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Author: Brian S McGowan, PhD

ABSTRACT: New directions in medical education related to psychiatry

Abstract The 100-year anniversary of the Flexner report provides an opportunity to reflect on the future of medical education. We will consider the legacy of the original report, the centenary follow up to that report and consider how these, in concert with emerging learning theories, will influence medical education. We first provide a brief overview of the original Flexner report and review the recommendations of the 2010 centenary follow up to the report. We then discuss some of the major developments in learning theory and consider how they have influenced medical education. In general, there has been a gradual shift from passive to active methods, spurred in part by constructivist theories of learning. Many of the attitudes and skills required are particular strengths of the psychiatrist, making psychiatric educators particularly suitable to lead curricular change. Although much literature is devoted to determining the ‘best’ educational method, we take an ecumenical approach, suggesting that the various pedagogical approaches are all legitimate educational tools from which to choose. Each has its strength and limitations, and when designing a curriculum we should consider these when making pedagogical choices. We finish with some practical advice for those contemplating curricular change.

via New directions in medical education relat… [Int Rev Psychiatry. 2013] – PubMed – NCBI.

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ABSTRACT: As technology and generations in medical education change, what remains is the intersection between educator, learners, assessment and context

Abstract The information era has begun to create major shifts in educational systems, including those in undergraduate medical and graduate psychiatric training programmes. Despite these changes, teaching and learning in formal educational settings remains predominately the product of the intersection between educator, learners, assessment and context. This article reviews intrinsic and external forces influencing each of these elements, such as intergenerational differences in teaching and learning styles, education technologies as they relate to delivery and maintenance of curricula, competency frameworks of assessment, and individual learning and teaching development plans. Maintaining a focus on the relationship between these factors and re-conceptualizing psychiatric education and formal medical education systems in general as a mutual two-way learning exchange between participants will promote careers of lifelong learning.

via As technology and generations in medical … [Int Rev Psychiatry. 2013] – PubMed – NCBI.

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ABSTRACT: The General Surgery Chief Resident Operative Experience: 23 Years of National ACGME Case Logs.

IMPORTANCE The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. OBJECTIVE To evaluate changes in operative experience for general surgery CRs. DESIGN, SETTING, AND PARTICIPANTS Review of Accreditation Council for Graduate Medical Education case logs from 1989-1990 through 2011-2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. MAIN OUTCOMES AND MEASURES Total cases and defined categories were evaluated for changes over time. RESULTS The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P < .001). Total CR cases dropped to their lowest following implementation of the 80-hour work week (236 cases), but rebounded in period 5. The percentage of residents’ 5-year operative experience performed as CRs has decreased (30% in period 1 vs 25.6% in period 5, P < .001). Regarding case mix: thoracic, trauma, and vascular cases declined steadily, while alimentary and intra-abdominal operations increased. Recent graduates averaged 80 alimentary and 78 intra-abdominal procedures during their CR years. Compared with period 1, in which these 2 categories represented 47.1% of CR experience, in period 5, they represented 65.2% (P < .001). Endocrine experience has been relatively unchanged. CONCLUSIONS AND RELEVANCE Total CR cases declined especially acutely following implementation of the 80-hour work week but have since rebounded. Chief resident cases contribute less to overall experience, although this proportion stabilized before the 80-hour work week. Case mix has narrowed, with significant increases in alimentary and intra-abdominal cases. Broad-based general surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.

via The General Surgery Chief Resident Operative Exper… [JAMA Surg. 2013] – PubMed – NCBI.

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ABSTRACT: Measuring Impact of JAMA Dermatology Practice Gaps Section on Training in US Dermatology Residency Programs

MPORTANCE JAMA Dermatology Practice Gaps commentaries are intended to aid in the interpretation of the literature to make it more practical and applicable to daily patient care. Practice Gaps commentaries have had an impact on physician clinical practice and dermatology residency curricula. OBJECTIVE To assess the impact of JAMA Dermatology Practice Gaps commentaries on dermatology residency training programs in the United States, including journal club discussions and local quality improvement activities. DESIGN, SETTING, PARTICIPANTS A web-based questionnaire of 17 questions was sent via e-mail to US dermatology residency program directors PDs in February 2012. MAIN OUTCOMES AND MEASURES Program director report of incorporating Practice Gaps themes and discussions into resident journal club activities, clinical practice, quality improvement activities, or research projects in the residency programs, as a result of a Practice Gaps commentary. RESULTS Of the 114 surveys distributed to US dermatology residency PDs, 48 were completed 42% response rate. Sixty percent of PDs reported familiarity with the Practice Gaps section of JAMA Dermatology, and 56% discuss these commentaries during resident journal club activities. Quality improvement and research projects have been initiated as a result of Practice Gaps commentaries. CONCLUSIONS AND RELEVANCE Practice Gaps commentaries are discussed during most dermatology residency journal club activities. Practice Gaps have had an impact on physician practice and dermatology residency curricula and can serve as a tool for enhanced continuing medical education and quality improvement initiatives.

via Measuring Impact of JAMA Dermatology Practice … [JAMA Dermatol. 2013] – PubMed – NCBI.

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ABSTRACT: Forumclínic: the shaping of virtual communities to assist patients with chronic diseases.

Information and communication technologies (ICTs) provide new opportunities to complement traditional care while enhancing patient autonomy. With the objective to supplement patient care, a group of health professionals at the Hospital Clínic de Barcelona created Forumclínic, an online networking website in Spanish and Catalan. In 2008, seven web- and DVD-based chronic disease portals (Diabetes, Schizophrenia, Cardiac Ischemia, COPD, Depression, Breast Cancer and cardiovascular risk) were created with the following resources: multimedia patient education material; physician-specialist transcribed research (articles) news; an open question forum (for clinician-user and user-to-user interaction); and patient and specialist interview videos on the progress of disease, common diagnosis and treatment procedures; and information on the best or worst prognoses. Using data from Google Analytics, server logs were used to observe online behaviour patterns and user postings. This data combined with a mixed methods approach were used to evaluate the development of a virtual community (VC). A virtual community was developed when the number of forum visits was greater than those in the disease portal (definition). While nearly half of the visitors were from the Americas, the Schizophrenia, Breast Cancer, Depression and COPD forums met the criteria for and developed a virtual community. However, the Diabetes and Cardiac Ischemia forums did not reach VC status. It is also interesting to note that users in their late thirties and early forties were primarily women. The development of four virtual communities in Forumclínic seems to support the self-care needs of virtual patients. Users also reported appreciating the increased interaction with experts online and commonly collaborated with the forum moderator to guide and support other users with similar conditions in managing their health. Thence, we believe that Forumclínic is a good model to complement traditional patient care. A formal evaluation of this adjuvant form of care, from both the users’ and moderators’ perspective, is currently in its final stages.

via Forumclínic: the shaping of virtu… [Stud Health Technol Inform. 2013] – PubMed – NCBI.

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ABSTRACT: Social media and patient self-management: not all sites are created equal.

This paper compares two social media sites that aim to support patients to enhance self-management. The first site, PatientsLikeMe is a well established global site designed to allow peer-to-peer communication between people with similar conditions. The second, HealthShare, is a recently developed site for Australians described as “Australias Social Health Network”. The comparison conducted examines the purpose, ownership, and design of both sites as well as how the data they collect is used. Analysis highlights that PatientsLikeMe actively facilitates patient self-management, while HealthShare is revealed to be a professionally moderated health information portal presented as a social networking site. While the impetus for the development of PatientsLikeMe is clear, the motives underpinning HealthShare are less obvious. With increasing patient interest in connecting with, and sharing information with one another, awareness of the nature and motivations underpinning sites that provide these services is of increasing relevance

via Social media and patient self-man… [Stud Health Technol Inform. 2013] – PubMed – NCBI.

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ABSTRACT: Literacy, cognitive function, and health: results of the LitCog study.

BACKGROUND:
Emerging evidence suggests the relationship between health literacy and health outcomes could be explained by cognitive abilities.
OBJECTIVE:
To investigate to what degree cognitive skills explain associations between health literacy, performance on common health tasks, and functional health status.
DESIGN:
Two face-to-face, structured interviews spaced a week apart with three health literacy assessments and a comprehensive cognitive battery measuring ‘fluid’ abilities necessary to learn and apply new information, and ‘crystallized’ abilities such as background knowledge.
SETTING:
An academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois.
PATIENTS:
Eight hundred and eighty-two English-speaking adults ages 55 to 74.
MEASUREMENTS:
Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA), and Newest Vital Sign (NVS). Performance on common health tasks were globally assessed and categorized as 1) comprehending print information, 2) recalling spoken information, 3) recalling multimedia information, 4) dosing and organizing medication, and 5) healthcare problem-solving.
RESULTS:
Health literacy measures were strongly correlated with fluid and crystallized cognitive abilities (range: r=0.57 to 0.77, all p<0.001). Lower health literacy and weaker fluid and crystallized abilities were associated with poorer performance on healthcare tasks. In multivariable analyses, the association between health literacy and task performance was substantially reduced once fluid and crystallized cognitive abilities were entered into models (without cognitive abilities: β= -28.9, 95 % Confidence Interval (CI) -31.4 to -26.4, p; with cognitive abilities: β= -8.5, 95 % CI -10.9 to -6.0).
LIMITATIONS:
Cross-sectional analyses, English-speaking, older adults only.
CONCLUSIONS:
The most common measures used in health literacy studies are detecting individual differences in cognitive abilities, which may predict one’s capacity to engage in self-care and achieve desirable health outcomes. Future interventions should respond to all of the cognitive demands patients face in managing health, beyond reading and numeracy.

via Literacy, cognitive function, and health: r… [J Gen Intern Med. 2012] – PubMed – NCBI.

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ABSTRACT: Recent trends in continuing medical education among obstetrician-gynecologists.

OBJECTIVE:To estimate current trends in continuing medical education among obstetrician-gynecologists in relation to the Maintenance of Certification program.METHODS:A validated questionnaire was mailed to 1,030 randomly selected physicians of the American College of Obstetricians and Gynecologists in the United States, Puerto Rico, and Canada. Participants were asked about current practices and opinions regarding continuing medical education activities. Responses were compared between members mandated for Maintenance of Certification (board certification 1986 or later; time-limited certificate) or not (board certification before 1986; nontime-limited certificate).RESULTS:Five hundred twenty (50.4%) surveys were completed. Respondents were more often male (57.1%), generalists (87.3%), in community-based (73.8%) group practices (77.2%) with mean (±standard deviation) age 52.4±9.9 years. College physicians mandated to participate in the Maintenance of Certification program were more likely to rely on Annual Board Certification articles as a major source of continuing medical education credits compared with those not requiring Maintenance of Certification (79.9% compared with 44.6%, P<.001). This finding remained significant after multivariable adjustment for age, gender, years in practice, and practice type (odds ratio [OR] 9.09, 95% confidence interval [CI] 4.03-20.5). Conversely, Maintenance of Certification requirement led to decreased use of the national or international meetings (OR 0.31, 95% CI 0.14-0.67) and self-selected continuing medical education materials (OR 0.29, 95% CI 0.14-0.60) as sources of continuing medical education credits. Despite these differences, physicians in both groups equally valued the relevance of Annual Board Certification articles (92.6% compared with 96.4%, P=.23), the importance of content at academic meetings (98.3% compared with 99.3%, P=.33), the usefulness of simulation drills (97.8% compared with 94.3%, P=.35), and the general ability of continuing medical education activities to improve skills as a physician (90.9% compared with 86.4%, P=.20).CONCLUSION:Requirement of the Maintenance of Certification program has led to significant changes in continuing medical education choices by obstetrician-gynecologists. The changes in continuing medical education appear related to mandated obligations rather than personal preference.

via Recent trends in continuing medical education… [Obstet Gynecol. 2011] – PubMed – NCBI.

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ABSTRACT: Teaching professionalism in medical education: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25.

Introduction: We undertook a systematic review to identify the best evidence for how professionalism in medicine should be taught. Methods: Eligible studies included any articles published between 1999 and 2009 inclusive. We reviewed papers presenting viewpoints and opinions as well as empirical research. We performed a comparative and thematic synthesis on all papers meeting inclusion criteria in order to capture the best available evidence on how to teach professionalism. Results: We identified 217 papers on how to teach professionalism. Of these, we determined 43 to be best evidence. Few studies provided comprehensive evaluation or assessment data demonstrating success. As yet, there has not emerged a unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum. Discussion: Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in current teaching programmes, and are widely held to be the most effective techniques for developing professionalism. While it is generally held that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory.

via Teaching professionalism in medical education: A B… [Med Teach. 2013] – PubMed – NCBI.

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MANUSCRIPT: A short questionnaire to assess pediatric resident’s competencies: the validation process.

BACKGROUND:
In order to help assess resident performance during training, the Residency Affair Committee of the Pediatric Residency Program of the University of Padua (Italy) administered a Resident Assessment Questionnaire (ReAQ), which both residents and faculty were asked to complete. The aim of this article is to present the ReAQ and its validation.
METHODS:
The ReAQ consists of 20 items that assess the six core competencies identified by the Accreditation Council of Graduate Medical Education (ACGME). A many-facet Rasch measurement analysis was used for validating the ReAQ.
RESULTS:
Between July 2011 and June 2012, 211 evaluations were collected from residents and faculty. Two items were removed because their functioning changed with the gender of respondents. The step calibrations were ordered. The self evaluations (residents rating themselves) positively correlated with the hetero evaluations (faculty rating residents; Spearman’s rho = 0.75, p < 0.001). Unfortunately, the observed agreement among faculty was smaller than expected (Exp = 47.1%; Obs = 41%), which indicates that no enough training to faculty for using the tool was provided.
CONCLUSIONS:
In its final form, the ReAQ provides a valid unidimensional measure of core competences in pediatric residents. It produces reliable measures, distinguishes among groups of residents according to different levels of performance, and provides a resident evaluation that holds an analogous meaning for residents and faculty.

via A short questionnaire to assess pediatric res… [Ital J Pediatr. 2013] – PubMed – NCBI.

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