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Author: Brian S McGowan, PhD

ABSTRACT: Making the professionalism curriculum for undergraduate medical education more relevant

Background: This study was an assessment of the professionalism curriculum at a community-based medical school from the perspective of undergraduate medical students. Aims: The goal of this study was to ascertain the perspectives of faculty and students on their interpretations of professionalism and its role in medical education to improve and expand existing professionalism curricula. Method: An online survey was created and sent to all students (n = 245) and selected faculty (n = 41). The survey utilized multiple choice and open-ended questions to allow responders to provide their insights on the definition of professionalism and detail how professionalism is taught and evaluated at their institution. A content analysis was conducted to categorize open-ended responses and the resulting themes were further examined using SPSS 20.0 for Windows (IBM Corp., Armonk, NY) frequency analyses. Results: Students and faculty respondents were similar in their definitions of medical professionalism and their perceptions of teaching methods. Role modeling was the most common and preferred method of professionalism education. Responses to whether evaluations of professional behavior were effective suggested both students and faculty are unclear about current professionalism assessments. Conclusion: This study showed that a cohesive standardized definition of professionalism is needed, as well as clearer guidelines on how professionalism is assessed.

via Making the professionalism curriculum for undergra… [Med Teach. 2013] – PubMed – NCBI.

ABSTRACT: Lifelong Learning and Self-assessment Is Relevant to Emergency Physician

BACKGROUND:
The Lifelong Learning and Self-assessment (LLSA) component of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program is a self-assessment exercise for physicians. Beginning in 2011, an optional continuing medical education (CME) activity was added.
OBJECTIVES:
As a part of a CME activity option for the LLSA, a survey was used to determine the relevancy of the LLSA readings and the degree to which medical knowledge garnered by the LLSA activity would modify clinical care.
METHODS:
Survey results from the 2011 LLSA CME activity were reviewed. This survey was composed of seven items, including questions about the relevancy of the readings and the impact on the physician’s clinical practice. The questions used a 5-point Likert scale and data underwent descriptive analyses.
RESULTS:
There were 2841 physicians who took the LLSA test during the study period, of whom 1354 (47.7%) opted to participate in the 2011 LLSA CME activity. All participants completed surveys. The LLSA readings were reported to be relevant to the overall clinical practice of Emergency Medicine (69.6% strongly relevant, 28.1% some relevance, and 2.3% little or no relevance), and provided information that would likely help them change their clinical practices (high likelihood 38.8%, some likelihood 53.0%, little or no change 8.2%).
CONCLUSIONS:
The LLSA component of the ABEM MOC program is relevant to the clinical practice of Emergency Medicine. Through this program, physicians gain new knowledge about the practice of Emergency Medicine, some of which is reported to change physicians’ clinical practices.

via Lifelong Learning and Self-assessment Is Relevan… [J Emerg Med. 2013] – PubMed – NCBI.

ABSTRACT: Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82

Over the past two decades, there has been an exponential and enthusiastic adoption of simulation in healthcare education internationally. Medicine has learned much from professions that have established programs in simulation for training, such as aviation, the military and space exploration. Increased demands on training hours, limited patient encounters, and a focus on patient safety have led to a new paradigm of education in healthcare that increasingly involves technology and innovative ways to provide a standardized curriculum. A robust body of literature is growing, seeking to answer the question of how best to use simulation in healthcare education. Building on the groundwork of the Best Evidence in Medical Education (BEME) Guide on the features of simulators that lead to effective learning, this current Guide provides practical guidance to aid educators in effectively using simulation for training. It is a selective review to describe best practices and illustrative case studies. This Guide is the second part of a two-part AMEE Guide on simulation in healthcare education. The first Guide focuses on building a simulation program, and discusses more operational topics such as types of simulators, simulation center structure and set-up, fidelity management, and scenario engineering, as well as faculty preparation. This Guide will focus on the educational principles that lead to effective learning, and include topics such as feedback and debriefing, deliberate practice, and curriculum integration – all central to simulation efficacy. The important subjects of mastery learning, range of difficulty, capturing clinical variation, and individualized learning are also examined. Finally, we discuss approaches to team training and suggest future directions. Each section follows a framework of background and definition, its importance to effective use of simulation, practical points with examples, and challenges generally encountered. Simulation-based healthcare education has great potential for use throughout the healthcare education continuum, from undergraduate to continuing education. It can also be used to train a variety of healthcare providers in different disciplines from novices to experts. This Guide aims to equip healthcare educators with the tools to use this learning modality to its full capability.

via Simulation in healthcare education: A best evidenc… [Med Teach. 2013] – PubMed – NCBI.

ABSTRACT: Sex differences among obstetrician-gynecologists: a review of survey studies.

Whether practice differences exist between the sexes is a question of clinical and educational significance. The obstetrician-gynecologist ob-gyn workforce has been shifting to majority women. An examination of sex differences in ob-gyn practice contributes to the discussion about how the changing workforce may impact womens healthcare. We sought to review survey studies to assess whether there are specific topics in which differences in attitudes, opinions, and practice patterns between male and female ob-gyns are apparent. We conducted a systematic review to identify all survey studies of ob-gyns from the years 2002-2012. A total of 93 studies were reviewed to identify statements of sex differences and categorized by conceptual theme. Sex differences were identified in a number of areas. In general, women report more supportive attitudes toward abortion. A number of differences were identified with regard to workforce issues, such as women earning 23% less than their male counterparts as reported in 1 study and working an average of 4.1 fewer hours per week than men in another study. Men typically provide higher selfratings than women in a number of areas. Other noted findings include men tending toward more pharmaceutical therapies and women making more referrals for medical conditions. Although a number of areas of difference were identified, the impact of such differences is yet to be determined. Additional research may help to clarify the reasons for such differences and their potential impact on patients. Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this CME activity, physicians should be better able to determine how the relevance of studying sex differences among physicians, specifically ob-gyns, can help improve patient care, assess whether there are topical areas in which male and female ob-gyns have reported different beliefs, practices, attitudes, and opinions, and examine how the limitations of survey studies and systematic reviews can affect the findings of these studies and reviews

via Sex differences among obstetrician-gynec… [Obstet Gynecol Surv. 2013] – PubMed – NCBI.

ABSTRACT: Constructing an adaptive care model for the management of disease-related symptoms throughout the course of multiple sclerosis–performance improvement CME.

BACKGROUND:
Symptom management remains a challenging clinical aspect of MS.
OBJECTIVE:
To design a performance improvement continuing medical education (PI CME) activity for better clinical management of multiple sclerosis (MS)-related depression, fatigue, mobility impairment/falls, and spasticity.
METHODS:
Ten volunteer MS centers participated in a three-stage PI CME model: A) baseline assessment; B) practice improvement CME intervention; C) reassessment. Expert faculty developed performance measures and activity intervention tools. Designated MS center champions reviewed patient charts and entered data into an online database. Stage C data were collected eight weeks after implementation of the intervention and compared with Stage A baseline data to measure change in performance.
RESULTS:
Aggregate data from the 10 participating MS centers (405 patient charts) revealed performance improvements in the assessment of all four MS-related symptoms. Statistically significant improvements were found in the documented assessment of mobility impairment/falls (p=0.003) and spasticity (p<0.001). For documentation of care plans, statistically significant improvements were reported for fatigue (p=0.007) and mobility impairment/falls (p=0.040); non-significant changes were noted for depression and spasticity.
CONCLUSIONS:
Our PI CME interventions demonstrated performance improvement in the management of MS-related symptoms. This PI CME model (available at www.achlpicme.org/ms/toolkit) offers a new perspective on enhancing symptom management in patients with MS

via Constructing an adaptive care model for the manag… [Mult Scler. 2013] – PubMed – NCBI.

A Roadmap for Grantsmanship in Medical Education: Applying the SACRED Principles

If there is one constant challenge in the way we innovate, evolve, and assess continuing medical education, it might be the simple reality that these efforts take resources. In response, medical educators often spend upwards of half of their time trying to find the resources that will allow them to develop, pilot, and produce the educational interventions that they envision. This leads the community down two paths: 1) make do with the resources that are available, or 2) commit the time to ‘perfect’ ones proposal writing and grantsmanship such that funding can be secured and innovation can be pursued.

On the other hand, there are countless organizations tasked with the alternative challenge – they are committed to funding medical education and research that will drive change in healthcare, but they struggle to effectively tie their funding decisions to a rationale assessment of which proposals are most likely to be successful. As a result, there may not be a high fidelity in their funding allocation and over time this inefficiency leads to a depletion of funding and an exacerbation of the problems define in paragraph one.

So how might we overcome theseCME_Grant_Writing challenges such that educational providers may more effectively conceive and construct grant proposals that tell the proper story and such that funding organizations may review, analyze, and fund proposals that they can have confidence will work?

For nearly a decade I have been exploring and promoting a SACRED model for grantsmanship to identify and simplify the critical information needed to be shared. In this post I would like to briefly introduce this model more broadly. Since I originally conceived of the model in ~2004 I have been constantly looking for evidence of its success and/or shortcomings and as I write this post I can whole-heartily support its efficacy…and I can now provide countless examples of how the model has been employed successfully to increase a provider’s funding rates and to simplify a funder’s review and the fidelity of their decisions.

Moreover, in reviewing and funding thousands of educational grant proposals myself, and in successfully writing dozens and dozens of educational grant proposal over the past decade I have come to learn that while the SACRED model serves as a valuable roadmap, success ultimately lies in how the roadmap is employed. I will try to write about this in subsequent posts. For now, let me simply introduce the elements of the roadmap.

The critical elements of grantsmanship in medical education are as follows:

  1. Scientific Rationale: is there expertise and sophistication in the linkages between the identified clinical gaps educational needs,
  2. Audience: more specifically how have you explored and defined the needs and preference of the intended audience of learners (Do you have unique access or experience with these learners?),
  3. Compliance models and track record (self-explanatory for those in continuing medical education),
  4. Results: alignment of assessment methodology and one’s organizational track record,
  5. Educational Design: tell a concise and evidence-based story about the intended interventional models and one’s organizational track record, and
  6. Differentiation: provide a more detailed explanation of how the broader plan will be implemented and what makes your approach unique and valuable (funding justification is critical here).

Early on it was pointed out to me that the SACRED model could just as easily be renamed the SCARED model – and the irony of this is not lost on many. But since the approach is intended to make the planning and funding of innovative and effective medical education easier and less worrisome, I believe the SACRED moniker fits.

Having introduced the 6 key elements of the model, my hope is that you may begin to explore your internal grantsmanship models: do your proposals highlight and emphasize these elements? Or, do your review practices identify and deconstruct these elements? I believe that just this initial self-assessment will provide the community with a valuable exercise.

FWIW, I look forward to hearing what you think about the model, and I certainly look forward to hearing how the self-assessment goes! Feel free to contact me if you are immediately interested in a next level exploration or if you want to understand how to ‘move the needle’ with your internal processes.

At a minimum…I hope this helps all of us in some small way!

Brian

MANUSCRIPT: A feeling of flow: exploring junior scientists experiences with dictation of scientific articles

BackgroundScience involves publishing results, but many scientists do not master this. We introduced dictation as a method of producing a manuscript draft, participating in writing teams and attending a writing retreat to junior scientists in our department. This study aimed to explore the scientists experiences with this process.MethodsFour focus group interviews were conducted and comprised all participating scientists n = 14. Each transcript was transcribed verbatim and coded independently by two interviewers. The coding structure was discussed until consensus and from this the emergent themes were identified.ResultsParticipants were 7 PhD students, 5 scholarship students and 2 clinical research nurses. Three main themes were identified: Preparing and then letting go indicated that dictating worked best when properly prepared. The big dictation machine described benefits of writing teams when junior scientists got feedback on both content and structure of their papers. Barriers to and drivers for participation described flow-like states that participants experienced during the dictation.ConclusionsMotivation and a high level of preparation were pivotal to be able to dictate a full article in one day. The descriptions of flow-like states seemed analogous to the theoretical model of flow which is interesting, as flow is usually deemed a state reserved to skilled experts. Our findings suggest that other academic groups might benefit from using the concept including dictation of manuscripts to encourage participants confidence in their writing skills.

via BMC Medical Education | Abstract | A feeling of flow: exploring junior scientists experiences with dictation of scientific articles.

MANUSCRIPT: Natural language processing: algorithms and tools to extract computable information from EHRs and from the biomedical literature

The increasing adoption of electronic health records EHRs and the corresponding interest in using these data for quality improvement and research have made it clear that the interpretation of narrative text contained in the records is a critical step. The biomedical literature is another important information source that can benefit from approaches requiring structuring of data contained in narrative text. For the first time, we dedicate an entire issue of JAMIA to biomedical natural language processing NLP, a topic that has been among the most cited in this journal for the past few years. We start with a description of a contest to select the best performing algorithms for detection of temporal relationships in clinical documents see page 806, followed by a general review of significance and brief description of commonly used methods to address this task see page 814.

via Natural language processing: algorithms and tools to extract computable information from EHRs and from the biomedical literature — Ohno-Machado et al. 20 5: 805 — Journal of the American Medical Informatics Association.

MANUSCRIPT: Asynchronous vs didactic education: it’s too early to throw in the towel on tradition

Background
Asynchronous, computer based instruction is cost effective, allows self-directed pacing and review, and addresses preferences of millennial learners. Current research suggests there is no significant difference in learning compared to traditional classroom instruction. Data are limited for novice learners in emergency medicine. The objective of this study was to compare asynchronous, computer-based instruction with traditional didactics for senior medical students during a week-long intensive course in acute care. We hypothesized both modalities would be equivalent.

Methods
This was a prospective observational quasi-experimental study of 4th year medical students who were novice learners with minimal prior exposure to curricular elements. We assessed baseline knowledge with an objective pre-test. The curriculum was delivered in either traditional lecture format (shock, acute abdomen, dyspnea, field trauma) or via asynchronous, computer-based modules (chest pain, EKG interpretation, pain management, trauma). An interactive review covering all topics was followed by a post-test. Knowledge retention was measured after 10 weeks. Pre and post-test items were written by a panel of medical educators and validated with a reference group of learners. Mean scores were analyzed using dependent t-test and attitudes were assessed by a 5-point Likert scale.

Results
44 of 48 students completed the protocol. Students initially acquired more knowledge from didactic education as demonstrated by mean gain scores (didactic: 28.39% +/- 18.06; asynchronous 9.93% +/- 23.22). Mean difference between didactic and asynchronous = 18.45% with 95% CI [10.40 to 26.50]; p = 0.0001. Retention testing demonstrated similar knowledge attrition: mean gain scores -14.94% (didactic); -17.61% (asynchronous), which was not significantly different: 2.68% +/- 20.85, 95% CI [-3.66 to 9.02], p = 0.399. The attitudinal survey revealed that 60.4% of students believed the asynchronous modules were educational and 95.8% enjoyed the flexibility of the method. 39.6% of students preferred asynchronous education for required didactics; 37.5% were neutral; 23% preferred traditional lectures.

Conclusions
Asynchronous, computer-based instruction was not equivalent to traditional didactics for novice learners of acute care topics. Interactive, standard didactic education was valuable. Retention rates were similar between instructional methods. Students had mixed attitudes toward asynchronous learning but enjoyed the flexibility. We urge caution in trading in traditional didactic lectures in favor of asynchronous education for novice learners in acute care.

via BMC Medical Education | Abstract | Asynchronous vs didactic education: it’s too early to throw in the towel on tradition.

ABSTRACT: Effective leadership – The way to excellence in health professions education

The current times are witnessing an explosion of new knowledge in medicine. The demographic profile, geographic distribution of many diseases is changing, there have been dramatic shifts in the health care delivery, healthcare professionals are more socially and professionally accountable, patients have become more consumerist in their attitude. These factors coupled with the increasing demand for trained health care professionals has led to, firstly, a rapid increase in the health professionals education institutions and secondly curricular changes and adoption of newer teaching learning methodologies, to equip the graduates with the desirable outcomes. The scene in health professions education is one characterized by rapid activity and change. A time which demands effective leadership at these institutions for achieving excellence. Drawing from a decade long experience, at different medical schools in the gulf region, the author opines that it is effective leadership, as observed at the institutions where he worked, which is responsible for realization of institutional vision, rapid development and achievement of excellence.

via Effective leadership – The way to excellence in he… [Med Teach. 2013] – PubMed – NCBI.