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Author: Brian S McGowan, PhD

MANUSCRIPT: ABC of learning and teaching in medicine: Applying educational theory in practice

How many times have we as teachers been confronted with situations in which we really were not sure what to do? We “flew by the seat of our pants,” usually doing with our learners what had been done with us. It would be useful to be able to turn to a set of guiding principles based on evidence, or at least on long term successful experience.

Fortunately, a body of theory exists that can inform practice. An unfortunate gap between academics and practitioners, however, has led to a perception of theory as belonging to an “ivory tower” and not relevant to practice. Yet the old adage that “there is nothing more practical than a good theory” still rings true today. This chapter describes several educational theories and guiding principles and then shows how these could be applied to three case studies realting to the “real world.”

via ABC of learning and teaching in medicine: Applying educational theory in practice.

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ABSTRACT: Validation study of a computer-based open surgical trainer: SimPraxis(®) simulation platform

BACKGROUND:
Technological advances have dramatically changed medical education, particularly in the era of work-hour restrictions, which increasingly highlights a need for novel methods to teach surgical skills. The purpose of this study was to evaluate the validity of a novel, computer-based, interactive, cognitive simulator for training surgeons to perform pelvic lymph node dissection (PLND).
METHODS:
Eight prostate cancer experts evaluated the content of the simulator. Contextual aspects of the simulator were rated on a five-point Likert scale. The experts and nine first-year residents completed a simulated PLND. Time and deviations were logged, and the results were compared between experts and novices using the Mann-Whitney test.
RESULTS:
Before training, 88% of the experts felt that a validated simulator would be useful for PLND training. After testing, 100% of the experts felt that it would be more useful than standard video training. Eighty-eight percent stated that they would like to see the simulator in the curriculum of residency programs and 56% thought it would be useful for accreditation purposes. The experts felt that the simulator aided in overall understanding, training indications, concepts and steps of the procedure, training how to use an assistant, and enhanced the knowledge of anatomy. Median performance times taken by experts and interns to complete a PLND procedure on the simulator were 12.62 and 23.97 minutes, respectively. Median deviation from the incorporated procedure pathway for experts was 24.5 and was 89 for novices.
CONCLUSION:
We describe an interactive, computer-based simulator designed to assist in mastery of the cognitive steps of an open surgical procedure. This platform is intuitive and flexible, and could be applied to any stepwise medical procedure. Overall, experts outperformed novices in their performance on the trainer. Experts agreed that the content was acceptable, accurate, and representative.

via Validation study of a computer-based open… [Adv Med Educ Pract. 2013] – PubMed – NCBI.

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ABSTRACT: Integrating improvement learning into a family medicine residency curriculum.

BACKGROUND AND OBJECTIVES:
Knowledge of improvement practices is a critical skill for family medicine residents who will lead patient-centered medical homes. The Accreditation Council for Graduate Medical Education includes systems-based practice and improvement knowledge as a core competency for residency education. The objective of this report is to describe the 6-year implementation and development of our practice-based improvement curriculum in a family medicine residency.
METHODS:
In 2006, Oregon Health and Science University Family Medicine Residency implemented an improvement curriculum that focused on clinic-based improvement and involved longitudinal didactics. Over the course of 6 years, the curriculum has been refined to include longitudinal instruction of improvement principles according to the levels of training and clinic-based didactics and experientials that are team oriented. Residents complete ambulatory improvement projects over the cycle of 12 months and present outcomes each year. Residents evaluated their knowledge, experience, confidence, and satisfaction at the end of the academic year.
RESULTS:
Ninety percent of residents designed and lead improvement projects upon graduation from residency in 2011. Resident confidence to make a change in local health care settings at the end of the curriculum was high and improved from 2009/2010 to 2010/2011. Upon graduation from the program, 100% of residents reported competence or proficiency in their ability to apply knowledge to an improvement project and present results.
CONCLUSIONS:
We describe a longitudinal, practical, developmental, and clinically based experiential improvement curriculum that has been successfully integrated into a family medicine residency program.

via Integrating improvement learning into a family medic… [Fam Med. 2013] – PubMed – NCBI.

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ABSTRACT: Simulation training for acute medical specialist trainees: a pilot.

Simulation training is a method of interactive teaching and training for healthcare professionals. Medical education research demonstrates that high fidelity simulation leads to effective learning. Acute Medical Specialist Year Three-plus Trainee (ST3+) doctors are often required to manage high-pressure situations, requiring a combination of clinical and non-clinical abilities. We therefore hypothesised that simulation training could be an ideal training tool for this cohort. We designed a simulation training day for ST3+trainees which exposed them to ethically challenging scenarios. The learning objectives were mapped to the acute medical curriculum, focusing on areas trainees may traditionally describe as either difficult to achieve, or for those for which providing evidence may be challenging. Simulation scenarios and debriefing sessions enabled trainees to explore different views in a protected environment, and feedback was strongly positive. We strongly recommend simulation training as a teaching tool for Acute Medical ST3+ doctors.

via Simulation training for acute medical specialist t… [Acute Med. 2013] – PubMed – NCBI.

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ABSTRACT: Educational Experiences Residents Perceive As Most Helpful for the Acquisition of the ACGME Competencies

BACKGROUND:
The Accreditation Council for Graduate Medical Education (ACGME) requires physicians in training to be educated in 6 competencies considered important for independent medical practice. There is little information about the experiences that residents feel contribute most to the acquisition of the competencies.
OBJECTIVE:
To understand how residents perceive their learning of the ACGME competencies and to determine which educational activities were most helpful in acquiring these competencies.
METHOD:
A web-based survey created by the graduate medical education office for institutional program monitoring and evaluation was sent to all residents in ACGME-accredited programs at the David Geffen School of Medicine, University of California-Los Angeles, from 2007 to 2010. Residents responded to questions about the adequacy of their learning for each of the 6 competencies and which learning activities were most helpful in competency acquisition.
RESULTS:
We analyzed 1378 responses collected from postgraduate year-1 (PGY-1) to PGY-3 residents in 12 different residency programs, surveyed between 2007 and 2010. The overall response rate varied by year (66%-82%). Most residents (80%-97%) stated that their learning of the 6 ACGME competencies was “adequate.” Patient care activities and observation of attending physicians and peers were listed as the 2 most helpful learning activities for acquiring the 6 competencies.
CONCLUSION:
Our findings reinforce the importance of learning from role models during patient care activities and the heterogeneity of learning activities needed for acquiring all 6 competencies.

via Educational Experiences Residents Perceive A… [J Grad Med Educ. 2012] – PubMed – NCBI.

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MANUSCRIPT: Use of a structured template to facilitate practice-based learning and improvement projects

BACKGROUND:
The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents’ competency in practice-based learning and improvement (PBLI) is particularly challenging.
PURPOSE:
We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning.
METHODS:
We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008-2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure.
RESULTS:
An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template.
DISCUSSION:
The development of the tool generated program leaders’ support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.

via Use of a structured template to facilitate p… [J Grad Med Educ. 2012] – PubMed – NCBI.

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ABSTRACT: Social networking profiles and professionalism issues in residency applicants: an original study-cohort study.

OBJECTIVE:
To determine the frequency of social networking, the degree of information publicly disclosed, and whether unprofessional content was identified in applicants from the 2010 Residency Match.
BACKGROUND:
Medical professionalism is an essential competency for physicians to learn, and information found on social networking sites may be hazardous to the doctor-patient relationship and an institution’s public perception. No study has analyzed the social network content of applicants applying for residency.
METHODS:
Online review of social networking Facebook profiles of graduating medical students applying for a residency in orthopedic surgery. Evidence of unprofessional content was based upon Accreditation Council for Graduate Medical Education guidelines. Additional recorded applicant data included as follows: age, United States Medical Licensing Examination part I score, and residency composite score. Relationship between professionalism score and recorded data points was evaluated using an analysis of variance.
RESULTS:
Nearly half of all applicants, 46% (200/431), had a Facebook profile. The majority of profiles (85%) did not restrict online access to their profile. Unprofessional content was identified in 16% of resident applicant profiles. Variables associated with lower professionalism scores included unmarried relationship status and lower residency composite scores.
CONCLUSION:
It is critical for healthcare professionals to recognize both the benefits and risks present with electronic communication and to vigorously protect the content of material allowed to be publically accessed through the Internet.

via Social networking profiles and professio… [J Surg Educ. 2013 Jul-Aug] – PubMed – NCBI.

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MAUNSCRIPT: The next accreditation system: stakeholder expectations and dialogue with the community

In February 2012, in an article in the New England Journal of Medicine,1 the Accreditation Council for Graduate Medical Education ACGME provided an initial description and the rationale for the Next Accreditation System NAS. We follow up with this piece, which reflects on questions about the NAS, as a starting point for a dialogue with the community, and as the first in a series of articles that will describe key attributes of the NAS, offer practical guidance to programs and sponsoring institutions, and solicit stakeholder input. Dialogue with the community will be helpful in answering questions and in allowing the ACGME to clarify and refine certain elements of the NAS. This dialogue needs to be mindful that many details of the NAS are yet to be finalized. In communicating about the NAS, ACGME, thus, must balance a timely response to the communitys desire to learn more and the need to have details well established to avoid a need to make changes after details have been released to stakeholders and the public.

via The next accreditation system: stakeholder e… [J Grad Med Educ. 2012] – PubMed – NCBI.

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ABSTRACT: Imaging informatics for consumer health: towards a radiology patient portal

Objective With the increased routine use of advanced imaging in clinical diagnosis and treatment, it has become imperative to provide patients with a means to view and understand their imaging studies. We illustrate the feasibility of a patient portal that automatically structures and integrates radiology reports with corresponding imaging studies according to several information orientations tailored for the layperson.Methods The imaging patient portal is composed of an image processing module for the creation of a timeline that illustrates the progression of disease, a natural language processing module to extract salient concepts from radiology reports 73% accuracy, F1 score of 0.67, and an interactive user interface navigable by an imaging findings list. The portal was developed as a Java-based web application and is demonstrated for patients with brain cancer.Results and discussion The system was exhibited at an international radiology conference to solicit feedback from a diverse group of healthcare professionals. There was wide support for educating patients about their imaging studies, and an appreciation for the informatics tools used to simplify images and reports for consumer interpretation. Primary concerns included the possibility of patients misunderstanding their results, as well as worries regarding accidental improper disclosure of medical information.Conclusions Radiologic imaging composes a significant amount of the evidence used to make diagnostic and treatment decisions, yet there are few tools for explaining this information to patients. The proposed radiology patient portal provides a framework for organizing radiologic results into several information orientations to support patient education.

via Imaging informatics for consumer health: towards a radiology patient portal — Arnold et al. — Journal of the American Medical Informatics Association.

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ABSTRACT: Goal Instructions, Response Format, and Idea Generation in Groups

This study examined the separate and joint impact of two standard, but seemingly conflicting brainstorming rules on idea generation in interacting and nominal groups: the free-wheeeling rule, which calls for the production of dissimilar ideas, and the build-on rule, which encourages idea combination and improvement. We also tested whether the superior performance of interacting groups found in several previous studies using a brainwriting technique may have been due to the different response formats employed by groups and individuals. Interacting groups and individuals generated ideas for improving their university under one of three sets of instructions. In one condition, participants were given the build-on rule, but not the free-wheeling rule, and in another condition, the reverse was true. In the third condition, both rules were provided. When the two rules were presented separately, interacting and nominal groups responded similarly, generating ideas from more semantic categories in response to the free-wheeling rule, and generating more practical ideas in response to the build-on rule. But when those rules were presented simultaneously, interacting groups generated ideas from fewer semantic categories than did nominal groups. In addition, interacting groups produced more ideas overall than nominal groups, but only when the two used different response formats.

via Goal Instructions, Response Format, and Idea Generation in Groups.

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