competencies by addressing three critical components of a competency-based approach to communication skills: patient safety, faculty development, and direct observation of residents. This approach to teaching and assessing communication skills provides a rationale for incorporating routine direct observation into graduate medical education programs and also for designing communication skills training that ensures graduating residents develop the skills needed to provide safe, effective patient care.

via Evidence-based competencies for improving communic… [Med Teach. 2013] – PubMed – NCBI.

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ABSTRACT: Survey of academic pediatric hospitalist programs in the US: Organizational, administrative, and financial factors

AbstractBACKGROUND:Many pediatric academic centers have hospital medicine programs. Anecdotal data suggest that variability exists in program structure.OBJECTIVE:To provide a description of the organizational, administrative, and financial structures of academic pediatric hospital medicine (PHM).METHODS:This online survey focused on the organizational, administrative, and financial aspects of academic PHM programs, which were defined as hospitalist programs at US institutions associated with accredited pediatric residency program (n = 246) and identified using the Accreditation Council for Graduate Medical Education (ACGME) Fellowship and Residency Electronic Interactive Database. PHM directors and/or residency directors were targeted by both mail and the American Academy of Pediatrics Section on Hospital Medicine LISTSERV.RESULTS:The overall response rate was 48.8% (120/246). 81.7% (98/120) of hospitals reported having an academic PHM program, and 9.1% (2/22) of hospitals without a program reported plans to start a program in the next 3 years. Over a quarter of programs provide coverage at multiple sites. Variability was identified in many program factors, including hospitalist workload and in-house coverage provided. Respondents reported planning increased in-house hospitalist coverage coinciding with the 2011 ACGME work-hour restrictions. Few programs reported having revenues greater than expenses (26% single site, 4% multiple site).CONCLUSIONS:PHM programs exist in the majority of academic centers, and there appears to be variability in many program factors. This study provides the most comprehensive data on academic PHM programs and can be used for benchmarking as well as program development. Journal of Hospital Medicine 2013;. © 2013 Society of Hospital Medicine.

via Survey of academic pediatric hospitalist programs… [J Hosp Med. 2013] – PubMed – NCBI.

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ABSTRACT: Integrative medicine in residency education: developing competency through online curriculum training

Abstract
INTRODUCTION:
The Integrative Medicine in Residency (IMR) program, a 200-hour Internet-based, collaborative educational initiative was implemented in 8 family medicine residency programs and has shown a potential to serve as a national model for incorporating training in integrative/complementary/alternative medicine in graduate medical education.
INTERVENTION:
The curriculum content was designed based on a needs assessment and a set of competencies for graduate medical education developed following the Accreditation Council for Graduate Medical Education outcome project guidelines. The content was delivered through distributed online learning and included onsite activities. A modular format allowed for a flexible implementation in different residency settings.
EVALUATION:
TO ASSESS THE FEASIBILITY OF IMPLEMENTING THE CURRICULUM, A MULTIMODAL EVALUATION WAS UTILIZED, INCLUDING: (1) residents’ evaluation of the curriculum; (2) residents’ competencies evaluation through medical knowledge testing, self-assessment, direct observations, and reflections; and (3) residents’ wellness and well-being through behavioral assessments.
RESULTS:
The class of 2011 (n  =  61) had a high rate of curriculum completion in the first and second year (98.7% and 84.2%) and course evaluations on meeting objectives, clinical utility, and functioning of the technology were highly rated. There was a statistically significant improvement in medical knowledge test scores for questions aligned with content for both the PGY-1 and PGY-2 courses.
CONCLUSIONS:
The IMR program is an advance in the national effort to make training in integrative medicine available to physicians on a broad scale and is a success in terms of online education. Evaluation suggests that this program is feasible for implementation and acceptable to residents despite the many pressures of residency.

via Integrative medicine in residency education:… [J Grad Med Educ. 2012] – PubMed – NCBI.

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ABSTRACT: Incorporating evidence into clinical teaching: enhanced geriatrics specialty case-based residency presentations.

Abstract
INTRODUCTION:
Case-based presentations are widely used in medical education and are a preferred education modality to teach about the care of geriatric patients across a range of medical specialties.
METHODS:
We incorporated evidence-based materials from topical literature syntheses into case-based presentations on the care of geriatric patients for use by specialty residents. These enhanced case-based presentations were used to augment learning and to facilitate detection of additional educational needs for future resident training sessions.
RESULTS:
Forty case-based presentations were presented to 11 specialty programs during a 4-year period. The program was popular, and program directors and residents requested additional presentations. Geriatric evidence-based summaries were viewed online 375 times during the course of the project. Geriatric clinical consults increased from an average of 10 consults a year to 141 from 64 different providers during the first year.
DISCUSSION:
Case-based presentation, enhanced with evidence-based summaries of research literature generated by information specialists, is a feasible and effective approach to teaching clinical content. These presentations can be used to target geriatrics educational competencies for resident trainees in nongeriatric specialties.

via Incorporating evidence into clinical teachin… [J Grad Med Educ. 2012] – PubMed – NCBI.

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ABSTRACT: The patient satisfaction chasm: the gap between hospital management and frontline clinicians — Rozenblum et al. 22 (3): 242 — BMJ Quality and Safety

Abstract
Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process.

Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA.

Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries (p<0.0001). Among responders, only 38% remembered targeted actions to improve patient satisfaction and just 34% stated having received feedback from hospital management regarding patient satisfaction status in their department during the past year. In multivariate analyses, clinicians who received feedback from hospital management and remembered targeted actions to improve patient satisfaction were more likely to state that their department had a structured plan to improve patient satisfaction.

Conclusions This portrait of clinicians’ attitudes highlights a chasm between hospital management and frontline clinicians with respect to improving patient satisfaction. It appears that while hospital management asserts that patient-centred care is important and invests in patient satisfaction and patient experience surveys, our findings suggest that the majority do not have a structured plan for promoting improvement of patient satisfaction and engaging clinicians in the process.

via The patient satisfaction chasm: the gap between hospital management and frontline clinicians — Rozenblum et al. 22 (3): 242 — BMJ Quality and Safety.

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