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Author: Brian S McGowan, PhD

ABSTRACT: Physicians’ Knowledge and Practice of Lung Cancer Screening: A Cross-Sectional Survey Comparing General Practitioners, Thoracic Oncologists, and Pulmonologists in France.

BACKGROUND:
Screening for lung cancer by low-dose computed tomography scan (LDCTS) has been demonstrated to reduce lung cancer-specific and overall mortality rates in high-risk individuals. From trial to clinical practice, it is crucial to obtain an accurate level of knowledge of the physicians who will recruit patients for a screening program. The actual current practice and knowledge of practitioners are unknown. This could be critical to develop dedicated continuous medical education programs.
MATERIALS AND METHODS:
Three groups of French physicians-pulmonologists (PUs), thoracic oncologists (TOs), and general practitioners (GPs)-were surveyed through a dedicated questionnaire on lung cancer screening.
RESULTS:
A total of 242 physicians answered the questionnaire; 81% of TOs knew that LDCTS showed efficacy for screening lung cancer compared with 52% of PUs and 18% of GPs (P < .0001). Approximately one third of physicians recommended lung cancer screening in daily practice at the time of the survey, including 53% of PUs, 34% of TOs, and 20% of GPs (P < .001). However, 94% of GPs, 44% of PUs, and 33% of TOs used inappropriate tests, mainly chest radiography. Most GPs proposed screening for all smokers, whereas PUs and TOs reserved screening for heavy smokers (P = .040). Most PUs and TOs recommended annual LDCTS (76%), whereas the majority of GPs sent patients for screening tests every 3 to 5 years (93%; P < .0001).
CONCLUSIONS:
These results highlight the interest of physicians for lung cancer screening; meanwhile, our data stress the need for appropriate medical education and recommendations based on available evidence.

via Physicians’ Knowledge and Practice of Lung … [Clin Lung Cancer. 2013] – PubMed – NCBI.

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ABSTRACT: Burnout in medical students: a systematic review

Background  Burnout is a state of mental and physical exhaustion related to work or care-giving activities. Distress during medical school can lead to burnout, with significant consequences, particularly if burnout continues into residency and beyond. The authors reviewed literature pertaining to medical student burnout, its prevalence, and its relationship to personal, environmental, demographic and psychiatric factors. We ultimately offer some suggestions to address and potentially ameliorate the current dilemma posed by burnout during medical education. Methods  A literature review was conducted using a PubMed/Medline, and PsycInfo search from 1974 to 2011 using the keywords: ‘burnout’, ‘stress’, ‘well-being’, ‘self-care’, ‘psychiatry’ and ‘medical students’. Three authors agreed independently on the studies to be included in this review. Results  The literature reveals that burnout is prevalent during medical school, with major US multi-institutional studies estimating that at least half of all medical students may be affected by burnout during their medical education. Studies show that burnout may persist beyond medical school, and is, at times, associated with psychiatric disorders and suicidal ideation. A variety of personal and professional characteristics correlate well with burnout. Potential interventions include school-based and individual-based activities to increase overall student well-being. Discussion  Burnout is a prominent force challenging medical students’ well-being, with concerning implications for the continuation of burnout into residency and beyond. To address this highly prevalent condition, educators must first develop greater awareness and understanding of burnout, as well as of the factors that lead to its development. Interventions focusing on generating wellness during medical training are highly recommended.

via Burnout in medical students: a systematic review. [Clin Teach. 2013] – PubMed – NCBI.

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ABSTRACT: Low fidelity, high quality: a model for e-learning.

Background:  E-learning continues to proliferate as a method to deliver continuing medical education. The effectiveness of e-learning has been widely studied, showing that it is as effective as traditional forms of education. However, most reports focus on whether the e-learning is effective, rather than discussing innovations to allow clinical educators to ask ‘how’ and ‘why’ it is effective, and to facilitate local reproduction. Context:  Previous work has set out a number of barriers to the introduction of e-learning interventions. Cost, the time to produce interventions, and the training requirements for educators and trainees have all been identified as barriers. We set out to design an e-learning intervention on paediatric prescribing that could address these issues using a low-fidelity approach, and report our methods so as to allow interested readers to use a similar approach. Innovation:  Using low-cost, readily accessible tools and applying appropriate educational theory, the intervention was produced in a short period of time. As part of a randomised controlled trial, long-term retention of prescribing skills was demonstrated, with significantly higher prescribing skill scores in the e-learning group at 4 and 12 weeks (p < 0.0001). Feedback was universally positive, with Likert responses suggesting that it was useful, convenient and easy to use. Implications:  A low-fidelity approach to designing can successfully overcome many of the barriers to the introduction of e-learning. The design model described is simple and can be used by clinical teachers to support local development. Further research could investigate the experiences of these clinicians using this method of instructional design

via Low fidelity, high quality: a model for e-learning. [Clin Teach. 2013] – PubMed – NCBI.

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MANUSCRIPT: How do United Kingdom (UK) medical schools identify and support undergraduate medical students who ‘fail’ communication assessments? A national survey.

BACKGROUND:
The doctor’s ability to communicate effectively (with patients, relatives, advocates and healthcare colleagues) relates directly to health outcomes, and so is core to clinical practice. The remediation of medical students’ clinical communication ability is rarely addressed in medical education literature. There is nothing in the current literature reporting a contemporary national picture of how communication difficulties are managed, and the level of consequence (progression implications) for students of performing poorly. This survey aimed to consolidate practices for identifying and processes for managing students who ‘fail’ communication assessments across all UK medical schools.
METHODS:
Data were collected via an email survey to all leads for clinical communication in all UK Medical Schools for the UK Council for Clinical Communication in Undergraduate Medical Education.
RESULTS:
All but two participating Schools reported some means of support and/or remediation in communication. There was diversity of approach, and variance in the level of systemisation adopted. Variables such as individuality of curricula, resourcing issues, student cohort size and methodological preferences were implicated as explaining diversity. Support is relatively ad hoc, and often in the hands of a particular dedicated individual or team with an interest in communication delivery with few Schools reporting robust, centralised, school level processes.
CONCLUSIONS:
This survey has demonstrated that few Medical Schools have no identifiable system of managing their students’ clinical communication difficulties. However, some Schools reported ad hoc approaches and only a small number had a centralised programme. There is scope for discussion and benchmarking of best practice across all Schools with allocation of appropriate resources to support this.

via How do United Kingdom (UK) medical schools iden… [BMC Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: What does ‘race’ have to do with medical education research?

CONTEXT:
We live in a world of ethnoracial conflict. This is confirmed every day by opening and reading the newspaper. This everyday world seems far away in the pages of a medical education journal, but is it? The goal of this paper is to suggest that one need not look very far in medical education to encounter ethnoracial issues, and further, that research methods that are not ethnoracially biased must be employed to study these topics.
DISCUSSION:
We will draw attention to the relevance of employing an ethical conceptual approach to research involving ‘race’ by demonstrating how one author researching internationally educated health professionals has put ‘race’ front and centre in his analysis. He does this by using a postcolonial method of analysis termed a ‘doubled-research’ technique that sets up categories such as ‘race’ but then decolonizes them to avoid essentialism or stereotyping. We compare this method to another mainstream method employed for the same topic of inquiry which has sidelined ‘race’ in the analysis, potentially hiding findings about ethnoracial relations involving health professionals in our ‘multicultural’ society. This demonstration leads to the important question of whether research methods can be epistemologically racist-a question that has been raised about conventional research on education in general. Our argument is not meant to be the last word on this topic, but the first in this journal.
CONCLUSIONS:
We conclude that there is an internal ethics or axiology within research perspectives and methodologies that needs to be examined where ethnoracial issues are prominent. The use of mainstream approaches to undertake research can unintentionally ‘leave unsaid’ central aspects of what is researched while antiracist methods such as the one described in this article can open up the data to allow for a richer and deeper understanding of the problem.

via What does ‘race’ have to do with medical education … [Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: The use of social-networking sites in medical education

Background: A social-network site is a dedicated website or application which enables users to communicate with each other and share information, comments, messages, videos and images. Aims: This review aimed to ascertain if “social-networking sites have been used successfully in medical education to deliver educational material”, and whether “healthcare professionals, and students, are engaging with social-networking sites for educational purposes”. Method: A systematic-review was undertaken using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eight databases were searched with pre-defined search terms, limits and inclusion criteria. Data was extracted into a piloted data-table prior to the narrative-synthesis of the Quality, Utility, Extent, Strength, Target and Setting of the evidence. Results: 1047 articles were identified. Nine articles were reviewed with the majority assessing learner satisfaction. Higher outcome measures were rarely investigated. Educators used Facebook, Twitter, and a custom-made website, MedicineAfrica to achieve their objectives. Conclusions: Social-networking sites have been employed without problems of professionalism, and received positive feedback from learners. However, there is no solid evidence base within the literature that social-networking is equally or more effective than other media available for educational purposes

via The use of social-networking sites in medical educ… [Med Teach. 2013] – PubMed – NCBI.

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MANUSCRIPT: Evaluation of standardized doctor’s orders as an educational tool for undergraduate medical students: a prospective cohort study.

BACKGROUND:
Standardized doctor’s orders are replacing traditional order writing in teaching hospitals. The impact of this shift in practice on medical education is unknown. It is possible that preprinted orders interfere with knowledge acquisition and retention by not requiring active decision-making. The objective of the study was to evaluate the impact of standardized admission orders on disease-specific knowledge among undergraduate medical trainees.
METHODS:
This prospective cohort study enrolled Year 3 (n = 121) and Year 4 (n = 54) medical students at two academic hospitals in Toronto (Ontario, Canada) during their general internal medicine rotation. We used standardized orders for patient admissions for alcohol withdrawal (AW) and for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) as the intervention and manual order writing as the control. Educational outcomes were assessed through end-of-rotation questionnaires assessing disease-specific knowledge of AW and AECOPD.Results and discussions: Of 175 students, 105 had exposure to patients with alcohol withdrawal during their rotation, and 68 students wrote admission orders. Among these 68 students, 48 used standardized orders (intervention, n = 48) and 20 used manual order writing (control, n = 20). Only 3 students used standardized orders for AECOPD, precluding analysis. There was no significant difference found in mean total score of questionnaires between those who used AW standardized orders and those who did not (11.8 vs. 11.0, p = 0.4). Students who had direct clinical experience had significantly higher mean total scores (11.6 vs. 9.0, p < 0.0001 for AW; 13.8 vs. 12.6, p = 0.02 for AECOPD) compared to students who did not. When corrected for overall knowledge, this difference only persisted for AW.
CONCLUSIONS:
No significant differences were found in total scores between students who used standardized admission orders and traditional manual order writing. Clinical exposure was associated with increase in disease-specific knowledge.

via Evaluation of standardized doctor’s orders as a… [BMC Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume: A Multi-institutional Study

IMPORTANCE The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. OBJECTIVE To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class N = 52 with 16-hour work limit compared with the 4 preceding years 2007-2010; N = 197 without 16-hour work limit. A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. MAIN OUTCOMES AND MEASURES Total, major, first-assistant, and defined-category case totals. RESULTS As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases 65.9 vs 88.8, P = .005, a 31.8% decrease in major cases 54.9 vs 80.5, P < .001, and a 46.3% decrease in first-assistant cases 11.1 vs 20.7, P = .008. There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. CONCLUSIONS AND RELEVANCE The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.

via Effect of the 16-Hour Work Limit on General Surger… [JAMA Surg. 2013] – PubMed – NCBI.

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ABSTRACT: I feel disconnected: learning technologies in resident education

With the rapid development of technology in medical education, orthopaedic educators are recognizing that the way residents learn and access information is profoundly changing. Residency programs are faced with the challenging problem that current educational methods are not designed to take full advantage of the information explosion and rapid technologic changes. This disconnection is often seen in the potentially separate approaches to education preferred by residents and orthopaedic educators. Becoming connected with residents requires understanding the possible learning technologies available and the learners abilities, needs, and expectations. It is often assumed that approaches to strategic lifelong learning are developed by residents during their training; however, without the incorporation of technology into the learning environment, residents will not be taught the digital literacy and information management strategies that will be needed in the future. To improve learning, it is important to highlight and discuss current technologic trends in education, the possible technologic disconnection between educators and learners, the types of learning technologies available, and the potential opportunities for getting connected.

via I feel disconnected: learning technologies… [Instr Course Lect. 2013] – PubMed – NCBI.

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ABSTRACT: The Pictor Technique A Method for Exploring the Experience of Collaborative Working

Collaborative working is a crucial part of contemporary health and social care. Researching the experiences of those involved—as professionals, patients, or carers—is challenging, given the complexity of many cases and the taken-for-granted nature of roles and identities in relation to it. In this article we introduce the Pictor technique for exploring experiences of collaborative working. This is a visual technique in which participants construct a representation of roles and relationships in a particular case using arrow-shaped adhesive notes or cards. The chart so produced helps the participant tell the story of his or her experience and serves as a focus for further exploration with the researcher. We describe the background to Pictor and illustrate its use with professionals, patients, and carers, drawing on recent and current research. We examine how Pictor relates to other visual methods, and conclude by considering how the technique might be developed in the future.

via The Pictor Technique.

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