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Author: Brian S McGowan, PhD

MANUSCRIPT: eLearning to facilitate the education and implementation of the Chelsea Critical Care Physical Assessment: a novel measure of function in critical illness

OBJECTIVE:
To evaluate the efficacy of eLearning in the widespread standardised teaching, distribution and implementation of the Chelsea Critical Care Physical Assessment (CPAx) tool-a validated tool to assess physical function in critically ill patients.
DESIGN:
Prospective educational study. An eLearning module was developed through a conceptual framework, using the four-stage technique for skills teaching to teach clinicians how to use the CPAx. Example and test video case studies of CPAx assessments were embedded within the module. The CPAx scores for the test case studies and demographic data were recorded in a secure area of the website. Data were analysed for inter-rater reliability using intraclass correlation coefficients (ICCs) to see if an eLearning educational package facilitated consistent use of the tool. A utility and content validity questionnaire was distributed after 1 year to eLearning module registrants (n=971). This was to evaluate uptake of the CPAx in clinical practice and content validity of the CPAx from the perspective of clinical users.
SETTING:
The module was distributed for use via professional forums (n=2) and direct contacts (n=95).
PARTICIPANTS:
Critical care clinicians.
PRIMARY OUTCOME MEASURE:
ICC of the test case studies.
RESULTS:
Between July and October 2014, 421 candidates from 15 countries registered for the eLearning module. The ICC for case one was 0.996 (95% CI 0.990 to 0.999; n=207). The ICC for case two was 0.988 (0.996 to 1.000; n=184). The CPAx has a strong total scale content validity index (s-CVI) of 0.94 and is well used.
CONCLUSIONS:
eLearning is a useful and reliable way of teaching psychomotor skills, such as the CPAx. The CPAx is a well-used measure with high content validity rated by clinicians.

via eLearning to facilitate the education and implementation of the Chelsea Critical Care Physical Assessment: a novel measure of function in critical … – PubMed – NCBI.

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ABSTRACT: Exploring the potential uses of value-added metrics in the context of postgraduate medical education

CONTEXT:
Increasing pressure is being placed on external accountability and cost efficiency in medical education and training internationally. We present an illustrative data analysis of the value-added of postgraduate medical education.
METHOD:
We analysed historical selection (entry) and licensure (exit) examination results for trainees sitting the UK Membership of the Royal College of General Practitioners (MRCGP) licensing examination (N = 2291). Selection data comprised: a clinical problem solving test (CPST); a situational judgement test (SJT); and a selection centre (SC). Exit data was an applied knowledge test (AKT) from MRCGP. Ordinary least squares (OLS) regression analyses were used to model differences in attainment in the AKT based on performance at selection (the value-added score). Results were aggregated to the regional level for comparisons.
RESULTS:
We discovered significant differences in the value-added score between regional training providers. Whilst three training providers confer significant value-added, one training provider was significantly lower than would be predicted based on the attainment of trainees at selection.
CONCLUSIONS:
Value-added analysis in postgraduate medical education potentially offers useful information, although the methodology is complex, controversial, and has significant limitations. Developing models further could offer important insights to support continuous improvement in medical education in future.

via Exploring the potential uses of value-added metrics in the context of postgraduate medical education. – PubMed – NCBI.

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ABSTRACT: Connectivism: A knowledge learning theory for the digital age?

BACKGROUND:
The emergence of the internet, particularly Web 2.0 has provided access to the views and opinions of a wide range of individuals opening up opportunities for new forms of communication and knowledge formation. Previous ways of navigating and filtering available information are likely to prove ineffective in these new contexts. Connectivism is one of the most prominent of the network learning theories which have been developed for e-learning environments. It is beginning to be recognized by medical educators. This article aims to examine connectivism and its potential application.
CONTENT:
The conceptual framework and application of connectivism are presented along with an outline of the main criticisms. Its potential application in medical education is then considered.
CONCLUSIONS:
While connectivism provides a useful lens through which teaching and learning using digital technologies can be better understood and managed, further development and testing is required. There is unlikely to be a single theory that will explain learning in technological enabled networks. Educators have an important role to play in online network learning.

via Connectivism: A knowledge learning theory for the digital age? – PubMed – NCBI.

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ABSTRACT: Charting a Key Competency Domain: Understanding Resident Physician Interprofessional Collaboration (IPC) Skills.

BACKGROUND:
Interprofessional collaboration (IPC) is essential for quality care. Understanding residents’ level of competence is a critical first step to designing targeted curricula and workplace learning activities. In this needs assessment, we measured residents’ IPC competence using specifically designed Objective Structured Clinical Exam (OSCE) cases and surveyed residents regarding training needs.
METHODS:
We developed three cases to capture IPC competence in the context of physician-nurse collaboration. A trained actor played the role of the nurse (Standardized Nurse – SN). The Interprofessional Education Collaborative (IPEC) framework was used to create a ten-item behaviorally anchored IPC performance checklist (scored on a three-point scale: done, partially done, well done) measuring four generic domains: values/ethics; roles/responsibilities; interprofessional communication; and teamwork. Specific skills required for each scenario were also assessed, including teamwork communication (SBAR and CUS) and patient-care-focused tasks. In addition to evaluating IPC skills, the SN assessed communication, history-taking and physical exam skills. IPC scores were computed as percent of items rated well done in each domain (Cronbach’s alpha > 0.77). Analyses include item frequencies, comparison of mean domain scores, correlation between IPC and other skills, and content analysis of SN comments and resident training needs.
RESULTS:
One hundred and seventy-eight residents (of 199 total) completed an IPC case and results are reported for the 162 who participated in our medical education research registry. IPC domain scores were: Roles/responsibilities mean = 37 % well done (SD 37 %); Values/ethics mean = 49 % (SD 40 %); Interprofessional communication mean = 27 % (SD 36 %); Teamwork mean = 47 % (SD 29 %). IPC was not significantly correlated with other core clinical skills. SNs’ comments focused on respect and IPC as a distinct skill set. Residents described needs for greater clarification of roles and more workplace-based opportunities structured to support interprofessional education/learning.
CONCLUSIONS:
The IPC cases and competence checklist are a practical method for conducting needs assessments and evaluating IPC training/curriculum that provides rich and actionable data at both the individual and program levels.

via Charting a Key Competency Domain: Understanding Resident Physician Interprofessional Collaboration (IPC) Skills. – PubMed – NCBI.

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ABSTRACT: Social media and anatomy education: Using twitter to enhance the student learning experience in anatomy

Neuroanatomy is a difficult subject in medical education, with students often feeling worried and anxious before they have even started, potentially decreasing their engagement with the subject. At the University of Southampton, we incorporated the use of Twitter as a way of supporting students’ learning on a neuroanatomy module to evaluate how it impacted upon their engagement and learning experience. The #nlm2soton hashtag was created and displayed (via a widget) on the university’s virtual learning environment (VLE) for a cohort of 197 Year 2 medical students studying neuroanatomy. Student usage was tracked to measure levels of engagement throughout the course and frequency of hashtag use was compared to examination results. Student opinions on the use of Twitter were obtained during a focus group with eleven students and from qualitative questionnaires. The hashtag was used by 91% of the student cohort and, within this, more students chose to simply view the hashtag rather than make contributions. The completed questionnaire responses (n = 150) as well as focus group outcomes revealed the value of using Twitter. A negligible correlation was found between student examination scores and their viewing frequency of the hashtag however, no correlation was found between examination scores and contribution frequency. Despite this, Twitter facilitated communication, relieved anxieties and raised morale, which was valued highly by students and aided engagement with neuroanatomy. Twitter was successful in creating and providing a support network for students during a difficult module

via Social media and anatomy education: Using twitter to enhance the student learning experience in anatomy. – PubMed – NCBI.

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MANUSCRIPT: Accuracy and readability of cardiovascular entries on Wikipedia: are they reliable learning resources for medical students?

Objective To evaluate accuracy of content and readability level of English Wikipedia articles on cardiovascular diseases, using quality and readability tools.Methods Wikipedia was searched on the 6 October 2013 for articles on cardiovascular diseases. Using a modified DISCERN (DISCERN is an instrument widely used in assessing online resources), articles were independently scored by three assessors. The readability was calculated using Flesch-Kincaid Grade Level. The inter-rater agreement between evaluators was calculated using the Fleiss κ scale.Results This study was based on 47 English Wikipedia entries on cardiovascular diseases. The DISCERN scores had a median=33 (IQR=6). Four articles (8.5%) were of good quality (DISCERN score 40–50), 39 (83%) moderate (DISCERN 30–39) and 4 (8.5%) were poor (DISCERN 10–29). Although the entries covered the aetiology and the clinical picture, there were deficiencies in the pathophysiology of diseases, signs and symptoms, diagnostic approaches and treatment. The number of references varied from 1 to 127 references; 25.9±29.4 (mean±SD). Several problems were identified in the list of references and citations made in the articles. The readability of articles was 14.3±1.7 (mean±SD); consistent with the readability level for college students. In comparison, Harrison’s Principles of Internal Medicine 18th edition had more tables, less references and no significant difference in number of graphs, images, illustrations or readability level. The overall agreement between the evaluators was good (Fleiss κ 0.718 (95% CI 0.57 to 0.83).Conclusions The Wikipedia entries are not aimed at a medical audience and should not be used as a substitute to recommended medical resources. Course designers and students should be aware that Wikipedia entries on cardiovascular diseases lack accuracy, predominantly due to errors of omission. Further improvement of the Wikipedia content of cardiovascular entries would be needed before they could be considered a supplementary resource.

via Accuracy and readability of cardiovascular entries on Wikipedia: are they reliable learning resources for medical students? — Azer et al. 5 (10) — BMJ Open.

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ABSTRACT: E-Learning in Urology: Implementation of the Learning and Teaching Platform CASUS

BACKGROUND:
E-learning is playing an increasing role in medical education, supporting a problem-based and practical oriented education without putting patients at risk and compensating for the decrease in instructor-centered teaching. Not much research has been done concerning learning effects and reaction on behalf of the students.
METHODS:
We created computer-based cases for four important diagnoses in urology using the authoring system CASUS®. Fourth-year medical school students were randomized into two groups: (1) the CASUS® group, using the online cases for preparation, and (2) the book group, using a textbook. A multiple-choice test referring to the prepared topic had to be completed at the beginning of each lecture and the results were analyzed. Evaluation of the students concerning the acceptance of the program was done at the end of the semester.
RESULTS:
Members of the CASUS® group scored significantly higher with an average of 20% better test results than students using textbooks for preparation. Evaluation regarding the program showed a highly positive rating. Limitations include the small study population and the possibly biased test performance of the students.
CONCLUSION:
Computerized patient cases facilitate practice-oriented teaching and result in an interesting and engaging learning model with improved learning outcomes.

via E-Learning in Urology: Implementation of the Learning and Teaching Platform CASUS® – Do Virtual Patients Lead to Improved Learning Outcomes? A Rand… – PubMed – NCBI.

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ABSTRACT: A Survey of Simulation Utilization in Anesthesiology Residency Programs in the United States

Given the evolution of competency-based education and evidence supporting the benefits of incorporating simulation into anesthesiology residency training, simulation will likely play an important role in the training and assessment of anesthesiology residents. Currently, there are little data available regarding the current status of simulation-based curricula across US residency programs. In this study, we assessed simulation-based training and assessment in US anesthesiology programs using a survey designed to elicit information regarding the type, frequency, and content of the simulation courses offered at the 132 Accreditation Council of Graduate Medical Education-certified anesthesiology training programs. The response rate for the survey was 66%. Although most of the responding programs offered simulation-based courses for interns and residents and during CA-1 orientation, the curriculum varied greatly among programs. Approximately 40% of responding programs use simulation for resident assessment and remediation. The majority of responding programs favored standard simulation-based training as part of residency training (89%), and the most common perceived obstacles to doing so were time, money, and human resources. The results from this survey highlight that there are currently large variations in simulation-based training and assessment among training programs. It also confirms that many program directors feel that standardizing some components of simulation-based education and assessment would be beneficial. Given the positive impact simulation has on skill retention and operating room preparedness, it may be worthwhile to consider developing a standard curriculum.

via A Survey of Simulation Utilization in Anesthesiology Residency Programs in the United States. – PubMed – NCBI.

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ABSTRACT: Toward Data-Driven Radiology Education-Early Experience Building Multi-Institutional Academic Trainee Interpretation Log Database (MATILDA)

The residency review committee of the Accreditation Council of Graduate Medical Education (ACGME) collects data on resident exam volume and sets minimum requirements. However, this data is not made readily available, and the ACGME does not share their tools or methodology. It is therefore difficult to assess the integrity of the data and determine if it truly reflects relevant aspects of the resident experience. This manuscript describes our experience creating a multi-institutional case log, incorporating data from three American diagnostic radiology residency programs. Each of the three sites independently established automated query pipelines from the various radiology information systems in their respective hospital groups, thereby creating a resident-specific database. Then, the three institutional resident case log databases were aggregated into a single centralized database schema. Three hundred thirty residents and 2,905,923 radiologic examinations over a 4-year span were catalogued using 11 ACGME categories. Our experience highlights big data challenges including internal data heterogeneity and external data discrepancies faced by informatics researchers

via Toward Data-Driven Radiology Education-Early Experience Building Multi-Institutional Academic Trainee Interpretation Log Database (MATILDA). – PubMed – NCBI.

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