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Author: Brian S McGowan, PhD

ABSTRACT: Debriefing 101: training faculty to promote learning in simulation-based training

BACKGROUND:
Debriefing is recognized as essential for successful simulation-based training. Unfortunately, its effective use is variable. We developed a train the trainer workshop to teach key evidence-based components of effective debriefing.
METHOD:
A workshop focusing on best practices for debriefing in surgical simulation-based training was developed for the 2012 Annual Meeting of the Association for Surgical Education. Content emphasized key theoretical concepts related to and evidence-based components of an effective debriefing. Additionally, the workshop incorporated experiential learning via active debriefing following a simulated scenario.
RESULTS:
Content of the workshop emphasized effective debriefing as the key to learning in simulation-based education. Key elements of debriefing for educators to keep in mind include the following: approach, learning environment, engagement of learners, reaction, reflection, analysis, diagnosis, and application.
CONCLUSIONS:
Effective debriefing is an essential skill for educators involved in surgical simulation-based training. Without it, learning opportunities are missed. Training the trainer in effective debriefing is essential to ensure standardization of practice.

via Debriefing 101: training faculty to promote learning in simulation-… – PubMed – NCBI.

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MANUSCRIPT: Case based teaching at the bed side versus in classroom for undergraduates and residents of pediatrics

Introduction: Bedside teaching is defined as teaching in the presence of a patient, it is a vital component of medical education. The aim of this study was to evaluate the effectiveness of two methods of case based teaching (at the bedside and in the classroom) in the teaching hospitals (for both undergraduates and residents of pediatrics).

Methods: Thirty undergraduates and twenty pediatric residents were asked to study a topic of their curriculum from their text then pretest was taken from learners in the two levels; then either lecture with power point or case presentation or bed side discussion were conducted. One week later post- test was taken, and then evaluation of these three methods was done by a questionnaire from learners.

Results: The majority of under-graduates and all of pediatric residents had evaluated case based teaching superior to bedside teaching and these two methods superior to lecture method.

Conclusions: They believed that in the case based teaching they are more relaxed and have more self-esteem than at the bedside of the patients. Clinician teacher must involve participants and learners in the process of bedside teaching, by preparing a comfortable situation and by using available technology.

via Case based teaching at the bed side versus in classroom for undergraduates and residents of pediatrics.

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PERSPECTIVE: The role of educational technology in medical education

Being one of the most effective tools for educational system improvement, educational Technology plays an important role in learning facilitation. In order to have a deeper, more effective and long lasting learning impact, this systematic approach designs, implements and evaluates the teaching- learning process, using specific purposes, new methods of psychology and communication sciences and also human and non-human resources (1).

A fruitful and effective educational system which results in actual learning improvement cannot be achieved unless its faculty members become competent. To achieve this goal, not only they must attain and/or maintain academic qualifications, especially in their teaching area, but also be familiar with the newest communication and teaching methods and equipped with educational and professional skills.

Considering the growing movement of education towards the new technologies and the Ministry of Health and Medical Education tendency for upgrading the educational technology and virtual learning, the need for experts in education technology was clear. Therefore, given its mission which focuses on scientific promotion and academic training improvement, in an cooperation with shiraz educational development center along with Center of Excellence for electronic learning`s staff and faculty members, Shiraz Educational Technology unit, established the Master of education technology courses (2).

Education’s technology and E-Learning, have arises a condition in which many educational goals, such as independent learning, self-directed learning, learning regardless of time or place, collaborative learning and providing immediate feedbacks and assessment of learning, appears more achievable.

Electronic medical education has become very popular in developed countries and is rapidly developing, since it has educational value and the tremendous broadening audience through educational programs.

Considering the fact that currently, while the faculty members have to learn most of the new means of teaching, for most of their students, these new means of education such as computers and other associated applications are not really consider technology since they are not only completely familiar with but also very capable of utilizing them. Therefore, while faculties are trying to learn these new methods of transferring information, students’ expectations are getting higher each day, Hence it seems that educational technology mastery is an important neglected competency in faculties which mandates an especial training program for the universities’ upgrading and improvement.

via The role of educational technology in medical education.

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MANUSCRIPT: Improving the learning of clinical reasoning through computer-based cognitive representation

OBJECTIVE:
Clinical reasoning is usually taught using a problem-solving approach, which is widely adopted in medical education. However, learning through problem solving is difficult as a result of the contextualization and dynamic aspects of actual problems. Moreover, knowledge acquired from problem-solving practice tends to be inert and fragmented. This study proposed a computer-based cognitive representation approach that externalizes and facilitates the complex processes in learning clinical reasoning. The approach is operationalized in a computer-based cognitive representation tool that involves argument mapping to externalize the problem-solving process and concept mapping to reveal the knowledge constructed from the problems.
METHODS:
Twenty-nine Year 3 or higher students from a medical school in east China participated in the study. Participants used the proposed approach implemented in an e-learning system to complete four learning cases in 4 weeks on an individual basis. For each case, students interacted with the problem to capture critical data, generate and justify hypotheses, make a diagnosis, recall relevant knowledge, and update their conceptual understanding of the problem domain. Meanwhile, students used the computer-based cognitive representation tool to articulate and represent the key elements and their interactions in the learning process.
RESULTS:
A significant improvement was found in students’ learning products from the beginning to the end of the study, consistent with students’ report of close-to-moderate progress in developing problem-solving and knowledge-construction abilities. No significant differences were found between the pretest and posttest scores with the 4-week period. The cognitive representation approach was found to provide more formative assessment.
CONCLUSIONS:
The computer-based cognitive representation approach improved the learning of clinical reasoning in both problem solving and knowledge construction.

via Improving the learning of clinical reasoning through computer-based… – PubMed – NCBI.

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ABSTRACT: Twelve tips to support the development of clinical reasoning skills using virtual patient cases.

Clinical reasoning is a critical core competency in medical education. Strategies to support the development of clinical reasoning skills have focused on methodologies used in traditional settings, including lectures, small groups, activities within Simulation Centers and the clinical arena. However, the evolving role and growing utilization of virtual patients (VPs) in undergraduate medical education; as well as an increased emphasis on blended learning, multi-modal models that include VPs in core curricula; suggest a growing requirement for strategies or guidelines that directly focus on VPs. The authors have developed 12 practical tips that can be used in VP cases to support the development of clinical reasoning. These are based on teaching strategies and principles of instructional design and pedagogy, already used to teach and assess clinical reasoning in other settings. Their application within VPs will support educators who author or use VP cases that promote the development of clinical reasoning.

via Twelve tips to support the development of clinical reasoning skills… – PubMed – NCBI.

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ABSTRACT: A novel use of Twitter to provide feedback and evaluations.

BACKGROUND:
Inconsistencies in work schedules and faculty supervision are barriers to monthly emergency medicine (EM) resident doctor evaluations. Direct and contemporaneous feedback may be effective in providing specific details that determine a resident’s evaluation.
OBJECTIVES:
To determine whether Twitter, an easy to use application that is available on the Internet via smartphones and desktops, can provide direct and contemporaneous feedback that is easily accessible, and easy to store and refer back to.
METHODS:
First- to third-year EM residents were administered a survey to assess their thoughts on the current monthly evaluation system. Subsequently, residents obtained a Twitter account and were instructed to follow a single general faculty Twitter account for ease of data collection. Following completion of an 8-week study period, a second survey was administered to assess resident thoughts on contemporaneous feedback and evaluations versus the traditional form.
RESULTS:
Of the 24 EM residents, 13 were available for study. A total of 220 ‘tweets’ were provided by seven faculty members, with a mean of 11 tweets (range 8-17) per resident. The 13 residents received a total of eight formal evaluations from 19 faculty members. The second survey demonstrated that this method provided more detailed evaluations and increased the volume of feedback.
CONCLUSION:
Contemporaneous feedback and evaluation provides a greater volume of feedback that is more detailed than end-of-course evaluations. Twitter is an effective and easy means to provide this feedback. Limitations included the length of study time and the inability to have all of the EM residents involved in the study.

via A novel use of Twitter to provide feedback and evaluations. – PubMed – NCBI.

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MANUSCRIPT: Attitudes and knowledge regarding health care policy and systems: a survey of medical students in Ontario and California

BACKGROUND:
Canada and the United States have similar medical education systems, but different health care systems. We surveyed medical students in Ontario and California to assess their knowledge and views about health care policy and systems, with an emphasis on attitudes toward universal care.
METHODS:
A web-based survey was administered during the 2010-2011 academic year to students in 5 medical schools in Ontario and 4 in California. The survey collected demographic data and evaluated attitudes and knowledge regarding broad health care policy issues and health care systems. An index of support for universal health care was created, and logistic regression models were used to examine potential determinants of such support.
RESULTS:
Responses were received from 2241 students: 1354 from Ontario and 887 from California, representing 42.9% of eligible respondents. Support for universal health care coverage was higher in Ontario (86.8%) than in California (51.1%), p < 0.001. In California, females, self-described nonconservatives, students with the intent to be involved in health care policy as physicians and students with a primary care orientation were associated with support for universal coverage. In Ontario, self-described liberals and accurate knowledge of the Canadian system were associated with support. A single-payer system for practice was preferred by 35.6% and 67.4% of students in California and Ontario, respectively. The quantity of instruction on health care policy in the curriculum was judged too little by 73.1% and 57.5% of students in California and Ontario, respectively.
INTERPRETATION:
Medical students in Ontario are substantially more supportive of universal access to health care than their California counterparts. A majority of students in both regions identified substantial curricular deficiencies in health care policy instruction.

via Attitudes and knowledge regarding health care policy and systems: a… – PubMed – NCBI.

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ABSTRACT: Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer-related cognitive impairment in adults.

Over the past few decades, a body of research has emerged confirming what many adult patients with noncentral nervous system cancer have long reported-that cancer and its treatment are frequently associated with cancer-related cognitive impairment (CRCI). The severity of CRCI varies, and symptoms can emerge early or late in the disease course. Nonetheless, CRCI is typically mild to moderate in nature and primarily involves the domains of memory, attention, executive functioning, and processing speed. Animal models and novel neuroimaging techniques have begun to unravel the pathophysiologic mechanisms underlying CRCI, including the role of inflammatory cascades, direct neurotoxic effects, damage to progenitor cells, white matter abnormalities, and reduced functional connectivity, among others. Given the paucity of research on CRCI with other cancer populations, this review synthesizes the current literature with a deliberate focus on CRCI within the context of breast cancer. A hypothetical case-study approach is used to illustrate how CRCI often presents clinically and how current science can inform practice. While the literature regarding intervention for CRCI is nascent, behavioral and pharmacologic approaches are discussed.

via Clinical characteristics, pathophysiology, and management of noncen… – PubMed – NCBI.

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ABSTRACT: From Time-Based to Competency-Based Standards: Core Transitional Competencies in Plastic Surgery.

PURPOSE:
Competency-based medical education is becoming increasingly prevalent and is likely to be mandated by the Royal College in the near future. The objective of this study was to define the core technical competencies that should be possessed by plastic surgery residents as they transition into their senior (presently postgraduate year 3) years of training.
METHODS:
A list of potential core competencies was generated using a modified Delphi method that included the investigators and 6 experienced, academic plastic surgeons from across Canada and the United States. Generated items were divided into 7 domains: basic surgical skills, anesthesia, hand surgery, cutaneous surgery, esthetic surgery, breast surgery, and craniofacial surgery. Members of the Delphi group were asked to rank particular skills on a 4-point scale with anchored descriptors. Item reduction resulted in a survey consisting of 48 skills grouped into the aforementioned domains. This self-administered survey was distributed to all Canadian program directors (n = 11) via e-mail for validation and further item reduction.
RESULTS:
The response rate was 100% (11/11). Using the average rankings of program directors, 26 “core” skills were identified. There was agreement of core skills across all domains except for breast surgery and esthetic surgery. Of them, 7 skills were determined to be above the level of a trainee at this stage; a further 15 skills were agreed to be important, but not core, competencies.
CONCLUSIONS:
Overall, 26 competencies have been identified as “core” for plastic surgery residents to possess as they begin their senior, on-service years. The nature of these skills makes them suitable for teaching in a formal, simulated environment, which would ensure that all plastic surgery trainees are competent in these tasks as they transition to their senior years of residency

via From Time-Based to Competency-Based Standards: Core Transitional Co… – PubMed – NCBI.

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