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Author: Brian S McGowan, PhD

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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MANUSCRIPT: Using Technology, Bioinformatics and Health Informatics Approaches to Improve Learning Experiences in Optometry Education, Research and Practice

Rapid advances in ocular diagnostic approaches and emerging links of pathological changes in the eye with systemic disorders have widened the scope of optometry as the front line of eye health care. Expanding professional requirements stipulate that optometry students get a meticulous training in relevant information and communication technologies (ICT) and various bioinformatics and health informatics software to meet current and future challenges. Greater incorporation of ICT approaches in optometry education can facilitate increased student engagement in shared learning experiences and improve collaborative learning. This, in turn, will enable students to participate in and prepare for the complex real-world situations. A judicious use of ICTs by teachers in learning endeavors can help students develop innovative patterns of thinking to be a successful optometry professional. ICT-facilitated learning enables students and professionals to carry out their own research and take initiatives and thus shifts the equilibrium towards self-education. It is important that optometry and allied vision science schools adapt to the changing professional requirements with pedagogical evolution and react appropriately to provide the best educational experience for the students and teachers. This review aims to highlight the scope of ICT applications in optometry education and professional development drawing from similar experiences in other disciplines. Further, while enhanced use of ICT in optometry has the potential to create opportunities for transformative learning experiences, many schools use it merely to reinforce conventional teaching practices. Tremendous developments in ICT should allow educators to consider using ICT tools to enhance communication as well as providing a novel, richer, and more meaningful medium for the comprehensive knowledge construction in optometry and allied health disciplines.

via Using Technology, Bioinformatics and Health Informatics Approaches to Improve Learning Experiences in Optometry Education, Research and Practice. – PubMed – NCBI.

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MANUSCRIPT: Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training

BACKGROUND:
Patient safety training often provides learners with a health professional’s perspective rather than the patient’s. Personal narratives of health-related harm allow patients to share their stories with health professionals to influence clinical behaviour by rousing emotions and improving attitudes to safety.
AIM:
This study measured the impact of patient narratives used to train junior doctors in patient safety.
METHODS:
An open, multi-centre, two-arm, parallel design randomised controlled trial was conducted in the North Yorkshire East Coast Foundation School (NYECFS). The intervention consisted of 1-h-long patient narratives followed by discussion. The control arm received conventional faculty-delivered teaching. The Attitude to Patient Safety Questionnaire (APSQ) and the Positive and Negative Affect Schedule (PANAS) were used to measure the impact of the intervention.
RESULTS:
142 trainees received the intervention; 141 the control teaching. There was no evidence of a difference in post-intervention APSQ scores between the groups. There was a statistically significant difference in the underlying distribution of both post PA (positive affect) and post NA (negative affect) scores between the groups on the PANAS (p<0.001) with indications of both higher PA and NA scores in the intervention group.
CONCLUSIONS:
Involving patients with experiences of safety incidents in training has an ideological appeal and seems an obvious choice in designing safety interventions. On the basis of our primary outcome measure, we were unable to demonstrate effectiveness of the intervention in changing general attitudes to safety compared to control. While the intervention may impact on emotional engagement and learning about communication, we remain uncertain whether this will translate into improved behaviours in the clinical context or indeed if there are any negative effects.

via Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in trai… – PubMed – NCBI.

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MANUSCRIPT: Key characteristics of successful quality improvement curricula in physician education: a realist review

PURPOSE:
Quality improvement (QI) is a common competency that must be taught in all physician training programmes, yet, there is no clear best approach to teach this content in clinical settings. We conducted a realist systematic review of the existing literature in QI curricula within the clinical setting, highlighting examples of trainees learning QI by doing QI.
METHOD:
Candidate theories describing successful QI curricula were articulated a priori. We searched MEDLINE (1 January 2000 to 12 March 2013), the Cochrane Library (2013) and Web of Science (15 March 2013) and reviewed references of prior systematic reviews. Inclusion criteria included study design, setting, population, interventions, clinical and educational outcomes. The data abstraction tool included categories for setting, population, intervention, outcomes and qualitative comments. Themes were iteratively developed and synthesised using realist review methodology. A methodological quality tool assessed the biases, confounders, secular trends, reporting and study quality.
RESULTS:
Among 39 studies, most were before-after design with resident physicians as the primary population. Twenty-one described clinical interventions and 18 described educational interventions with a mean intervention length of 6.58 (SD=9.16) months. Twenty-eight reported successful clinical improvements; no studies reported clinical outcomes that worsened. Characteristics of successful clinical QI curricula include attention to the interface of educational and clinical systems, careful choice of QI work for the trainees and appropriately trained local faculty.
CONCLUSIONS:
This realist review identified success characteristics to guide training programmes, medical schools, faculty, trainees, accrediting organisations and funders to further develop educational and improvement resources in QI educational programmes.

via Key characteristics of successful quality improvement curricula in physician education: a realist review. – PubMed – NCBI.

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MANUSCRIPT: Visual analytics in medical education: impacting analytical reasoning and decision making for quality improvement

The medical curriculum is the main tool representing the entire undergraduate medical education. Due to its complexity and multilayered structure it is of limited use to teachers in medical education for quality improvement purposes. In this study we evaluated three visualizations of curriculum data from a pilot course, using teachers from an undergraduate medical program and applying visual analytics methods. We found that visual analytics can be used to positively impacting analytical reasoning and decision making in medical education through the realization of variables capable to enhance human perception and cognition on complex curriculum data. The positive results derived from our evaluation of a medical curriculum and in a small scale, signify the need to expand this method to an entire medical curriculum. As our approach sustains low levels of complexity it opens a new promising direction in medical education informatics research.

via Visual analytics in medical education: impacting analytical reasoning and decision making for quality improvement. – PubMed – NCBI.

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