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Author: Brian S McGowan, PhD

ABSTRACT: Effects of a signature on rates of change: a randomized controlled trial involving continuing education and the commitment-to-change model.

Abstract
PURPOSE:
Physicians frequently are asked to sign commitments to change practice, based upon their involvement in continuing medical education (CME) activities. Although use of the commitment-to-change model is increasingly widespread in CME, the effect of signing such commitments on rates of change is not well understood.
METHOD:
Immediately after a CME session, 110 physicians were asked to specify a change they intended to make in practice and to designate a level of commitment to change. To determine the effects of a signature on rates of change, physicians were randomly assigned to control (signature) and experimental (non-signature) groups. Follow-up surveys were conducted at two and three months to determine rates of change.
RESULTS:
In all, 88 physicians completed the first questionnaire, and 64 of them completed the follow-up. Consistent with prior studies involving the commitment-to-change model, those expressing an intention to change were significantly more likely to change on follow-up (p =.035). There was no significant difference between signature and non-signature groups (p =.99), regardless of age or gender.
CONCLUSIONS:
Signatures appear unimportant to assuring compliance with commitments to change used in CME conferences. A physician’s behavior can be expected to change if the specified change is consistent with the physician’s beliefs and sense of what is important. The relative influences of components of the commitment-to-change model require further study to determine more clearly their roles in causation and measurement.

via Effects of a signature on rates of change: a random… [Acad Med. 2001] – PubMed – NCBI.

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MANUSCRIPT: Effect of a primary care continuing education program on clinical practice of chronic obstructive pulmonary disease: translating theory into practice.

Abstract
OBJECTIVES:
To describe the development and implementation process and assess the effect on self-reported clinical practice changes of a multidisciplinary, collaborative, interactive continuing medical education (CME)/continuing education (CE) program on chronic obstructive pulmonary disease (COPD).
METHODS:
Multidisciplinary subject matter experts and education specialists used a systematic instructional design approach and collaborated with the American College of Chest Physicians and American Academy of Nurse Practitioners to develop, deliver, and reproduce a 1-day interactive COPD CME/CE program for 351 primary care clinicians in 20 US cities from September 23, 2009, through November 13, 2010.
RESULTS:
We recorded responses to demographic, self-confidence, and knowledge/comprehension questions by using an audience response system. Before the program, 173 of 320 participants (54.1%) had never used the Global Initiative for Chronic Obstructive Lung Disease recommendations for COPD. After the program, clinician self-confidence improved in all areas measured. In addition, participant knowledge and comprehension significantly improved (mean score, 77.1%-94.7%; P<.001). We implemented the commitment-to-change strategy in courses 6 through 20. A total of 271 of 313 participants (86.6%) completed 971 commitment-to-change statements, and 132 of 271 (48.7%) completed the follow-up survey. Of the follow-up survey respondents, 92 of 132 (69.7%) reported completely implementing at least one clinical practice change, and only 8 of 132 (6.1%) reported inability to make any clinical practice change after the program.
CONCLUSION:
A carefully designed, interactive, flexible, dynamic, and reproducible COPD CME/CE program tailored to clinicians’ needs that involves diverse instructional strategies and media can have short-term and long-term improvements in clinician self-confidence, knowledge/comprehension, and clinical practice

via Effect of a primary care continuing education… [Mayo Clin Proc. 2012] – PubMed – NCBI.

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MANUSCRIPT: The impact on medical practice of commitments to change following CME lectures: A randomized controlled trial

Abstract
Background: Self-reported commitment to change (CTC) could be a potentially valuable method to address the need for continuing medical education (CME) to demonstrate clinical outcomes. Aim: This study determines: (1) are clinicians who make CTCs more likely to report changes in their medical practices and (2) do these changes persist over time? Methods: Intervention participants (N¼80) selected up to three commitments from a predefined list following the lecture, while control participants (N¼64) generated up to three commitments at 7 days post-lecture. At 7 and 30 days post-lecture, participants were queried if any practice change occurred as a result of attending the lecture. Results: About 91% of the intervention group reported practice changes consistent with their commitments at 7 days. Only 32% in the control group reported changes (z¼7.32, p50.001). At 30 days, more participants in the intervention group relative to the control group reported change (58% vs. 22%, z¼3.74, p50.01). Once a participant from either group made a commitment, there were no differences in reported changes (63% vs. 67%, z¼50.00, p¼0.38). Conclusion: Integration of CTC is an effective method of reinforcing learning and measuring outcomes.

 

http://acmd615.pbworks.com/f/committmenttochange.pdf

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ABSTRACT: Unanticipated learning outcomes associated with commitment to change in continuing medical education

Abstract
INTRODUCTION:
Educator-derived, predetermined instructional objectives are integral to the traditional instructional model and form the linkage between instructional design and postinstruction evaluation. The traditional model does not consider unanticipated learning outcomes. We explored the contribution of learner-identified desired outcomes compared with learner outcomes that were not named in the instructional design.
METHOD:
This study was conducted at a short course in pediatrics in which 43 physicians, advanced practice nurses, nurses, and physician assistants voluntarily self-identified committed- to changes (CTCs). We compared these CTC predicates with the predetermined instructional objectives that had been published in advance in the conference brochure and syllabus. CTCs whose predicates described the same features as the instructional objectives were considered to be anticipated learning outcomes. CTCs lacking correspondence with instructional objectives were considered to represent unanticipated learning outcomes.
RESULTS:
Of the 157 CTCs, 68% were anticipated learning outcomes because their predicates could be linked to the instructional objectives. The remaining 32% of CTCs did not correspond to any of the instructional objectives and thus represented unanticipated learning outcomes.
DISCUSSION:
These findings demonstrate that evaluations based on instructional objectives, although valuable, are incomplete because educational activities may also stimulate many unanticipated learning outcomes. Continuing medical education planners can gain a fuller assessment of the effect of their educational endeavors by including predetermined instructional objectives and encouraging the constructivist practice of recognizing unanticipated learning.

via Unanticipated learning outcomes as… [J Contin Educ Health Prof. 2003] – PubMed – NCBI.

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ABSTRACT: Information about barriers to planned change: a randomized controlled trial involving continuing medical education lectures and commitment to change.

Abstract
PURPOSE:
To determine whether practicing physicians receiving only clinical information at a traditional continuing medical education (CME) lecture (control group) and physicians receiving clinical information plus information about barriers to behavioral change (study group) would alter their clinical behaviors at the same rate.
METHOD:
In a randomized controlled trial, the investigators matched 13 pairs of U.S. and Canadian medical schools, assigning one school from each pair to study or control conditions. Following the commitment-to-change model, the investigators asked the primary care physicians attending control or study lectures on the management of cardiovascular risks whether they intended to make behavioral changes as a result of participating in the lectures and, if so, to indicate the specific changes. Thirty to 45 days later, the investigators surveyed the responding physicians to learn whether they had implemented those changes.
RESULTS:
Information about barriers to change did not increase the likelihood that physicians in the study group would report successful changes; they were no more likely to change than those in the control group. However, the physicians in both study and control groups were significantly more likely to change (47% vs 7%, p < .001) if they indicated an intent to change immediately following the lecture.
CONCLUSIONS:
Successful change in practice may depend less on clinical and barriers information than on other factors that influence physicians’ performances. To further develop the commitment-to-change strategy in measuring the effects of planned change, it is important to isolate and learn the powers of individual components of the strategy as well as their collective influence on physicians’ clinical behaviors.

via Information about barriers to planned change: a ran… [Acad Med. 1998] – PubMed – NCBI.

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ABSTRACT: Commitment to change statements: a way of understanding how participants use information and skills taught in an educational session.

Abstract
BACKGROUND:
Commitment to change has gained increasing use in assessing short course effectiveness. This study examined the changes that learners intended to make in practice following an intensive day-long course offered at multiple sites, counted changes relative to the curriculum’s focus, and analyzed which changes were implemented in practice.
METHODS:
Participants at a course on the management of male sexual dysfunction were asked to identify the changes to which they would commit. Six months after the course, they were asked to indicate which changes they implemented fully, partially, or not at all.
RESULTS:
A total of 352 physicians attended the courses held in 21 centers. A majority of attendees (344 or 97.7%) completed forms at the end of the course, providing 1,635 commitment statements. Six months later, 197 (57.3%) physicians provided follow-up data about 935 (55.4%) of the commitment statements originally submitted. Of these, 602 (66.52%) were completely implemented. Many of the changes related to two specific aspects of the course, namely, sexual history taking and medical intervention, accounting for 45.93% of the intended commitments and 47.67% of the changes completely implemented. Slightly over half (58%) of the course time was devoted to these two areas. There was a significant correlation between the number of changes and the amount of time allocated to that content within the course.
FINDINGS:
Commitment to change statements offered by course participants can be used to examine the impact of a course relative to its learning focus. Continuing medical education providers must take a critical look at commitment to change statements as an “intervention” in their own right and determine how the tool can best be used as a continuing medical education intervention.

via Commitment to change statements: a… [J Contin Educ Health Prof. 2001] – PubMed – NCBI.

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ABSTRACT: Improving performance of natural language processing part-of-speech tagging on clinical narratives through domain adaptation

Abstract:

Objective Natural language processing NLP tasks are commonly decomposed into subtasks, chained together to form processing pipelines. The residual error produced in these subtasks propagates, adversely affecting the end objectives. Limited availability of annotated clinical data remains a barrier to reaching state-of-the-art operating characteristics using statistically based NLP tools in the clinical domain. Here we explore the unique linguistic constructions of clinical texts and demonstrate the loss in operating characteristics when out-of-the-box part-of-speech POS tagging tools are applied to the clinical domain. We test a domain adaptation approach integrating a novel lexical-generation probability rule used in a transformation-based learner to boost POS performance on clinical narratives.Methods Two target corpora from independent healthcare institutions were constructed from high frequency clinical narratives. Four leading POS taggers with their out-of-the-box models trained from general English and biomedical abstracts were evaluated against these clinical corpora. A high performing domain adaptation method, Easy Adapt, was compared to our newly proposed method ClinAdapt. Results The evaluated POS taggers drop in accuracy by 8.5–15% when tested on clinical narratives. The highest performing tagger reports an accuracy of 88.6%. Domain adaptation with Easy Adapt reports accuracies of 88.3–91.0% on clinical texts. ClinAdapt reports 93.2–93.9%. Conclusions ClinAdapt successfully boosts POS tagging performance through domain adaptation requiring a modest amount of annotated clinical data. Improving the performance of critical NLP subtasks is expected to reduce pipeline error propagation leading to better overall results on complex processing tasks.

via Improving performance of natural language processing part-of-speech tagging on clinical narratives through domain adaptation — Ferraro et al. — Journal of the American Medical Informatics Association.

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MANUSCRIPT: THE EFFECT OF THE FLIPPED CLASSROOM ON STUDENT ACHIEVEMENT AND STRESS

In this investigation, the effect of the flipped classroom and associated differentiation was studied to measure the impact on student achievement and student stress levels. For the second semester of their senior year, students watched video lectures outside of class and completed assignments during class time. Students reported lower stress levels in this type of classroom environment compared to other classes. While semester grades showed improvement, exam grades did not show significant improvement. Overall, students displayed positive feelings towards the treatment and enjoyed the associated benefits of being able to choose their own assignments and explore concepts they found interesting more in-depth.

http://etd.lib.montana.edu/etd/2012/marlowe/MarloweC0812.pdf

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RESOURCE: Flipping the Classroom

“Flipping the classroom” has become something of a buzzword in the last several years, driven in part by high profile publications in The New York Times (Fitzpatrick, 2012); The Chronicle of Higher Education (Berrett, 2012); and Science (Mazur, 2009); In essence, “flipping the classroom” means that students gain first exposure to new material outside of class, usually via reading or lecture videos, and then use class time to do the harder work of assimilating that knowledge, perhaps through problem-solving, discussion, or debates.

Bloom’s Taxonomy (Revised)
In terms of Bloom’s revised taxonomy (2001), this means that students are doing the lower levels of cognitive work (gaining knowledge and comprehension) outside of class, and focusing on the higher forms of cognitive work (application, analysis, synthesis, and/or evaluation) in class, where they have the support of their peers and instructor. This model contrasts from the traditional model in which “first exposure” occurs via lecture in class, with students assimilating knowledge through homework; thus the term “flipped classroom.”

via Flipping the Classroom | Center for Teaching | Vanderbilt University.

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RESOURCE: San Jose State U. Says Replacing Live Lectures With Videos Increased Test Scores – Wired Campus – The Chronicle of Higher Education

The 85 students in the flipped course at San Jose State watched the edX lecture videos at home and attended class twice a week to practice what they had learned and ask questions. Two other sections of students took a traditional version of the course.

The midterm-examination scores of students in the flipped section were higher than those in the traditional sections, said Mr. Ghadiri. Although the midterm questions were more difficult for the flipped students, their median score was 10 to 11 points higher.

The final reckoning of whether the students have learned better through the flipped classroom will come in the class’s last week. Professors plan to give the same final exam to all of the sections. Researchers will then control the data for grade-point average and prerequisite knowledge to “prove to ourselves and fellow faculty that we didn’t stuff the classroom with dead ringers,” Mr. Parent said.

The university will also survey students’ views of their experience in the alternative format before deciding whether to develop more flipped-classroom courses. “I think, in a way, that’s more important,” said Ping Hsu, interim dean of engineering. “If students feel this is a better way to learn, then that says a lot, perhaps more than exam scores.”

via San Jose State U. Says Replacing Live Lectures With Videos Increased Test Scores – Wired Campus – The Chronicle of Higher Education.

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