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Author: Brian S McGowan, PhD

ABSTRACT: Retention of Vaginal Breech Delivery Skills Taught in Simulation

OBJECTIVE:The optimal frequency of conducting simulation training for high-acuity, low-frequency events in obstetrics and gynaecology residency programs is unknown. This study evaluated retention over time of vaginal breech delivery skills taught in simulation, by comparing junior and senior residents. In addition, the residents’ subjective comfort level to perform this skill clinically was assessed.METHODS:This prospective cohort study included 22 obstetrics and gynaecology residents in a Canadian residency training program. Digital recordings were completed for pre-training, immediate post-training, and delayed (10-26 weeks later) post-training intervals of a vaginal breech delivery simulation, with skill assessment by a blinded observer using a binary checklist. Residents also completed questionnaires to assess their subjective comfort level at each interval.RESULTS:Junior and senior residents had significant improvements in vaginal breech delivery skills from the pre-training assessment to both the immediate post-training assessment (junior, P <0.001; senior, P <0.001) and the delayed post-training assessment (P <0.001 and P = 0.001, respectively). There was a significant decline in skills between the immediate and delayed post-training sessions for junior and senior residents (P = 0.003 and P <0.001, respectively). Both junior and senior residents gained more comfort immediately after the training (P <0.001 and P <0.001, respectively), without a significant change between immediate post-training and delayed post-training comfort levels (P = 0.19 and P = 0.11, respectively).CONCLUSION:Residents retained vaginal breech delivery skills taught in simulation 10-26 weeks later, although a decline in skills occurred over this time period. Comfort level was positively affected and retained. These results will aid in determining the frequency of simulation teaching for high-acuity, low-frequency events in a residency simulation curriculum.

via Retention of Vaginal Breech Delivery Skills Taught in Simulation. – PubMed – NCBI.

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RESOURCE: How ‘nudge theory’ can help shops avoid a backlash over plastic bag bans

On your way home tonight, you might stop at the supermarket to grab some ingredients for the evening meal. If you’re like many shoppers, you’ll pass through the self-service checkout, scan your items, and hurriedly place them in the conveniently waiting thin, grey plastic bag before finalising the purchase.At home, the purchases are packed away or lined up for immediate preparation. The plastic bag is scrunched into a little ball and stuffed away with others in your collection, to be used as bin liners or otherwise thrown away. All of these behaviours are, by and large, done without a great deal of thought.One of the most challenging tasks for marketers is to bring about changes in consumer behaviours that have become habitual, routine and “low involvement” – why spend time stopping and considering various brands of laundry detergent, for instance, when you can just quickly grab the one you’ve always used?The very nature of habitual behaviour means that responses to the same situational cues happen automatically and with little conscious thought. Habits are powerfully ingrained. One study estimates that around 45% of our daily actions are habitual, and most of our purchases and consumption is of the low-involvement variety.Repetitive consumer behaviour is a tough cycle to disrupt. And it is the very nature of these habitual responses that make many standard interventions relatively ineffective.But this is the task facing supermarkets in taking away customers’ access to free plastic bags.

via How ‘nudge theory’ can help shops avoid a backlash over plastic bag bans.

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ABSTRACT: The impact of a web-based educational program on the recognition and management of deteriorating patients

AIMS AND OBJECTIVES:
To evaluate the effectiveness of a web-based educational program to enhance enrolled nurses’ knowledge and skills in the recognition and management of deteriorating patients.
BACKGROUND:
Ward nurses of different skill levels play a pivotal role in detecting and responding to deteriorating patients. A skill-mix of registered nurses, enrolled nurses, licensed practice nurses or healthcare assistants is often employed for the provision of nursing care in acute settings. Non-registered nurses frequently perform bedside care and are in the best position to detect deteriorating patients and initiate immediate actions, including commanding the attention of registered nurses. Education is needed to improve the knowledge and skills of these nurses.
DESIGN:
A randomized controlled trial with a pre-test-post-test design.
METHODS:
The sample included enrolled nurses from an acute care tertiary hospital. Following a baseline evaluation, the experimental group received a web-based educational intervention. Pre-post assessment of skills and knowledge were evaluated with a simulated scenario and a knowledge questionnaire. Sixty-four nurses completed the entire study.
RESULTS:
Following the intervention, participants from the experimental group were significantly more likely than those in control group to monitor the patient’s respiratory and pulse rates. In addition, they had significantly higher post-test mean scores for knowledge and skills in assessing and managing clinical deterioration, and reporting deterioration.
CONCLUSION:
The web-based educational intervention significantly improved enrolled nurses’ knowledge and skills in the recognition and management of a deteriorating patient in a simulated setting.
RELEVANCE TO CLINICAL PRACTICE:
Ease of access to the web-based platform contributed to the feasibility and acceptability of this study, which has the potential to positively impact patient safety.

via The impact of a web-based educational program on the recognition and management of deteriorating patients. – PubMed – NCBI.

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ABSTRACT: Education in Sepsis: A Review for the Clinician of What Works, for Whom, and in What Circumstances

Sepsis is a major cause of morbidity and mortality in both the general and obstetric populations. Concerns have been raised regarding some cases of substandard care in the management of the septic and there is a real need for continuing multidisciplinary medical education in the recognition and management of the pregnant patient experiencing sepsis. This review aims to summarize studies on medical education in sepsis to both inform clinicians working in obstetrics and gynaecology and to assist in planning educational programs.

via Education in Sepsis: A Review for the Clinician of What Works, for Whom, and in What Circumstances. – PubMed – NCBI.

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ABSTRACT: The Use of the Delphi and Other Consensus Group Methods in Medical Education Research: A Review

PURPOSE:
Consensus group methods, such as the Delphi method and nominal group technique (NGT), are used to synthesize expert opinions when evidence is lacking. Despite their extensive use, these methods are inconsistently applied. Their use in medical education research has not been well studied. The authors set out to describe the use of consensus methods in medical education research and to assess the reporting quality of these methods and results.
METHOD:
Using scoping review methods, the authors searched the Medline, Embase, PsycInfo, PubMed, Scopus, and ERIC databases for 2009-2016. Full-text articles that focused on medical education and the keywords Delphi, RAND, NGT, or other consensus group methods were included. A standardized extraction form was used to collect article demographic data and features reflecting methodological rigor.
RESULTS:
Of the articles reviewed, 257 met the inclusion criteria. The Modified Delphi (105/257; 40.8%), Delphi (91/257; 35.4%), and NGT (23/257; 8.9%) methods were most often used. The most common study purpose was curriculum development or reform (68/257; 26.5%), assessment tool development (55/257; 21.4%), and defining competencies (43/257; 16.7%). The reporting quality varied, with 70.0% (180/257) of articles reporting a literature review, 27.2% (70/257) reporting what background information was provided to participants, 66.1% (170/257) describing the number of participants, 40.1% (103/257) reporting if private decisions were collected, 37.7% (97/257) reporting if formal feedback of group ratings was shared, and 43.2% (111/257) defining consensus a priori.
CONCLUSIONS:
Consensus methods are poorly standardized and inconsistently used in medical education research. Improved criteria for reporting are needed.

via The Use of the Delphi and Other Consensus Group Methods in Medical Education Research: A Review. – PubMed – NCBI.

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ABSTRACT: Are You Sure You Want to Do That? Fostering the Responsible Conduct of Medical Education Research

Engaging in questionable research practices (QRPs) is a noted problem across many disciplines, including medical education. While QRPs are rarely discussed in the context of medical education, that does not mean that medical education researchers are immune. Therefore, the authors seek to raise medical educators’ awareness of the responsible conduct of research (RCR) and call the community to action before QRPs negatively affect the field.The authors define QRPs and introduce examples that could easily happen in medical education research because of vulnerabilities particular to the field. The authors suggest that efforts in research, including medical education research, should focus on facilitating a change in the culture of research to foster RCR, and that these efforts should make explicit both the individual and system factors that ultimately influence researcher behavior. They propose a set of approaches within medical education training initiatives to foster such a culture: empowering research mentors as role models, open airing of research conduct dilemmas and infractions, protecting whistle blowers, establishing mechanisms for facilitating responsibly conducted research, and rewarding responsible researchers.The authors recommend that efforts at culture change be focused on the growing graduate programs, fellowships, and faculty academies in medical education to ensure that RCR training is an integral component for both students and faculty. They encourage medical education researchers to think creatively about solutions to the challenges they face and to act together as an international community to avoid wasting research efforts, damaging careers, and stunting medical education research through QRPs.

via Are You Sure You Want to Do That? Fostering the Responsible Conduct of Medical Education Research. – PubMed – NCBI.

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ABSTRACT: Evaluating a technology supported interactive response system during the laboratory section of a histology course

Monitoring of student learning through systematic formative assessment is important for adjusting pedagogical strategies. However, traditional formative assessments, such as quizzes and written assignments, may not be sufficiently timely for making adjustments to a learning process. Technology supported formative assessment tools assess student knowledge, allow for immediate feedback, facilitate classroom dialogues, and have the potential to modify student learning strategies. As an attempt to integrate technology supported formative assessment in the laboratory section of an upper-level histology course, the interactive application Learning CatalyticsTM , a cloud-based assessment system, was used. This study conducted during the 2015 Histology courses at Cornell University concluded that this application is helpful for identifying student misconceptions “on-the-go,” engaging otherwise marginalized students, and forming a new communication venue between students and instructors. There was no overall difference between grades from topics that used the application and grades from those that did not, and students reported that it only slightly helped improve their understanding of the topic (3.8 ± 0.99 on a five-point Likert scale). However, they highly recommended using it (4.2 ± 0.71). The major limitation was regarding the image display and graphical resolution of this application. Even though students embrace the use of technology, 39% reported benefits of having the traditional light microscope available. This cohort of students led instructors to conclude that the newest tools are not always better, but rather can complement traditional instruction methods.

via Evaluating a technology supported interactive response system during the laboratory section of a histology course. – PubMed – NCBI.

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MANUSCRIPT: Effectiveness of Adaptive E-Learning Environments on Knowledge, Competence, and Behavior in Health Professionals and Students

BACKGROUND:
Adaptive e-learning environments (AEEs) can provide tailored instruction by adapting content, navigation, presentation, multimedia, and tools to each user’s navigation behavior, individual objectives, knowledge, and preferences. AEEs can have various levels of complexity, ranging from systems using a simple adaptive functionality to systems using artificial intelligence. While AEEs are promising, their effectiveness for the education of health professionals and health professions students remains unclear.
OBJECTIVE:
The purpose of this systematic review is to assess the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students.
METHODS:
We will follow the Cochrane Collaboration and the Effective Practice and Organisation of Care (EPOC) Group guidelines on systematic review methodology. A systematic search of the literature will be conducted in 6 bibliographic databases (CINAHL, EMBASE, ERIC, PsycINFO, PubMed, and Web of Science) using the concepts “adaptive e-learning environments,” “health professionals/students,” and “effects on knowledge/skills/behavior.” We will include randomized and nonrandomized controlled trials, in addition to controlled before-after, interrupted time series, and repeated measures studies published between 2005 and 2017. The title and the abstract of each study followed by a full-text assessment of potentially eligible studies will be independently screened by 2 review authors. Using the EPOC extraction form, 1 review author will conduct data extraction and a second author will validate the data extraction. The methodological quality of included studies will be independently assessed by 2 review authors using the EPOC risk of bias criteria. Included studies will be synthesized by a descriptive analysis. Where appropriate, data will be pooled using meta-analysis by applying the RevMan software version 5.1, considering the heterogeneity of studies.
RESULTS:
The review is in progress. We plan to submit the results in the beginning of 2018.
CONCLUSION:
Providing tailored instruction to health professionals and students is a priority in order to optimize learning and clinical outcomes. This systematic review will synthesize the best available evidence regarding the effectiveness of AEEs in improving knowledge, competence, and behavior in health professionals and students. It will provide guidance to policy makers, hospital managers, and researchers in terms of AEE development, implementation, and evaluation in health care.

via Effectiveness of Adaptive E-Learning Environments on Knowledge, Competence, and Behavior in Health Professionals and Students: Protocol for a Syste… – PubMed – NCBI.

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ABSTRACT: Departing from PowerPoint default mode: Applying Mayer’s multimedia principles for enhanced learning of parasitology

PURPOSE:
PowerPoint (PPT™) presentation has become an integral part of day-to-day teaching in medicine. Most often, PPT™ is used in its default mode which in fact, is known to cause boredom and ineffective learning. Research has shown improved short-term memory by applying multimedia principles for designing and delivering lectures. However, such evidence in medical education is scarce. Therefore, we attempted to evaluate the effect of multimedia principles on enhanced learning of parasitology.
METHODOLOGY:
Second-year medical students received a series of lectures, half of the lectures used traditionally designed PPT™ and the rest used slides designed by Mayer’s multimedia principles. Students answered pre and post-tests at the end of each lecture (test-I) and an essay test after six months (test-II) which assessed their short and long term knowledge retention respectively. Students’ feedback on quality and content of lectures were collected.
RESULTS:
Statistically significant difference was found between post test scores of traditional and modified lectures (P = 0.019) indicating, improved short-term memory after modified lectures. Similarly, students scored better in test II on the contents learnt through modified lectures indicating, enhanced comprehension and improved long-term memory (P < 0.001). Many students appreciated learning through multimedia designed PPT™ and suggested for their continued use.
CONCLUSIONS:
It is time to depart from default PPT™ and adopt multimedia principles to enhance comprehension and improve short and long term knowledge retention. Further, medical educators may be trained and encouraged to apply multimedia principles for designing and delivering effective lectures.

via Departing from PowerPoint default mode: Applying Mayer’s multimedia principles for enhanced learning of parasitology. – PubMed – NCBI.

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ABSTRACT: Validation of a Teaching Effectiveness Assessment in Psychiatry Continuing Medical Education

OBJECTIVE:
Little is known about factors associated with effective continuing medical education (CME) in psychiatry. The authors aimed to validate a method to assess psychiatry CME teaching effectiveness and to determine associations between teaching effectiveness scores and characteristics of presentations, presenters, and participants.
METHODS:
This cross-sectional study was conducted at the Mayo Clinic Psychiatry Clinical Reviews and Psychiatry in Medical Settings. Presentations were evaluated using an eight-item CME teaching effectiveness instrument, its content based on previously published instruments. Factor analysis, internal consistency and interrater reliabilities, and temporal stability reliability were calculated. Associations were determined between teaching effectiveness scores and characteristics of presentations, presenters, and participants.
RESULTS:
In total, 364 participants returned 246 completed surveys (response rate, 67.6%). Factor analysis revealed a unidimensional model of psychiatry CME teaching effectiveness. Cronbach α for the instrument was excellent at 0.94. Item mean score (SD) ranged from 4.33 (0.92) to 4.71 (0.59) on a 5-point scale. Overall interrater reliability was 0.84 (95% CI, 0.75-0.91), and temporal stability was 0.89 (95% CI, 0.77-0.97). No associations were found between teaching effectiveness scores and characteristics of presentations, presenters, and participants.
CONCLUSIONS:
This study provides a new, validated measure of CME teaching effectiveness that could be used to improve psychiatry CME. In contrast to prior research in other medical specialties, CME teaching effectiveness scores were not associated with use of case-based or interactive presentations. This outcome suggests the need for distinctive considerations regarding psychiatry CME; a singular approach to CME teaching may not apply to all medical specialties

via Validation of a Teaching Effectiveness Assessment in Psychiatry Continuing Medical Education. – PubMed – NCBI.

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