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Author: Brian S McGowan, PhD

MANUSCRIPT: Interprofessional Training: Not Optional in Good Medical Education

Interprofessional education is a vital part of medical education, and students should not be permitted to exempt themselves from it. Physicians are part of a team, and the importance of teamwork will only increase as physician shortages continue and medical care becomes more complex. To learn to be good physicians in this emerging environment, students must appreciate the skills, strengths, and vocabularies of other professions. It is shortsighted to think that the best educators of future physicians can only be other physicians.

via Interprofessional Training: Not Optional in Good Medical Education, Sept 16 – AMA Journal of Ethics.

ABSTRACT: Patients with heart failure as co-designers of an educational website: implications for medical education

OBJECTIVES:
To identify the learning needs of patients with heart failure between outpatients follow-up visits from their perspective and to ascertain what they emphasize as being important in the design of an educational website for them.
METHODS:
We conducted a two-step qualitative study at Aarhus University Hospital, Denmark. Twenty patients with heart failure participated either in focus group interviews, diary writing, or video-recorded design sessions. Data on learning needs were collected in step 1 and analyses, therefore, helped develop the preliminary prototypes of a website. In step 2, patients worked on the prototypes in video-recorded design sessions, employing a think-aloud method. The interviews were transcribed and a content analysis was performed on the text and video data.
RESULTS:
Patients’ learning needs were multifaceted, driven by anxiety, arising from, and often influenced by, such daily situations and contexts as the medical condition, medication, challenges in daily life, and where to get support and how to manage their self-care. They emphasized different ways of adapting the design to the patient group to enable interaction with peers and professionals and specific interface issues.
CONCLUSIONS:
This study provided insights into the different learning needs of patients with heart failure, how managing daily situations is the starting point for these needs and how emotions play a part in patients’ learning. Moreover, it showed how patient co-designers proved to be useful for understanding how to design a website that supports patients’ learning: insights, which may become important in designing online learning tools for patients.

via Patients with heart failure as co-designers of an educational website: implications for medical education. – PubMed – NCBI.

ABSTRACT: Gestalt assessment of online educational resources may not be sufficiently reliable and consistent

PURPOSE:
Online open educational resources are increasingly used in medical education, particularly blogs and podcasts. However, it is unclear whether these resources can be adequately appraised by end-users. Our goal was to determine whether gestalt-based recommendations are sufficient for emergency medicine trainees and attending physicians to reliably recommend online educational resources to others.
METHODS:
Raters (33 trainees and 21 attendings in emergency medicine from North America) were asked to rate 40 blog posts according to whether, based on their gestalt, they would recommend the resource to (1) a trainee or (2) an attending physician. The ratings’ reliability was assessed using intraclass correlation coefficients (ICC). Associations between groups’ mean scores were assessed using Pearson’s r. A repeated measures analysis of variance (RM-ANOVA) was completed to determine the effect of the level of training on gestalt recommendation scale (i. e. trainee vs. attending).
RESULTS:
Trainees demonstrated poor reliability when recommending resources for other trainees (ICC = 0.21, 95% CI 0.13-0.39) and attendings (ICC = 0.16, 95% CI = 0.09-0.30). Similarly, attendings had poor reliability when recommending resources for trainees (ICC = 0.27, 95% CI 0.18-0.41) and other attendings (ICC = 0.22, 95% CI 0.14-0.35). There were moderate correlations between the mean scores for each blog post when either trainees or attendings considered the same target audience. The RM-ANOVA also corroborated that there is a main effect of the proposed target audience on the ratings by both trainees and attendings.
CONCLUSIONS:
A gestalt-based rating system is not sufficiently reliable when recommending online educational resources to trainees and attendings. Trainees’ gestalt ratings for recommending resources for both groups were especially unreliable. Our findings suggest the need for structured rating systems to rate online educational resources.

via Gestalt assessment of online educational resources may not be sufficiently reliable and consistent. – PubMed – NCBI.

MANUSCRIPT: Reflective Journals: Unmasking student perceptions of anatomical education

In medical education, reflection has been considered to be a core skill in professional competence. The anatomy laboratory is an ideal setting for faculty/student interaction and provides invaluable opportunities for active learning and reflection on anatomical knowledge. This study was designed to record student attitudes regarding human cadaveric dissection, explore their experiences of anatomy through an analysis of their journal-reflective writings and determine whether this type of creative writing had a beneficial effect on those students who chose to complete them. A total of seventy-five journals from Medical and Allied Health Science students were collected and analysed. Results were categorized according to the following themes: (i) Dissecting room stressors (27.6%); (ii) Educational value of dissection (26.3%); (iii) Appreciation, Gratitude, Respect & Curiosity for the cadaver (18.9%); (iv) Positive and negative sentiments expressed in the dissecting room (25.8%); (v) Benefit of alternate teaching modalities (4.6%); (vi) Spirituality/Religious Beliefs (3.7%); (vii) Shared humanity and emotional bonds (3.69%); (viii) Acknowledgement of human anatomical variations (3.2%); (ix) Beauty and complexity of the human body (1.8%) and (x) Psychological detachment (0.9%). Students appreciated the opportunity to share their emotions and reflect on the humanistic dimension of anatomy as a subject. Student reflections illustrated clearly their thoughts and some of the difficult issues with which they wrestled.. The anatomy laboratory is seen as the budding clinician’s first encounter with a patient, albeit a cadaver. This was the first time that reflective journals were given to students in the discipline. Reflective journals allow students to express themselves in an open-ended and creative fashion. It also assists students to integrate anatomy and clinical medicine and assists in applying their basic anatomical knowledge in an authentic, yet safe environment.

via Reflective Journals: Unmasking student perceptions of anatomical education. – PubMed – NCBI.

ABSTRACT: The Leadership Case for Investing in Continuing Professional Development

Continuing medical education (CME) has the power and capacity to address many challenges in the health care environment, from clinician well-being to national imperatives for better health, better care, and lower cost. Health care leaders who recognize the strategic value of education and engage their people in education can expect a meaningful return on their investment-not only in terms of the quality and safety of their clinicians’ work but also in the spirit and cohesiveness of the clinicians who work at their institution. To optimize the benefits of education, clinical leaders need to think of accredited CME as the professional development vehicle that can help them drive change and achieve goals, in consort with quality improvement efforts, patient safety projects, and other systems changes. An empowered CME program, with its multiprofessional scope and educational expertise, can contribute to initiatives focused on both clinical and nonclinical areas, such as quality and safety, professionalism, team communication, and process improvements. In this Commentary, the author describes principles and action steps for aligning leadership and educational strategy and urges institutional leaders to embrace the continuing professional development of their human capital as an organizational responsibility and opportunity and to view engagement in education as an investment in people.

via The Leadership Case for Investing in Continuing Professional Development. – PubMed – NCBI.

ABSTRACT: Defining Clinical Excellence in Hospital Medicine: A Qualitative Study

INTRODUCTION:
There are now more than 50,000 hospitalists working in the United States. Limited empiric research has been performed to characterize clinical excellence in hospital medicine. We conducted a qualitative study to discover elements judged to be most pertinent to excellence in clinical care delivered by hospitalists.
METHODS:
The chiefs of hospital medicine at five hospitals were asked to identify their “clinically best” hospitalists. Data collection, in the form of one-on-one interviews, was directed by an interview guide. Interviews were transcribed verbatim, and the informants’ perspectives were analyzed using editing analysis to identify themes.
RESULTS:
A total of 26 hospitalists were interviewed. The mean age of the physicians was 38 years, 13 (50%) were women, and 16 (62%) were non-white. Seven themes emerged that related to clinical excellence in hospital medicine: communicating effectively, appreciating partnerships and collaboration, having superior clinical judgment, being organized and efficient, connecting with patients, committing to continued growth and development, and being professional and humanistic.
DISCUSSION:
This qualitative study describes how respected hospitalists think about excellence in clinical care in hospital medicine. Their perspectives can be used to guide continuing medical education, so that offered programs can pay attention to enhancing the skills of learners so they can develop towards excellence, rather than using only competence as the desired target objective.

via Defining Clinical Excellence in Hospital Medicine: A Qualitative Study. – PubMed – NCBI.

The Science of Storytelling: What Do Stories Look Like?

With all of the buzz around ‘telling better stories’ as a means of making educational interventions more memorable – a noble pursuit for sure – there doesn’t seems to be a lot of agreement on what this really means. As a result there appears to be little progress being made (and maybe even some confusion and contention)!

Enter science 😉

In a recent publication, Reagan et al have leveraged semantic analysis and a big data approach to deconstruct the general emotional arcs of more than 1,300 stories. Here is their abstracts:

“Advances in computing power, natural language processing, and digitization of text now make it possible to study a culture’s evolution through its texts using a “big data” lens. Our ability to communicate relies in part upon a shared emotional experience, with stories often following distinct emotional trajectories and forming patterns that are meaningful to us. Here, by classifying the emotional arcs for a filtered subset of 1,327 stories from Project Gutenberg’s fiction collection, we find a set of six core emotional arcs which form the essential building blocks of complex emotional trajectories. We strengthen our findings by applying Matrix decomposition, supervised learning, and unsupervised learning. For each of these six core emotional arcs, we examine the closest characteristic stories in publication today and find that particular emotional arcs enjoy greater success, as measured by downloads.”

To dig into their methods and broader conclusions click here!

I have been doing some related work over the past few years, helping educational designers to visualize the rhythm of their own ‘stories’….an eye-opening endeavor for sure (see figure).

I have had the pleasure of working with designers to inspect and understand their own ‘learning grams’ which depict how their educational activities unfold, each icon representing a learning moment they have designed to drive reflection or nudge a learning action. This is yet another benefit of the Learning Actions Model – it allows designers to create moments that support the key elements of their content and in doing so perfectly paints the picture of the story they intend to tell.

For reasons both obvious and less-than-obvious, story telling in medical education is not exactly the same as story telling in fiction; but the value of studying the ‘shape’ of stories is no less valuable. And as I read Reagan’s work on stories, and as I reflect on the reaction designers have to ‘seeing’ their own stories deconstructed within the ArcheViewer; I feel like the science of storytelling is finally coming together!

Science of Learning: The 2017 Spring Tour

One of my favorite parts of the Spring is the various meetings and symposia I am invited to – whether face-to-face or virtual – the opportunity to learn from and share with various learning professionals is perhaps my favorite part of being a Chief Learning Officer.

Over the next month or so I will be leading a session at the 2nd Annual Learning-Technology-Design Conference hosted by Tagoras, as well as Keynoting the America Medical Writer Association Annual Meeting and the Lehigh Valley Health Network’s Innovation in Education Meeting. Each meeting allows me to engage with an audience of peers and to continue to advocate for the Science of Learning.

While the commitment of time and planning can be overwhelming at times, I fully subscribe to the adage that, “if you really want to learn something, teach it…” – and this year I have committed to work on three separate, but related topics. As I get closer to each presentation, I thought I might share a few new ideas I have come to learn!

Later this week, the Spring tour begins with a session entitled, “Measure Well: ‘Hacking’ Learning Analytics.” The goals of this session are to help learning professionals develop their own ‘work smarter, not harder’ approaches to gathering, understanding, and leveraging learning data. In preparing for this session I reflected on how frustrating ‘outcomes’ can be for those professionals that fail to effectively operationalize a framework and quickly find their efforts being wasted – efforts that should take minutes, instead take hours (or weeks) – or simply fail altogether. This recognition is summarized in one of my introductory slides:

Stop #2 on the Spring tour takes place a few weeks later with a session entitled, “What Do We Really Know About Learning?” The goals of the second session are to deconstruct learning and to simplify its foundational science. This is a talk I have given dozens of times, but each time I prepare I challenge myself to find a new angle – to tell the story in a slightly different way. This time I’ve forced myself to revisit the fore-fathers of behavioral economics and to look for ways to apply this seemingly unrelated field to better understand the science of learning. In doing so I may have stumbled on the most (simple and) critical lesson an educational designer may ever learn:

Stop #3 on the Spring tour takes place in April when I will visit colleagues at LVHN where my Keynote is entitled, “(Effective) Learning and Behavior Change Requires Time.” In this third session I will make the case that one-off and episodic educational interventions are – with very few exceptions – never going to help us achieve the outcomes we desire! The simple truth is that learning is rarely ever a moment, instead it is a process – as is teaching – and therefore both learners and educators need time:

In preparing for each of these sessions I can spend hours and hours huddled away in my office re-crafting, honing, and simplifying my stories…and it is all worth it!

Each time I walk on stage, I whole-heartedly believe that we are moving the community forward; I believe that sharing from the gospel of ‘learning science’ will empower educational professionals; and I believe that only when advancing collectively will the continuing education of healthcare professionals drive achievement of the triple aim.

And when I look at the big picture this way, I just can’t help but get a bit fired up!

(Though, to be fair, the downside of all this preparing for the Spring tour is that I really need to get out more…or at least move near an open window…)

Where does the ’17 years’ data point come from?

In 2010, after years of hearing that “[it takes on average]…17 years from research to practice…” I spent some time to dig into the facts…and I came away both impressed (by the underlying science) and concerned (by the barriers we face). The following is what I shared with my colleagues at Pfizer at the time….which generated MUCH conversation:

Here is the authors’ theoretical evidence: 

And, here is the authors’ empirical evidence: 

 

And finally here is the description of the simple mathematical construct for the 17 year reference:

 

Oh, by the way, this ’17 years’ measure is only getting us to 50% utilization of clinical recommendations!

Other (chilling) thoughts – remember this is 17 years ago, things are likely much worse:

  • Passive diffusion does not work:
    • If a doc were to read 2 articles a day, by the end of any year they would be centuries behind!
    • A general physician would have to peruse 19 articles a day to keep up with relevant science
    • Textbooks are often wrong, outdated, and misleading (w/ refs to support)
    • 75% of docs admitted having problems understanding statistics commonly found in journals
  • Medical education and the acquisition of professional credentials do not guarantee that medical knowledge will be coupled rigorously to the decision making processes needed in practice
  • Innovative technologies are needed to deliver credible and evidence to the point of care

So, as we all make our way out to the west coast for the annual Alliance meeting, keep these challenges in mind. On one hand, very little has gotten better since 2010, on the other hand I believe we may be closer than ever to bending the innovation curve!

If our paths cross this week, I’d love to hear your thoughts on the topic!

For those interested in digging into these ideas for themselves, here is a link to the full reference:

​Balas EA, Boren SA. Managing clinical knowledge for health care improvement. In: Bemmel J, McCray AT, editors. Yearbook of Medical Informatics 2000: Patient-Centered Systems. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000:65-70.

 

ABSTRACT: Study skills in anatomy and physiology: Is there a difference?

Many factors influence the way individual students study, including but not limited to: previous coursework, attitudes toward the class (motivation, intimidation, risk, etc.), metacognition, and work schedules. However, little of this research has involved medical students. The present article asks the question, “Do individual medical students study differently for different classes?” Study skills surveys were given to United States medical students at an allopathic medical school and an osteopathic medical school. Students were surveyed near the end of their first year gross anatomy course and again near the end of their first year physiology course. Survey items included Likert scale and open-ended questions about study habits and basic demographic information. The survey responses were correlated with each student’s final grade percentages in the courses. Analysis revealed that the four most common study habits were reviewing lecture notes, taking practice examinations, completing learning exercises, and making drawings and diagrams. The two surveys (anatomy and physiology) from each individual were also compared to see if students reported different study habits in anatomy versus physiology. A negative correlation was found between changing study habits between courses and final anatomy grade percentages. Additional analyses suggest that those students who do change their study habits between courses are increasing the number of study strategies that they attempt. This increase in the number of study strategies attempted may not allow the student to reach the same depth of understanding as their colleagues who utilize fewer strategies.

via Study skills in anatomy and physiology: Is there a difference? – PubMed – NCBI.