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Author: Brian S McGowan, PhD

ABSTRACT: Surgical residents’ perceptions of 2011 Accreditation Council for Graduate Medical Education duty hour regulations.

IMPORTANCE:
In 2010, the Accreditation Council for Graduate Medical Education (ACGME) proposed increased regulation of work hours and supervision for residents. New Common Program requirements that took effect in July 2011 dramatically changed the customary 24-hour in-house call schedule. Surgical residents are more likely to be affected by these duty hour restrictions.
OBJECTIVE:
To examine surgical residents’ views of the 2011 ACGME Common Program requirements after implementation in July 2011.
DESIGN:
A 20-question electronic survey was administered 6 months after implementation of 2011 ACGME regulations to 123 participating institutions.
SETTING:
ACGME-accredited teaching hospitals in the United States and US territories.
PARTICIPANTS:
The total sample was 1013 voluntarily participating residents in general surgery and surgical specialties at ACGME-accredited institutions.
MAIN OUTCOMES AND MEASURES:
Residents’ perceptions of changes in education, patient care, and quality of life after institution of 2011 ACGME duty hour regulations and their compliance with these rules.
RESULTS:
A subset of 1013 residents training in general surgery or a surgical subspecialty was identified from a demographically representative sample of 6202 survey respondents. Most surgical residents indicated that education (55.1%), preparation for senior roles (68.4%), and work schedules (50.7%) are worse after implementation of the 2011 regulations. They reported no change in supervision (80.8%), safety of patient care (53.4%), or amount of rest (57.8%). Although quality of life is perceived as better for interns (61.9%), most residents believe that it is worse for senior residents (54.4%). A majority report increased handoffs (78.2%) and a shift of junior-level responsibilities to senior residents (68.7%). Finally, many residents report noncompliance (67.6%) and duty hour falsification (62.1%).
CONCLUSIONS AND RELEVANCE:
A majority of surgical residents disapprove of 2011 ACGME Common Program requirements (65.9%). The proposed benefits of the increased duty hour restrictions-improved education, patient care, and quality of life-have ostensibly not borne out in surgical training. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the 2011 ACGME regulations.

via Surgical residents’ perceptions of 2011 Accreditat… [JAMA Surg. 2013] – PubMed – NCBI.

ABSTRACT: How to Teach Medication Management: A Review of Novel Educational Materials in Geriatrics.

Medication management is an important component of medical education, particularly in the field of geriatrics. The Association of American Medical Colleges has put forth 26 minimum geriatrics competencies under eight domains for graduating medical students; medication management is one of these domains. The Portal of Geriatric Online education (www.POGOe.org) is an online public repository of geriatrics educational materials and modules developed by geriatrics educators and academicians in the United States, freely available for use by educators and learners in the field. The three POGOe materials presented in this review showcase pearls of medication management for medical and other professional students in novel learning formats that can be administered without major prior preparation. The review compares and contrasts the three materials in descriptive and tabular formats to enable its appropriate use by educators in promoting self-learning or group learning among their learners.

via How to Teach Medication Management: A Revie… [J Am Geriatr Soc. 2013] – PubMed – NCBI.

MANUSCRIPT: Improving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study).

OBJECTIVE:
To assess the effects of a multifaceted educational intervention in Norwegian general practice aiming to reduce antibiotic prescription rates for acute respiratory tract infections and to reduce the use of broad spectrum antibiotics.
DESIGN:
Cluster randomised controlled study.
SETTING:
Existing continuing medical education groups were recruited and randomised to intervention or control.
PARTICIPANTS:
79 groups, comprising 382 general practitioners, completed the interventions and data extractions.
INTERVENTIONS:
The intervention groups had two visits by peer academic detailers, the first presenting the national clinical guidelines for antibiotic use and recent research evidence on acute respiratory tract infections, the second based on feedback reports on each general practitioner’s antibiotic prescribing profile from the preceding year. Regional one day seminars were arranged as a supplement. The control arm received a different intervention targeting prescribing practice for older patients.
MAIN OUTCOME MEASURES:
Prescription rates and proportion of non-penicillin V antibiotics prescribed at the group level before and after the intervention, compared with corresponding data from the controls.
RESULTS:
In an adjusted, multilevel model, the effect of the intervention on the 39 intervention groups (183 general practitioners) was a reduction (odds ratio 0.72, 95% confidence interval 0.61 to 0.84) in prescribing of antibiotics for acute respiratory tract infections compared with the controls (40 continuing medical education groups with 199 general practitioners). A corresponding reduction was seen in the odds (0.64, 0.49 to 0.82) for prescribing a non-penicillin V antibiotic when an antibiotic was issued. Prescriptions per 1000 listed patients increased from 80.3 to 84.6 in the intervention arm and from 80.9 to 89.0 in the control arm, but this reflects a greater incidence of infections (particularly pneumonia) that needed treating in the intervention arm.
CONCLUSIONS:
The intervention led to improved antibiotic prescribing for respiratory tract infections in a representative sample of Norwegian general practitioners, and the courses were feasible to the general practitioners.

via Improving antibiotic prescribing in acute respiratory tr… [BMJ. 2013] – PubMed – NCBI.

ABSTRACT: How we used two social media tools to enhance aspects of active learning during lectures.

Background: Medical education is evolving to include active learning approaches, yet some courses will remain lecture-based. Social media tools used by students may foster collaborative learning during lectures. Aim: We present preliminary results from a pilot study that integrated two social technologies, Google Docs and SurveyMonkey, into 22 hour-long lectures for a course called “Social Influences on Health” attended by 154 students. Methods: At the conclusion of the semester, we reviewed student usage patterns with both technologies and collected data from students via course evaluations that included a standard Likert Scale. We used thematic analysis to identify emergent themes from evaluations. Results: On average, students contributed 6 comments/questions to the Google Doc in each lecture, and 35 students participated in SurveyMonkey. Engagement with both technologies increased throughout the semester and no unprofessional incidents were observed. The mean student rating for integration of Google Docs and SurveyMonkey was 3.4 or “above average” SD = 1.17. Thematic analysis identified perceived strengths of this approach as well as areas for improvement. Conclusions: Social media such as Google Docs and SurveyMonkey can facilitate interaction and provide students with control over content and flow of lecture-based courses, but educators must be mindful of practical and conceptual limitations.

via How we used two social media tools to enhance aspe… [Med Teach. 2013] – PubMed – NCBI.

ABSTRACT: A Randomized Trial of Two e-Learning Strategies for Teaching Substance Abuse Management Skills to Physicians.

PURPOSE:
To compare the educational effectiveness of two virtual patient (VP)-based e-learning strategies, versus no training, in improving physicians’ substance abuse management knowledge, attitudes, self-reported behaviors, and decision making.
METHOD:
The 2011-2012 study was a posttest-only, three-arm, randomized controlled trial in 90 resident and 30 faculty physicians from five adult medicine primary care training programs. The intervention was one of two 2-hour VP-based e-learning programs, designed by national experts to teach structured screening, brief interventions, referral, and treatment skills. One used traditional problem solving with feedback (unworked example), and the other incorporated an expert demonstration first, followed by problem solving with feedback (worked example). The main outcome measure was performance on the Physicians’ Competence in Substance Abuse Test (P-CSAT, maximum score = 315), a self-administered, previously validated measure of physicians’ competence in managing substance abuse. The survey was completed at the outset of the study and two months later.
RESULTS:
Overall P-CSAT scores were virtually identical (202-211, P > .05) between both intervention groups and the no-training control group at both times. Average faculty P-CSAT scores (221.9, 224.6) were significantly higher (P < .01) than resident scores (203.7, 202.5) at both times.
CONCLUSIONS:
This study did not provide evidence that a brief, worked example, VP-based e-learning program or a traditional, unworked, VP-based e-learning program was superior to no training in improving physicians’ substance abuse management skills. The study did provide additional evidence that the P-CSAT distinguishes between physicians who should possess different levels of substance abuse management skills.

via A Randomized Trial of Two e-Learning Strategies for… [Acad Med. 2013] – PubMed – NCBI.

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.

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.

MANUSCRIPT: Social media use among patients and caregivers: a scoping review.

OBJECTIVE:
To map the state of the existing literature evaluating the use of social media in patient and caregiver populations.
DESIGN:
Scoping review.
DATA SOURCES:
Medline, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge and ProQuest (2000-2012).
STUDY SELECTION:
Studies reporting primary research on the use of social media (collaborative projects, blogs/microblogs, content communities, social networking sites, virtual worlds) by patients or caregivers.
DATA EXTRACTION:
Two reviewers screened studies for eligibility; one reviewer extracted data from relevant studies and a second performed verification for accuracy and completeness on a 10% sample. Data were analysed to describe which social media tools are being used, by whom, for what purpose and how they are being evaluated.
RESULTS:
Two hundred eighty-four studies were included. Discussion forums were highly prevalent and constitute 66.6% of the sample. Social networking sites (14.8%) and blogs/microblogs (14.1%) were the next most commonly used tools. The intended purpose of the tool was to facilitate self-care in 77.1% of studies. While there were clusters of studies that focused on similar conditions (eg, lifestyle/weight loss (12.7%), cancer (11.3%)), there were no patterns in the objectives or tools used. A large proportion of the studies were descriptive (42.3%); however, there were also 48 (16.9%) randomised controlled trials (RCTs). Among the RCTs, 35.4% reported statistically significant results favouring the social media intervention being evaluated; however, 72.9% presented positive conclusions regarding the use of social media.
CONCLUSIONS:
There is an extensive body of literature examining the use of social media in patient and caregiver populations. Much of this work is descriptive; however, with such widespread use, evaluations of effectiveness are required. In studies that have examined effectiveness, positive conclusions are often reported, despite non-significant findings.

via Social media use among patients and caregivers: a s… [BMJ Open. 2013] – PubMed – NCBI.

ABSTRACT: Social Media Use by Health Care Professionals and Trainees: A Scoping Review

PURPOSE:To conduct a scoping review of the literature on social media use by health care professionals and trainees.METHOD:The authors searched MEDLINE, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge, and ProQuest for studies published between 2000 and 2012. They included those reporting primary research on social media use by health care professionals or trainees. Two reviewers screened studies for eligibility; one reviewer extracted data and a second verified a 10% sample. They analyzed data descriptively to determine which social media tools were used, by whom, for what purposes, and how they were evaluated.RESULTS:The authors included 96 studies in their review. Discussion forums were the most commonly studied tools 43/96; 44.8%. Researchers more often studied social media in educational than practice settings. Of common specialties, administration, critical appraisal, and research appeared most often 11/96; 11.5%, followed by public health 9/96; 9.4%. The objective of most tools was to facilitate communication 59/96; 61.5% or improve knowledge 41/96; 42.7%. Thirteen studies evaluated effectiveness 13.5%, and 41 42.7% used a cross-sectional design.CONCLUSIONS:These findings provide a map of the current literature on social media use in health care, identify gaps in that literature, and provide direction for future research. Social media use is widespread, particularly in education settings. The versatility of these tools suggests their suitability for use in a wide range of professional activities. Studies of their effectiveness could inform future practice.

via Social Media Use by Health Care Professionals and T… [Acad Med. 2013] – PubMed – NCBI.

RESOURCE: In Connectivism, No One Can Hear You Scream: a Guide to Understanding the MOOC Novice | Open Education | HYBRID PEDAGOGY

I’m not a Constructivist, Behaviourist, Cognitivist, or Connectivist. This is not a call for a return to an older theory. I’m a pragmatist, like many educators. I flirt outrageously with every theory that will have me. I’m ideologically promiscuous. I go with what works, and I am ruthless in weeding out what doesn’t. I do this because there is no “one size fits all” theory. Because there is no “one size fits all” student. And because students, participants, and learners are the final metric that measures any theory, and experience is the proving ground for theory. Faith to a theory, ideological monogamy, gets in the way of the evidence.

This is the beginning of a conversation with myself and others about where my online practice should go, rather than the end of one.  I want to focus on the novice experience in cMOOCs, and how the theory may badly serve some of its participants.

What we think about who we are, and where we are, tells us how much we are likely to learn. This is key to the gap in Connectivist thought. Central to that gap, at the core of what I think Connectivism might be missing is this idea:
Motivation is the engine of effort, and the sense of self is the ticking heart of motivation. Our sense of self is formed by the experiences we have, the environments we have them in, and the people who design those environments. And that negotiated sense of self can engineer the success or failure of the educational experience. It can also shape our sense of ourselves long after the experience is over.

via In Connectivism, No One Can Hear You Scream: a Guide to Understanding the MOOC Novice | Open Education | HYBRID PEDAGOGY.