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Author: Brian S McGowan, PhD

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.

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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.

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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.

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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.

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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?

 

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ABSTRACT: Gamified Twitter Microblogging to Support Resident Preparation for the American Board of Surgery In-Service Training Examination

OBJECTIVE:
We sought to determine if a daily gamified microblogging project improves American Board of Surgery In-Service Training Examination (ABSITE) scores for participants.
DESIGN:
In July 2016, we instituted a gamified microblogging project using Twitter as the platform and modified questions from one of several available question banks. A question of the day was posted at 7-o׳clock each morning, Monday through Friday. Respondents were awarded points for speed, accuracy, and contribution to discussion topics. The moderator challenged respondents by asking additional questions and prompted them to find evidence for their claims to fuel further discussion. Since 4 months into the microblogging program, a survey was administered to all residents. Responses were collected and analyzed. After 6 months of tweeting, residents took the ABSITE examination. We compared participating residents׳ ABSITE percentile rank to those of their nonparticipating peers. We also compared residents׳ percentile rank from 2016 to those in 2017 after their participation in the microblogging project.
SETTING:
The University of Connecticut general surgery residency is an integrated program that is decentralized across 5 hospitals in the central Connecticut region, including Saint Francis Hospital and Medical Center, located in Hartford.
PARTICIPANTS:
We advertised our account to the University of Connecticut general surgery residents. Out of 45 residents, 11 participated in Twitter microblogging (24.4%) and 17 responded to the questionnaire (37.8%).
RESULTS:
In all, 100% of the residents who were participating in Twitter reported that daily microblogging prompted them to engage in academic reading. Twitter participants significantly increased their ABSITE percentile rank from 2016 to 2017 by an average of 13.7% (±14.1%) while nonparticipants on average decreased their ABSITE percentile rank by 10.0% (±16.6) (p = 0.003).
CONCLUSIONS:
Microblogging via Twitter with gamification is a feasible strategy to facilitate improving performance on the ABSITE, especially in a geographically distributed residency.

via Gamified Twitter Microblogging to Support Resident Preparation for the American Board of Surgery In-Service Training Examination. – PubMed – NCBI.

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MANUSCRIPT: Resource format preferences across the medical curriculum

OBJECTIVE:
This research study sought to determine the formats (print or electronic) of articles and book chapters most-preferred by first-year medical students, third-year medical students entering clinical clerkships, and incoming residents and to determine if these preferences change during the course of the medical curriculum. These trends will enable academic health sciences libraries to make appropriate collection development decisions to best cater to their user populations.
METHODS:
First-year medical students, third-year medical students, and incoming medical residents were asked to complete a paper survey from September 2014 to June 2015. The survey consisted of five multiple-choice questions, with two questions given space for optional short answers. Quantitative and qualitative responses were collected and calculated using Microsoft Excel.
RESULTS:
First-year students, third-year students, and incoming residents all preferred to read journal articles and book chapters in print, except in cases where the article or book chapter is under ten pages in length. Although print is preferred, demand for electronic articles and book chapters increases as students progress from undergraduate medical education into residency. The only category where a majority of incoming residents chose an electronic resource was which format they would give to a colleague, if the article or book chapter was critical to the care of an individual patient.
CONCLUSIONS:
The preference for print resources is strong across the medical curriculum, although residents show an increased preference for electronic materials when compared to first- and third-year students. Academic health sciences libraries should take these preferences into account when making decisions regarding collection development.

via Resource format preferences across the medical curriculum. – PubMed – NCBI.

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MANUSCRIPT: An Analysis of the Top-cited Articles in Emergency Medicine Education Literature

NTRODUCTION:
Dissemination of educational research is critical to improving medical education, promotion of faculty and ultimately patient care. The objective of this study was to identify the top 25 cited education articles in the emergency medicine (EM) literature and the top 25 cited EM education articles in all journals, as well as report on the characteristics of the articles.
METHODS:
Two searches were conducted in the Web of Science in June 2016 using a list of education-related search terms. We searched 19 EM journals for education articles as well as all other literature for EM education-related articles. Articles identified were reviewed for citation count, article type, journal, authors, and publication year.
RESULTS:
With regards to EM journals, the greatest number of articles were classified as articles/reviews, followed by research articles on topics such as deliberate practice (cited 266 times) and cognitive errors (cited 201 times). In contrast in the non-EM journals, research articles were predominant. Both searches found several simulation and ultrasound articles to be included. The most common EM journal was Academic Emergency Medicine (n = 18), and Academic Medicine was the most common non-EM journal (n=5). A reasonable number of articles included external funding sources (6 EM articles and 13 non-EM articles.).
CONCLUSION:
This study identified the most frequently cited medical education articles in the field of EM education, published in EM journals as well as all other journals indexed in Web of Science. The results identify impactful articles to medical education, providing a resource to educators while identifying trends that may be used to guide EM educational research and publishing efforts.

via An Analysis of the Top-cited Articles in Emergency Medicine Education Literature. – PubMed – NCBI.

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ABSTRACT: Cystic Fibrosis Diagnostic Challenges over 4 Decades: Historical Perspectives and Lessons Learned

OBJECTIVE:
Because cystic fibrosis (CF) can be difficult to diagnose, and because information about the genetic complexities and pathologic basis of the disease has grown so rapidly over the decades, several consensus conferences have been held by the US CF Foundation, and a variety of other efforts to improve diagnostic practices have been organized by the European CF Society. Despite these efforts, the application of diagnostic criteria has been variable and caused confusion.
STUDY DESIGN:
To improve diagnosis and achieve standardization in terms and definitions worldwide, the CF Foundation in 2015 convened a committee of 32 experts in the diagnosis of CF from 9 countries. As part of the process, all previous consensus-seeking exercises sponsored by the CF Foundation, along with the important efforts of the European CF Society, were comprehensively and critically reviewed. The goal was to better understand why consensus conferences and their publications have not led to the desired results.
RESULTS:
Lessons learned from previous diagnosis consensus processes and products were identified. It was decided that participation in developing a consensus was generally not inclusive enough for global impact. It was also found that many efforts to address sweat test issues were valuable but did not always improve clinical practices as CF diagnostic testing evolved. It also became clear from this review that premature applications of potential diagnostic tests such as nasal potential difference and intestinal current measurement should be avoided until validation and standardization occur. Finally, we have learned that due to the significant and growing number of cases that are challenging to diagnose, an associated continuing medical education program is both desirable and necessary.
CONCLUSIONS:
It is necessary but not sufficient to organize and publish CF diagnosis consensus processes. Follow-up implementation efforts and monitoring practices seem essential.

via Cystic Fibrosis Diagnostic Challenges over 4 Decades: Historical Perspectives and Lessons Learned. – PubMed – NCBI.

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MANUSCRIPT: Rapid Cycle Deliberate Practice in Medical Education – a Systematic Review

Rapid Cycle Deliberate Practice (RCDP) is a novel simulation-based education model that is currently attracting interest, implementation, exploration and research in medical education. In RCDP, learners rapidly cycle between deliberate practice and directed feedback within the simulation scenario until mastery is achieved. The objective of this systematic review is to examine the literature and summarize the existing knowledge on RCDP in simulation-based medical education. Fifteen resources met inclusion criteria; they were diverse and heterogeneous, such that we did not perform a quantitative synthesis or meta-analysis but rather a narrative review on RCDP. All resources described RCDP in a similar manner. Common RCDP implementation strategies included: splitting simulation cases into segments, micro debriefing in the form of ‘pause, debrief, rewind and try again’ and providing progressively more challenging scenarios. Variable outcome measures were used by the studies including qualitative assessments, scoring tools, procedural assessment using checklists or video review, time to active skills and clinical reports. Results were limited and inconsistent. There is an absence of data on retention after RCDP teaching, on RCDP, with learners from specialties other than pediatrics, on RCDP for adult resuscitation scenarios and if RCDP teaching translates into practice change in the clinical realm. We have identified important avenues for future research on RCDP.

via Rapid Cycle Deliberate Practice in Medical Education – a Systematic Review. – PubMed – NCBI.

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