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Author: Brian S McGowan, PhD

MANUSCRIPT: How well do health professionals interpret diagnostic information? A systematic review

OBJECTIVE:
To evaluate whether clinicians differ in how they evaluate and interpret diagnostic test information.
DESIGN:
Systematic review.
DATA SOURCES:
MEDLINE, EMBASE and PsycINFO from inception to September 2013; bibliographies of retrieved studies, experts and citation search of key included studies.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES:
Primary studies that provided information on the accuracy of any diagnostic test (eg, sensitivity, specificity, likelihood ratios) to health professionals and that reported outcomes relating to their understanding of information on or implications of test accuracy.
RESULTS:
We included 24 studies. 6 assessed ability to define accuracy metrics: health professionals were less likely to identify the correct definition of likelihood ratios than of sensitivity and specificity. -25 studies assessed Bayesian reasoning. Most assessed the influence of a positive test result on the probability of disease: they generally found health professionals’ estimation of post-test probability to be poor, with a tendency to overestimation. 3 studies found that approaches based on likelihood ratios resulted in more accurate estimates of post-test probability than approaches based on estimates of sensitivity and specificity alone, while 3 found less accurate estimates. 5 studies found that presenting natural frequencies rather than probabilities improved post-test probability estimation and speed of calculations.
CONCLUSIONS:
Commonly used measures of test accuracy are poorly understood by health professionals. Reporting test accuracy using natural frequencies and visual aids may facilitate improved understanding and better estimation of the post-test probability of disease.

via How well do health professionals interpret diagnostic information? A systematic review. – PubMed – NCBI.

MANUSCRIPT: Effectiveness of interprofessional education by on-field training for medical students, with a pre-post design

BACKGROUND:
Interprofessional Education (IPE) implies how to achieve successful teamwork, and is based on collaborative practice which enhance occasions for relationships between two or more healthcare professions. This study evaluates the effectiveness of IPE in changing attitudes after a training recently introduced to medical education for second-year students at the University of Padova, Italy.
METHODS:
All medical students following a new program for IPE were enrolled in this study. The Interdisciplinary Education Perception Scale (IEPS) was administered before and after training, according to observation-based and practice-based learning. Data were analysed with Student’s paired t-test and Wilcoxon’s signed rank test.
RESULTS:
277 medical students completed both questionnaires. Statistically significant improvements were found in students’ overall attitudes as measured by the IEPS and four subscale scores. Gender-stratified analyses showed that improvements were observed only in female students in subscale 4 (“Understanding Others’ Values”). Students who had a physician and/or health worker in their family did not show any improvement in subscales 2 (“Perceived need for cooperation”) or 4 (“Understanding Others’ Values”).
CONCLUSIONS:
Our results indicate that IPE training has a positive influence on students’ understanding of collaboration and better attitudes in interprofessional teamwork. More research is needed to explore other factors which may influence specific perceptions among medical students.

via Effectiveness of interprofessional education by on-field training for medical students, with a pre-post design. – PubMed – NCBI.

ABSTRACT: Interprofessional Podiatric Surgical Simulation A Pilot Study.

BACKGROUND:
Interprofessional collaboration is key to quality outcomes in the health-care systems of today. Simulation is a common tool in podiatric medical education, and interprofessional education has become more common in podiatric medicine programs. Interprofessional simulation is the blending of these educational strategies.
METHODS:
A quantitative design was used to determine the impact of an isolated interprofessional podiatric surgical simulation between nurse anesthesia and podiatric medical students.
RESULTS:
Statistically significant differences were observed among participants between preintervention and postintervention surveys using the revised Interdisciplinary Education Perception Scale.
CONCLUSIONS:
Interprofessional simulation can be an effective educational opportunity for podiatric medical and nurse anesthesia students.

via Interprofessional Podiatric Surgical Simulation A Pilot Study. – PubMed – NCBI.

ABSTRACT: Emotional Intelligence and Simulation

Emotional intelligence (EI) is an established concept in the business literature with evidence that it is an important factor in determining career achievement. There is increasing interest in the role that EI has in medical training, but it is still a nascent field. This article reviews the EI literature most relevant to surgical training and proposes that simulation offers many benefits to the development of EI. Although there are many unanswered questions, it is expected that future research will demonstrate the effectiveness of using simulation to develop EI within surgery.

via Emotional Intelligence and Simulation. – PubMed – NCBI.

ABSTRACT: The importance of medical education in the changing field of pain medicine

Suffering chronic pain is a global epidemic that requires a closer look on how we are educating trainees to become more effective in pain management. The vast majority of medical professionals will encounter treatment of pain throughout their career. Our current system for educating these medical professionals is flawed in a number of ways. Improving pain education will narrow the gap between over and under treatment of acute and chronic pain. Reviews have demonstrated dissatisfaction among practitioners throughout the world on how pain education is currently conducted. Changing the educational process will require support from several areas: medical educators, clinicians, policymakers, administrators and several other organizations.

via The importance of medical education in the changing field of pain medicine. – PubMed – NCBI.

ABSTRACT: Committing to patient-centered medical education.

BACKGROUND:
Regular encounters of patients and medical students in a managed and structured consultation format, to focus on partnership in health care and chronic illness management, can address the student learning and professional development requirements facing contemporary medical education.
CONTEXT:
To engage and maintain such a strategy demands commitment and a belief in the importance of patient-centred medicine. The mechanism by which the Launceston Clinical School, University of Tasmania, has embraced this challenge over 8 years is the Patient Partner Program (P3).
INNOVATION:
Acknowledged as a program that enhances student learning, P3 features learning objectives that integrate the capabilities of managing the consultative craft and foster the growth of practitioners skilled in patient engagement.
IMPLICATIONS:
The possibility for the development of insights into patient experiences, doctor-patient relationships and broader health care perspectives arise from such interactions. Additionally, P3 is a beacon of university-community engagement for medical schools, and therefore provides a platform for future research into students’ learning with community patients, and the impact on patients engaged in such educational program. This article outlines the approach, impact and challenges of our medical school’s commitment to patient-centred education. Regular encounters of patients and medical students can address the student learning and professional development requirements.

via Committing to patient-centred medical education. – PubMed – NCBI.

ABSTRACT: Fostering and assessing professionalism and communication skills in neurosurgical education

NTRODUCTION:
Incorporation of the 6 ACGME core competencies into surgical training has proven a considerable challenge particularly for the two primarily behavioral competencies, professionalism and interpersonal and communication skills. We report on experience with two specific interventions to foster the teaching and continuous evaluation of these competencies for neurosurgery residents.
MATERIAL AND METHODS:
In 2010, the Society of Neurological Surgeons (SNS) organized the first comprehensive Neurosurgery Boot Camp courses, held at six locations throughout the US and designed to assess and teach not only psychomotor skills but also components of all six Accreditation Council for Graduate Medical Education (ACGME) core competencies. These courses are comprised of various educational methodologies, including online material, faculty lectures, clinical scenario and group discussions, manual skills stations, and pre- and post-course assessments. Resident progress in each of the 6 ACGME competencies is now tracked using the neurosurgical Milestones, developed by the ACGME in collaboration with the SNS. In addition, the Milestones drafting group for neurosurgery has formulated a milestone-compatible evaluation system to directly populate Milestone reports. These evaluations utilize formative, summative, and 360-degree evaluations that are considered by a faculty core competency committee in finalizing milestones levels for each resident.
RESULTS:
Initial attendance at the 2010 Boot Camp course was 94% of the incoming resident class and in subsequent years, 100%. Pre- and post-course surveys demonstrated a significant and sustained increase in knowledge. The value of these courses has been recognized by the ACGME, which requires Boot Camp or equivalent participation prior to acting with indirect supervision during clinical activities. Neurosurgery was one of 7 early Milestone adopter specialties, beginning use in July, 2013. Early milestone data will establish benchmarks prior to utilization for “high stake” decisions such as promotion, graduation, and termination.
CONCLUSIONS:
The full impact of the neurosurgical Boot Camps and Milestones on residency education remains to be measured, although published data from the first years of the Boot Camp Courses demonstrate broad acceptance and early effectiveness. A complementary junior resident course has now been introduced for rising second-year residents. The Milestones compatible evaluation system now provides for multi-source formative and summative evaluation of neurosurgical residents within the new ACGME reporting rubric. Combined with consensus milestone assignments, this system provides new specificity and objectivity to resident evaluations. The correlation of milestone level assignments with other measurements of educational outcome awaits further study.

via Fostering and assessing professionalism and communication skills in neurosurgical education. – PubMed – NCBI.

ABSTRACT: Impact of performance improvement continuing medical education on cardiometabolic risk factor control: the COSEHC initiative

INTRODUCTION:
The Consortium for Southeastern Hypertension Control (COSEHC) implemented a study to assess benefits of a performance improvement continuing medical education (PI CME) activity focused on cardiometabolic risk factor management in primary care patients.
METHODS:
Using the plan-do-study-act (PDSA) model as the foundation, this PI CME activity aimed at improving practice gaps by integrating evidence-based clinical interventions, physician-patient education, processes of care, performance metrics, and patient outcomes. The PI CME intervention was implemented in a group of South Carolina physician practices, while a comparable physician practice group served as a control. Performance outcomes at 6 months included changes in patients’ cardiometabolic risk factor values and control rates from baseline. We also compared changes in diabetic, African American, the elderly (> 65 years), and female patient subpopulations and in patients with uncontrolled risk factors at baseline.
RESULTS:
Only women receiving health care by intervention physicians showed a statistical improvement in their cardiometabolic risk factors as evidenced by a -3.0 mg/dL and a -3.5 mg/dL decrease in mean LDL cholesterol and non-HDL cholesterol, respectively, and a -7.0 mg/dL decrease in LDL cholesterol among females with uncontrolled baseline LDL cholesterol values. No other statistical differences were found.
DISCUSSION:
These data demonstrate that our PI CME activity is a useful strategy in assisting physicians to improve their management of cardiometabolic control rates in female patients with abnormal cholesterol control. Other studies that extend across longer PI CME PDSA periods may be needed to demonstrate statistical improvements in overall cardiometabolic treatment goals in men, women, and various subpopulations.

via Impact of performance improvement continuing medical education on cardiometabolic risk factor control: the COSEHC initiative. – PubMed – NCBI.

MANUSCRIPT: Free open access medical education can help rural clinicians deliver ‘quality care, out there’.

Rural clinicians require expertise across a broad range of specialties, presenting difficulty in maintaining currency of knowledge and application of best practice. Free open access medical education is a new paradigm in continuing professional education. Use of the internet and social media allows a globally accessible crowd-sourced adjunct, providing inline (contextual) and offline (asynchronous) content to augment traditional educational principles and the availability of relevant resources for life-long learning. This markedly reduces knowledge translation (the delay from inception of a new idea to bedside implementation) and allows rural clinicians to further expertise by engaging in discussion of cutting edge concepts with peers worldwide.

via Free open access medical education can help rural clinicians deliver ‘quality care, out there’. – PubMed – NCBI.

ABSTRACT: Learning theory and its application to the use of social media in medical education

BACKGROUND:
There is rapidly increasing pressure to employ social media in medical education, but a review of the literature demonstrates that its value and role are uncertain.
OBJECTIVE:
To determine if medical educators have a conceptual framework that informs their use of social media and whether this framework can be mapped to learning theory.
METHODS:
Thirty-six participants engaged in an iterative, consensus building process that identified their conceptual framework and determined if it aligned with one or more learning theories.
RESULTS:
The results show that the use of social media by the participants could be traced to two dominant theories-Connectivism and Constructivism. They also suggest that many medical educators may not be fully informed of these theories.
CONCLUSIONS:
Medical educators’ use of social media can be traced to learning theories, but these theories may not be explicitly utilised in instructional design. It is recommended that formal education (faculty development) around learning theory would further enhance the use of social media in medical education.

via Learning theory and its application to the use of social media in medical education. – PubMed – NCBI.