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Author: Brian S McGowan, PhD

ABSTRACT: Durability of the effect of online diabetes training for medical residents on knowledge, confidence, and inpatient glycemia.

Abstract
BACKGROUND:
Inpatient dysglycemia is associated with increased morbidity, mortality and cost. Medical education must not only address knowledge gaps, but also improve clinical care.
METHODS:
All 129 medicine residents at a large academic medical center were offered a case-based online curriculum on the management of inpatient dysglycemia in the fall of 2009. First-year residents took a 3-h course with 10 modules. Second and third-year residents, who had been educated the prior year, underwent abbreviated training. All residents were offered a 20-min refresher course in the spring of 2009. We assessed resident knowledge, resident confidence, and patient glycemia on two teaching wards before and after the initial intervention, as well as after the refresher course.
RESULTS:
A total of 117 residents (91%) completed the initial training; 299 analyzed admissions generated 11, 089 blood glucose values and 4799 event blood glucose values. Admissions with target glycemia increased from 19.4% to 33.0% (P = 0.035) by the end of the curriculum. There was a strong downward trend in hyperglycemia from 22.4% to 11.3% (P = 0.055) without increased hypoglycemia. Confidence and knowledge increased significantly among first-time and repeat participants. Residents rated the intervention as highly relevant to their practice and technologically well implemented.
CONCLUSION:
Optimization of an online curriculum covering the management of inpatient glycemia over the course of 2 years led to significantly more admissions in the target glycemia range. Given its scalability, modularity and applicability, this web-based educational intervention may become the standard curriculum for the management of inpatient glycemia.

via Durability of the effect of online diabetes train… [J Diabetes. 2012] – PubMed – NCBI.

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MANUSCRIPT: Cancer screening in the United States, 2013 – A CME Activity

In this yearly report, we provide a summary of the current American Cancer Society (ACS) cancer screening guidelines, a summary of guidance to health care professionals and the public related to early cancer detection tests that are not yet recommended for mass screening due to uncertainty about the balance of benefits and harms, and the most recent data on adult cancer screening rates and trends. In order for guidelines to reflect the most current scientific evidence, the ACS monitors the medical and scientific literature on an ongoing basis, and generally guidelines have been reviewed and updated at least every 5 years, or sooner if new evidence warrants an immediate update in recommendations. An update in the ACS guidelines development process was published in 2011, and also summarized in this journal in 2012.1,2 The annual guideline reviews, as well as the more detailed cancer screening guideline updates, are published as stand-alone articles and are available online at cacancerjournal.com. Table 1 shows the recent history of guidelines updates, as well as those currently in progress.3-15 In this update of ACS cancer screening guidelines, we describe the current guidelines, an update in the guidance for lung cancer screening announced in 2011,2 and an update in cervical cancer screening guidelines.7

 

http://onlinelibrary.wiley.com/doi/10.3322/caac.21174/pdf

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ABSTRACT: Twelve tips for getting started using mixed methods in medical education research.

Abstract
Background: Mixed methods research, which is gaining popularity in medical education, provides a new and comprehensive approach for addressing teaching, learning, and evaluation issues in the field. Aim: The aim of this article is to provide medical education researchers with 12 tips, based on consideration of current literature in the health professions and in educational research, for conducting and disseminating mixed methods research. Conclusion: Engaging in mixed methods research requires consideration of several major components: the mixed methods paradigm, types of problems, mixed method designs, collaboration, and developing or extending theory. Mixed methods is an ideal tool for addressing a full range of problems in medical education to include development of theory and improving practice.

via Twelve tips for getting started using mixed method… [Med Teach. 2013] – PubMed – NCBI.

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ABSTRACT: Recommendations for a New Curriculum in Pain Medicine for Medical Students: Toward a Career Distinguished by Competence and Compassion.

Abstract
OBJECTIVE:
The education of physicians is a fundamental obligation within medicine that must remain closely aligned with clinical care. And although medical education in pain care is essential, the current state of medical education does not meet the needs of physicians, patients, or society. To address this, we convened a committee of pain specialist medical student educators.
METHODS:
Tasked with creating systematically developed and valid recommendations for clinical education, we conducted a survey of pain medicine leadership within the American Academy of Pain Medicine (AAPM). The survey was conducted in two waves. We asked AAPM board members to rate 194 previously published pain medicine learning objectives for medical students; 79% of those eligible for participation responded.
RESULTS:
The “Top 5” list included the awareness of acute and chronic pain, skillfulness in clinical appraisal, promotion of compassionate practices, displaying empathy toward the patient, and knowledge of terms and definitions for substance abuse. The “Top 10” list included the major pharmacological classes as well as skills in examination, communication, prescribing, and interviewing. The “Top 20” list included the pain care of cognitively impaired populations, those with comorbid illness, and older adults. With the survey results in consideration, the committee produced a new recommended topic list for curricula in pain medicine. We strongly recommend that adequate resources are devoted to fully integrated medical curricula in pain so that students will learn not only the necessary clinical knowledge but also be prepared to address the professional, personal, and ethical challenges that arise in caring for those with pain.
CONCLUSIONS:
We conclude that improved medical education in pain is essential to prepare providers who manifest both competence and compassion toward their patients.

via Recommendations for a New Curriculum in Pain Medici… [Pain Med. 2013] – PubMed – NCBI.

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ABSTRACT: Knowledge and usability of a trauma training system for general surgery residents.

Abstract
BACKGROUND:Resident work-hour restrictions challenge educators to supplement residents surgical education. We evaluated a computer-based trauma surgery systems ability to increase residents surgical knowledge.METHODS:Modules on thoracic and abdominal surgical approaches were evaluated. Surgical residents with 1 or more years of experience completed the pretest, an interactive module, the post-test, and a usability survey.RESULTS:Fifteen participants completed both modules. Thoracic module pretest and post-test scores were 56 ± 11 mean ± standard deviation and 90 ± 10, respectively P < .0001. Mean abdominal module scores were 48 ± 20 and 85 ± 14, respectively P < .0001. The usability survey showed that 87% of participants would use these modules to supplement their trauma training, 93% could easily distinguish anatomic detail, and 100% thought that procedures were shown clearly.CONCLUSIONS:This novel computer-based trauma education training system improved residents knowledge of anatomy, surgical incisions, exposures, and technique. As innovative didactic tools arise in postgraduate medical education, it is crucial to document their effects on educational processes, learning satisfaction, and knowledge outcomes.

via Knowledge and usability of a trauma training syste… [Am J Surg. 2013] – PubMed – NCBI.

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MANUSCRIPT: Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality

A b s t r a c t While evidence-based medicine has increasingly broad-based support in health care, it remains difficult to get physicians to actually practice it. Across most domains in medicine, practice has lagged behind knowledge by at least several years. The authors believe that the key tools for closing this gap will be information systems that provide decision support to users at the time they make decisions, which should result in improved quality of care. Furthermore, providers make many errors, and clinical decision support can be useful for finding and preventing such errors. Over the last eight years the authors have implemented and studied the impact of decision support across a broad array of domains and have found a number of common elements important to success. The goal of this report is to discuss these lessons learned in the interest of informing the efforts of others working to make the practice of evidence-based medicine a reality.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC264429/pdf/523.pdf

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MANUSCRIPT: The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation

Background: Clinical practice guidelines are not uniformly successful in influencing clinicians’ behaviour toward best practices. Implementability refers to a set of characteristics that predict ease of (and obstacles to) guideline implementation. Our objective is to develop and validate a tool for appraisal of implementability of clinical guidelines.

http://www.biomedcentral.com/content/pdf/1472-6947-5-23.pdf

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MANUSCRIPT: Why Don’t Physicians Follow Clinical Practice Guidelines? A Framework for Improvement

Context Despite wide promulgation, clinical practice guidelines have had limited effect on changing physician behavior. Little is known about the process and factors involved in changing physician practices in response to guidelines.
Objective To review barriers to physician adherence to clinical practice guidelines.

http://rds.epi-ucsf.org/ticr/syllabus/courses/66/2009/10/22/Lecture/readings/Cabana.JAMA.1999.pdf

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MANUSCRIPT: Enhancing the Use of Clinical Guidelines: A Social Norms Perspective

This article reviews the history of guideline development and use, assesses the current state of implementation, identifies obstacles to adoption, and suggests strategies to overcome these obstacles. The major finding is that the current approach to development, dissemination, and encouraged use of guidelines is inconsistent with knowledge of psychology.

The major recommendations are that the approach to translation of evidence into practice be revised to address convenience; to respond to public and peer demand; to provide immediate feedback concerning performance; and to leverage existing incentives, transparencies, and accountabilities. Implementation of these recommendations is expected to augment safety and best practice in the health-care community.

 

http://www.jsmf.org/about/s/norms.pdf

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RESOURCE: Coursera forced to call off a MOOC amid complaints about the course

Maybe it was inevitable that one of the new massive open online courses would crash. After all, MOOCs are being launched with considerable speed, not to mention hype. But MOOC advocates might have preferred the collapse of a course other than the one that was suspended this weekend, one week into instruction: “Fundamentals of Online Education: Planning and Application.”Technology and design problems are largely to blame for the courses problems. And many students are angry that a course about online education — let alone one offered by the Georgia Institute of Technology — wouldnt have figured out the tech issues in advance, or been able to respond quickly once they became evident. Many of the problems related to the courses use of Google Docs to sign up for group discussions.

via Coursera forced to call off a MOOC amid complaints about the course | Inside Higher Ed.

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