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Author: Brian S McGowan, PhD

ABSTRACT: Team-based learning in a pathology residency training program

OBJECTIVES:
Team-based learning (TBL) has been integrated into undergraduate and medical education curricula in many institutions. However, TBL has not been widely introduced into postgraduate medical education. Our study aimed to measure the effect of TBL on promoting learning and teamwork in the setting of pathology residency training.
METHODS:
Four TBL sessions were held and individual and group readiness assurance tests (IRAT/GRATs) were performed; scores were compared using Wilcoxon matched-pairs signed rank tests. Residents completed 18-item validated team performance surveys measuring the quality of team interactions on a scale of 0 (none of the time) to 6 (all of the time). Mean and standard deviation were calculated for each item.
RESULTS:
Scores on the IRAT vs GRAT were significantly different (P < .05). The team performance survey received mean scores ranging from 5.3 ± 1.1 to 6.0 ± 0.0.
CONCLUSIONS:
The use of TBL promotes teamwork and learning in a pathology residency program. Residents scored higher on the readiness assurance tests when working in teams, demonstrating the effectiveness of team learning and achievement. In addition, the Accreditation Council for Graduate Medical Education competencies of professionalism and interpersonal and communication skills were further enhanced by incorporating TBL into pathology residency training.

via Team-based learning in a pathology residenc… [Am J Clin Pathol. 2014] – PubMed – NCBI.

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ABSTRACT: A survey of interprofessional education in chiropractic continuing education in the United States

Objective : The purpose of this study is to describe the state of chiropractic continuing education vis-à-vis interprofessional education (IPE) with medical doctors (MD) in a survey of a sample of US doctors of chiropractic (DC) and through a review of policies. Methods : Forty-five chiropractors with experience in interprofessional settings completed an electronic survey of their experiences and perceptions regarding DC-MD IPE in chiropractic continuing education (CE). The licensing bodies of the 50 US states and the District of Columbia were queried to assess the applicability of continuing medical education (CME) to chiropractic relicensure. Results : The majority (89.1%) of survey respondents who attend CE-only events reported that they rarely to never experienced MD-IPE at these activities. Survey respondents commonly attended CME-only events, and 84.5% stated that they commonly to very commonly experienced MD-IPE at these activities. More than half (26 of 51) of the licensing bodies did not provide sufficient information to determine if CME was applicable to DC relicensure. Thirteen jurisdictions (25.5%) do not, and 12 jurisdictions (23.5%) do accept CME credits for chiropractic relicensure. Conclusion : The majority of integrated practice DCs we surveyed reported little to no IPE occurring at CE-only events, yet significant IPE occurring at CME events. However, we found only 23.5% of chiropractic licensing bodies allow CME credit to apply to chiropractic relicensure. These factors may hinder DC-MD IPE in continuing education.

via A survey of interprofessional education in ch… [J Chiropr Educ. 2014] – PubMed – NCBI.

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ABSTRACT: The expert patient as teacher: an interprofessional Health Mentors programme

BACKGROUND:
To meet future health care needs, medical education must increase the emphasis on chronic illness care, interprofessional teamwork, and working in partnership with patients and families. One way to address these needs is to involve patients as teachers in longitudinal interprofessional educational programmes grounded in principles of patient-professional partnerships and shared decision-making.
CONTEXT:
The University of British Columbia has a history of initiatives designed to bring patient and community voices into health professional education. Increasing opportunities for interprofessional education has become important because of accreditation requirements.
INNOVATION:
We describe preliminary findings from a 3-year pilot of an interprofessional Health Mentors programme, an elective patient-as-teacher initiative in which groups of four students from different disciplines learn together, with and from a mentor with a chronic condition (an ‘expert by experience’) over three semesters. The goals, achieved through six themed meetings and a symposium, are to learn about living with a chronic condition from the patient’s perspective and to develop interprofessional competencies. Groups are given suggested topics for each meeting, but function as self-managed learning communities, and are encouraged to explore their own questions. Faculty members support direct learning between students and mentors through setting broad objectives and responding to the student reflections written after each group meeting. Students and mentors rate the programme highly, and a wide range of important learning outcomes have been documented. Medical education must increase the emphasis on chronic illness care, working in partnership with patients
IMPLICATIONS:
Key characteristics, generalisable to other educational programmes, include the role of faculty staff in supporting learning between students and patients, a minimalist structure to promote ownership and creativity, and flexible delivery.

via The expert patient as teacher: an interprofession… [Clin Teach. 2014] – PubMed – NCBI.

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ABSTRACT: The role of social media in clinical excellence

BACKGROUND:
The provision of excellent patient care is a goal shared by all doctors. The role of social media (SM) in helping medical students and doctors achieve clinical excellence is unknown. Social media may help facilitate the achievement of clinical excellence
PURPOSE:
This report aimed to identify examples of how SM may be used to help promote the achievement of clinical excellence in medical learners.
METHODS:
Three of the authors previously conducted a systematic review of the published literature on SM use in undergraduate, graduate and continuing medical education. Two authors re-examined the 14 evaluative studies to identify any examples of SM use that may facilitate the achievement of clinical excellence and to consider whether there were any aspects of clinical excellence for which no studies had been performed, and, if so, whether SM was relevant to these domains.
RESULTS:
Each study touched on one or more of the following domains of clinical excellence: communication and interpersonal skills; professionalism and humanism; knowledge; diagnostic acumen; exhibiting a passion for patient care; a scholarly approach to clinical practice; and explicitly modelling expertise to medical trainees. No study addressed the role of SM to promote the skillful negotiation of the health care system, and in collaboration with investigators to advance science and discovery; however, additional evidence suggested that SM may play an adjunctive role in promoting the achievement of these aspects of clinical excellence.
CONCLUSION:
This report supports the hypothesis that SM may help facilitate the achievement of clinical excellence; however, further research is needed into the role of SM in promoting the achievement of clinical excellence.

via The role of social media in clinical excellence. [Clin Teach. 2014] – PubMed – NCBI.

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ABSTRACT: Resident duty hour changes: impact in the patient-centered medical home

BACKGROUND AND OBJECTIVES:
Family medicine residency programs are challenged with balancing hospital-based training with a longitudinal primary care continuity experience. In response to the Preparing the Personal Physician for Practice (P4) Initiative, the University of Missouri (MU) Family Medicine Residency Program sought to increase the presence of its residents in their continuity clinic, ie, the patient-centered medical home (PCMH). While initially successful, these efforts encountered formidable barriers with the July 2011 duty hour regulations from the Accreditation Council for Graduate Medical Education (ACGME).
METHODS:
PCMH hours and visit numbers were collected and analyzed for MU residents from July 2005 through June 2012.
RESULTS:
Comparing the 2 years before the P4 schedule changes to the first 3 years after the P4 changes, MU first-year residents experienced a 27% increase in patient visits with a 13% increase in hours. In the subsequent 2 years, which incorporated compliance with the new ACGME regulations, first-year residents experienced a 33% decrease in visits with a 25% decrease in hours. This negated the increases seen with the previous P4 schedule changes, and residents in all years of training experienced less visits, less hours, and less visits per hour.
CONCLUSIONS:
New duty hour regulations not only limit the time resident physicians spend in the hospital but also their experience in the ambulatory setting. Considering the emphasis family medicine training programs place on continuity of care and the PCMH, the new regulations will have significant implications for these programs.

via Resident duty hour changes: impact in the patient-ce… [Fam Med. 2014] – PubMed – NCBI.

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ABSTRACT: Learning culture and feedback: an international study of medical athletes and musicians

OBJECTIVES:
Feedback should facilitate learning, but within medical education it often fails to deliver on its promise. To better understand why feedback is challenging, we explored the unique perspectives of doctors who had also trained extensively in sport or music, aiming to: (i) distinguish the elements of the response to feedback that are determined by the individual learner from those determined by the learning culture, and (ii) understand how these elements interact in order to make recommendations for improving feedback in medical education.
METHODS:
Using a constructivist grounded theory approach, we conducted semi-structured interviews with 27 doctors or medical students who had high-level training and competitive or performance experience in sport (n = 15) or music (n = 12). Data were analysed iteratively using constant comparison. Key themes were identified and their relationships critically examined to derive a conceptual understanding of feedback and its impact.
RESULTS:
We identified three essential sources of influence on the meaning that feedback assumed: the individual learner; the characteristics of the feedback, and the learning culture. Individual learner traits, such as motivation and orientation toward feedback, appeared stable across learning contexts. Similarly, certain feedback characteristics, including specificity, credibility and actionability, were valued in sport, music and medicine alike. Learning culture influenced feedback in three ways: (i) by defining expectations for teachers and teacher-learner relationships; (ii) by establishing norms for and expectations of feedback, and (iii) by directing teachers’ and learners’ attention toward certain dimensions of performance. Learning culture therefore neither creates motivated learners nor defines ‘good feedback’; rather, it creates the conditions and opportunities that allow good feedback to occur and learners to respond.
CONCLUSIONS:
An adequate understanding of feedback requires an integrated approach incorporating both the individual and the learning culture. Our research offers a clear direction for medicine’s learning culture: normalise feedback; promote trusting teacher-learner relationships; define clear performance goals, and ensure that the goals of learners and teachers align.

via Learning culture and feedback: an international stu… [Med Educ. 2014] – PubMed – NCBI.

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ABSTRACT: Oncology training programs: are we doing comparative effectiveness research justice?

Comparative effectiveness research (CER) is defined as an assessment of all available options for a specific medical condition, with intent to estimate effectiveness in specific subpopulations. Medical professionals must receive training in CER, including its general goals, the ‘toolbox’ necessary to perform CER and its design. Oncologic training programs are currently not doing justice to CER: a rationale for conducting CER has been proposed, funding from the US government is available, but encouragement from oncologic residencies and fellowships is minimal. Encouragement to train oncologic physicians in CER is limited by a few factors, including inadequate emphasis on evidence weighing, and no explicit mention of factors key to CER in the Accreditation Council for Graduate Medical Education guidelines. As residency program requirements transition to milestone-based curricula and evaluations, explicit recommendations regarding CER and patient-centered outcomes research should be implemented for all programs. Upper level trainees who have reached milestones related to CER will be competitive applicants for research funding.

via Oncology training programs: are we doing comp… [J Comp Eff Res. 2013] – PubMed – NCBI.

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ABSTRACT: Adaptive and perceptual learning technologies in medical education and training

Recent advances in the learning sciences offer remarkable potential to improve medical education and maximize the benefits of emerging medical technologies. This article describes 2 major innovation areas in the learning sciences that apply to simulation and other aspects of medical learning: Perceptual learning (PL) and adaptive learning technologies. PL technology offers, for the first time, systematic, computer-based methods for teaching pattern recognition, structural intuition, transfer, and fluency. Synergistic with PL are new adaptive learning technologies that optimize learning for each individual, embed objective assessment, and implement mastery criteria. The author describes the Adaptive Response-Time-based Sequencing (ARTS) system, which uses each learner’s accuracy and speed in interactive learning to guide spacing, sequencing, and mastery. In recent efforts, these new technologies have been applied in medical learning contexts, including adaptive learning modules for initial medical diagnosis and perceptual/adaptive learning modules (PALMs) in dermatology, histology, and radiology. Results of all these efforts indicate the remarkable potential of perceptual and adaptive learning technologies, individually and in combination, to improve learning in a variety of medical domains.

via Adaptive and perceptual learning technologies in med… [Mil Med. 2013] – PubMed – NCBI.

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MANUSCRIPT: Effect of a web-based curriculum on primary care practice: basic skin cancer triage trial.

BACKGROUND AND OBJECTIVES:Primary care physicians PCPs are uniquely positioned to detect melanoma. Effective educational interventions targeted at PCPs may improve early melanoma detection. A previous in-person Basic Skin Cancer Triage BSCT 2-hour course demonstrated significant short-term improvement in provider practices, attitudes, ability, confidence, and knowledge. We conducted a randomized trial to test the efficacy of the BSCT course implemented as a web-based learning program, compared to a similar control web-based course on weight assessment.METHODS:We recruited a sample of 57 PCPs and 3,341 of their patients from four geographically diverse centers. Skin cancer control activities by PCPs were assessed by physician survey and by chart review and patient telephone interview about their recent visit to their PCP at baseline and at 1–2 months and 12 months after course completion.RESULTS:Some effect of intervention on skin cancer parameters was self-reported by physicians; this was not confirmed by patient survey or chart-extracted data. Rates of skin cancer control practices by PCPs were low across both groups before and after intervention. The positive changes in physician-reported behaviors total body skin examination [TBSE], intentions discuss skin cancer detection, confidence performing TBSE, office practices, and knowledge 58% skin versus 49% control were neither matched by differences in practice reported by their patients, nor persisted in a longer term follow-up, hence may be attributable to physician recall bias due to the experience of the course or desire to please study investigators and were less dramatic as compared to our previously reported in-person BSCT intervention. Thus this approach by itself appears unlikely to result in improved PCP handling of skin cancer issues.CONCLUSIONS:Given previous success with our in-person course, the features required to make WBL a more effective tool for medical education must be further explored.

via Effect of a web-based curriculum on primary care pra… [Fam Med. 2013] – PubMed – NCBI.

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MANUSCRIPT: Improvement in generic problem-solving abilities of students by use of tutor-less problem-based learning in a large classroom setting.

Problem-based learning (PBL) was originally introduced in medical education programs as a form of small-group learning, but its use has now spread to large undergraduate classrooms in various other disciplines. Introduction of new teaching techniques, including PBL-based methods, needs to be justified by demonstrating the benefits of such techniques over classical teaching styles. Previously, we demonstrated that introduction of tutor-less PBL in a large third-year biochemistry undergraduate class increased student satisfaction and attendance. The current study assessed the generic problem-solving abilities of students from the same class at the beginning and end of the term, and compared student scores with similar data obtained in three classes not using PBL. Two generic problem-solving tests of equal difficulty were administered such that students took different tests at the beginning and the end of the term. Blinded marking showed a statistically significant 13% increase in the test scores of the biochemistry students exposed to PBL, while no trend toward significant change in scores was observed in any of the control groups not using PBL. Our study is among the first to demonstrate that use of tutor-less PBL in a large classroom leads to statistically significant improvement in generic problem-solving skills of students.

via Improvement in generic problem-solving abi… [CBE Life Sci Educ. 2013] – PubMed – NCBI.

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