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Author: Brian S McGowan, PhD

MANUSCRIPT: Misleading health-related information promoted through video-based social media: anorexia on YouTube.

INTRODUCTION:
The amount of information being uploaded onto social video platforms, such as YouTube, Vimeo, and Veoh, continues to spiral, making it increasingly difficult to discern reliable health information from misleading content. There are thousands of YouTube videos promoting misleading information about anorexia (eg, anorexia as a healthy lifestyle).
OBJECTIVE:
The aim of this study was to investigate anorexia-related misinformation disseminated through YouTube videos.
METHODS:
We retrieved YouTube videos related to anorexia using the keywords anorexia, anorexia nervosa, proana, and thinspo on October 10, 2011.Three doctors reviewed 140 videos with approximately 11 hours of video content, classifying them as informative, pro-anorexia, or others. By informative we mean content describing the health consequences of anorexia and advice on how to recover from it; by pro-anorexia we mean videos promoting anorexia as a fashion, a source of beauty, and that share tips and methods for becoming and remaining anorexic. The 40 most-viewed videos (20 informative and 20 pro-anorexia videos) were assessed to gauge viewer behavior.
RESULTS:
The interrater agreement of classification was moderate (Fleiss’ kappa=0.5), with 29.3% (n=41) being rated as pro-anorexia, 55.7% (n=78) as informative, and 15.0% (n=21) as others. Pro-anorexia videos were favored 3 times more than informative videos (odds ratio [OR] 3.3, 95% CI 3.3-3.4, P<.001).
CONCLUSIONS:
Pro-anorexia information was identified in 29.3% of anorexia-related videos. Pro-anorexia videos are less common than informative videos; however, in proportional terms, pro-anorexia content is more highly favored and rated by its viewers. Efforts should focus on raising awareness, particularly among teenagers, about the trustworthiness of online information about beauty and healthy lifestyles. Health authorities producing videos to combat anorexia should consider involving celebrities and models to reach a wider audience. More research is needed to study the characteristics of pro-anorexia videos in order to develop algorithms that will automatically detect and filter those videos before they become popular.
PMID: 23406655 [PubMed – indexed for MEDLINE] PMCID: PMC3636813 Free PMC Article

via Misleading health-related information pro… [J Med Internet Res. 2013] – PubMed – NCBI.

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ABSTRACT: Web 2.0 chronic disease self-management for older adults: a systematic review.

BACKGROUND:
Participatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults.
OBJECTIVE:
To review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s).
METHODS:
A systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles.
RESULTS:
Most interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions.
CONCLUSIONS:
There is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease.

via Web 2.0 chronic disease self-management f… [J Med Internet Res. 2013] – PubMed – NCBI.

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RESOURCE: The Flipped Classroom Guide for Teachers

Unlike the traditional classroom model, a Flipped Classroom puts students in charge of their own learning.  By providing lectures online, educators give students the opportunity to learn at their own pace. Once a student masters a concept, he can move on. Also, students who need more time to master a concept won’t get left behind.

This means all students are not working on the same area at the same time in and out of the classroom. In the Flipped Classroom environment, the teacher becomes the guide off to the side, acting as more of facilitator, helping and guiding small groups and individuals toward learning success.

via The Flipped Classroom Guide for Teachers.

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MANUSCRIPT: Qualities of an effective teacher: what do medical teachers think?

Results
The top three desirable qualities of an effective teacher in our study were knowledge of
subject, enthusiasm and communication skills. Faculty with longer teaching experienced
ranked classroom behaviour/instructional delivery higher than their less experienced
counterparts. There was no difference of perspectives based on cultural background, gender
or discipline (medicine and dentistry).

Conclusion
This study found that the faculty perspectives were similar, regardless of the discipline,
gender and cultural background. Furthermore, on review of literature similar findings are
seen in studies done in allied medical and non-medical fields. These findings support
common teacher training programs for the teachers of all disciplines, rather than having
separate training programs exclusively for medical teachers. Logistically, this would make it
much easier to arrange such programs in universities or colleges with different faculties or
disciplines.

 

http://www.biomedcentral.com/content/pdf/1472-6920-13-128.pdf

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MANUSCRIPT: Team-based learning for psychiatry residents: a mixed methods study

BACKGROUND:
Team-based learning (TBL) is an effective teaching method for medical students. It improves knowledge acquisition and has benefits regarding learner engagement and teamwork skills. In medical education it is predominately used with undergraduates but has potential benefits for training clinicians. The aims of this study were to examine the impact of TBL in a sample of psychiatrists in terms of classroom engagement, attitudes towards teamwork, learner views and experiences of TBL.
METHODS:
Forty-four psychiatry residents participated in an Addictions Psychiatry TBL module. Mixed-methods were used for evaluation. Self-rated measures of classroom engagement (Classroom Engagement Survey, CES) were compared with conventional lectures, and attitudes regarding the value of teams (Value of Teams Scale, VTS) were compared before and after the module. Independent t-tests were used to compare ‘lecture’ CES scores with TBL CES scores and pre and post scores for the VTS. Feedback questionnaires were completed. Interviews were conducted with a subset of residents and transcripts analysed using thematic analysis.
RESULTS:
Twenty-eight residents completed post-course measures (response rate 63.6%). Seven participants volunteered for qualitative interviews–one from each team. There was a significant difference in the mean CES score lectures compared to TBL (p < 0.001) but no difference was found in mean VTS score pre and post for either subscale (p = 0.519; p = 0.809). All items on the feedback questionnaire were positively rated except two regarding session preparation. The qualitative analysis generated seven themes under four domains: ‘Learning in teams’, ‘Impact on the individual learner’, ‘Relationship with the teacher’ and ‘Efficiency and effectiveness of the learning process’.
CONCLUSIONS:
In this group of residents, TBL significantly improved learner-rated classroom engagement and seemed to promote interactivity between learners. TBL was generally well-received, although required learners to prepare for class which was difficult for some. TBL did not change these clinicians’ views about teamwork.

via Team-based learning for psychiatry residents: a… [BMC Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Cost analyses approaches in medical education: there are no simple solutions

CONTEXT:
Medical education is expensive. Although we have made progress in working out ‘what works’ in medical education, there are few data on whether medical education offers value relative to cost. Research into cost and value in medical education is beset by problems. One of the major problems is the lack of clear definitions for many of the terms commonly used. Phrases such as cost-effectiveness analysis, cost-benefit analysis, cost-utility analysis and cost-feasibility analysis are used without authors explaining to readers what they mean (and sometimes without authors themselves understanding what they mean). Sometimes such terms are used interchangeably and sometimes they are used as rhetorical devices without any real evidence that backs up such rhetoric as to the cost-effectiveness or otherwise of educational interventions. The frequent misuse of these terms is surprising considering the importance of the topics under consideration and the need for precision in many aspects of medical education.
METHODS:
Here we define commonly used terms in cost analyses and give examples of their usage in the context of medical education.
CONCLUSIONS:
Cost-effectiveness analysis refers to the evaluation of two or more alternative educational approaches or interventions according to their costs and their effects in producing a certain outcome. Cost-benefit analysis refers to ‘the evaluation of alternatives according to their costs and benefits when each is measured in monetary terms’. Cost-utility analysis is the examination of two or more alternatives according to their cost and their utility. In this context, utility means the satisfaction among individuals as a result of one or more outcome or the perceived value of the expected outcomes to a particular constituency. Cost-feasibility analysis involves simply measuring the cost of a proposed intervention in order to decide whether it is feasible.

via Cost analyses approaches in medical education: ther… [Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: A Clinician Performance Initiative to Improve Quality of Care for Patients with Osteoporosis

Abstract Background: Osteoporosis is a widespread but largely preventable disease. Improved adherence to screening and treatment recommendations is needed to reduce fracture and mortality rates. Additionally, clinicians face increasing demands to demonstrate proficient quality patient care aligning with evidence-based standards. Methods: A three-stage, clinician-focused performance improvement (PI) continuing medical education (CME) initiative was developed to enhance clinician awareness and execution of evidence-based standards of osteoporosis care. Clinician performance was evaluated through a retrospective chart analysis of patients at risk or with a diagnosis of osteoporosis. Results: Seventy-five participants reported their patient practices on a total of 1875 patients before and 1875 patients after completing a PI initiative. Significant gains were made in the use of Fracture Risk Assessment Tool (FRAX) (stage A, 26%, n=1769 vs. stage C, 51%, n=1762; p<0.001), assessment of fall risk (stage A, 46%, n=1276 vs. stage C, 89%, n=1190; p<0.001), calcium levels (stage A, 62%, n=1451 vs. stage C, 89%, n=1443; p<0.001), vitamin D levels (stage A, 79%, n=1438 vs. stage C, 93%, n=1439; p<0.001), and medication adherence (stage A, 88%, n=1136 vs. stage C, 96%, n=1106; p<0.001). Conclusions: Gains in patient screening, treatment, and adherence were associated with an initiative promoting self-evaluation and goal setting. Clinicians must assess their performance to improve patient care and maintain certification. PI CME is a valid, useful educational tool for accomplishing these standards

via A Clinician Performance Initiative… [J Womens Health (Larchmt). 2013] – PubMed – NCBI.

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ABSTRACT: Preventive intervention in diabetes: a new model for continuing medical education

Competence and skills in overcoming clinical inertia for diabetes treatment, and actually supporting and assisting the patient through adherence and compliance (as opposed to just reiterating what they “should” be doing and then assigning them the blame if they fail) is a key component to success in addressing diabetes, and to date it is a component that has received little formal attention. To improve and systematize diabetes care, it is critical to move beyond the “traditional” continuing medical education (CME) model of imparting knowledge as the entirety of the educational effort, and move toward a focus on Performance Improvement CME. This new approach does not just teach new information but also provides support for improvements where needed most within practice systems based on targeted data-based on self-assessments for the entire system of care. Joslin data conclude that this new approach will benefit support, clinical, and office teams as well as the specialist. In short, the Performance Improvement CME structure reflects the needed components of the successful practice today, particularly for chronic conditions such as diabetes, including the focus on interdisciplinary team care and on quality improvement, which is becoming more and more aligned with reimbursement schemes, public and private, in the U.S.

via Preventive intervention in diabetes: a new mod… [Am J Prev Med. 2013] – PubMed – NCBI.

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MANUSCRIPT: Medical Education and Professional Training— Changing the Trajectory

At least 15 reports have called for change in medical
education in the last decade ending 2010. The problems
facing medical education have been thoroughly elucidated.
There is remarkable congruence in the recommendations
of these reports. There reports have called for changes
in terms of integrating the educational continuum, need
for evaluation and research, new methods of fi nancing,
leadership importance, social accountability, use of
technology, alignment with healthcare delivery and sets
directions for the healthcare workforce reinforcing the
recommendations of CanMEDS, GMC(UK), ACGME/
ABMS and IOM highlighted earlier

 

http://www.annals.edu.sg/pdf/42VolNo2Feb2013/V42N2p99.pdf

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ABSTRACT: Mythmaking in medical education and medical practice

BACKGROUND:
Despite the emergence of evidence-based medicine, gaps in medical knowledge are filled by tradition, common sense, and experience, giving rise to medical myths.
METHODS:
We explored the origins of and evidence related to four medical myths: patients with shellfish allergies should not receive intravenous contrast, patients with atrial fibrillation of less than 48 hours’ duration do not require anticoagulation before cardioversion, patients with suspected meningitis should have a computed tomography (CT) scan before a lumbar puncture, and patients with respiratory disease should not receive β-blockers. We conducted a literature review to describe each myth’s origins and the quality of supporting evidence.
RESULTS:
All patients with allergies, including but not limited to seafood allergies, are at an increased risk for anaphylactoid reactions to radiocontrast. No conclusive studies indicate that patients with atrial fibrillation of less than 48 hours’ duration do not require anticoagulation before cardioversion. A CT scan before lumbar puncture in suspected acute bacterial meningitis is a clinically inefficient precaution. β-blockers can be safely used in patients with respiratory disease and may even prevent cardiac events in these patients.
CONCLUSIONS:
These familiar myths have maintained prominent roles in medical thinking because they represent wisdom passed down from eminent sources, they teach physiology and medical skills, and they offer physicians a sense of control in the face of uncertainty. In addition to providing scientific evidence, changing physicians’ practice requires acknowledging that even meticulous care cannot always avert bad outcomes.

via Mythmaking in medical education and medical… [Eur J Intern Med. 2013] – PubMed – NCBI.

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