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Author: Brian S McGowan, PhD

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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MANUSCRIPT: A mixed-method research to investigate the adoption of mobile devices and Web2.0 technologies among medical students and educators

ACKGROUND:
The past decade has witnessed the increasing adoption of Web 2.0 technologies in medical education. Recently, the notion of digital habitats, Web 2.0 supported learning environments, has also come onto the scene. While there has been initial research on the use of digital habitats for educational purposes, very limited research has examined the adoption of digital habitats by medical students and educators on mobile devices. This paper reports the Stage 1 findings of a two-staged study. The whole study aimed to develop and implement a personal digital habitat, namely digiMe, for medical students and educators at an Australian university. The first stage, however, examined the types of Web 2.0 tools and mobile devices that are being used by potential digiMe users, and reasons for their adoption.
METHODS:
In this first stage of research, data were collected through a questionnaire and semi-structured interviews. Questionnaire data collected from 104 participants were analysed using the Predictive Analytics SoftWare (PASW). Frequencies, median and mean values were pursued. Kruskal Wallis tests were then performed to examine variations between views of different participant groups. Notes from the 6 interviews, together with responses to the open-ended section of the questionnaire, were analysed using the constructivist grounded theory approach, to generate key themes relevant to the adoption of Web 2.0 tools and mobile devices.
RESULTS:
The findings reflected the wide use of mobile devices, including both smart phones and computing tablets, by medical students and educators for learning, teaching and professional development purposes. Among the 22 types of Web 2.0 tools investigated, less than half of these tools were frequently used by the participants, this reflects the mismatch between users’ desires and their actual practice. Age and occupation appeared to be the influential factors for their adoption. Easy access to information and improved communication are main purposes.
CONCLUSIONS:
This paper highlights the desire of medical students and educators for a more effective use of Web 2.0 technologies and mobile devices, and the observed mismatch between the desire and their actual practice. It also recognises the critical role of medical education institutions in facilitating this practice to respond to the mismatch.

via A mixed-method research to investigate the adoption of mobile devices and Web2.0 technologies among medical students and educators. – PubMed – NCBI.

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ABSTRACT: From chalkboard, slides, and paper to e-learning: How computing technologies have transformed anatomical sciences education

Until the late-twentieth century, primary anatomical sciences education was relatively unenhanced by advanced technology and dependent on the mainstays of printed textbooks, chalkboard- and photographic projection-based classroom lectures, and cadaver dissection laboratories. But over the past three decades, diffusion of innovations in computer technology transformed the practices of anatomical education and research, along with other aspects of work and daily life. Increasing adoption of first-generation personal computers (PCs) in the 1980s paved the way for the first practical educational applications, and visionary anatomists foresaw the usefulness of computers for teaching. While early computers lacked high-resolution graphics capabilities and interactive user interfaces, applications with video discs demonstrated the practicality of programming digital multimedia linking descriptive text with anatomical imaging. Desktop publishing established that computers could be used for producing enhanced lecture notes, and commercial presentation software made it possible to give lectures using anatomical and medical imaging, as well as animations. Concurrently, computer processing supported the deployment of medical imaging modalities, including computed tomography, magnetic resonance imaging, and ultrasound, that were subsequently integrated into anatomy instruction. Following its public birth in the mid-1990s, the World Wide Web became the ubiquitous multimedia networking technology underlying the conduct of contemporary education and research. Digital video, structural simulations, and mobile devices have been more recently applied to education. Progressive implementation of computer-based learning methods interacted with waves of ongoing curricular change, and such technologies have been deemed crucial for continuing medical education reforms, providing new challenges and opportunities for anatomical sciences educators.

via From chalkboard, slides, and paper to e-learning: How computing technologies have transformed anatomical sciences education. – PubMed – NCBI.

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ABSTRACT: Online dissection audio-visual resources for human anatomy: Undergraduate medical students’ usage and learning outcomes

In an attempt to improve undergraduate medical student preparation for and learning from dissection sessions, dissection audio-visual resources (DAVR) were developed. Data from e-learning management systems indicated DAVR were accessed by 28% ± 10 (mean ± SD for nine DAVR across three years) of students prior to the corresponding dissection sessions, representing at most 58% ± 20 of assigned dissectors. Approximately 50% of students accessed all available DAVR by the end of semester, while 10% accessed none. Ninety percent of survey respondents (response rate 58%) generally agreed that DAVR improved their preparation for and learning from dissection when used. Of several learning resources, only DAVR usage had a significant positive correlation (P = 0.002) with feeling prepared for dissection. Results on cadaveric anatomy practical examination questions in year 2 (Y2) and year 3 (Y3) cohorts were 3.9% (P < 0.001, effect size d = -0.32) and 0.3% lower, respectively, with DAVR available compared to previous years. However, there were positive correlations between students’ cadaveric anatomy question scores with the number and total time of DAVR viewed (Y2, r = 0.171, 0.090, P = 0.002, n.s., respectively; and Y3, r = 0.257, 0.253, both P < 0.001). Students accessing all DAVR scored 7.2% and 11.8% higher than those accessing none (Y2, P = 0.015, d = 0.48; and Y3, P = 0.005, d = 0.77, respectively). Further development and promotion of DAVR are needed to improve engagement and learning outcomes of more students.

via Online dissection audio-visual resources for human anatomy: Undergraduate medical students’ usage and learning outcomes. – PubMed – NCBI.

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ABSTRACT: Practical trials in medical education: linking theory, practice and decision making

CONTEXT:
Concerns have been raised over the gap between education theory and practice and how research can contribute to inform decision makers on their choices and priorities. Little is known about how educational theories and research outcomes produced under optimal conditions in highly controlled settings generalise to the real-life education context. One way of bridging this gap is applying the concept of practical trials in medical education. In this paper we elaborate on characteristics of practical trials and based on examples from medical education we discuss the challenges, limitations and future directions for this kind of research.
CURRENT STATE:
Practical trials have the overall aim of informing decision makers. They are carried out in real-life settings and are characterised by (i) comparison of viable alternative education strategies, (ii) broad inclusion criteria regarding participants across several settings and (iii) multiple outcome measures with long-term follow-up to evaluate both benefits and risks. Questions posed by practical trials may be proactive in applying theory in the development of educational innovations or reactive to educational reforms and innovations. Non-inferiority or equivalence designs are recommended when comparing viable alternatives and the use of crossover designs, cluster randomisation or stepped wedge trial designs are feasible when studying implementations across several settings. Outcome measures may include variables related to learners, teachers, educational administration, quality of care, patient outcomes and cost.
CONCLUSIONS:
Practical trials in medical education may contribute to bridge the gap between education theory and practice and aid decision makers in making evidence-based choices and priorities. Conducting practical trials is not without challenges and rigorous design and methods must be applied. Of concern is that the practical focus may lead to failure to include a sound theoretical basis in the research questions and the interventions studied, and that authors fail to obtain informed consent from their participants.

via Practical trials in medical education: linking theory, practice and decision making. – PubMed – NCBI.

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ABSTRACT: Variation in general practitioners’ information-seeking behaviour – a cross-sectional study

OBJECTIVE:
To assess general practitioners’ (GPs’) information-seeking behaviour and perceived importance of sources of scientific medical information and to investigate associations with GP characteristics.
DESIGN:
A national cross-sectional survey was distributed electronically in December 2013.
SETTING:
Danish general practice.
SUBJECTS:
A population of 3440 GPs (corresponding to approximately 96% of all Danish GPs).
MAIN OUTCOME MEASURES:
GPs’ use and perceived importance of information sources. Multilevel mixed-effects logit models were used to investigate associations with GP characteristics after adjusting for relevant covariates.
RESULTS:
A total of 1580 GPs (46.4%) responded to the questionnaire. GPs’ information-seeking behaviour is associated with gender, age and practice form. Single-handed GPs use their colleagues as an information source significantly less than GPs working in partnership practices and they do not use other sources more frequently. Compared with their younger colleagues, GPs aged above 44 years are less likely to seek information from colleagues, guidelines and websites, but more likely to seek information from medical journals. Male and female GPs seek information equally frequently. However, whereas male GPs are more likely than female GPs to find that pharmaceutical sales representative and non-refundable CME meetings are important, they are less likely to find that colleagues, refundable CME meetings, guidelines and websites are important.
CONCLUSION:
Results from this study indicate that GP characteristics should be taken into consideration when disseminating scientific medical information, to ensure that patients receive medically updated, high-quality care. KEY POINTS Research indicates that information-seeking behaviour is associated with GP characteristics. Further insights could provide opportunities for targeting information dissemination strategies. Single-handed GPs seek information from colleagues less frequently than GPs in partnerships and do not use other sources more frequently. GPs aged above 44 years do not seek information as frequently as their younger colleagues and prefer other information sources. Male and female GPs seek information equally frequently, but do not consider information sources equally important in keeping medically updated.

via Variation in general practitioners’ information-seeking behaviour – a cross-sectional study on the influence of gender, age and practice form. – PubMed – NCBI.

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ABSTRACT: Improving Learner Handovers in Medical Education

Multiple studies have demonstrated that the information included in the Medical Student Performance Evaluation fails to reliably predict medical students’ future performance. This faulty transfer of information can lead to harm when poorly prepared students fail out of residency or, worse, are shuttled through the medical education system without an honest accounting of their performance. Such poor learner handovers likely arise from two root causes: (1) the absence of agreed-on outcomes of training and/or accepted assessments of those outcomes, and (2) the lack of standardized ways to communicate the results of those assessments. To improve the current learner handover situation, an authentic, shared mental model of competency is needed; high-quality tools to assess that competency must be developed and tested; and transparent, reliable, and safe ways to communicate this information must be created.To achieve these goals, the authors propose using a learner handover process modeled after a patient handover process. The CLASS model includes a description of the learner’s Competency attainment, a summary of the Learner’s performance, an Action list and statement of Situational awareness, and Synthesis by the receiving program. This model also includes coaching oriented towards improvement along the continuum of education and care. Just as studies have evaluated patient handover models using metrics that matter most to patients, studies must evaluate this learner handover model using metrics that matter most to providers, patients, and learners.

via Improving Learner Handovers in Medical Education. – PubMed – NCBI.

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