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Author: Brian S McGowan, PhD

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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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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