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Author: Brian S McGowan, PhD

MANUSCRIPT: Physician as teacher: Promoting health and wellness among elementary school students

BACKGROUND:
Every day, physicians engage in teaching during their patient encounters. It may be that medical students who are introduced to the principles of teaching and learning are more likely to become good communicators and learners. Service-learning may be an effective way for medical students to practice skills in teaching and communication in a real-world setting, while also filling a need within the community. The purpose of this study was to identify common themes within medical students’ reflections on what they learned through participating in a teaching exercise with local elementary school children.
METHODS:
As a required component of a longitudinal prevention and public health course that spans the first and second years of undergraduate medical education, second year students at the Oakland University William Beaumont School of Medicine, in Detroit, Michigan, in the USA completed a service-learning activity, which included teaching a standardized curricular module to local elementary school children. Students were required to complete a reflection assignment based on their teaching experience. Medical students’ responses to assignment’s three guided questions were qualitatively coded to identify common themes among the responses related to the teaching activity.
RESULTS:
Qualitative analysis of students’ reflections revealed several themes regarding what the students learned and viewed as the benefits of the activity: The importance of early education and parental involvement; the importance of understanding your audience when teaching; the importance of simplifying complex concepts to the audience’s level; and the importance of preparation for teaching. Medical students identified the difficulties of communicating at an audience appropriate level and providing patient education outside the confines of a controlled classroom setting.
DISCUSSION:
This activity provided medical students with hands-on experience presenting to an audience age-appropriate, health-related topics. Presenting in an elementary school environment helped students better understand what health information various age groups knew about and the importance of clarifying information when communicating with a younger audience.

via Physician as teacher: Promoting health and wellness among elementar… – PubMed – NCBI.

ABSTRACT: Successful collaboration in education: the UMeP.

BACKGROUND:
As the health care education landscape in the UK changes rapidly and dramatically, collaboration across institutions bridging undergraduate and postgraduate fields is increasingly necessary. Collaboration entails both risks and benefits. There is a paucity of advice on how to ensure collaborative projects in medical education are effective. There is a paucity of advice on how to ensure collaborative projects in medical education are effective
CONTEXT:
In 2011 three medical schools began a collaborative project along with NHS Education for Scotland (NES) to modify, develop and deliver a medical school version of the NES foundation programme ePortfolio, called UMeP. The underlying principal was the introduction of an authentic ePortfolio early in undergraduate life. The challenge of three diverse medical schools with significantly different curricula and assessment approaches working together with a single postgraduate ePortfolio was complex and demanding.
DISCUSSION:
We reveal the complexities of collaboration on education projects and draw on our experiences to provide illustrative examples of collaboration. Despite the increased complexity and need for compromise, we argue that successful collaborative partnerships are key to maximising the circumstances in which education innovation can be successful, and create the potential for robust evaluation and research.

via Successful collaboration in education: the UMeP. – PubMed – NCBI.

ABSTRACT: Top tips for a teaching fellowship

BACKGROUND:
Dedicated medical education posts are an exciting opportunity for doctors to focus on their development as clinical teachers. Within the seven hospital trusts that host students from the University of Bristol there are now 19 clinical teaching fellowship (CTF) posts. On starting a dedicated medical education post, the opportunities available can seem overwhelming, and on reflection many of the local 2012-13 CTFs would have changed their initial practice. The purpose of this article was to explore and collate the experiences of CTFs to produce a selection of practical ‘top tips’.
METHODS:
A questionnaire was sent to all 19 CTFs via e-mail, asking them to state what they would do the same and what they would do differently if they had their time again. Dedicated medical education posts are an exciting opportunity for doctors to focus on their development as clinical teachers
RESULTS:
Eight themes were drawn from the 13 (68%) returned questionnaires, with each theme mentioned between four and 11 times. The themes included: keeping a portfolio of evidence; personal development; undertaking educational research; developing as a clinical teacher; and administration.
CONCLUSION:
Our aim for this article was to generate practical top tips for those doctors considering, about to start or having just commenced a dedicated teaching role, helping individuals to get the most from their time. It also explains what these teaching fellowships can involve, and gives those thinking of undertaking a dedicated teaching role a better idea of what to expect.

via Top tips for a teaching fellowship. – PubMed – NCBI.

ABSTRACT: A regional teaching fellow community of practice

BACKGROUND:
Increasing numbers of clinical teaching fellows are responsible for a significant proportion of undergraduate teaching nationally. Developing a regional community of practice can help overcome the isolation of these posts, with potential benefits for all involved.
CONTEXT:
A community of practice relies on the mutual engagement of people in a similar situation working towards a common goal. Working together and sharing resources enables teaching fellows to make the most of their post, which ultimately benefits those that they are teaching.
INNOVATION:
We developed a regional clinical teaching fellow community of practice in Bristol in 2010/11. Our community has continued to develop since completing our posts as clinical teaching fellows, and has provided a platform for new communities to develop amongst the groups of subsequent teaching fellows coming through. We encourage all regions who have clinical teaching fellows to develop a regional community of practice
IMPLICATIONS:
We encourage all regions who have clinical teaching fellows to develop a regional community of practice. We also encourage trainees to join TASME (Trainees in the Association for the Study of Medical Education), a new national community of practice for trainees involved in medical education.

via A regional teaching fellow community of practice. – PubMed – NCBI.

ABSTRACT: Committing to patient-centred 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: What steps are necessary to create assessments?

Before we work out what constitutes an assessment’s value for a given cost in medical education, we must first outline the steps necessary to create an assessment, and then assign a cost to each step. In this study we undertook the first phase of this process: we sought to work out all the steps necessary to create written selected-response assessments. First, the lead author created an initial list of potential steps for developing written assessments. This was then distributed to the other three authors. These authors independently added further steps to the list. The lead author incorporated the contributions of these others and created a second draft. This process was repeated until consensus was achieved amongst the study’s authors. Next, the list was shared by means of an online questionnaire with 100 healthcare professionals with experience in medical education. The results of the authors’ and healthcare professionals’ thoughts and feedback on the steps, needed to create written assessment, are outlined below in full. We outlined the steps that are necessary to create written or web-based selected-response assessments.

via What steps are necessary to create written or web-based selected-re… – PubMed – NCBI.

MANUSCRIPT: Evaluation of the flipped classroom approach in a veterinary professional skills course

BACKGROUND:
The flipped classroom is an educational approach that has had much recent coverage in the literature. Relatively few studies, however, use objective assessment of student performance to measure the impact of the flipped classroom on learning. The purpose of this study was to evaluate the use of a flipped classroom approach within a medical education setting to the first two levels of Kirkpatrick and Kirkpatrick’s effectiveness of training framework.
METHODS:
This study examined the use of a flipped classroom approach within a professional skills course offered to postgraduate veterinary students. A questionnaire was administered to two cohorts of students: those who had completed a traditional, lecture-based version of the course (Introduction to Veterinary Medicine [IVM]) and those who had completed a flipped classroom version (Veterinary Professional Foundations I [VPF I]). The academic performance of students within both cohorts was assessed using a set of multiple-choice items (n=24) nested within a written examination. Data obtained from the questionnaire were analyzed using Cronbach’s alpha, Kruskal-Wallis tests, and factor analysis. Data obtained from student performance in the written examination were analyzed using the nonparametric Wilcoxon rank sum test.
RESULTS:
A total of 133 IVM students and 64 VPF I students (n=197) agreed to take part in the study. Overall, study participants favored the flipped classroom approach over the traditional classroom approach. With respect to student academic performance, the traditional classroom students outperformed the flipped classroom students on a series of multiple-choice items (IVM mean =21.4±1.48 standard deviation; VPF I mean =20.25±2.20 standard deviation; Wilcoxon test, w=7,578; P<0.001).
CONCLUSION:
This study demonstrates that learners seem to prefer a flipped classroom approach. The flipped classroom was rated more positively than the traditional classroom on many different characteristics. This preference, however, did not translate into improved student performance, as assessed by a series of multiple-choice items delivered during a written examination.

via Evaluation of the flipped classroom approach in a veterinary profes… – PubMed – NCBI.

ABSTRACT: Slow Medical Education

Slow medical education borrows from other “slow” movements by offering a complementary orientation to medical education that emphasizes the value of slow and thoughtful reflection and interaction in medical education and clinical care. Such slow experiences, when systematically structured throughout the curriculum, offer ways for learners to engage in thoughtful reflection, dialogue, appreciation, and human understanding, with the hope that they will incorporate these practices throughout their lives as physicians. This Perspective offers several spaces in the medical curriculum where slowing down is possible: while reading and writing at various times in the curriculum and while providing clinical care, focusing particularly on conducting the physical exam and other dimensions of patient care. Time taken to slow down in these ways offers emerging physicians opportunities to more fully incorporate their experiences into a professional identity that embodies reflection, critical awareness, cultural humility, and empathy. The authors argue that these curricular spaces must be created in a very deliberate manner, even on busy ward services, throughout the education of physicians.

via Slow Medical Education. – PubMed – NCBI.

The Emergence of a Real “Profession” in Continuing Education

The content in the embedded video below dates back to a talk I developed in 2011, shortly after I first  read the Alliance’s retrospective on its first 20 years. I recently recorded an audio track to archive the presentation and to begin to explore what’s changed over the past 3-4 years. In this blog post I will dig a bit more deeply into where we are today as we begin to see signs of the emergence of a real “Profession” in continuing education.

 

As this community endeavors to establish itself as key stakeholders in the healthcare Quality Improvement arms race, I have found myself reflecting back on countless conversations about whether or not we (those focused on continuing education in healthcare) can define ourselves as a true profession.

As you will see in the video, the first place to start any conversation about what makes a “Profession” is to work from a common ground or established definition, for instance: A Profession in medicine or science is derived from a cadre of like-minded and connected individuals working within a common framework or science. From here we can deconstruct these elements to better understand what is meant by ‘like-minded’, by ‘connected’, and by a ‘common science’.

When this presentation was given in 2011 the conversation within the CE community seemed to suggest that becoming a professional in CE was simply an element of one’s job – if you were employed within an organization that supports CE for healthcare professionals then you had the right to call yourself a professional. Conflating matters even more, at the time the new Alliance competencies and the NC-CME certification process seemed to validate this belief. The end effect was that there was a broad scale lowering of the bar and an undermining of the community’s real aspirations.

That was then…

Over the past few years I have seen a significant shift in this community to embrace what are the foundational elements of our emerging Profession. While it is early in this process, I think it is essential to recognize the elements that are in play and (hopefully) accelerate this critical transformation.

Perhaps the best way to do this is to give clear examples of where I see the emergence of cadre of like-minded and connected individuals working within a common framework or science.

We are becoming more ‘like-minded’ –

I have always been hard-pressed to believe that developing education for education’s sake was going to have the impact on healthcare that this community hoped for. Yet for the better part of the past 20 years, this was what was actually going on. And whether or not the designers and planners recognized it or would admit it, by-and-large I still see this approach taken today my many within the community.

But over the past year or two I have seen a significant uptick in the recognition that high quality healthcare is a product of a culture and a system; that educational interventions must be tied to non-interventional strategies; and that properly supporting the process of learning is critical to empowering clinicians to evolve. To be frank, I am seeing more and more members of this community embrace the reality that education outside a system for implementing change is a relatively low-fidelity solution – and that more and more of our resources and efforts must be directed to those interventions proven to be most effective and efficient.

In support of this belief I point to two examples: 1) the advent of the QIE Roadmap by the Alliance and 2) the launch of the NCQA’s Transformation of the PCMH model. These examples arise from two organizations arriving at a like-minded solution and a recognition that the greatest impact of CE lies in support of a healthcare organization’s quality culture transformation.

We are becoming more ‘connected’ –

This will come as no surprise to many, but I whole-heartedly embrace the opportunity that new media have to level the playing field and empower the masses to learn, to share, and to evolve. Dating back to the launch of the CMEAdvocate blog, to our weekly CMEchats (#CMEchat), and through to the construction of the ArcheMedX Resource Center – I have been making a constant effort to make learning and sharing more accessible and to better connect this community.

But what I feel began as a very small network of early adopters, bloomed to a mainstream Professional expectation with last week’s CMEPalooza. Largely on the volunteer effort of Derek Warnick and Scott Kober, nearly 30 moderators and speakers contributed to what amounted to a seven-hour long conversation and sharing of best practices with nearly 500 learners. These sessions have already been archived and serve as wonderful assets for the community to share. Add to this that there are now more than 9,500 members of the LinkedIn CME group started by Lawrence Sherman and hundreds of active discussions to partake in. In 2014 this community seems to have fully embraced the notion that the collective is more powerful than the individual!

We are focusing in on our ‘common framework or science’ –

But for this shift to a cadre of like-minded and connected individuals to truly become a Profession we must have commit to a shared praxis or common framework– this become the unifying body of evidence that drives the transformation. Our framework is that of the science of adult learning and implementation science. And here too I have seen dramatic shifts in what how this community thinks and acts. More and more members of this community are elevating their practices to build interventions based on solid evidence, focusing efforts on areas of proven need, and committing to publish their findings in peer-reviewed journals or present their work in broadly accessible and credible ways.

As one example, a brief manuscript describing work from our Partners at ANCC and UVA has recently been received and accepted by the Journal of Continuing Education in Nursing – this is the first CE-focused report on the use of the flipped classroom and we couldn’t be more proud to have supported the planning, design, implementation, and analysis of this project. We will share much more about this important work when the article is published in early November!

To be clear, culture change is not easy; sometimes there needs to be tremendous forces applied from both external and internal sources before the elements properly align. But having lived through these turbulent times, I see this community being reshaped. I see a new era of like-mindedness, of connectedness, and I see the community hungry for more and more evidence to focus their efforts and demonstrate their successes. And, while perhaps the community has not invited these pressures in, I am starting to see signs that we are reacting and adapting in ways that have us on a path for better things – our collective challenge is to stay this course and to allow this new shared vision and openness to guide us on the path to truly becoming a Profession.

 

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ABSTRACT: Evaluation of a pictograph enhancement system for patient instruction: a recall study

Objective We developed a novel computer application called Glyph that automatically converts text to sets of illustrations using natural language processing and computer graphics techniques to provide high quality pictographs for health communication. In this study, we evaluated the ability of the Glyph system to illustrate a set of actual patient instructions, and tested patient recall of the original and Glyph illustrated instructions.

Methods We used Glyph to illustrate 49 patient instructions representing 10 different discharge templates from the University of Utah Cardiology Service. 84 participants were recruited through convenience sampling. To test the recall of illustrated versus non-illustrated instructions, participants were asked to review and then recall a set questionnaires that contained five pictograph-enhanced and five non-pictograph-enhanced items.

Results The mean score without pictographs was 0.47 (SD 0.23), or 47% recall. With pictographs, this mean score increased to 0.52 (SD 0.22), or 52% recall. In a multivariable mixed effects linear regression model, this 0.05 mean increase was statistically significant (95% CI 0.03 to 0.06, p<0.001).

Discussion In our study, the presence of Glyph pictographs improved discharge instruction recall (p<0.001). Education, age, and English as first language were associated with better instruction recall and transcription.

Conclusions Automated illustration is a novel approach to improve the comprehension and recall of discharge instructions. Our results showed a statistically significant in recall with automated illustrations. Subjects with no-colleague education and younger subjects appeared to benefit more from the illustrations than others.

via Evaluation of a pictograph enhancement system for patient instruction: a recall study — Zeng-Treitler et al. 21 (6): 1026 — Journal of the American Medical Informatics Association.