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Author: Brian S McGowan, PhD

ABSTRACT: The Evolving Role of Online Virtual Patients in Internal Medicine Clerkship Education Nationally.

PURPOSE:
Despite the significant resources required to develop and maintain virtual patient (VP) programs, little is known about why this innovation has been adopted and how it is implemented. Understanding needs and implementation strategies is important for effective curriculum planning.
METHOD:
In 2009 and 2011, surveys were offered to 110 U.S. internal medicine clerkship directors regarding their goals for adoption of Simulated Internal Medicine Patient Learning Experience VPs. In 2011, respondents were asked how they implemented VPs in their curricula. Results were analyzed using chi-square and Fisher exact test.
RESULTS:
Responses were obtained from 33 clerkship directors in 2009 and 45 in 2011. Comparing 2009 with 2011, improving students’ knowledge (29/33 [88%] versus 40/45 [91%]), differential diagnoses (27/33 [82%] versus 38/45 [86%]), and ability to identify key findings (26/33 [79%] versus 38/45 [86%]) remained somewhat or very important reasons for adopting VPs. Meeting Liaison Committee on Medical Education ED-2 (31/33 [94%] versus 33/45 [73%], P = .011) and ED-8 requirements (25/33 [76%] versus 25/45 [56%], P = .004) declined in importance. Eight of 38 (21%) replaced a learning activity with VPs, 9/38 (24%) integrated VPs into other learning activities, and 21/38 (55%) simply added VPs onto their curricula.
CONCLUSIONS:
This large, multi-institutional study reports national trends in VP adoption and integration. Meeting cognitive learning objectives remained an important reason for adopting VPs, whereas meeting regulatory requirements decreased significantly in importance. Opportunities remain for more systematically integrating VPs into clerkship curricula. Clarifying the changing goals may help with this process.

via The Evolving Role of Online Virtual Patients in Int… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Developing Physicians as Catalysts for Change

Failures in care coordination are a reflection of larger systemic shortcomings in communication and in physician engagement in shared team leadership. Traditional medical care and medical education neither focus on nor inspire responses to the challenges of coordinating care across episodes and sites. The authors suggest that the absence of attention to gaps in the continuum of care has led physicians to attempt to function as the glue that holds the health care system together. Further, medical students and residents have little opportunity to provide feedback on care processes and rarely receive the training and support they need to assess and suggest possible improvements.The authors argue that this absence of opportunity has driven cynicism, apathy, and burnout among physicians. They support a shift in culture and medical education such that students and residents are trained and inspired to act as catalysts who initiate and expedite positive changes. To become catalyst physicians, trainees require tools to partner with patients, staff, and faculty; training in implementing change; and the perception of this work as inherent to the role of the physician.The authors recommend that medical schools consider interprofessional training to be a necessary component of medical education and that future physicians be encouraged to grow in areas outside the “purely clinical” realm. They conclude that both physician catalysts and teamwork are essential for improving care coordination, reducing apathy and burnout, and supporting optimal patient outcomes.

via Developing Physicians as Catalysts for Change. [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: The Challenge of Promoting Professionalism Through Medical Ethics and Humanities Education

Given recent emphasis on professionalism training in medical schools by accrediting organizations, medical ethics and humanities educators need to develop a comprehensive understanding of this emphasis. To achieve this, the Project to Rebalance and Integrate Medical Education (PRIME) II Workshop (May 2011) enlisted representatives of the three major accreditation organizations to join with a national expert panel of medical educators in ethics, history, literature, and the visual arts. PRIME II faculty engaged in a dialogue on the future of professionalism in medical education. The authors present three overarching themes that resulted from the PRIME II discussions: transformation, question everything, and unity of vision and purpose.The first theme highlights that education toward professionalism requires transformational change, whereby medical ethics and humanities educators would make explicit the centrality of professionalism to the formation of physicians. The second theme emphasizes that the flourishing of professionalism must be based on first addressing the dysfunctional aspects of the current system of health care delivery and financing that undermine the goals of medical education. The third theme focuses on how ethics and humanities educators must have unity of vision and purpose in order to collaborate and identify how their disciplines advance professionalism. These themes should help shape discussions of the future of medical ethics and humanities teaching.The authors argue that improvement of the ethics and humanities-based knowledge, skills, and conduct that fosters professionalism should enhance patient care and be evaluated for its distinctive contributions to educational processes aimed at producing this outcome.

via The Challenge of Promoting Professionalism Through … [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Does Medical Training Promote or Deter Self-Directed Learning? A Longitudinal Mixed-Methods Study

PURPOSE:
The School of Medicine, University of Saskatchewan curriculum promotes self-direction as one of its learning philosophies. The authors sought to identify changes in self-directed learning (SDL) readiness during training.
METHOD:
Guglielmino’s SDL Readiness Scale (SDLRS) was administered to five student cohorts (N = 375) at admission and the end of every year of training, 2006 to 2010. Scores were analyzed using repeated-measurement analysis. A focus group and interviews captured students’ and instructors’ perceptions of self-direction.
RESULTS:
Overall, the mean SDLRS score was 230.6; men (n = 168) 229.5; women (n = 197) 232.3, higher than in the average adult population. However, the authors were able to follow only 275 students through later years of medical education. There were no significant effects of gender, years of premedical training, and Medical College Admission Test scores on SDLRS scores. Older students were more self-directed. There was a significant drop in scores at the end of year one for each of the cohorts (P < .001), and no significant change to these SDLRS scores as students progressed through medical school. Students and faculty defined SDL narrowly and had similar perceptions of curricular factors affecting SDL.
CONCLUSIONS:
The initial scores indicate high self-direction. The drop in scores one year after admission, and the lack of change with increased training, show that the current educational interventions may require reexamination and alteration to ones that promote SDL. Comparison with schools using a different curricular approach may bring to light the impact of curriculum on SDL.

via Does Medical Training Promote or Deter Self-Directe… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Educational strategies for improving clinical reasoning

Clinical reasoning serves as a crucial skill for all physicians regardless of their area of expertise. Helping trainees develop effective and appropriate clinical reasoning abilities is a central aim of medical education. Teaching clinical reasoning however can be a very difficult challenge for practicing physicians. Better understanding of the different cognitive processes involved in physician clinical reasoning provides a foundation from which to guide learner development of effective reasoning skills, while pairing assessment of learner reasoning abilities with understanding of different improvement strategies offers the opportunity to maximize educational efforts for learners. Clinical reasoning errors often can occur as a result of one of four problems in trainees as well as practicing physicians; inadequate knowledge, faulty data gathering, faulty data processing, or faulty metacognition. Educators are encouraged to consider at which point a given learner’s reasoning is breaking down. Experimentation with different strategies for improving clinical reasoning can help address learner struggles in each of these domains. In this chapter, various strategies for improving reasoning related to knowledge acquisition, data gathering, data processing, and clinician metacognition will be discussed. Understanding and gaining experience using the different educational strategies will provide practicing physicians with a toolbox of techniques for helping learners improve their reasoning abilities

via Educational strategie… [Curr Probl Pediatr Adolesc Health Care. 2013] – PubMed – NCBI.

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ABSTRACT: Improving diabetes outcomes using a web-based registry and interactive education: a multisite collaborative approach

NTRODUCTION:
To support the adoption of guideline concordant care by primary care practices, the New York Diabetes Coalition (NYDC) promoted use of an electronic diabetes registry and developed an interactive educational module on using the registry and improving patient communication. The NYDC hypothesized that use of a registry with immediate feedback would achieve measurable and clinically meaningful improvement in the proportion of patients at goal for diabetes health metrics.
RESEARCH DESIGN AND METHODS:
In 2006-2007, the NYDC recruited 7 small to midsized primary care practices to implement the registry and to receive education and coaching on registry use, practice work flow, and patient engagement. The patient cohort included those with 2 or more visits with a diagnosis of diabetes within a 12-month period. Each patient’s health measure status (at goal, above goal, not recorded) was assessed quarterly for hemoglobin A1C , low-density lipoprotein (LDL), and blood pressure (BP), and most recent A1C value was noted. A cohort analysis was performed using random effects regression models to assess the impact of the registry over time for each diabetes health metric.
RESULTS:
After controlling for variability between sites, with each subsequent quarter during the registry period patients were 1.4 times more likely to have A1C ≤ 9, almost twice (OR = 1.8) as likely to have LDL < 100, and 1.3 times more likely to have BP < 140/90. These improvements in compliance were statistically significant. Average A1C also improved over time, though this did not reach statistical significance.
DISCUSSION:
Utilizing a Web-based registry and interactive education, the project demonstrated improved patient outcomes, as well as the feasibility of collecting aggregate data from unrelated, independent practices.

via Improving diabetes outcomes using … [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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ABSTRACT: Multisource feedback: can it meet criteria for good assessment?

INTRODUCTION:
High-quality instruments are required to assess and provide feedback to practicing physicians. Multisource feedback (MSF) uses questionnaires from colleagues, coworkers, and patients to provide data. It enables feedback in areas of increasing interest to the medical profession: communication, collaboration, professionalism, and interpersonal skills. The purpose of the study was to apply the 7 assessment criteria as a framework to examine the quality of MSF instruments used to assess practicing physicians.
METHODS:
The criteria for assessment (validity, reproducibility, equivalence, feasibility, educational effect, catalytic effect, and acceptability) were examined for 3 sets of instruments, drawing on published data.
RESULTS:
Three MSF instruments with a sufficient body of research for inclusion-the Canadian Physician Achievement Review instruments and the United Kingdom’s GMC and CFEP360 instruments-were examined. There was evidence that MSF has been assessed against all criteria except educational effects, although variably for some of the instruments. The greatest emphasis was on validity, reproducibility, and feasibility for all of the instruments. Assessments of the catalytic effect were not available for 1 of the 2 UK instruments and minimally examined for the other. Data about acceptability are implicit in the UK instruments from their endorsement by the Royal College of General Practice and explicitly examined in the Canadian instruments.
DISCUSSION:
The 7 criteria provided a useful framework to assess the quality of MSF instruments and enable an approach to analyzing gaps in instrument assessment. These criteria are likely to be helpful in assessing other instruments used in medical education.

via Multisource feedback: can it meet … [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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MANUSCRIPT: Experiences and barriers to implementation of clinical practice guideline for depression in Korea

BACKGROUND:
Clinical guidelines can improve health-care delivery, but there are a number of challenges in adopting and implementing the current practice guidelines for depression. The aim of this study was to determine clinical experiences and perceived barriers to the implementation of these guidelines in psychiatric care.
METHODS:
A web-based survey was conducted with 386 psychiatric specialists to inquire about experiences and attitudes related to the depression guidelines and barriers influencing the use of the guidelines. Quantitative data were analyzed, and qualitative data were transcribed and coded manually.
RESULTS:
Almost three quarters of the psychiatrists (74.6%) were aware of the clinical guidelines for depression, and over half of participants (55.7%) had had clinical experiences with the guidelines in practice. The main reported advantages of the guidelines were that they helped in clinical decision making and provided informative resources for the patients and their caregivers. Despite this, some psychiatrists were making treatment decisions that were not in accordance with the depression guidelines. Lack of knowledge was the main obstacle to the implementation of guidelines assessed by the psychiatrists. Other complaints addressed difficulties in accessing the guidelines, lack of support for mental health services, and general attitudes toward guideline necessity. Overall, the responses suggested that adding a summary booklet, providing teaching sessions, and improving guidance delivery systems could be effective tools for increasing depression guideline usage.
CONCLUSION:
Individual barriers, such as lack of awareness and lack of familiarity, and external barriers, such as the supplying system, can affect whether physicians’ implement the guidelines for the treatment of depression in Korea. These findings suggest that further medical education to disseminate guidelines contents could improve public health for depression.

via Experiences and barriers to implementation of… [BMC Psychiatry. 2013] – PubMed – NCBI.

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ABSTRACT: Evidence-based medicine training in undergraduate medical education: a review and critique of the literature published 2006-2011

PURPOSE:
To characterize recent evidence-based medicine (EBM) educational interventions for medical students and suggest future directions for EBM education.
METHOD:
The authors searched the MEDLINE, Scopus, Educational Resource Information Center, and Evidence-Based Medicine Reviews databases for English-language articles published between 2006 and 2011 that featured medical students and interventions addressing multiple EBM skills. They extracted data on learner and instructor characteristics, educational settings, teaching methods, and EBM skills covered.
RESULTS:
The 20 included articles described interventions delivered in 12 countries in classroom (75%), clinic (25%), and/or online (20%) environments. The majority (60%) focused on clinical students, whereas 30% targeted preclinical students and 10% included both. EBM skills addressed included recognizing a knowledge gap (20%), asking a clinical question (90%), searching for information (90%), appraising information (85%), applying information (65%), and evaluating practice change (5%). Physicians were most often identified as instructors (60%); co-teachers included librarians (20%), allied health professionals (10%), and faculty from other disciplines (10%). Many studies (60%) included interventions at multiple points during one year, but none were longitudinal across students’ tenures. Teaching methods varied. Intervention efficacy could not be determined.
CONCLUSIONS:
Settings, learner levels and instructors, teaching methods, and covered skills differed across interventions. Authors writing about EBM interventions should include detailed descriptions and employ more rigorous research methods to allow others to draw conclusions about efficacy. When designing EBM interventions, educators should consider trends in medical education (e.g., online learning, interprofessional education) and in health care (e.g., patient-centered care, electronic health records).

via Evidence-based medicine training in undergraduate m… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Understanding the needs of department chairs in academic medicine

PURPOSE:
The challenges for senior academic leadership in medicine are significant and becoming increasingly complex. Adapting to the rapidly changing environment of health care and medical education requires strong leadership and management skills. This article provides empirical evidence about the intricate needs of department chairs to provide insight into the design of support and development opportunities.
METHOD:
In an exploratory case study, 21 of 25 (84%) department chairs within a faculty of medicine at a large Canadian university participated in semistructured interviews from December 2009 to February 2010. The authors conducted an inductive thematic analysis and identified a coding structure through an iterative process of relating and grouping of emerging themes.
RESULTS:
These participants were initially often insufficiently prepared for the demands of their roles. They identified a specific set of needs. They required cultural and structural awareness to navigate their hospital and university landscapes. A comprehensive network of support was necessary for eliciting advice and exchanging information, strategy, and emotional support. They identified a critical need for infrastructure growth and development. Finally, they stressed that they needed improvement in both effective interpersonal and influence skills in order to meet their mandate.
CONCLUSIONS:
Given the complexities and emotional burden of their role, it is necessary for chairs to have a range of supports and capabilities to succeed in their roles. Their leadership effectiveness can be enhanced by providing transitional processes and supports, development, and mentoring as well as facilitating the development of communities of peers

via Understanding the needs of department chairs in aca… [Acad Med. 2013] – PubMed – NCBI.

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