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Author: Brian S McGowan, PhD

ABSTRACT: A “Resident-as-Teacher” Curriculum Using a Flipped Classroom Approach: Can a Model Designed for Efficiency Also Be Effective?

PROBLEM:
The Accreditation Council for Graduate Medical Education requires training that enhances resident teaching skills. Despite this requirement, many residency training programs struggle to implement effective resident-as-teacher (RAT) curricula, particularly within the context of the 80-hour resident workweek.
APPROACH:
In 2013, the authors developed and evaluated an intensive one-day RAT curriculum using a flipped classroom approach. Twenty-nine second-year residents participated in daylong RAT sessions. The curriculum included four 1-hour workshops focusing on adult learning principles, giving feedback, teaching a skill, and orienting a learner. Each workshop, preceded by independent reading, featured peer co-teaching, application, and feedback. The authors evaluated the curriculum using pre- and postworkshop objective structured teaching examinations (OSTEs) and attitudinal and self-efficacy teaching questionnaires.
OUTCOMES:
Residents demonstrated statistically significant improvements in performance between pre- and postworkshop OSTEs on each of three core skills: giving feedback (P = .005), orienting a learner (P < .001), and teaching a skill (P < .001). Residents expressed positive attitudes surrounding teaching on the retrospective pre-post attitudinal instrument (P < .001) and rated themselves as more effective teachers (P < .001) after the training.
NEXT STEPS:
The authors have demonstrated that the flipped classroom approach is an efficient and effective method for training residents to improve teaching skills, especially in an era of work hour restrictions. They have committed to the continuation of this curriculum and are planning to include assessment of its long-term effects on resident behavior change and educational outcomes.

via A “Resident-as-Teacher” Curriculum Using a Flipped Classroom Approach: Can a Model Designed for Efficiency Also Be Effective? – PubMed – NCBI.

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MANUSCRIPT: eLearning to facilitate the education and implementation of the Chelsea Critical Care Physical Assessment

OBJECTIVE:
To evaluate the efficacy of eLearning in the widespread standardised teaching, distribution and implementation of the Chelsea Critical Care Physical Assessment (CPAx) tool-a validated tool to assess physical function in critically ill patients.
DESIGN:
Prospective educational study. An eLearning module was developed through a conceptual framework, using the four-stage technique for skills teaching to teach clinicians how to use the CPAx. Example and test video case studies of CPAx assessments were embedded within the module. The CPAx scores for the test case studies and demographic data were recorded in a secure area of the website. Data were analysed for inter-rater reliability using intraclass correlation coefficients (ICCs) to see if an eLearning educational package facilitated consistent use of the tool. A utility and content validity questionnaire was distributed after 1 year to eLearning module registrants (n=971). This was to evaluate uptake of the CPAx in clinical practice and content validity of the CPAx from the perspective of clinical users.
SETTING:
The module was distributed for use via professional forums (n=2) and direct contacts (n=95).
PARTICIPANTS:
Critical care clinicians.
PRIMARY OUTCOME MEASURE:
ICC of the test case studies.
RESULTS:
Between July and October 2014, 421 candidates from 15 countries registered for the eLearning module. The ICC for case one was 0.996 (95% CI 0.990 to 0.999; n=207). The ICC for case two was 0.988 (0.996 to 1.000; n=184). The CPAx has a strong total scale content validity index (s-CVI) of 0.94 and is well used.
CONCLUSIONS:
eLearning is a useful and reliable way of teaching psychomotor skills, such as the CPAx. The CPAx is a well-used measure with high content validity rated by clinicians.

via eLearning to facilitate the education and implementation of the Chelsea Critical Care Physical Assessment: a novel measure of function in critical … – PubMed – NCBI.

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MANUSCRIPT: Social Media in Health Science Education: An International Survey

BACKGROUND:
Social media is an asset that higher education students can use for an array of purposes. Studies have shown the merits of social media use in educational settings; however, its adoption in health science education has been slow, and the contributing reasons remain unclear.
OBJECTIVE:
This multidisciplinary study aimed to examine health science students’ opinions on the use of social media in health science education and identify factors that may discourage its use.
METHODS:
Data were collected from the Universitas 21 “Use of social media in health education” survey, distributed electronically among the health science staff and students from 8 universities in 7 countries. The 1640 student respondents were grouped as users or nonusers based on their reported frequency of social media use in their education.
RESULTS:
Of the 1640 respondents, 1343 (81.89%) use social media in their education. Only 462 of the 1320 (35.00%) respondents have received specific social media training, and of those who have not, the majority (64.9%, 608/936) would like the opportunity. Users and nonusers reported the same 3 factors as the top barriers to their use of social media: uncertainty on policies, concerns about professionalism, and lack of support from the department. Nonusers reported all the barriers more frequently and almost half of nonusers reported not knowing how to incorporate social media into their learning. Among users, more than one fifth (20.5%, 50/243) of students who use social media “almost always” reported sharing clinical images without explicit permission.
CONCLUSIONS:
Our global, interdisciplinary study demonstrates that a significant number of students across all health science disciplines self-reported sharing clinical images inappropriately, and thus request the need for policies and training specific to social media use in health science education.

via Social Media in Health Science Education: An International Survey. – PubMed – NCBI.

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MANUSCRIPT: Insights into Global Health Practice from the Agile Software Development Movement

Global health practitioners may feel frustration that current models of global health research, delivery, and implementation are overly focused on specific interventions, slow to provide health services in the field, and relatively ill-equipped to adapt to local contexts. Adapting design principles from the agile software development movement, we propose an analogous approach to designing global health programs that emphasizes tight integration between research and implementation, early involvement of ground-level health workers and program beneficiaries, and rapid cycles of iterative program improvement. Using examples from our own fieldwork, we illustrate the potential of ‘agile global health’ and reflect on the limitations, trade-offs, and implications of this approach.

via Insights into Global Health Practice from the Agile Software Development Movement. – 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: Training the Workforce: Description of a Longitudinal Interdisciplinary Education and Mentoring Program in Palliative Care.

CONTEXT:
The rapid increase in demand for palliative care (PC) services has led to concerns regarding workforce shortages and threats to the resiliency of PC teams.
OBJECTIVES:
To describe the development, implementation, and evaluation of a regional interdisciplinary training program in PC.
METHODS:
Thirty nurse and physician “fellows” representing 22 health systems across the Chicago region participated in a two-year PC training program. The curriculum was delivered through multiple conferences, self-directed e-learning, and individualized mentoring by expert local faculty (“mentors”). Fellows shadowed mentors’ clinical practices and received guidance on designing, implementing and evaluating a practice improvement project (PIP) to address gaps in PC at their institutions.
RESULTS:
Enduring, interdisciplinary relationships were built at all levels across health care organizations. Fellows made significant increases in knowledge and self-reported confidence in adult and pediatric PC and program development skills, and frequency performing these skills. Fellows and mentors reported high satisfaction with the educational program.
CONCLUSION:
This interdisciplinary PC training model addressed local workforce issues by increasing the number of clinicians capable of providing palliative care. Unique features include individualized longitudinal mentoring, interdisciplinary education, on-site project implementation, and local network-building. Future research will address the impact of the addition of social work and chaplain trainees to the program.

via Training the Workforce: Description of a Longitudinal Interdisciplinary Education and Mentoring Program in Palliative Care. – PubMed – NCBI.

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ABSTRACT: Ensuring the quality of multiple-choice exams administered to small cohorts: A cautionary tale

INTRODUCTION:Multiple-choice questions (MCQs) are a cornerstone of assessment in medical education. Monitoring item properties (difficulty and discrimination) are important means of investigating examination quality. However, most item property guidelines were developed for use on large cohorts of examinees; little empirical work has investigated the suitability of applying guidelines to item difficulty and discrimination coefficients estimated for small cohorts, such as those in medical education. We investigated the extent to which item properties vary across multiple clerkship cohorts to better understand the appropriateness of using such guidelines with small cohorts.METHODS:Exam results for 32 items from an MCQ exam were used. Item discrimination and difficulty coefficients were calculated for 22 cohorts (n = 10-15 students). Discrimination coefficients were categorized according to Ebel and Frisbie (1991). Difficulty coefficients were categorized according to three guidelines by Laveault and Grégoire (2014). Descriptive analyses examined variance in item properties across cohorts.RESULTS:A large amount of variance in item properties was found across cohorts. Discrimination coefficients for items varied greatly across cohorts, with 29/32 (91%) of items occurring in both Ebel and Frisbie’s ‘poor’ and ‘excellent’ categories and 19/32 (59%) of items occurring in all five categories. For item difficulty coefficients, the application of different guidelines resulted in large variations in examination length (number of items removed ranged from 0 to 22).DISCUSSION:While the psychometric properties of items can provide information on item and exam quality, they vary greatly in small cohorts. The application of guidelines with small exam cohorts should be approached with caution.

via Ensuring the quality of multiple-choice exams administered to small cohorts: A cautionary tale. – PubMed – NCBI.

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2016 Taught Us That Learning IS A Behavior

Of all the things we learned in 2016, one lesson should forever change the way education is designed and delivered: Learning is a Behavior.

For as long as educators have been designing education for healthcare professionals (really all adult learners), the idea has been that if the content is effectively aligned with educational needs then learners will learn..and, if you follow some general principles, then that learning can be optimized.

Were it only that easy!

Our learners are overwhelmed: time is short, life gets in the way, they are distracted…yet we soldier on clinging to this idea that if content is aligned then the ‘self-directed’ and ‘autonomous’ nature of adults learners will bolster learning.

overwhelmed-learners

 

This assumption has haunted me for years – its why I conducted the Learning Actions research and its why I started ArcheMedX – our vision and model is grounded in the notion that learning isn’t necessarily all that easy and that the ‘actions’ critical to learning need to be supported and nudged.

Like any other complex behavior, we humans sometimes get it right. But more often than not, when push comes to shove, we will struggle to make the decisions and take the actions that are in our best interest. We overlook our limitations and we overstate our discipline. As a result, we make bad choices when it comes to eating, exercising, shopping, relationships.  Perhaps nothing better defines our humanity than our irrationality!

My guess is that nothing in that prior paragraph comes as a surprise.. What is new is the notion that these same challenges often undermine how we learn. (Let that soak in for a second….)

Understanding and accepting this reality is game-changing. I’d go so far as to say that the ‘Learning is a Behavior’ idea provides us great promise – because the same solutions that have been demonstrated to improve and support our general behavioral decisions are the same solutions that we now know improve and support our learning behaviors.

With each Partner, each Initiative, each Activity, and each designed learning moment crafted within the ArcheViewer we have demonstrated the impact of nudging better learning behaviors.

In the end, accepting that learning is a behavior is uniquely empowering – we, as the designers of the learning experience, now have critical control over the learning actions that are taken.

Thank you for helping us prove this point!

 

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ABSTRACT: Clinical Research Informatics for Big Data and Precision Medicine

OBJECTIVES:
To reflect on the notable events and significant developments in Clinical Research Informatics (CRI) in the year of 2015 and discuss near-term trends impacting CRI.
METHODS:
We selected key publications that highlight not only important recent advances in CRI but also notable events likely to have significant impact on CRI activities over the next few years or longer, and consulted the discussions in relevant scientific communities and an online living textbook for modern clinical trials. We also related the new concepts with old problems to improve the continuity of CRI research.
RESULTS:
The highlights in CRI in 2015 include the growing adoption of electronic health records (EHR), the rapid development of regional, national, and global clinical data research networks for using EHR data to integrate scalable clinical research with clinical care and generate robust medical evidence. Data quality, integration, and fusion, data access by researchers, study transparency, results reproducibility, and infrastructure sustainability are persistent challenges.
CONCLUSION:
The advances in Big Data Analytics and Internet technologies together with the engagement of citizens in sciences are shaping the global clinical research enterprise, which is getting more open and increasingly stakeholder-centered, where stakeholders include patients, clinicians, researchers, and sponsors.

via Clinical Research Informatics for Big Data and Precision Medicine. – PubMed – NCBI.

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MANUSCRIPT: Attitudes and Perceptions of Medical Undergraduates Towards Mobile Learning (M-learning)

NTRODUCTION:
Mobile technology is one of the latest extensions of technological innovations that can be integrated into medical education. With the aid of these devices, students learn faster outside the classroom by having quick access to the internet and easy retrieval of required health related learning resources to keep alongside of recent trend and development. In medicine practice one has to continuously update his/her medical knowledge and mobile learning will serve as a tool for self-directed learning.
AIM:
To explore the attitudes and perceptions of undergraduate students towards M-learning.
MATERIALS AND METHODS:
This educational research included 90 third year MBBS students having clinical posting under the Department of Community Medicine from tertiary healthcare institute in Nashik. Students learning approach was studied with the help of pre-validated questionnaire to know whether they have deep or surface approach to learning. M-learning group was formed on mobile social app to supplement conventional teaching-learning. One subject topic (Tuberculosis, Dengue fever/DHF, Hypertension and Diabetes Mellitus etc.) per week was allotted and after conventional teaching on first day of week the learning materials for the topic chosen for that week were uploaded on the group and students could download as well as share their ideas, learning resources, ask doubts and answer questions at least twice weekly through this mobile platform anytime, anywhere. At the end of three months students attitudes and perceptions towards M-learning were studied by pre-validated structured questionnaires. A five point Likert scale was used (5= strongly agree to 1= strongly disagree) for answering each item of all three questionnaires. The score of 60% (90 out of 150) and the score of 75% (30 out of 40) for each item was considered as the measure that indicates whether or not the student had a positive attitude and perceived the importance of M-learning respectively. Utilisation of M-learning was also studied.
RESULTS:
It was found that 47 (52.2%) students had deep learning approach, 10 (11.1%) students had surface learning approach. An 80% of students had positive attitude towards M-learning and 76.7% students had perceived the importance of M-learning. A 52.2% of students were actively involved in M-learning group for learning purpose. But 57.8% students did not download (at least twice weekly) the shared reference material, 38.9% students never read and/or replied to the questions asked and 60.0% students never asked any doubts/questions related to the discussion.
CONCLUSION:
Students had positive attitude and perceived the importance of M-learning. But when they were provided with the opportunity, they did not show appreciable M-learning utilization. This could be because, M-learning was not implemented by all departments; also it was not the part of student’s regular assessment and probably a lesser study duration.

via Attitudes and Perceptions of Medical Undergraduates Towards Mobile Learning (M-learning). – PubMed – NCBI.

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