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Author: Brian S McGowan, PhD

MANUSCRIPT: Physicians perceptions of an educational support system integrated into an electronic health record.

The purpose of this study is to determine the perceptions by physicians of an educational system integrated into an electronic health record (EHR). Traditional approaches to continuous medical education (CME) have not shown improvement in patient health care outcomes. Hospital Italiano de Buenos Aires (HIBA) has implemented a system that embeds information pearls into the EHR, providing learning opportunities that are integrated into the patient care process. This study explores the acceptability and general perceptions of the system by physicians when they are in the consulting room. We interviewed 12 physicians after one or two weeks of using this CME system and we performed a thematic analysis of these interviews. The themes that emerged were use and ease of use of the system; value physicians gave to the system; educational impact on physicians; respect for the individual learning styles; content available in the system; and barriers that were present or absent for using the CME system. We found that the integrated CME system developed at HIBA was well accepted and perceived as useful and easy to use. Future work will involve modifications to the system interface, expansion of the content offered and further evaluation.

via Physicians perceptions of an educ… [Stud Health Technol Inform. 2013] – PubMed – NCBI.

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ABSTRACT: Medical education in an electronic health record-mediated world.

This paper reflects on the extent to which we are preparing learners for practice in an electronic health record (EHR)-mediated world. We are currently training the last generation to remember a world without the Internet and the first who will practice in a largely EHR-mediated practice environment. We undertook a thematic review of the literature connecting medical education with e-health using the concepts of ‘electronic health record’ or ‘electronic medical record’ as a proxy for the broader notion of e-health. Our findings are more equivocal and cautious than earlier commentators might have expected and while there are examples of good practice and successful integration, the majority of articles we reviewed raised issues and problems with the current links between EHRs and medical education. Medical professionals in particular are quite ambivalent about many of the changes brought about by EHRs, and in the absence of changes in perception and practice it is likely that the connections between medical education and e-health will continue to be problematic. We hope that this paper will lead to an improved understanding of these problems and will serve to advance the discourse on how medical education should engage with the world of e-health and the world of e-health with medical education

via Medical education in an electronic health record-m… [Med Teach. 2013] – PubMed – NCBI.

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ABSTRACT: Open-book tests: search behaviour, time used and test scores

BACKGROUND:
Because of the increasing medical knowledge and the focus of medical education on acquiring competencies, the use of open-book tests seems inevitable. Dealing with a large body of information, indicating which kind of information is needed to solve a problem, and finding and understanding that knowledge at the right moment are behaviours that cannot be assessed during closed-book tests.
AIMS:
To examine whether there is a relationship between students’ search behaviour – using references or not when answering a question – during open-book tests and their test scores.
METHOD:
Second- (N = 491) and third-year medical students (N = 325) participated in this study. Search behaviour was operationalized as the number of questions for which students consulted their references. Furthermore, we collected data on the time students spent on answering all open-book questions and their test scores. To determine the relations, we calculated Spearman’s and Pearson’s correlations.
RESULTS:
Second- and third-year students consulted their references for 87% and 73% of the questions and spent 5.0 and 4.3 min on answering an open-book question, respectively. We did not find significant correlations between search behaviour and test scores.
CONCLUSION:
Both ‘well’ and ‘poorer performing’ students often consulted their references. Spending almost 5 min per open-book question in multiple choice format seems to be too much. More research is needed to establish optimal open-book test time and to explore how ‘well performing’ students use their references during open-book tests.

via Open-book tests: search behaviour, time used and t… [Med Teach. 2013] – PubMed – NCBI.

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ABSTRACT: Twelve tips for getting started using mixed methods in medical education research

BACKGROUND:
Mixed methods research, which is gaining popularity in medical education, provides a new and comprehensive approach for addressing teaching, learning, and evaluation issues in the field.
AIM:
The aim of this article is to provide medical education researchers with 12 tips, based on consideration of current literature in the health professions and in educational research, for conducting and disseminating mixed methods research.
CONCLUSION:
Engaging in mixed methods research requires consideration of several major components: the mixed methods paradigm, types of problems, mixed method designs, collaboration, and developing or extending theory. Mixed methods is an ideal tool for addressing a full range of problems in medical education to include development of theory and improving practi

via Twelve tips for getting started using mixed method… [Med Teach. 2013] – PubMed – NCBI.

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MANUSCRIPT: Education and training of pain medicine specialists in the United States.

Many pain patients present with a complex set of symptoms and comorbidities that defy the acumen of any one specific medical specialty; thus the knowledge and skills of the pain physician must, out of necessity cross specialty borders. The competency that comes from mastering essential skills is accomplished during the pain medicine training. The goal of pain medicine training in the United States is to provide the postgraduate trainee with the exposure to multiple disciplines of medicine, as well as multiple interventions, so that upon completion of training, the pain physician will have the necessary skill set to provide competent, appropriate, comprehensive care for the often medically complicated pain patient. In the United States, many training programs are governed by guidelines that have been established by the Accreditation Council for Graduate Medical Education (ACGME).

via Education and training of pain medici… [Eur J Phys Rehabil Med. 2013] – PubMed – NCBI.

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ABSTRACT: Evolution of practice gaps in gastrointestinal and endoscopic surgery: 2012 report from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Continuing Education Committee.

BACKGROUND:
In an effort to fulfill its charge to develop and maintain a comprehensive educational program to serve the members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the SAGES Continuing Education Committee (CEC) reports a summary of findings related to its evaluation of the 2012 SAGES annual meeting.
METHODS:
All attendees to the 2012 annual meeting had the opportunity to complete an immediate postmeeting questionnaire as part of their continuing medical education (CME) certification in which they identified up to two learning themes, answered questions related to potential practice change items that are based on those learning themes, and complete a needs assessment related to important learning topics for future meetings. In addition, participants in the postgraduate and hands-on courses were asked to complete questions about case volume and comfort levels related to procedures/topics in those courses. All respondents to this initial survey were sent a 3-month follow-up questionnaire in which they were asked how successfully they had implemented the intended practice changes and what, if any, barriers they encountered. Postgraduate and hands-on course participants completed case volume and comfort level questions. Descriptive statistical analysis of this deidentified data was undertaken.
RESULTS:
Response rates were 42 % and 56 % for CME-eligible attendees/respondents for the immediate postmeeting and 3-month follow-up questionnaires, respectively. Top learning themes for respondents were Bariatric, Hernia, Foregut, and Colorectal. Improving minimally invasive surgical (MIS) technique and managing complications related to MIS procedures were top intended practice changes. Partial implementation was common with top barriers including cost restrictions, lack of institutional support, and lack of time.
CONCLUSIONS:
The 2012 annual meeting analysis provides insight into educational needs among respondents and will help with planning content for future meetings

via Evolution of practice gaps in gastrointestinal a… [Surg Endosc. 2013] – PubMed – NCBI.

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MANUSCRIPT: Limitations of poster presentations reporting educational innovations at a major international medical education conference.

Background: In most areas of medical research, the label of ‘quality’ is associated with well-accepted standards. Whilst its interpretation in the field of medical education is contentious, there is agreement on the key elements required when reporting novel teaching strategies. We set out to assess if these features had been fulfilled by poster presentations at a major international medical education conference. Methods: Such posters were analysed in four key areas: reporting of theoretical underpinning, explanation of instructional design methods, descriptions of the resources needed for introduction, and the offering of materials to support dissemination. Results: Three hundred and twelve posters were reviewed with 170 suitable for analysis. Forty-one percent described their methods of instruction or innovation design. Thirty-three percent gave details of equipment, and 29% of studies described resources that may be required for delivering such an intervention. Further resources to support dissemination of their innovation were offered by 36%. Twenty-three percent described the theoretical underpinning or conceptual frameworks upon which their work was based. Conclusions: These findings suggest that posters presenting educational innovation are currently limited in what they offer to educators. Presenters should seek to enhance their reporting of these crucial aspects by employing existing published guidance, and organising committees may wish to consider explicitly requesting such information at the time of initial submission.

via Limitations of poster presentations reportin… [Med Educ Online. 2013] – PubMed – NCBI.

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MANUSCRIPT: An exploratory study into the effect of time-restricted internet access on face-validity, construct validity and reliability of postgraduate knowledge progress testing.

BACKGROUND:
Yearly formative knowledge testing (also known as progress testing) was shown to have a limited construct-validity and reliability in postgraduate medical education. One way to improve construct-validity and reliability is to improve the authenticity of a test. As easily accessible internet has become inseparably linked to daily clinical practice, we hypothesized that allowing internet access for a limited amount of time during the progress test would improve the perception of authenticity (face-validity) of the test, which would in turn improve the construct-validity and reliability of postgraduate progress testing.
METHODS:
Postgraduate trainees taking the yearly knowledge progress test were asked to participate in a study where they could access the internet for 30 minutes at the end of a traditional pen and paper test. Before and after the test they were asked to complete a short questionnaire regarding the face-validity of the test.
RESULTS:
Mean test scores increased significantly for all training years. Trainees indicated that the face-validity of the test improved with internet access and that they would like to continue to have internet access during future testing. Internet access did not improve the construct-validity or reliability of the test.
CONCLUSION:
Improving the face-validity of postgraduate progress testing, by adding the possibility to search the internet for a limited amount of time, positively influences test performance and face-validity. However, it did not change the reliability or the construct-validity of the test.

via An exploratory study into the effect of time-re… [BMC Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Building learning communities: evolution of the colleges at Vanderbilt University School of Medicine

Learning communities, which are an emerging trend in medical education, create a foundation for professional and academic development through the establishment of longitudinal relationships between students and faculty. In this article, the authors describe the robust learning community system at Vanderbilt University School of Medicine, which encompasses wellness, career planning, professional development, and academics.The Vanderbilt Advisory Colleges Program introduced in 2006 initially focused on two goals: promoting wellness and providing career advising. In the 2011-2012 academic year, the focus of the colleges expanded to incorporate an enhanced level of personal career advising and an academic component. In the four-year College Colloquium course, faculty selected as college mentors teach the medical humanities and lead sessions dedicated to student professional development in the areas of leadership, research, and service-learning. This academic and professional development program builds on the existing strengths of the colleges and has transformed the colleges into learning communities.The authors reflect on lessons learned and discuss future plans. They report that internal data and data from the Association of American Medical Colleges Medical School Graduation Questionnaire support consistently high and increasing satisfaction among Vanderbilt medical students, across the metrics of personal counseling, faculty mentoring, and career planning.

via Building learning communities: evolution of the col… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Reframing clinical workplace learning using the theory of distributed cognition

In medicine, knowledge is embodied and socially, temporally, spatially, and culturally distributed between actors and their environment. In addition, clinicians increasingly are using technology in their daily work to gain and share knowledge. Despite these characteristics, surprisingly few studies have incorporated the theory of distributed cognition (DCog), which emphasizes how cognition is distributed in a wider system in the form of multimodal representations (e.g., clinical images, speech, gazes, and gestures) between social actors (e.g., doctors and patients) in the physical environment (e.g., with technological instruments and computers). In this article, the authors provide an example of an interaction between medical actors. Using that example, they then introduce the important concepts of the DCog theory, identifying five characteristics of clinical representations-that they are interwoven, co-constructed, redundantly accessed, intersubjectively shared, and substantiated-and discuss their value for learning. By contrasting these DCog perspectives with studies from the field of medical education, the authors argue that researchers should focus future medical education scholarship on the ways in which medical actors use and connect speech, bodily movements (e.g., gestures), and the visual and haptic structures of their own bodies and of artifacts, such as technological instruments and computers, to construct complex, multimodal representations. They also argue that future scholarship should “zoom in” on detailed, moment-by-moment analysis and, at the same time, “zoom out” following the distribution of cognition through an overall system to develop a more integrated view of clinical workplace learning.

via Reframing clinical workplace learning using the the… [Acad Med. 2013] – PubMed – NCBI.

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