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Author: Brian S McGowan, PhD

ABSTRACT: PBL and Beyond: Trends in Collaborative Learning

Building upon the disruption to lecture-based methods triggered by the introduction of problem-based learning, approaches to promote collaborative learning are becoming increasingly diverse, widespread and generally well accepted within medical education. Examples of relatively new, structured collaborative learning methods include team-based learning and just-in-time teaching. Examples of less structured approaches include think-pair share, case discussions, and the flipped classroom. It is now common practice in medical education to employ a range of instructional approaches to support collaborative learning. We believe that the adoption of such approaches is entering a new and challenging era. We define collaborate learning by drawing on the broader literature, including Chi’s ICAP framework that emphasizes the importance of sustained, interactive explanation and elaboration by learners. We distinguish collaborate learning from constructive, active, and passive learning and provide preliminary evidence documenting the growth of methods that support collaborative learning. We argue that the rate of adoption of collaborative learning methods will accelerate due to a growing emphasis on the development of team competencies and the increasing availability of digital media. At the same time, the adoption collaborative learning strategies face persistent challenges, stemming from an overdependence on comparative-effectiveness research and a lack of useful guidelines about how best to adapt collaborative learning methods to given learning contexts. The medical education community has struggled to consistently demonstrate superior outcomes when using collaborative learning methods and strategies. Despite this, support for their use will continue to expand. To select approaches with the greatest utility, instructors must carefully align conditions of the learning context with the learning approaches under consideration. Further, it is critical that modifications are made with caution and that instructors verify that modifications do not impede the desired cognitive activities needed to support meaningful collaborative learning.

via PBL and Beyond: Trends in Collaborative Lear… [Teach Learn Med. 2013] – PubMed – NCBI.

ABSTRACT: Teaching Medical Error Disclosure to Residents Using Patient-Centered Simulation Training

PURPOSE:
To determine whether a standardized patient encounter and self-guided tutorial would improve first-year residents’ self-efficacy for disclosing medical errors.
METHOD:
In 2011, 55 first-year residents participated in a simulation in which they disclosed an error to a standardized patient playing the part of a family member. Residents completed the simulation twice, four weeks apart, and completed presession knowledge and self-efficacy (based on the Accreditation Council for Graduate Medical Education [ACGME] core competencies) assessments and repeated the self-efficacy assessment after the sessions. Residents reviewed the videos of their encounters either alone (self-debrief) or with a faculty observer (faculty debrief). Between sessions, they completed a self-paced learning tutorial. Two external faculty also rated the residents’ performances using videos of the encounters.
RESULTS:
Residents’ self-efficacy significantly increased from a Session 1 pretest mean (standard deviation) score of 119.6 (26.6) to a Session 2 posttest score of 150.3 (24.9) for all ACGME competencies (P < .001, Cohen’s d = 1.19). The external reviewers’ ratings provided additional, objective support for residents’ improvement on questions assessing ACGME competencies (P = .001). Comparisons of the self-efficacy of residents in the self-debrief versus faculty debrief groups yielded no significant differences on any ACGME competencies.
CONCLUSIONS:
Timely, explicit, and empathetic disclosure of medical errors to patients and family is essential to maintaining trust and is an important part of patient-centered medical care. This intervention easily could be replicated in other settings and is applicable to many members of the health care team, not just to residents.

via Teaching Medical Error Disclosure to Residents Usin… [Acad Med. 2013] – PubMed – NCBI.

ABSTRACT: Connectedness, Sense of Community, and Academic Satisfaction in a Novel Community Campus Medical Education Model.

PURPOSE:
Developing a sense of community and establishing connectivity are important in enhancing learners’ success and preventing their sense of isolation. The A.T. Still University School of Osteopathic Medicine in Arizona (SOMA) has implemented a novel approach to medical education in which, beginning in the second year, students are geographically dispersed to 11 community campuses associated with community health centers around the United States, at both inner-city and rural locations. This study assessed students’ sense of community, academic satisfaction, and level of connectedness in their first through fourth years of medical school at SOMA.
METHOD:
The Rovai Classroom Community Scale and open-ended questions were administered via an online survey instrument to 412 students enrolled at SOMA for the 2011-2012 academic year. Participation was voluntary, and all results were anonymous. Data were analyzed using one-way ANOVA to compare results between classes.
RESULTS:
Comparisons revealed an increasing degree of isolation and a decreasing sense of community and academic satisfaction progressing from the first through fourth years of medical school. Students suggested possible solutions that may be applied to medical schools and other graduate schools to improve the level of connectedness for students who are learning at a distance.
CONCLUSIONS:
Connectivity, sense of community, and academic satisfaction may decrease for students in undergraduate medical education participating in a combination of distance learning and intermittent in-person activities. Interventions have the potential to improve these parameters. Long-term follow-up of students’ satisfaction is suggested.

via Connectedness, Sense of Community, and Academic Sat… [Acad Med. 2013] – PubMed – NCBI.

ABSTRACT: How Do You Deliver a Good Obstetrician? Outcome-Based Evaluation of Medical Education

he goal of medical education is the production of a workforce capable of improving the health and health care of patients and populations, but it is hard to use a goal that lofty, that broad, and that distant as a standard against which to judge the success of schools or training programs or particular elements within them. For that reason, the evaluation of medical education often focuses on elements of its structure and process, or on the assessment of competencies that could be considered intermediate outcomes. These measures are more practical because they are easier to collect, and they are valuable when they reflect activities in important positions along the pathway to clinical outcomes. But they are all substitutes for measuring whether educational efforts produce doctors who take good care of patients.The authors argue that the evaluation of medical education can become more closely tethered to the clinical outcomes medical education aims to achieve. They focus on a specific clinical outcome-maternal complications of obstetrical delivery-and show how examining various observable elements of physicians’ training and experience helps reveal which of those elements lead to better outcomes. Does it matter where obstetricians trained? Does it matter how much experience they have? Does it matter how good they were to start? Each of these questions reflects a component of the production of a good obstetrician and, most important, defines a good obstetrician as one whose patients in the end do well.

via How Do You Deliver a Good Obstetrician? Outcome-Bas… [Acad Med. 2013] – PubMed – NCBI.

MANUSCRIPT: Audio podcasts in practical courses in biochemistry – cost-efficient e-learning in a well-proven format from radio broadcasting

Introduction: Audio podcasts are an e-learning format that may help to motivate students to deal with the contents of medical education more intensely. We adopted a well-proven format from radio broadcasting, the radio documentary, to direct the listeners’ attention to information about practical courses in biochemistry over a period of 20 minutes at most. Information, original sounds, and a specific atmosphere allow listeners to perceive the contents intensely. Method: In order to organise the production of the podcast as cost-efficient and least time-consuming as possible, a student, a teacher, a clinician, and a technical assistant compile the core themes of their respective text blocks in an editorial conference first. After that, the speakers can elaborate on and record their blocks independently. Coordination is widely handled by the student. At two points of time, the podcasts were evaluated by the medical students by means of a questionnaire. Results: With little cost and time expenses, eight podcasts were produced. They have been used by the students extensively and have also been evaluated very positively by non-student listeners. For long-term usage, a regular reference to the podcast offer is required in the courses. Conclusion: Involving students, successful podcasts can be produced to support classroom teaching with little expenses and contribute to the external presentation of the medical faculty.

via Audio podcasts in practical courses in bio… [GMS Z Med Ausbild. 2013] – PubMed – NCBI.

MANUSCRIPT: Training of leadership skills in medical education

Background: Effective team performance is essential in the delivery of high-quality health-care. Leadership skills therefore are an important part of physicians everyday clinical life. To date, the development of leadership skills are underrepresented in medical curricula. Appropriate training methods for equipping doctors with these leadership skills are highly desirable. Objective: The review aims to summarize the findings in the current literature regarding training in leadership skills in medicine and tries to integrate the findings to guide future research and training development. Method: The PubMED, ERIC, and PsycArticles, PsycINFO, PSYNDEX and Academic search complete of EBSCOhost were searched for training of leadership skills in medicine in German and English. Relevant articles were identified and findings were integrated and consolidated regarding the leadership principles, target group of training and number of participants, temporal resources of the training, training content and methods, the evaluation design and trainings effects. Results: Eight studies met all inclusion criteria and no exclusion criteria. The range of training programs is very broad and leadership skill components are diverse. Training designs implied theoretical reflections of leadership phenomena as well as discussions of case studies from practice. The duration of training ranged from several hours to years. Reactions of participants to trainings were positive, yet no behavioral changes through training were examined. Conclusions: More research is needed to understand the factors critical to success in the development of leadership skills in medical education and to adapt goal-oriented training methods. Requirements analysis might help to gain knowledge about the nature of leadership skills in medicine. The authors propose a stronger focus on behavioral training methods like simulation-based training for leadership skills in medical education.

via Training of leadership skills in medical e… [GMS Z Med Ausbild. 2013] – PubMed – NCBI.

ABSTRACT: The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No. 30.

Background: Team-Based Learning (TBL) is a student-centred active learning method, requiring less faculty time than other active learning methods. While TBL may have pedagogical value, individual studies present inconsistent findings. The aim of this systematic review was to assess the effectiveness of TBL on improving learning outcomes in health professions education. Methods: A peer-reviewed systematic review protocol was registered with the Best Evidence in Medical Education (BEME) organization. After comprehensive literature searching, title and full-text review were completed by two independent reviewers. Included studies assessed TBL and a valid comparator in health professions. Included studies were assessed for methodological quality by two independent reviewers. Studies were categorised by outcomes using the Kirkpatrick framework. Results: Of 330 screened titles, 14 were included. Seven studies reported significant increase in knowledge scores for the TBL group, four reported no difference and three showed improvement but did not comment on statistical significance. Only one study reported significant improvement in learner reaction for the TBL group while another study reported a significant difference favouring the comparator. Conclusions: Despite improvement in knowledge scores, there was mixed learner reaction. This may reflect the increased demands on learners in this student-centred teaching strategy, although further study is needed.

via The effectiveness of team-based learning on learni… [Med Teach. 2013] – PubMed – NCBI.

Abstract: Breaking bad news in amyotrophic lateral sclerosis: The need for medical education

The manner in which physicians deliver difficult diagnoses is an area of discontent for patients with amyotrophic lateral sclerosis (ALS). The American Academy of Neurology’s Practice Parameter for care of the ALS Patient recommended teaching and evaluating strategies for disclosing the diagnosis (10). Our objective was to examine residents’ ability in and perceptions of communicating the diagnosis of ALS. Twenty-two resident physicians were videotaped and rated by two ALS neurologists as they delivered an ALS diagnosis to a standardized patient (SP) during an objective structured clinical examination (OSCE). Residents self-rated immediately after the OSCE, again after viewing their videotape, and completed a survey regarding the OSCE and delivering difficult diagnoses. OSCE performance was suboptimal, particularly for communication skills and empathy. The two examiners’ scores correlated except for the empathy subscore. Residents’ self-assessments did not align with the examiners’ scores either before or after watching their videotape. The survey uncovered residents’ apprehension and dissatisfaction with their training in diagnosis delivery. The results highlight a need for resident education in delivering an ALS diagnosis. The lack of correlation between residents’ and examiners’ scoring requires further study. Evaluation of empathy is particularly challenging. Residents agreed that OSCE participation was worthwhile.

via Breaking bad … [Amyotroph Lateral Scler Frontotemporal Degener. 2013] – PubMed – NCBI.

ABSTRACT: Review of online educational resources for medical physicists

Medical physicists are often involved in the didactic training of graduate students, residents (both physics and physicians), and technologists. As part of continuing medical education, we are also involved in maintenance of certification projects to assist in the education of our peers. As such, it is imperative that we remain current concerning available educational resources. Medical physics journals offer book reviews, allowing us an opportunity to learn about newly published books in the field. A similar means of communication is not currently available for online educational resources. This information is conveyed through informal means. This review presents a summary of online resources available to the medical physics community that may be useful for educational purposes.

via Review of online educational resources … [J Appl Clin Med Phys. 2013] – PubMed – NCBI.

ABSTRACT: owards meaningful simulation-based learning with medical students and junior physicians

Background: This research provides an educational perspective on simulation-based medical education by implementing both the characteristics of meaningful learning and the concepts of facilitating, training, and learning processes. Aims: This study aims to evaluate, from the perspectives of both facilitators and students, the meaningfulness of five different simulation-based courses. Methods: The courses were implemented in the spring of 2010. The data were collected from facilitators (n = 9) and students (n = 25) using group interviews (one individual interview), observations, video recordings, and pre- and post-questionnaires. The research analyzes qualitative data using the qualitative content analysis method to answer the following research question: From facilitators’ and students’ perspectives, how does the facilitating and training in simulation-based learning environments (SBLEs) foster the meaningful learning of students? Results: It seems that simulation-based learning is, at its foundation, meaningful since it inherently supports the many characteristics of meaningful learning. However, characteristics also exist that simulation-based learning does not inherently support. In this study, the goal-oriented, self-directed, and individual training characteristics were only somewhat supported during the facilitation and training in SBLEs. Conclusions: In running these courses in the future, facilitators should concentrate on those characteristics that were only somewhat supported.

via Towards meaningful simulation-based learning with … [Med Teach. 2013] – PubMed – NCBI.