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Author: Brian S McGowan, PhD

ABSTRACT: Before your very eyes: the value and limitations of eye tracking in medical education

ONTEXT:
Medicine is a highly visual discipline. Physicians from many specialties constantly use visual information in diagnosis and treatment. However, they are often unable to explain how they use this information. Consequently, it is unclear how to train medical students in this visual processing. Eye tracking is a research technique that may offer answers to these open questions, as it enables researchers to investigate such visual processes directly by measuring eye movements. This may help researchers understand the processes that support or hinder a particular learning outcome.
AIM:
In this article, we clarify the value and limitations of eye tracking for medical education researchers. For example, eye tracking can clarify how experience with medical images mediates diagnostic performance and how students engage with learning materials. Furthermore, eye tracking can also be used directly for training purposes by displaying eye movements of experts in medical images.
CONCLUSIONS:
Eye movements reflect cognitive processes, but cognitive processes cannot be directly inferred from eye-tracking data. In order to interpret eye-tracking data properly, theoretical models must always be the basis for designing experiments as well as for analysing and interpreting eye-tracking data. The interpretation of eye-tracking data is further supported by sound experimental design and methodological triangulation.

via Before your very eyes: the value and limitations of eye tracking in medical education. – PubMed – NCBI.

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MANUSCRIPT: Leveraging Social Media to Promote Evidence-Based Continuing Medical Education

IMPORTANCE:
New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME).
OBJECTIVE:
To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME.
DESIGN:
We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different “hooks” (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians.
SETTING:
The National Physicians Alliance (NPA) membership.
PARTICIPANTS:
NPA e-mail recipients, Facebook followers and friends, and Twitter followers.
MAIN OUTCOMES AND MEASURES:
Clicks to the NPA’s CME landing site.
RESULTS:
On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (p<0.001). Twitter posts (p = 0.13) and paid Facebook posts (p = 0.06) were not statistically different from e-mail in generating clicks to the landing site. Use of different hooks to engage physicians had no impact on clicks to the landing site. Interviews with physicians suggested that social media might not be a preferred vehicle for disseminating CME.
CONCLUSIONS:
Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email.

via Leveraging Social Media to Promote Evidence-Based Continuing Medical Education. – PubMed – NCBI.

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ABSTRACT: A proficiency-based virtual reality endoscopy curriculum improves performance on the fundamentals of endoscopic surgery examination

INTRODUCTION:
The fundamentals of endoscopic surgery (FES) examination is a national test of knowledge and skill in flexible gastrointestinal endoscopy. The skill portion of the examination involves five tasks that assesses the following skills: scope navigation, loop reduction, mucosal inspection, retroflexion, and targeting. This project aimed to assess the efficacy of a proficiency-based virtual reality (VR) curriculum in preparing residents for the FES skills exam.
METHODS:
Experienced (>100 career colonoscopies) and inexperienced endoscopists (<50 career colonoscopies) were recruited to participate. Six VR modules were identified as reflecting the skills tested in the exam. All participants were asked to perform each of the selected modules twice, and median performance was compared between the two groups. Inexperienced endoscopists were subsequently randomized in matched pairs into a repetition (10 repetitions of each task) or proficiency curriculum. After completion of the respective curriculum, FES scores and pass rates were compared to national data and historical institutional control data (endoscopy-rotation training alone).
RESULTS:
Five experienced endoscopists and twenty-three inexperienced endoscopists participated. Construct valid metrics were identified for six modules and proficiency benchmarks were set at the median performance of experienced endoscopists. FES scores of inexperienced endoscopists in the proficiency group had significantly higher FES scores (530 ± 86) versus historical control (386.7 ± 92.2, p = 0.0003) and higher pass rate (proficiency: 100%, historical control 61.5%, p = 0.01).
CONCLUSION:
Trainee engagement in a VR curriculum yields superior FES performance compared to an endoscopy rotation alone. Compared to the 2012-2016 national resident pass rate of 80, 100% of trainees in a proficiency-based curriculum passed the FES manual skills examination.

via A proficiency-based virtual reality endoscopy curriculum improves performance on the fundamentals of endoscopic surgery examination. – PubMed – NCBI.

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ABSTRACT: Four tenets of modern validity theory for medical education assessment and evaluation

alidity is considered by many to be the most important criterion for evaluating a set of scores, yet few agree on what exactly the term means. Since the mid-1800s, scholars have been concerned with the notion of validity, but over time, the term has developed a variety of meanings across academic disciplines and contexts. Accordingly, when scholars with different academic backgrounds, many of whom hold deeply entrenched perspectives about validity conceptualizations, converge in the field of medical education assessment, it is a recipe for confusion. Thus, it is important to work toward a consensus about validity in the context of medical education assessment. Thus, the purpose of this work was to present four fundamental tenets of modern validity theory in an effort to establish a framework for scholars in the field of medical education assessment to follow when conceptualizing validity, interpreting validity evidence, and reporting research findings.

via Four tenets of modern validity theory for medical education assessment and evaluation. – PubMed – NCBI.

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ABSTRACT: ECHO Pain Curriculum: Balancing Mandated Continuing Education With the Needs of Rural Health Care Practitioners

Chronic pain is a common problem in the United States. Health care professions training at the undergraduate and graduate levels in managing chronic pain is insufficient. The Chronic Pain and Headache Management TeleECHO Clinic (ECHO Pain) is a telehealth approach at Project ECHO (Extension for Community Healthcare Outcomes), which supports clinicians interested in improving their knowledge and confidence in treating patients with chronic pain and safe opioid management. It is a vehicle for educating practicing clinicians (at the “spoke”) based on work-place learning with cases selected by participants from their patient panels combined with short lectures by experts (at the “hub”). ECHO Pain has designed an innovative, interprofessional longitudinal curriculum appropriate for individual and team-based clinicians which includes relevant basic and advanced pain topics. The specific design and delivery of the curriculum enhances its relevance and accessibility to busy clinicians in practice, yet also satisfies statutory requirements for CME in New Mexico. Specific features which balance hub-and-spoke needs are presented in this descriptive article, which is intended to serve as a guide to other clinician educators interested in developing or implementing similar telehealth curricula.

via ECHO Pain Curriculum: Balancing Mandated Continuing Education With the Needs of Rural Health Care Practitioners. – PubMed – NCBI.

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ABSTRACT: Impact of a Social Media Group Page on Undergraduate Medical Physiology Learning

OBJECTIVE:
To investigate the impact of associating classroom learning of medical physiology with a Facebook group page in an all-women medical college of a conservative small city in Pakistan.
STUDY DESIGN:
Qualitative interpretivist study using semi-structured interviews.
PLACE AND DURATION OF STUDY:
Women Medical College Abbottabad, Pakistan, from March to December 2014.
METHODOLOGY:
Aclosed Facebook study group was established at a local medical college in Pakistan. It was used to upload learning resources and initiate discussions, coordinated with classroom lectures of physiology. Thirteen semistructured interviews were conducted with volunteer students according to a standard protocol.
RESULTS:
Five major themes were identified. Facebook group is something new and exciting; it motivated self-study, research, collaborative learning and improved class attendance. Convenience of easily accessible resources allowed the students to concentrate on the lecture rather than note taking. It was easier to communicate with the instructor through Facebook than face to face. Lurkers were also learning. High achievers who had adapted to the current didactic system of teaching were less receptive of the collaborative learning and favored teaching geared towards exam preparation.
CONCLUSION:
Using social media for e-learning in undergraduate medical education can enhance the student learning experience, especially in resource-limited regions where Information and communication technology is not an integrated part of the teaching process.

via Impact of a Social Media Group Page on Undergraduate Medical Physiology Learning. – PubMed – NCBI.

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ABSTRACT: Evaluation of large-group lectures in medicine – development of the SETMED-L questionnaire

BACKGROUND:
The seven categories of the Stanford Faculty Development Program (SFDP) represent a framework for planning and assessing medical teaching. Nevertheless, so far there is no specific evaluation tool for large-group lectures that is based on these categories. This paper reports the development and psychometric validation of a short German evaluation tool for large-group lectures in medical education (SETMED-L: ‘Student Evaluation of Teaching in MEDical Lectures’) based on the SFDP-categories.
METHODS:
Data were collected at two German medical schools. In Study 1, a full information factor analysis of the new 14-item questionnaire was performed. In Study 2, following cognitive debriefings and adjustments, a confirmatory factor analysis was performed. The model was tested for invariance across medical schools and student gender. Convergent validity was assessed by comparison with results of the FEVOR questionnaire.
RESULTS:
Study 1 (n = 922) yielded a three-factor solution with one major (10 items) and two minor factors (2 items each). In Study 2 (n = 2740), this factor structure was confirmed. Scale reliability ranged between α = 0.71 and α = 0.88. Measurement invariance was given across student gender but not across medical schools. Convergent validity in the subsample tested (n = 246) yielded acceptable results.
CONCLUSION:
The SETMED-L showed satisfactory to very good psychometric characteristics. The main advantages are its short yet comprehensive form, the integration of SFDP-categories and its focus on medical education.

via Evaluation of large-group lectures in medicine – development of the SETMED-L (Student Evaluation of Teaching in MEDical Lectures) questionnaire. – PubMed – NCBI.

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ABSTRACT: Retention of Vaginal Breech Delivery Skills Taught in Simulation

OBJECTIVE:The optimal frequency of conducting simulation training for high-acuity, low-frequency events in obstetrics and gynaecology residency programs is unknown. This study evaluated retention over time of vaginal breech delivery skills taught in simulation, by comparing junior and senior residents. In addition, the residents’ subjective comfort level to perform this skill clinically was assessed.METHODS:This prospective cohort study included 22 obstetrics and gynaecology residents in a Canadian residency training program. Digital recordings were completed for pre-training, immediate post-training, and delayed (10-26 weeks later) post-training intervals of a vaginal breech delivery simulation, with skill assessment by a blinded observer using a binary checklist. Residents also completed questionnaires to assess their subjective comfort level at each interval.RESULTS:Junior and senior residents had significant improvements in vaginal breech delivery skills from the pre-training assessment to both the immediate post-training assessment (junior, P <0.001; senior, P <0.001) and the delayed post-training assessment (P <0.001 and P = 0.001, respectively). There was a significant decline in skills between the immediate and delayed post-training sessions for junior and senior residents (P = 0.003 and P <0.001, respectively). Both junior and senior residents gained more comfort immediately after the training (P <0.001 and P <0.001, respectively), without a significant change between immediate post-training and delayed post-training comfort levels (P = 0.19 and P = 0.11, respectively).CONCLUSION:Residents retained vaginal breech delivery skills taught in simulation 10-26 weeks later, although a decline in skills occurred over this time period. Comfort level was positively affected and retained. These results will aid in determining the frequency of simulation teaching for high-acuity, low-frequency events in a residency simulation curriculum.

via Retention of Vaginal Breech Delivery Skills Taught in Simulation. – PubMed – NCBI.

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RESOURCE: How ‘nudge theory’ can help shops avoid a backlash over plastic bag bans

On your way home tonight, you might stop at the supermarket to grab some ingredients for the evening meal. If you’re like many shoppers, you’ll pass through the self-service checkout, scan your items, and hurriedly place them in the conveniently waiting thin, grey plastic bag before finalising the purchase.At home, the purchases are packed away or lined up for immediate preparation. The plastic bag is scrunched into a little ball and stuffed away with others in your collection, to be used as bin liners or otherwise thrown away. All of these behaviours are, by and large, done without a great deal of thought.One of the most challenging tasks for marketers is to bring about changes in consumer behaviours that have become habitual, routine and “low involvement” – why spend time stopping and considering various brands of laundry detergent, for instance, when you can just quickly grab the one you’ve always used?The very nature of habitual behaviour means that responses to the same situational cues happen automatically and with little conscious thought. Habits are powerfully ingrained. One study estimates that around 45% of our daily actions are habitual, and most of our purchases and consumption is of the low-involvement variety.Repetitive consumer behaviour is a tough cycle to disrupt. And it is the very nature of these habitual responses that make many standard interventions relatively ineffective.But this is the task facing supermarkets in taking away customers’ access to free plastic bags.

via How ‘nudge theory’ can help shops avoid a backlash over plastic bag bans.

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ABSTRACT: The impact of a web-based educational program on the recognition and management of deteriorating patients

AIMS AND OBJECTIVES:
To evaluate the effectiveness of a web-based educational program to enhance enrolled nurses’ knowledge and skills in the recognition and management of deteriorating patients.
BACKGROUND:
Ward nurses of different skill levels play a pivotal role in detecting and responding to deteriorating patients. A skill-mix of registered nurses, enrolled nurses, licensed practice nurses or healthcare assistants is often employed for the provision of nursing care in acute settings. Non-registered nurses frequently perform bedside care and are in the best position to detect deteriorating patients and initiate immediate actions, including commanding the attention of registered nurses. Education is needed to improve the knowledge and skills of these nurses.
DESIGN:
A randomized controlled trial with a pre-test-post-test design.
METHODS:
The sample included enrolled nurses from an acute care tertiary hospital. Following a baseline evaluation, the experimental group received a web-based educational intervention. Pre-post assessment of skills and knowledge were evaluated with a simulated scenario and a knowledge questionnaire. Sixty-four nurses completed the entire study.
RESULTS:
Following the intervention, participants from the experimental group were significantly more likely than those in control group to monitor the patient’s respiratory and pulse rates. In addition, they had significantly higher post-test mean scores for knowledge and skills in assessing and managing clinical deterioration, and reporting deterioration.
CONCLUSION:
The web-based educational intervention significantly improved enrolled nurses’ knowledge and skills in the recognition and management of a deteriorating patient in a simulated setting.
RELEVANCE TO CLINICAL PRACTICE:
Ease of access to the web-based platform contributed to the feasibility and acceptability of this study, which has the potential to positively impact patient safety.

via The impact of a web-based educational program on the recognition and management of deteriorating patients. – PubMed – NCBI.

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