Author: Brian S McGowan, PhD

MANUSCRIPT: Can elearning be used to teach palliative care? – medical students’ acceptance, knowledge, and self-estimation of competence in palliative care after elearning

Background
Undergraduate palliative care education (UPCE) was mandatorily incorporated in medical education in Germany in 2009. Implementation of the new cross-sectional examination subject of palliative care (QB13) continues to be a major challenge for medical schools. It is clear that there is a need among students for more UPCE. On the other hand, there is a lack of teaching resources and patient availabilities for the practical lessons. Digital media and elearning might be one solution to this problem. The primary objective of this study is to evaluate the elearning course Palliative Care Basics, with regard to students’ acceptance of this teaching method and their performance in the written examination on the topic of palliative care. In addition, students’ self-estimation in competence in palliative care was assessed.

Methods
To investigate students’ acceptance of the elearning course Palliative Care Basics, we conducted a cross-sectional study that is appropriate for proof-of-concept evaluation. The sample consisted of three cohorts of medical students of Heinrich Heine University Dusseldorf (N = 670). The acceptance of the elearning approach was investigated by means of the standard evaluation of Heinrich Heine University. The effect of elearning on students’ self-estimation in palliative care competencies was measured by means of the German revised version of the Program in Palliative Care Education and Practice Questionnaire (PCEP-GR).

Results
The elearning course Palliative Care Basics was well-received by medical students. The data yielded no significant effects of the elearning course on students’ self-estimation in palliative care competencies. There was a trend of the elearning course having a positive effect on the mark in written exam.

Conclusions
Elearning is a promising approach in UPCE and well-accepted by medical students. It may be able to increase students’ knowledge in palliative care. However, it is likely that there are other approaches needed to change students’ self-estimation in palliative care competencies. It seems plausible that experience-based learning and encounters with dying patients and their relatives are required to increases students’ self-estimation in palliative care competencies.

via Can elearning be used to teach palliative care? – medical students’ acceptance, knowledge, and self-estimation of competence in palliative care after elearning | BMC Medical Education | Full Text.

MANUSCRIPT: Consensus on Quality Indicators of Postgraduate Medical E-Learning: Delphi Study

Background: The progressive use of e-learning in postgraduate medical education calls for useful quality indicators. Many evaluation tools exist. However, these are diversely used and their empirical foundation is often lacking.

Objective: We aimed to identify an empirically founded set of quality indicators to set the bar for “good enough” e-learning.

Methods: We performed a Delphi procedure with a group of 13 international education experts and 10 experienced users of e-learning. The questionnaire started with 57 items. These items were the result of a previous literature review and focus group study performed with experts and users. Consensus was met when a rate of agreement of more than two-thirds was achieved.

Results: In the first round, the participants accepted 37 items of the 57 as important, reached no consensus on 20, and added 15 new items. In the second round, we added the comments from the first round to the items on which there was no consensus and added the 15 new items. After this round, a total of 72 items were addressed and, of these, 37 items were accepted and 34 were rejected due to lack of consensus.

Conclusions: This study produced a list of 37 items that can form the basis of an evaluation tool to evaluate postgraduate medical e-learning. This is, to our knowledge, the first time that quality indicators for postgraduate medical e-learning have been defined and validated. The next step is to create and validate an e-learning evaluation tool from these items.

via JME-Consensus on Quality Indicators of Postgraduate Medical E-Learning: Delphi Study | de Leeuw | JMIR Medical Education.

MANUSCRIPT: E-learning in graduate medical education: survey of residency program directors

Background
E-learning—the use of Internet technologies to enhance knowledge and performance—has become a widely accepted instructional approach. Little is known about the current use of e-learning in postgraduate medical education. To determine utilization of e-learning by United States internal medicine residency programs, program director (PD) perceptions of e-learning, and associations between e-learning use and residency program characteristics.

Methods
We conducted a national survey in collaboration with the Association of Program Directors in Internal Medicine of all United States internal medicine residency programs.

Results
Of the 368 PDs, 214 (58.2%) completed the e-learning survey. Use of synchronous e-learning at least sometimes, somewhat often, or very often was reported by 85 (39.7%); 153 programs (71.5%) use asynchronous e-learning at least sometimes, somewhat often, or very often. Most programs (168; 79%) do not have a budget to integrate e-learning. Mean (SD) scores for the PD perceptions of e-learning ranged from 3.01 (0.94) to 3.86 (0.72) on a 5-point scale. The odds of synchronous e-learning use were higher in programs with a budget for its implementation (odds ratio, 3.0 [95% CI, 1.04–8.7]; P = .04).

Conclusions
Residency programs could be better resourced to integrate e-learning technologies. Asynchronous e-learning was used more than synchronous, which may be to accommodate busy resident schedules and duty-hour restrictions. PD perceptions of e-learning are relatively moderate and future research should determine whether PD reluctance to adopt e-learning is based on unawareness of the evidence, perceptions that e-learning is expensive, or judgments about value versus effectiveness.

via E-learning in graduate medical education: survey of residency program directors.

ABSTRACT: A Video-Based Coaching Intervention to Improve Surgical Skill in Fourth-Year Medical Students

OBJECTIVE:
For senior medical students pursuing careers in surgery, specific technical feedback is critical for developing foundational skills in preparation for residency. This pilot study seeks to assess the feasibility of a video-based coaching intervention to improve the suturing skills of fourth-year medical students.

DESIGN:
Fourth-year medical students pursuing careers in surgery were randomized to intervention vs. control groups and completed 2 video recorded suture tasks. Students in the intervention group received a structured coaching session between consecutive suturing tasks, whereas students in the control group did not. Each coaching session consisted of a video review of the students’ first suture task with a faculty member that provided directed feedback regarding technique. Following each suturing task, students were asked to self-assess their performance and provide feedback regarding the utility of the coaching session. All videos were deidentified and graded by independent faculty members for evaluation of suture technique.

SETTING:
The University of Michigan Medical School in Ann Arbor, Michigan.

PARTICIPANTS:
All fourth-year medical students pursuing careers in surgical specialties were contacted via e-mail for voluntary participation. In all, 16 students completed both baseline and follow up suture tasks.

RESULTS:
All students who completed the coaching session would definitely recommend the session for other students. A total of 94% of the students strongly agreed that the exercise was a beneficial experience, and 75% strongly agreed that it improved their technical skills. Based on faculty grading, students in the intervention group demonstrated greater average improvements in bimanual dexterity compared to students in the control group; whereas students in the control group demonstrated greater average improvements in domains of efficiency and tissue handling compared to the intervention group. Based on student self-assessments, those in the intervention group had greater subjective improvements in all scored domains of bimanual dexterity, efficiency, tissue handling, and consistency compared to the control group. Subjective, free-response comments centered on themes of becoming more aware of hand movements when viewing their suturing from a new perspective, and the usefulness of the coaching advice.

CONCLUSIONS:
This pilot study demonstrates the feasibility of a video-based coaching intervention for senior medical students. Students who participated in the coaching arm of the intervention noticed improvements in all domains of technical skill and noted that the experience was overwhelmingly positive. In summary, video-based review shows promise as an educational tool in medical education as a means to provide specific technical feedback.

via A Video-Based Coaching Intervention to Improve Surgical Skill in Fourth-Year Medical Students. – PubMed – NCBI.

ABSTRACT: Beyond Continuing Medical Education: Clinical Coaching as a Tool for Ongoing Professional Development

PROBLEM:
For most physicians, the period of official apprenticeship ends with the completion of residency or fellowship, yet the acquisition of expertise requires ongoing opportunities to practice a given skill and obtain structured feedback on one’s performance.

APPROACH:
In July 2013, the authors developed a clinical coaching pilot program to provide early-career hospitalists with feedback from a senior clinical advisor (SCA) at Massachusetts General Hospital. A Hospital Medicine Unit-wide retreat was held to help design the SCA role and obtain faculty buy-in. Twelve SCAs were recruited from hospitalists with more than five years of experience; each served as a clinical coach to 28 early-career hospitalists during the pilot. Clinical narratives and programmatic surveys were collected from SCAs and early-career hospitalists.

OUTCOMES:
Of 25 responding early-career hospitalists, 23 (92%) rated the SCA role as useful to very useful, 20 (80%) reported interactions with the SCA led to at least one change in their diagnostic approach, and 13 (52%) reported calling fewer subspecialty consults as a result of guidance from the SCA. In response to questions about professional development, 18 (72%) felt more comfortable as an independent physician following their interactions with the SCA, and 19 (76%) thought the interactions improved the quality of care they delivered.

NEXT STEPS:
To better understand the impact and generalizability of clinical coaching, a larger, longitudinal study is required to look at patient and provider outcomes in detail. Further refinement of the SCA role to meet faculty needs is needed and could include faculty development.

via Beyond Continuing Medical Education: Clinical Coaching as a Tool for Ongoing Professional Development. – PubMed – NCBI.

ABSTRACT: Virtual reality-based simulators for spine surgery: a systematic review

BACKGROUND CONTEXT:
Virtual reality (VR)-based simulators offer numerous benefits and are very useful in assessing and training surgical skills. Virtual reality-based simulators are standard in some surgical subspecialties, but their actual use in spinal surgery remains unclear. Currently, only technical reviews of VR-based simulators are available for spinal surgery.

PURPOSE:
Thus, we performed a systematic review that examined the existing research on VR-based simulators in spinal procedures. We also assessed the quality of current studies evaluating VR-based training in spinal surgery. Moreover, we wanted to provide a guide for future studies evaluating VR-based simulators in this field.

STUDY DESIGN AND SETTING:
This is a systematic review of the current scientific literature regarding VR-based simulation in spinal surgery.

METHODS:
Five data sources were systematically searched to identify relevant peer-reviewed articles regarding virtual, mixed, or augmented reality-based simulators in spinal surgery. A qualitative data synthesis was performed with particular attention to evaluation approaches and outcomes. Additionally, all included studies were appraised for their quality using the Medical Education Research Study Quality Instrument (MERSQI) tool.

RESULTS:
The initial review identified 476 abstracts and 63 full texts were then assessed by two reviewers. Finally, 19 studies that examined simulators for the following procedures were selected: pedicle screw placement, vertebroplasty, posterior cervical laminectomy and foraminotomy, lumbar puncture, facet joint injection, and spinal needle insertion and placement. These studies had a low-to-medium methodological quality with a MERSQI mean score of 11.47 out of 18 (standard deviation=1.81).

CONCLUSIONS:
This review described the current state and applications of VR-based simulator training and assessment approaches in spinal procedures. Limitations, strengths, and future advancements of VR-based simulators for training and assessment in spinal surgery were explored. Higher-quality studies with patient-related outcome measures are needed. To establish further adaptation of VR-based simulators in spinal surgery, future evaluations need to improve the study quality, apply long-term study designs, and examine non-technical skills, as well as multidisciplinary team training.

via Virtual reality-based simulators for spine surgery: a systematic review. – PubMed – NCBI.

ABSTRACT: Construction of Multiple Choice Questions Before and After An Educational Intervention

INTRODUCTION:
Khesar Gyalpo University of Medical Sciences of Bhutan, established in 2014, has ushered in a new era in medical education in Bhutan. Multiple Choice Questions are a common means of written assessment in medical education.

METHODS:
This was a quasi-experimental study conducted at the Faculty of Postgraduate Medicine, KGUMSB, Thimphu in December 2016. A total of 8 MCQs were prepared by four teaching faculties from different fields who had no prior training on construction of MCQs. It was delivered to a group of 16 randomly selected intern doctors. A 2 hours long workshop on construction of MCQs was conducted. After the workshop, the same MCQs were modified according to standard guidelines on developing MCQs and were tested in the same group of intern doctors. An analysis on the performance, difficulty factor, discrimination index and distractor analysis was done on the two sets of MCQs using Microsoft Excel and SPSS 20.0.

RESULTS:
For the pre- and post-workshop questions respectively, the pass percentage was 69.8% (11) and 81.3% (13), difficulty factor was 0.51 and 0.53, discrimination index was 0.59 and 0.47, distractor effectiveness was 83.3% and 74.9%.

CONCLUSIONS:
The workshop on MCQ development apparently seemed highly valuable and effective in changing the learning and performances of medical educators in the development of MCQs.

via Construction of Multiple Choice Questions Before and After An Educational Intervention. – PubMed – NCBI.

ABSTRACT: How preferred learning approaches change with time: a survey of GPs and GP Specialist Trainees

Background The Approaches and Study Skills Inventory for Students (ASSIST) questionnaire assesses whether learners prefer a deep, strategic or surface approach to learning. This study aimed to establish the effect of time since qualification, gender and work role on ASSIST scores of General Practitioners (GPs) and GP Specialist Trainees (GPSTs). Methods An anonymous online questionnaire with demographic questions and the ASSIST survey was completed by 1005 GPs and GPSTs from across the United Kingdom. Results Of the 544 GPs and 461 GPSTs completing the survey, 96.5% preferred a deep and/or strategic approach to learning. There was a significant increase in the preference for a deep approach with time from graduation and significantly less preference for a surface approach. There was no significant change in any of the scores over the GPST years. Men had significantly higher scores for a deep approach than women. Conclusions GPs and GPSTs prefer deep and strategic approaches to a surface approach. While higher levels of GP experience are associated with a higher deep approach score and a lower surface approach score, this change is not seen during progression through GP training. Men have higher scores for a deep approach than women.

via How preferred learning approaches change with time: a survey of GPs and GP Specialist Trainees. – PubMed – NCBI.

ABSTRACT: Objectively measured interprofessional education outcome and factors that enhance program effectiveness: A systematic review

Several studies have been conducted to evaluate the implementation of interprofessional education (IPE) across the globe. By looking at the timeline of each previous study, it can be inferred that the implementation of IPE has been improving continuously. However, the effectiveness of IPE still cannot be easily generalized due to misconceptions regarding how interprofessional collaboration capabilities should be evaluated. This study aims to generalize the learning outcomes that were produced by IPE in a global context and analyse the contributing factors. A systematic review was conducted within seven online databases as well as paperback periodical publications to search for the intended articles. A set of four criterions were assigned prior to the study using the standard Population-Intervention-Context-Outcome (PICO) model to ensure the included articles matched the study objectives. The quality of studies were appraised using the Medical Education Research Study Quality Improvement (MERSQI). Each included article was analysed using the narrative method to obtain the relevant information. Sixteen articles included in this study showed that IPE improved interprofessional collaborative knowledge, skills, and behaviour based on objective measurements. Complexity of the learning material, appropriateness of the program design, and referral to a specific standard of competence were assumed to play significant role towards the effectiveness of interprofessional education. This study results in several recommendation for future development of IPE, including a specific suggestion for its development in Asia region.

via Objectively measured interprofessional education outcome and factors that enhance program effectiveness: A systematic review. – PubMed – NCBI.

ABSTRACT: Subjective awareness of ultrasound expertise development: individual experience as a determinant of overconfidence

Medical decision-making requires years of experience in order to develop an adequate level of competence to successfully engage in safe practice. While diagnostic and technical skills are essential, an awareness of the extent and limits of our own knowledge and skills is critical. The present study examines clinicians’ subjective awareness in a diagnostic cardiac ultrasound task. Clinicians answered diagnostic and treatment related questions for a range of pathologies. Following these questions, clinicians indicated their level of confidence in their response. A comparison of response accuracy and confidence revealed that clinicians were generally overconfident in their responses. Critically, we observed that a clinician’s overconfidence was negatively correlated with prior experience: clinicians that had more prior experience expressed less overconfidence in their performance such that some clinicians were in fact underconfident. We discuss the implications for training in medical education and decision-making.

via Subjective awareness of ultrasound expertise development: individual experience as a determinant of overconfidence. – PubMed – NCBI.