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Author: Brian S McGowan, PhD

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.

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.

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.

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.

ABSTRACT: Experiential Learning in an Undergraduate Course in Group Communication and Decision Making

The innovative structure of an undergraduate course on communication and decision making in small groups, based on the framework of Kolb’s experiential learning theory, is described. The course involves doing in-class exercises that replicate published research about a given topic. Exercises involve completion of a group task, the manipulation of variables, and collection and analysis of data. Following each exercise, the students read the original research and other relevant materials. In the subsequent class, the students are debriefed through an examination of the class data and a discussion of the reading materials and potential practical applications. This sequence of experiment replication and discussion is repeated with a different exercise each week. The in-class activities are supplemented with written analysis assignments. Variations on the basic course module and other course components are described, and factors guiding design choices are discussed. Evidence of student learning relevant to course objectives is presented.

via Experiential Learning in an Undergraduate Course in Group Communication and Decision Making.

ABSTRACT: Social Learning Theory and the Health Belief Model

The Health Belief Model, social learning theory (recently relabelled social cognitive theory), self-efficacy, and locus of control have all been applied with varying success to problems of explaining, predicting, and influencing behavior. Yet, there is con ceptual confusion among researchers and practitioners about the interrelationships of these theories and variables. This article attempts to show how these explanatory fac tors may be related, and in so doing, posits a revised explanatory model which incor porates self-efficacy into the Health Belief Model. Specifically, self-efficacy is pro posed as a separate independent variable along with the traditional health belief var iables of perceived susceptibility, severity, benefits, and barriers. Incentive to behave (health motivation) is also a component of the model. Locus of control is not included explicitly because it is believed to be incorporated within other elements of the model. It is predicted that the new formulation will more fully account for health-related behavior than did earlier formulations, and will suggest more effective behavioral interventions than have hitherto been available to health educators.

via Social Learning Theory and the Health Belief Model.

MANUSCRIPT: Making psychological theory useful for implementing evidence based practice: a consensus approach — Michie et al. 14 (1): 26 — BMJ Quality and Safety

Background: Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience.

Methods: Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a “psychological theory” group (n = 18), a “health services research” group (n = 13), and a “health psychology” group (n = 30).

Results: Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour.

Conclusions: A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.

via Making psychological theory useful for implementing evidence based practice: a consensus approach — Michie et al. 14 (1): 26 — BMJ Quality and Safety.

ABSTRACT: Broadening conceptions of learning in medical education: the message from teamworking – Bleakley – 2006 – Medical Education – Wiley Online Library

Background  There is a mismatch between the broad range of learning theories offered in the wider education literature and a relatively narrow range of theories privileged in the medical education literature. The latter are usually described under the heading of ‘adult learning theory’.

Methods  This paper critically addresses the limitations of the current dominant learning theories informing medical education. An argument is made that such theories, which address how an individual learns, fail to explain how learning occurs in dynamic, complex and unstable systems such as fluid clinical teams.

Results  Models of learning that take into account distributed knowing, learning through time as well as space, and the complexity of a learning environment including relationships between persons and artefacts, are more powerful in explaining and predicting how learning occurs in clinical teams. Learning theories may be privileged for ideological reasons, such as medicine’s concern with autonomy.

Conclusions  Where an increasing amount of medical education occurs in workplace contexts, sociocultural learning theories offer a best-fit exploration and explanation of such learning. We need to continue to develop testable models of learning that inform safe work practice. One type of learning theory will not inform all practice contexts and we need to think about a range of fit-for-purpose theories that are testable in practice. Exciting current developments include dynamicist models of learning drawing on complexity theory.

via Broadening conceptions of learning in medical education: the message from teamworking – Bleakley – 2006 – Medical Education – Wiley Online Library.

ABSTRACT: Human and social capital as facilitators of lifelong learning in nursing

To ensure that lifelong learning is, and remains, a reality as a vehicle for facilitating continuing professional learning in nursing, certain mechanisms need to be instituted specifically for this purpose. Some of the key organisational facilitators for achieving this include individual performance reviews, Workforce Development Confederations, professional self-regulation, and Investors in People awards.

In a study exploring nurses’ perceptions of lifelong learning, it emerged that in addition to the organisational mechanisms that are necessary to achieve this aspiration, there are also various non-organisational or informal factors at work that enable nurses to initiate and continue professional learning. It seems that substantial informal teaching, learning and facilitation of learning occur through work-based contacts with other healthcare professionals, and this is complemented by support from non-healthcare related other significant individuals. These factors seem to constitute the notion of human and social capital (HSC), which is a concept that has been implicated as a significant instigator or enabler of professional learning.

This paper examines these non-organisational factors, clarifies the meanings and roles of human capital and social capital in healthcare, and discusses their implications for lifelong learning in nursing. The analysis is supported by findings from a qualitative study, which comprised of 27 semi-structured individual interviews and two focus groups with RNs on D grade and above.

via ScienceDirect.com – Nurse Education Today – Human and social capital as facilitators of lifelong learning in nursing.

What If We Re-engineered “Focus Groups” for Learning

Focus groups have been longed used to collect information, from market research, to educational research, to guideline-building consensus development. What strikes me is that in each of these models the emphasis has been on what the groups can provide the organizers – the information gatherers. In recent years my focus has been on the reverse engineering of group work – what do the group members themselves derive from these efforts. This is the essence of collaborative or social learning and this is a central theme in my book #socialQI: Simple Solutions for Improving Healthcare.

This month in the journal Small Group Research a series of articles were published that began to shed some more light on the impact of small group engagement on the individual – for our needs we might think in terms of the individual learner. As I read through this new assortment of research and hypotheses I was struck by the unlimited value proposition of bringing learners together within small, safe, trusted learning environments to work together through content and challenges in an effort towards building a new sense of understanding, confidence, and competence.

I was also struck by how this research blends perfectly with the Natural Learning Actions research we have been conducting:

Healthcare professionals (HCPs) acknowledge and appreciate that adult learning is built upon a core set of learning actions – note-taking, reminders/reflection, search, and social engagement – and only when these four learning actions are supported by educators and facilitators is learning truly optimized.

Our research is certainly not the first to describe the importance of social engagement in learning – though it does view it in a very unique way. Bandura’s landmark work in the 1960’s and 70’s set the stage for the field. Rosenstock was one of many who began to apply these models to health. And, more recently Godin explored these  models in the development of healthcare professionals. Safe to say that ‘social learning’ is a model with some very well-grounded research support. 

So what is our take-away message? As long as the cultural expectation of HCP lifelong learning hinges on the ‘individual’ as a free-agent learner who experiences educational content disconnected peers and colleagues, we will continue to evolve healthcare quality at a snail’s pace. For us to drive change through the educational interventions that we conceive, create, and implement, we must find scalable models to bring learners together, to enable the collective experience of learning, and to do so in ways that allows learners to trust in one another and in the environment in which they are engaging.

This is why we are spending so much time and effort advocating for virtual courses within virtual classrooms and what we have come to call our cohort-based learning architecture. When we build an architecture that support the first three natural learning actions such that we can simplify note-taking, reminders/reflection, and related search; and we re-engineer the learning experience such that learners are brought together with structure and controls to experience content and challenges together – only then will we have the impact on healthcare quality that is so desperately needed.

I will continue to collect and share more evidence for the success of these models, and I ask you to share any experience you may have with small groups or ‘focus groups’ re-engineered for learning.