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Author: Brian S McGowan, PhD

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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MANUSCRIPT: Federated queries of clinical data repositories: the sum of the parts does not equal the whole

Background and objective In 2008 we developed a shared health research information network (SHRINE), which for the first time enabled research queries across the full patient populations of four Boston hospitals. It uses a federated architecture, where each hospital returns only the aggregate count of the number of patients who match a query. This allows hospitals to retain control over their local databases and comply with federal and state privacy laws. However, because patients may receive care from multiple hospitals, the result of a federated query might differ from what the
result would be if the query were run against a single central repository. This paper describes the situations when this happens and presents a technique for correcting these errors.
Methods We use a one-time process of identifying which patients have data in multiple repositories by comparing one-way hash values of patient demographics. This enables us to partition the local databases such that all patients within a given partition have data at the same subset of hospitals. Federated queries are then run separately on each partition
independently, and the combined results are presented to the user.
Results Using theoretical bounds and simulated hospital networks, we demonstrate that once the partitions are made, SHRINE can produce more precise estimates of the number of patients matching a query. Conclusions Uncertainty in the overlap of patient populations across hospitals limits the effectiveness of SHRINE and other federated query tools. Our technique reduces this uncertainty while retaining an aggregate federated architecture.

 

http://www.amia.org/sites/amia.org/files/JAMIA-GriffinWeberMD-March-2013.pdf

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MANUSCRIPT: Development and implementation of a mini-Clinical Evaluation Exercise (mini-CEX) program to assess the clinical competencies of internal medicine residents: from faculty development to curriculum evaluation

Background
The mini-CEX is a valid and reliable method to assess the clinical competencies of trainees. Its data could be useful for educators to redesign curriculum as a process of quality improvement. The aim of this study was to evaluate a mini-CEX assessment program in our internal medicine residency training. We investigated the impact of mini-CEX workshops as a faculty development program on the acquisition of cognitive knowledge and the difference of practice behaviors among faculty members used the mini-CEX to assess residents’ performance at work.

Methods
We designed an observational, two-phase study. In the faculty development program, we started a mini-CEX workshop for trainers in 2010, and the short-term outcome of the program was evaluated by comparing the pretest and posttest results to demonstrate the improvement in cognitive knowledge on mini-CEX. From September 2010 to August 2011, we implemented a monthly mini-CEX assessment program in our internal medicine residency training. The data of these mini-CEX assessment forms were collected and analyzed.

Results
In the group of 49 mini-CEX workshop attendees, there was a statistically significant improvement in cognitive knowledge by comparing the pretest and posttest results (67.35 +/- 15.25 versus 81.22 +/- 10.34, p < 0.001). Among the 863 clinical encounters of mini-CEX, which involved 97 residents and 139 evaluators, 229(26.5%), 326(37.8%), and 308(35.7%) evaluations were completed by the first-year, second-year, and third- year residents separately. We found a statistically significant interaction between level of training and score in dimensions of mini-CEX. The scores in all dimensions measured were better for senior residents. Participation in mini-CEX workshops as a faculty development program strengthened the adherence of trainers to the principles of mini-CEX as a formative assessment in regard to provision of feedback. However, a deficiency in engaging residents’ reflection was found.

Conclusions
Faculty development is a prerequisite to train evaluators in order to implement a successful mini-CEX assessment program. We demonstrated the effectiveness of our mini-CEX workshops in terms of knowledge acquisition and enhancement of giving feedback when the faculty members used the tool. Further programs on providing effective feedback should be conducted to increase the impact of the mini-CEX as a formative assessment.

via BMC Medical Education | Abstract | Development and implementation of a mini-Clinical Evaluation Exercise (mini-CEX) program to assess the clinical competencies of internal medicine residents: from faculty development to curriculum evaluation.

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MANUSCRIPT: Perceptions of UK medical graduates’ preparedness for practice: A multi-centre qualitative study reflecting the importance of learning on the job

Background: There is evidence that graduates of different medical schools vary in their preparedness for their first post. In 2003 Goldacre et al. reported that over 40% of UK medical graduates did not feel prepared and found large differences between graduates of different schools. A follow-up survey showed that levels of preparedness had increased yet there was still wide variation. This study aimed to examine whether medical graduates from three diverse UK medical schools were prepared for practice.Methods: This was a qualitative study using a constructivist grounded theory approach. Prospective and cross-sectional data were collected from the three medical schools.A sample of 60 medical graduates (20 from each school) were targeted. They were interviewed three times: at the end of medical school (n = 65) and after four (n = 55) and 12 months (n = 46) as a Year 1 Foundation Programme doctor. Triangulated data were collected from clinicians via interviews across the three sites (n = 92). In addition three focus groups were conducted with senior clinicians who assess learning portfolios. The focus was on identifying areas of preparedness for practice and any areas of lack of preparedness.Results: Although selected for being diverse, we did not find substantial differences between the schools. The same themes were identified at each site. Junior doctors felt prepared in terms of communication skills, clinical and practical skills and team working. They felt less prepared for areas of practice that are based on experiential learning in clinical practice: ward work, being on call, management of acute clinical situations, prescribing, clinical prioritisation and time management and dealing with paperwork.Conclusions: Our data highlighted the importance of students learning on the job, having a role in the team in supervised practice to enable them to learn about the duties and responsibilities of a new doctor in advance of starting work.

via BMC Medical Education | Abstract | Perceptions of UK medical graduates’ preparedness for practice: A multi-centre qualitative study reflecting the importance of learning on the job.

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MANUSCRIPT: The association between academic engagement and achievement in health sciences students

Background
Educational institutions play an important role in encouraging student engagement, being necessary to know how engaged are students at university and if this factor is involved in student success.

To explore the association between academic engagement and achievement.

Methods
Cross-sectional study. The sample consisted of 304 students of Health Sciences. They were asked to fill out an on-line questionnaire. Academic achievements were calculated using three types of measurement.

Results
Positive correlations were found in all cases. Grade point average was the academic rate most strongly associated with engagement dimensions and this association is different for male and female students. The independent variables could explain between 18.9 and 23.9% of the variance (p < 0.05) in the population of university students being analyzed.

Conclusions
Engagement has been shown to be one of the many factors, which are positively involved, in the academic achievements of college students.

via BMC Medical Education | Abstract | The association between academic engagement and achievement in health sciences students.

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ABSTRACT: Junior doctors’ guide to portfolio learning and building.

Abstract
BACKGROUND:
A portfolio is a collection of evidence supporting an individual’s achievement of competencies and learning outcomes. The material included in the portfolio must be reflected upon, as reflection provides the evidence that learning has taken place.
CONTEXT:
Portfolio learning is important for two principal reasons: assessment of the trainee, and for lifelong learning and reflection. The ability of a portfolio to be used for both summative and formative assessment makes it a flexible and robust assessment method. A portfolio also demonstrates reflection and lifelong learning abilities. Reflective learning is key to postgraduate medical education: it is part of both the Foundation Programme curriculum and General Medical Council guidance on best practice.
INNOVATION:
To ensure correct learning outcomes are identified and evidenced, the curriculum programme must be referred to and an educational supervisor should be consulted. Once identified, it is necessary to: identify how these outcomes can be met (learning needs); decide what needs to be done to meet these needs; reflect on what has been done; and evidence what has been done in the portfolio. Evidence could include written feedback, certificates of course completion, online learning modules, etc.
IMPLICATIONS:
A learning portfolio is a necessary tool for every postgraduate medical trainee. The portfolio serves to record and evidence all learning that has taken place, and thereon acts as a guide for future learning needs. The key process to portfolio building and learning is the provision of evidence by reflecting upon the learning that has taken place.

via Junior doctors’ guide to portfolio learning and b… [Clin Teach. 2012] – PubMed – NCBI.

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