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Author: Brian S McGowan, PhD

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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ABSTRACT: Advancing faculty development in medical education: a systematic review

PURPOSE:
To (1) provide a detailed account of the nature and scope of faculty development (FD) programs in medical education, (2) assess the quality of FD studies, and (3) identify in what areas and through what means future research can purposefully build on existing knowledge.
METHOD:
The authors searched MEDLINE, CINAHL, and ERIC for articles reporting evaluations of FD initiatives published between 1989 and 2010. They applied standard systematic review procedures for sifting abstracts, scrutinizing full texts, and abstracting data, including program characteristics, evaluation methods, and outcomes. They used a modified Kirkpatrick model to guide their data abstraction.
RESULTS:
The authors included 22 articles reporting on 21 studies in their review. The most common program characteristics included a series/longitudinal format, intended for individuals, and offered to physicians only. Although the most common aim was to improve teaching effectiveness, several programs had multiple aims, including scholarship and leadership. Program evaluation focused on quantitative approaches. A number of studies employed longitudinal designs and included some follow-up component. Surveys were the most popular data collection method, participants the most common data source, and self-reported behavior changes the most commonly reported outcome.
CONCLUSIONS:
Although the authors’ findings showed some recent expansion in the scope of the FD literature, they also highlighted areas that require further focus and growth. Future research should employ more rigorous evaluation methods, explore the role of interprofessional teams and communities of practice in the workplace, and address how different organizational and contextual factors shape the success of FD programs

via Advancing faculty development in medical education:… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: The impact of lecture attendance and other variables on how medical students evaluate faculty in a preclinical program

PURPOSE:
High-quality audiovisual recording technology enables medical students to listen to didactic lectures without actually attending them. The authors wondered whether in-person attendance affects how students evaluate lecturers.
METHOD:
This is a retrospective review of faculty evaluations completed by first- and second-year medical students at the Ohio State University College of Medicine during 2009-2010. Lecture-capture technology was used to record all lectures. Attendance at lectures was optional; however, all students were required to complete lecturer evaluation forms. Students rated overall instruction using a five-option response scale. They also reported their attendance. The authors used analysis of variance to compare the lecturer ratings of attendees versus nonattendees. The authors included additional independent variables-year of student, student grade/rank in class, and lecturer degree-in the analysis.
RESULTS:
The authors analyzed 12,092 evaluations of 220 lecturers received from 358 students. The average number of evaluations per lecturer was 55. Seventy-four percent (n = 8,968 evaluations) of students attended the lectures they evaluated, whereas 26% (n = 3,124 evaluations) viewed them online. Mean lecturer ratings from attendees was 3.85 compared with 3.80 by nonattendees (P ≤ .05; effect size: 0.055). Student’s class grade and year, plus lecturer degree, also affected students’ evaluations of lecturers (effect sizes: 0.055-0.3).
CONCLUSIONS:
Students’ attendance at lectures, year, and class grade, as well as lecturer degree, affect students’ evaluation of lecturers. This finding has ramifications on how student evaluations should be collected, interpreted, and used in promotion and tenure decisions in this evolving medical education environment.

via The impact of lecture attendance and other variable… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Attitudes of primary care providers and recommendations of home blood pressure monitoring

To assess primary care providers’ (PCPs) opinions related to recommending home blood pressure monitoring (HBPM) for their hypertensive patients, the authors analyzed a Web-based 2010 DocStyles survey, which included PCPs’ demographics, health-related behaviors, recommendations on HBPM, views of patient knowledge, and use of continuing medical education. Of the 1254 PCPs who responded, 539 were family practitioners, 461 were internists, and 254 were nurse practitioners; 32% recommended HBPM to ≥90% of their patients and 26% recommended it to ≤40% of their patients. Nurse practitioners were significantly more likely to recommend HBPM than were internists (odds ratio, 0.55; 95% confidence interval, 0.40-0.78). The top reasons for not recommending HBPM were “patient can’t afford it” and “patient doesn’t need it.” A total of 20% of PCPs indicated that their patients were poor to lower middle class; these PCPs were less likely to recommend HBPM to their patients than were those PCPs with most patients in higher economic classes. Additional efforts are needed to provide education to providers, especially physicians, about the benefits of HBPM in improved and cost-effective blood pressure control in the United States.

via Attitudes of primary care provi… [J Clin Hypertens (Greenwich). 2013] – PubMed – NCBI.

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MANUSCRIPT: Summative assessments are more powerful drivers of student learning than resource intensive teaching formats

BACKGROUND:
Electrocardiogram (ECG) interpretation is a core clinical skill that needs to be acquired during undergraduate medical education. Intensive teaching is generally assumed to produce more favorable learning outcomes, but recent research suggests that examinations are more powerful drivers of student learning than instructional format. This study assessed the differential contribution of teaching format and examination consequences to learning outcome regarding ECG interpretation skills in undergraduate medical students.
METHODS:
A total of 534 fourth-year medical students participated in a six-group (two sets of three), partially randomized trial. Students received three levels of teaching intensity: self-directed learning (two groups), lectures (two groups) or small-group peer teaching facilitated by more advanced students (two groups). One of the two groups on each level of teaching intensity was assessed in a formative, the other in a summative written ECG examination, which provided a maximum of 1% credit points of the total curriculum. The formative examination provided individual feedback without credit points. Main outcome was the correct identification of ≥3 out of 5 diagnoses in original ECG tracings. Secondary outcome measures were time spent on independent study and use of additional study material.
RESULTS:
Compared with formative assessments, summative assessments increased the odds of correctly identifying at least three out of five ECG diagnoses (OR 5.14; 95% CI 3.26 to 8.09), of spending at least 2 h/week extra on ECG self-study (OR 4.02; 95% CI 2.65 to 6.12) and of using additional learning material (OR 2.86; 95% CI 1.92 to 4.24). Lectures and peer teaching were associated with increased learning effort only, but did not augment examination performance.
CONCLUSIONS:
Medical educators need to be aware of the paramount role of summative assessments in promoting student learning. Consequently, examinations within medical schools need to be closely matched to the desired learning outcomes. Shifting resources from implementing innovative and costly teaching formats to designing more high-quality summative examinations warrants further investigation

via Summative assessments are more powerful drivers of s… [BMC Med. 2013] – PubMed – NCBI.

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ABSTRACT: History of simulation in medicine: from resusci annie to the ann myers medical center

Medical and surgical graduate medical education has historically used a halstedian approach of “see one, do one, teach one.” Increased public demand for safety, quality, and accountability in the setting of regulated resident work hours and limited resources is driving the development of innovative educational tools. The use of simulation in nonmedical, medical, and neurosurgical disciplines is reviewed in this article. Simulation has been validated as an educational tool in nonmedical fields such as aviation and the military. Across most medical and surgical subspecialties, simulation is recognized as a valuable tool that will shape the next era of medical education, postgraduate training, and maintenance of certification

via History of simulation in medicine: from resusci… [Neurosurgery. 2013] – PubMed – NCBI.

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