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Author: Brian S McGowan, PhD

ABSTRACT: Dis-integration of communication in healthcare education: Workplace learning challenges and opportunities

The purpose of this paper, based on a 2016 Heidelberg International Conference on Communication in Healthcare (ICCH) plenary presentation, is to examine a key problem in communication skills training for health professional learners. Studies have pointed to a decline in medical students’ communication skills and attitudes as they proceed through their education, particularly during their clinical workplace training experiences. This paper explores some of the key factors in this disintegration, drawing on selected literature and highlighting some curriculum efforts and research conducted at the University of Iowa Carver College of Medicine as a case study of these issues. Five key factors contributing to the disintegration of communication skills and attitudes are presented including: 1) lack of formal communication skills training during clinical clerkships; 2) informal workplace teaching failing to explicitly address learner clinical communication skills; 3) emphasizing content over process in relation to clinician-patient interactions; 4) the relationship between ideal communication models and the realities of clinical practice; and 5) clinical teachers’ lack of knowledge and skills to effectively teach about communication in the clinical workplace. Within this discussion, potential practical responses by individual clinical teachers and broader curricular and faculty development efforts to address each of these factors are presented.

via Dis-integration of communication in healthcare education: Workplace learning challenges and opportunities. – PubMed – NCBI.

MANUSCRIPT: An active learning curriculum improves fellows’ knowledge and faculty teaching skills

OBJECTIVES:
Traditional didactic lectures are the mainstay of teaching for graduate medical education, although this method may not be the most effective way to transmit information. We created an active learning curriculum for Brigham and Women’s Hospital (BWH) gastroenterology fellows to maximize learning. We evaluated whether this new curriculum improved perceived knowledge acquisition and knowledge base. In addition, our study assessed whether coaching faculty members in specific methods to enhance active learning improved their perceived teaching and presentation skills.
METHODS:
We compared the Gastroenterology Training Exam (GTE) scores before and after the implementation of this curriculum to assess whether an improved knowledge base was documented. In addition, fellows and faculty members were asked to complete anonymous evaluations regarding their learning and teaching experiences.
RESULTS:
Fifteen fellows were invited to 12 lectures over a 2-year period. GTE scores improved in the areas of stomach (p<0.001), general gastroenterology (p=0.005), esophagus (p<0.001), and small bowel (p=0.001), and the total score (p=0.001) between pre- and postimplementation of the active learning curriculum. Scores in hepatology, as well as biliary and pancreatic study, showed a trend toward improvement (p>0.05). All fellows believed the lectures were helpful, felt more prepared to take the GTE, and preferred the interactive format to traditional didactic lectures. All lecturers agreed that they acquired new teaching skills, improved teaching and presentation skills, and learned new tools that could help them teach better in the future.
CONCLUSION:
An active learning curriculum is preferred by GI fellows and may be helpful for improving transmission of information in any specialty in medical education. Individualized faculty coaching sessions demonstrating new ways to transmit information may be important for an individual faculty member’s teaching excellence.

via An active learning curriculum improves fellows’ knowledge and faculty teaching skills. – PubMed – NCBI.

ABSTRACT: Use of 3D models of vascular rings and slings to improve resident education

OBJECTIVE:
Three-dimensional (3D) printing is a manufacturing method by which an object is created in an additive process, and can be used with medical imaging data to generate accurate physical reproductions of organs and tissues for a variety of applications. We hypothesized that using 3D printed models of congenital cardiovascular lesions to supplement an educational lecture would improve learners’ scores on a board-style examination.
DESIGN AND INTERVENTION:
Patients with normal and abnormal aortic arches were selected and anonymized to generate 3D printed models. A cohort of pediatric and combined pediatric/emergency medicine residents were then randomized to intervention and control groups. Each participant was given a subjective survey and an objective board-style pretest. Each group received the same 20-minutes lecture on vascular rings and slings. During the intervention group’s lecture, 3D printed physical models of each lesion were distributed for inspection. After each lecture, both groups completed the same subjective survey and objective board-style test to assess their comfort with and postlecture knowledge of vascular rings.
RESULTS:
There were no differences in the basic demographics of the two groups. After the lectures, both groups’ subjective comfort levels increased. Both groups’ scores on the objective test improved, but the intervention group scored higher on the posttest.
CONCLUSIONS:
This study demonstrated a measurable gain in knowledge about vascular rings and pulmonary artery slings with the addition of 3D printed models of the defects. Future applications of this teaching modality could extend to other congenital cardiac lesions and different learners.

via Use of 3D models of vascular rings and slings to improve resident education. – PubMed – NCBI.

ABSTRACT: Academic Primer Series: Key Papers About Competency-Based Medical Education

INTRODUCTION:
Competency-based medical education (CBME) presents a paradigm shift in medical training. This outcome-based education movement has triggered substantive changes across the globe. Since this transition is only beginning, many faculty members may not have experience with CBME nor a solid foundation in the grounding literature. We identify and summarize key papers to help faculty members learn more about CBME.
METHODS:
Based on the online discussions of the 2016-2017 ALiEM Faculty Incubator program, a series of papers on the topic of CBME was developed. Augmenting this list with suggestions by a guest expert and by an open call on Twitter for other important papers, we were able to generate a list of 21 papers in total. Subsequently, we used a modified Delphi study methodology to narrow the list to key papers that describe the importance and significance for educators interested in learning about CBME. To determine the most impactful papers, the mixed junior and senior faculty authorship group used three-round voting methodology based upon the Delphi method.
RESULTS:
Summaries of the five most highly rated papers on the topic of CBME, as determined by this modified Delphi approach, are presented in this paper. Major themes include a definition of core CBME themes, CBME principles to consider in the design of curricula, a history of the development of the CBME movement, and a rationale for changes to accreditation with CBME. The application of the study findings to junior faculty and faculty developers is discussed.
CONCLUSION:
We present five key papers on CBME that junior faculty members and faculty experts identified as essential to faculty development. These papers are a mix of foundational and explanatory papers that may provide a basis from which junior faculty members may build upon as they help to implement CBME programs.

via Academic Primer Series: Key Papers About Competency-Based Medical Education. – PubMed – NCBI.

ABSTRACT: Academic Primer Series: Key Papers About Peer Review

INTRODUCTION:
Peer review, a cornerstone of academia, promotes rigor and relevance in scientific publishing. As educators are encouraged to adopt a more scholarly approach to medical education, peer review is becoming increasingly important. Junior educators both receive the reviews of their peers, and are also asked to participate as reviewers themselves. As such, it is imperative for junior clinician educators to be well-versed in the art of peer reviewing their colleagues’ work. In this article, our goal was to identify and summarize key papers that may be helpful for faculty members interested in learning more about the peer-review process and how to improve their reviewing skills.
METHODS:
The online discussions of the 2016-17 Academic Life in Emergency Medicine (ALiEM) Faculty Incubator program included a robust discussion about peer review, which highlighted a number of papers on that topic. We sought to augment this list with further suggestions by guest experts and by an open call on Twitter for other important papers. Via this process, we created a list of 24 total papers on the topic of peer review. After gathering these papers, our authorship group engaged in a consensus-building process incorporating Delphi methods to identify the papers that best described peer review, and also highlighted important tips for new reviewers.
RESULTS:
We found and reviewed 24 papers. In our results section, we present our authorship group’s top five most highly rated papers on the topic of peer review. We also summarize these papers with respect to their relevance to junior faculty members and to faculty developers.
CONCLUSION:
We present five key papers on peer review that can be used for faculty development for novice writers and reviewers. These papers represent a mix of foundational and explanatory papers that may provide some basis from which junior faculty members might build upon as they both undergo the peer-review process and act as reviewers in turn.

via Academic Primer Series: Key Papers About Peer Review. – PubMed – NCBI.

ABSTRACT: Academic Primer Series: Five Key Papers about Study Designs in Medical Education

INTRODUCTION:
A proper understanding of study design is essential to creating successful studies. This is also important when reading or peer reviewing publications. In this article, we aimed to identify and summarize key papers that would be helpful for faculty members interested in learning more about study design in medical education research.
METHODS:
The online discussions of the 2016-2017 Academic Life in Emergency Medicine Faculty Incubator program included a robust and vigorous discussion about education study design, which highlighted a number of papers on that topic. We augmented this list of papers with further suggestions by expert mentors. Via this process, we created a list of 29 papers in total on the topic of medical education study design. After gathering these papers, our authorship group engaged in a modified Delphi approach to build consensus on the papers that were most valuable for the understanding of proper study design in medical education.
RESULTS:
We selected the top five most highly rated papers on the topic domain of study design as determined by our study group. We subsequently summarized these papers with respect to their relevance to junior faculty members and to faculty developers.
CONCLUSION:
This article summarizes five key papers addressing study design in medical education with discussions and applications for junior faculty members and faculty developers. These papers provide a basis upon which junior faculty members might build for developing and analyzing studies.

via Academic Primer Series: Five Key Papers about Study Designs in Medical Education. – PubMed – NCBI.

ABSTRACT: In search of educational efficiency: 30 years of Medical Education’s top-cited articles

CONTEXT:
Academic journals represent shared spaces wherein the significance of thematic areas, methodologies and paradigms are debated and shaped through collective engagement. By studying journals in their historical and cultural contexts, the academic community can gain insight into the ways in which authors and audiences propose, develop, harness, revise and discard research subjects, methodologies and practices.
METHODS:
Thirty top-cited articles published in Medical Education between 1986 and 2014 were analysed in a two-step process. First, a descriptive classification of articles allowed us to quantify the frequency of content areas over the time span studied. Secondly, a discourse analysis was conducted to identify the continuities, disruptions and tensions within the three most prominent content areas.
RESULTS:
The top-cited articles in Medical Education focused on three major areas of interest: problem-based learning, simulation and assessment. In each of these areas of interest, we noted a tension between the desire to produce and apply standardised tools, and the recognition that the contexts of medical education are highly variable and influenced by political and financial considerations. The general preoccupation with achieving efficiency may paradoxically jeopardise the ability of medical schools to address the contextual needs of students, teachers and patients.
CONCLUSIONS:
Understanding the topics of interest for a journal’s scholarly audience and how these topics are discursively positioned, provides important information for researchers in deciding how they wish to engage with the field, as well as for educators as they assess the relevance of educational products for their local contexts.

via In search of educational efficiency: 30 years of Medical Education’s top-cited articles. – PubMed – NCBI.

ABSTRACT: How physicians draw satisfaction and overcome barriers in their practices: “It sustains me”

OBJECTIVE:
Major reorganizations of medical practice today challenge physicians’ ability to deliver compassionate care. We sought to understand how physicians who completed an intensive faculty development program in medical humanism sustain their humanistic practices.
METHODS:
Program completers from 8 U.S. medical schools wrote reflections in answer to two open-ended questions addressing their personal motivations and the barriers that impeded their humanistic practice and teaching. Reflections were qualitatively analyzed using the constant comparative method.
RESULTS:
Sixty-eight physicians (74% response rate) submitted reflections. Motivating factors included: 1) identification with humanistic values; 2) providing care that they or their family would want; 3) connecting to patients; 4) passing on values through role modelling; 5) being in the moment. Inhibiting factors included: 1) time, 2) stress, 3) culture, and 4) episodic burnout.
CONCLUSIONS:
Determination to live by one’s values, embedded within a strong professional identity, allowed study participants to alleviate, but not resolve, the barriers. Collaborative action to address organizational impediments was endorsed but found to be lacking.
PRACTICE IMPLICATIONS:
Fostering fully mature professional development among physicians will require new skills and opportunities that reinforce time-honored values while simultaneously partnering with others to nurture, sustain and improve patient care by addressing system issues.

via How physicians draw satisfaction and overcome barriers in their practices: “It sustains me”. – PubMed – NCBI.

ABSTRACT: Does Robotic Surgical Simulator Performance Correlate With Surgical Skill?

OBJECTIVE:
To assess the relationship between robotic surgical simulation performance and the real-life surgical skill of attending surgeons. We hypothesized that simulation performance would not correlate with real-life robotic surgical skill in attending surgeons.
DESIGN:
In 2013, Birkmeyer et al. demonstrated an association between laparoscopic surgical performance as determined by expert review of video clips and surgical outcomes. Using that model of expert review, we studied the relationship between robotic simulator performance and real-life surgical skill. Ten attending robotic surgeons performed 4 tasks on the da Vinci Skills Simulator (Camera Targeting 1, Ring Walk 3, Suture Sponge 3, and Energy Dissection 3). Two video clips of a robotic-assisted operation were then recorded for each surgeon. Three expert robotic surgeons reviewed the recordings and rated surgical technique using the Global Evaluative Assessment of Robotic Skills.
SETTING:
University of Virginia; Charlottesville, VA; tertiary hospital PARTICIPANTS: All attending surgeons who perform robotic-assisted surgery at our institution were enrolled and completed the study.
RESULTS:
The surgeons had a median of 7.25 years of robotic surgical experience with a median of 91 cases (ranging: 20-346 cases) in the last 4 years. Median scores for each simulator task were 87.5%, 39.0%, 77.5%, and 81.5%. Using Pearson’s correlation, scores for each of the individual tasks correlated poorly with expert review of intraoperative performance. There was also no correlation (r = -0.0304) between overall simulation score (mean: 70.7 ± 9.6%) and expert video ratings (mean: 3.66 ± 0.32 points).
CONCLUSIONS:
There was no correlation between attending surgeons’ simulator performance and expert ratings of intraoperative videos based on the Global Evaluative Assessment of Robotic Skills scale. Although novice surgeons may put considerable effort into training on robotic simulators, performance on a simulator may not correlate with attending robotic surgical performance. Development of simulation exercises that guide novice surgeons toward expert performance is needed.

via Does Robotic Surgical Simulator Performance Correlate With Surgical Skill? – PubMed – NCBI.

Five Essential TED talks for educators (not about education)

Over the past 5+ years I have studied learning from a slightly different perspective…namely, I see learning as a behavior.

When you see the world through this unique lens you quickly come to grips with the reality that the science of learning is now infinitely more complex – we no longer need to ‘simply’ understand adult learning theory, pedagogy, memory science, or even neuroscience; we now need to embrace broader issues of psychology, sociology, and especially, behavioral economics.

Far from over-whelming, this new perspective is empowering both professionally and personally.

In other posts I have shared a primer on these critical, but often new-to-us fields of science, yet I am continually asked for more resources and advice on getting started – so here you go.

Below are what I believe to be five essential TED talks for educators. As you view each talk, continually challenge yourself to connect these new ideas to your educational planning, design, and delivery.

Good luck!

#1 Are We In Control of Our Decisions? with Dan Ariely

The author of Predictably Irrational, uses classic visual illusions and his own counterintuitive (and sometimes shocking) research findings to show how we’re not as rational as we think when we make decisions.

 

#2 The Puzzle of Motivation with Dan Pink

Dan presents us with a great take-away: Any action that takes even the slightest modicum of thinking is undermined with external motivations. As educators we must be able to spark and catalyze intrinsic motivation in learners!

#3 The Surprising Science of Happiness with Dan Gilbert

You may now know him from the Prudential commercials where he conducts pop-up experiments to help passers-by understand investing, but for decades Dan Gilbert has been exploring decision making, forecasting, and happiness.

#4 The paradox of choice with Barry Schwartz

Psychologist Barry Schwartz takes aim at a central tenet of western societies: freedom of choice. In Schwartz’s estimation, choice has made us not freer but more paralyzed, not happier but more dissatisfied. The reason for this is that we aren’t (as humans) really good at making the right decision and we live with regret that often haunts us…we need help! (And so do our learners)

#5 How to Start a Movement with Derek Sivers

A short excerpt of a longer talk, but this gets right to the heart of the status quo in educational planning and design…if you don’t have the guts to be the first mover, you must be open the opportunities as the ‘first follower’! In many ways, inventing new ideas is no more important than being able to see their application and using them!

 

Ok…how about one other (sort of) education-related suggestion 😉

#6 How to Escape Education’s Death Valley with Sir Ken Robinson

While on the surface this talk is focused on k-12 education…it has what I believe to be my favorite educational quote of all time, “There has never been a classroom better than its teacher!” yet how many times do we, in medical education, look to subject matter experts to ‘teach’ when they have little expertise in teaching?