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Author: Brian S McGowan, PhD

ABSTRACT: The Use of an Informational Video to Improve Patient Satisfaction, Preparedness, Mood, and Empowerment

BACKGROUND:
Massage therapy is commonly used in Canada for the treatment of a wide range of health concerns. Massage therapy is changing to meet the health care needs of Canadians. Rapid changes to the profession may create a gap between patient expectations of massage therapy treatment based on historic views of the profession and their experience in today’s practice. This gap could lead to patient confusion, dissatisfaction, or other negative outcomes.
PURPOSE:
This study sought to understand whether patient satisfaction, preparedness, mood, and patient empowerment are improved when new patients who attend a student massage therapy clinic watch an informational video, compared to those who receive the standard paper information sheet.
PARTICIPANTS:
The study used a convenience sample of new patients who presented for their first massage therapy appointment to the Humber College Student Massage Therapy Clinic. Participants were randomized either to the intervention group (video and paper information) or the comparison group (paper information only). The outcomes of interest in this study were patient preparedness, satisfaction, mood, and empowerment. Data were collected using two questionnaires, one before treatment and one after.
RESULTS:
A total of 108 patients participated in the study (55 comparison group; 53 intervention group). Demographic and clinical characteristics were comparable between the two groups. A statistically significant difference was seen between the two groups when comparing their responses to the pre-appointment statement: “I know what will happen in my initial massage therapy appointment” (p < .001). There was no statistically significant difference seen when comparing the responses of the related post-appointment statement (p = .63).
CONCLUSION:
This study found that an informational video improved perceived knowledge as patients entered the massage therapy treatment, but did not have a significant effect on satisfaction, mood, or patient empowerment. Other student clinics should consider the addition of an informational video to their procedures to increase patient knowledge of what to expect.

via The Use of an Informational Video to Improve Patient Satisfaction, Preparedness, Mood, and Empowerment. – PubMed – NCBI.

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MANUSCRIPT: Emotional intelligence as a crucial component to medical education.

OBJECTIVE:
The primary focus of this review was to discover what is already known about Emotional Intelligence (EI) and the role it plays within social relationships, as well as its importance in the fields of health care and health care education. This article analyzes the importance of EI in the field of health care and recommends various ways that this important skill can be built into medical programs.
METHODS:
Information was gathered using various database searches including EBSCOHOST, Academic Search Premier and ERIC. The search was conducted in English language journals from the last ten years. Descriptors include: Emotional Intelligence, medical students and communication skills, graduate medical education, Emotional Intelligence and graduate medical education, Emotional Intelligence training programs, program evaluation and development.
RESULTS:
Results of the study show a direct correlation between medical education and emotional intelligence competencies, which makes the field of medical education an ideal one in which to integrate further EI training.
CONCLUSIONS:
The definition of EI as an ability-based skill allows for training in specific competencies that can be directly applied to a specialized field. When EI is conceptualized as an ability that can be taught, learned, and changed, it may be used to address the specific aspects of the clinician-patient relationship that are not working well. For this reason, teaching EI should be a priority in the field of medical education in order to better facilitate this relationship in the future.

via Emotional intelligence as a crucial component to medical education. – PubMed – NCBI.

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ABSTRACT: Effect of Teachers Training Workshop Outcomes on Real Classroom Situations of Undergraduate Medical Students.

Faculty development by conducting regular training, workshops and research related to medical education has been a key feature to upgrade quality of medical education. Objective The aim of this study was to explore responses of the health science teachers, students and peers after the workshop after providing training on student assessment tools and teaching-learning methods. Method Two teacher-training workshops were conducted to the faculty members of B.P. Koirala Institute of Health Sciences from the departments of basic, clinical and allied sciences in Oct. 2010 and Jan. 2011. Qualitative questionnaire based study was conducted, and the questions were validated before the study by expert peer review process. The effect of the training workshop in real classroom outcomes was assessed incorporating student’s feedback, evaluation by peers and the self-evaluation by the teacher trainees. Result Pre-test and post-test scores of the participating teachers, before and after the workshop were 62.53 and 71.17 respectively. Among the participants 90.3% teachers expressed enhanced in their role as a teacher for medical undergraduates after the workshop. Conclusion In present study, the faculty members showed accrued interest to participate in teacher’s training workshops. The peer evaluation of teacher’s performance in their real classroom situations were rated higher than evaluation by the students. Therefore, such training workshops will have a greater impact on the ability of teachers in effective teaching in real classroom situations.

via Effect of Teachers Training Workshop Outcomes on Real Classroom Situations of Undergraduate Medical Students. – PubMed – NCBI.

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ABSTRACT: The effect of stress on learning in surgical skill acquisition.

BACKGROUND:
An excessive level of stress and anxiety in medical education can have a negative impact on learning. In particular, the interaction between attending surgeons and trainees in the operating room could induce stress on trainees that is counterproductive, especially if the teaching style or feedback is unduly harsh or critical.
AIM:
To characterize the effects of stress resulting from attending-trainee interaction during surgical skill acquisition.
METHODS:
Forty medical students learned to perform the FLS pattern-cutting task for the first time in one of four scenarios. In the control condition, no mentor was present. In the three experimental conditions, participants were observed, encouraged, or criticized by an expert surgeon.
RESULTS:
Task performance, as well as physiological and subjective indicators of stress, were measured. Taking both speed and accuracy into account, participants who were criticized performed the worst on the task, and those who were encouraged performed best. Physiological and subjective measures indicated that the criticized participants experienced the highest level of stress and anxiety.
CONCLUSION:
Even though providing constructive criticism to trainees is inevitable during the course of teaching, an exceedingly critical and negative mentoring style by attending physicians could be detrimental to trainees’ acquisition of surgical skills.

via The effect of stress on learning in surgical skill acquisition. – PubMed – NCBI.

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MANUSCRIPT: Evaluating the effectiveness of a peer-led education intervention to improve the patient safety attitudes of junior pharmacy students: a cross-sectional study using a latent growth curve modelling approach.

OBJECTIVE:
Despite the recognition that educating healthcare students in patient safety is essential, changing already full curricula can be challenging. Furthermore, institutions may lack the capacity and capability to deliver patient safety education, particularly from the start of professional practice studies. Using senior students as peer educators to deliver practice-based education can potentially overcome some of the contextual barriers in training junior students. Therefore, this study aimed to evaluate the effectiveness of a peer-led patient safety education programme for junior pharmacy students.
DESIGN:
A repeat cross-sectional design utilising a previously validated patient safety attitudinal survey was used to evaluate attitudes prior to, immediately after and 1 month after the delivery of a patient safety education programme. Latent growth curve (LGC) modelling was used to evaluate the change in attitudes of first-year students using second-year students as a comparator group.
SETTING:
Undergraduate university students in Sydney, Australia.
PARTICIPANTS:
175 first-year and 140 second-year students enrolled in the Bachelor of Pharmacy programme at the University of Sydney.
INTERVENTION:
An introductory patient safety programme was implemented into the first-year Bachelor of Pharmacy curriculum at the University of Sydney. The programme covered introductory patient safety topics including teamwork, communication skills, systems thinking and open disclosure. The programme consisted of 2 lectures, delivered by a senior academic, and a workshop delivered by trained final-year pharmacy students.
RESULTS:
A full LGC model was constructed including the intervention as a non-time-dependent predictor of change (χ(2) (51)=164.070, root mean square error of approximation=0.084, comparative fit index=0.913, standardised root mean square=0.056). First-year students’ attitudes significantly improved as a result of the intervention, particularly in relation to internalising errors (p=0.010), questioning behaviours (p<0.001) and open disclosure (p=0.008).
CONCLUSIONS:
Peer-led education is an effective method that can be adopted to improve junior pharmacy students’ attitudes towards patient safety.

via Evaluating the effectiveness of a peer-led education intervention to improve the patient safety attitudes of junior pharmacy students: a cross-sect… – PubMed – NCBI.

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MANUSCRIPT: Review of Simulation in Pediatrics: The Evolution of a Revolution.

Recent changes in medical education have highlighted the importance of experiential learning. Simulation is one model that has gained significant attention in the last decade and has been widely adopted as a training and assessment tool in medical education. Pediatric simulation has been utilized to teach various skills including resuscitation and trauma management, procedural skills, and team training. It is also a valuable tool for health care educators, as it allows learners to achieve competence without putting patients at risk. Recent literature demonstrates increased retention of knowledge and skills after simulation-based training. Further research is required to improve current simulation curriculums, develop validated assessment tools, and to demonstrate improved clinical outcomes after simulation-based training. We conducted an online search of original and review articles related to simulation and pediatric medical education and provide an overview of the role and utility of simulation in pediatrics. Key PointsSimulation in pediatrics has been widely accepted and adapted as a training and assessment tool in medical education.Simulation in pediatrics has been utilized to teach various skills including resuscitation and trauma management, procedural skills, and team training.Further research is required to improve current simulation curriculums, to develop validated assessment tools, and to demonstrate improved clinical outcomes after simulation-based training.

via Review of Simulation in Pediatrics: The Evolution of a Revolution. – PubMed – NCBI.

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ABSTRACT: ndividualized Performance Feedback to Surgical Residents Improves Appropriate Venous Thromboembolism Prophylaxis Prescription and Reduces Potentially Preventable VTE: A Prospective Cohort Study.

OBJECTIVE:To investigate the effect of providing personal clinical effectiveness performance feedback to general surgery residents regarding prescription of appropriate venous thromboembolism (VTE) prophylaxis.BACKGROUND:Residents are frequently charged with prescribing medications for patients, including VTE prophylaxis, but rarely receive individual performance feedback regarding these practice habits.METHODS:This prospective cohort study at the Johns Hopkins Hospital compared outcomes across 3 study periods: (1) baseline, (2) scorecard alone, and (3) scorecard plus coaching. All general surgery residents (n = 49) and surgical patients (n = 2420) for whom residents wrote admission orders during the first 9 months of the 2013-2014 academic year were included. Outcomes included the proportions of patients prescribed appropriate VTE prophylaxis, patients with preventable VTE, and residents prescribing appropriate VTE prophylaxis for every patient, and results from the Accreditation Council for Graduate Medical Education resident survey.RESULTS:At baseline, 89.4% of patients were prescribed appropriate VTE prophylaxis and only 45% of residents prescribed appropriate prophylaxis for every patient. During the scorecard period, appropriate VTE prophylaxis prescription significantly increased to 95.4% (P < 0.001). For the scorecard plus coaching period, significantly more residents prescribed appropriate prophylaxis for every patient (78% vs 45%, P = 0.0017). Preventable VTE was eliminated in both intervention periods (0% vs 0.35%, P = 0.046). After providing feedback, significantly more residents reported receiving data about practice habits on the Accreditation Council for Graduate Medical Education resident survey (87% vs 38%, P < 0.001).CONCLUSIONS:Providing personal clinical effectiveness feedback including data and peer-to-peer coaching improves resident performance, and results in a significant reduction in harm for patients.

via Individualized Performance Feedback to Surgical Residents Improves Appropriate Venous Thromboembolism Prophylaxis Prescription and Reduces Potentia… – PubMed – NCBI.

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ABSTRACT: Teaching and learning of medical biochemistry according to clinical realities: A case study

To foster medical students to become physicians who will be lifelong independent learners and critical thinkers with healthy skepticism and provide high-quality patient care guided by the best evidence, teaching of evidence-based medicine (EBM) has become an important component of medical education. Currently, the teaching and learning of biochemistry in medical schools incorporates its medical relevance and applications. However, to our knowledge there have been no reports on integrating EBM with teaching and learning medical biochemistry. Here, we present a case study to illustrate the significance of this approach. This case study was based on a biochemistry/nutrition question in a popular board review book about whether a homeless alcoholic man is at risk of developing a deficiency of vitamin E. The possible answers and explanation provided in the book raised a question about the correct answer, which provided us with an opportunity to adapt the philosophy and certain basic EBM principles to find evidence for the clinical applicability of a commonly taught biochemistry topic. The outcome of this case study not only taught us how to conduct an EBM exercise to answer a specific patient question, but also provided us with an opportunity for in-depth teaching and learning of the medical relevance of a specific biochemistry topic based on the best clinical evidence obtained from a systematic research of medical literature.

via Teaching and learning of medical biochemistry according to clinical realities: A case study. – PubMed – NCBI.

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MANUSCRIPT: Morbidity and Mortality Conference in Emergency Medicine Residencies and the Culture of Safety

INTRODUCTION:
Morbidity and mortality conferences (M+M) are a traditional part of residency training and mandated by the Accreditation Counsel of Graduate Medical Education. This study’s objective was to determine the goals, structure, and the prevalence of practices that foster strong safety cultures in the M+Ms of U.S. emergency medicine (EM) residency programs.
METHODS:
The authors conducted a national survey of U.S. EM residency program directors. The survey instrument evaluated five domains of M+M (Organization and Infrastructure; Case Finding; Case Selection; Presentation; and Follow up) based on the validated Agency for Healthcare Research & Quality Safety Culture survey.
RESULTS:
There was an 80% (151/188) response rate. The primary objectives of M+M were discussing adverse outcomes (53/151, 35%), identifying systems errors (47/151, 31%) and identifying cognitive errors (26/151, 17%). Fifty-six percent (84/151) of institutions have anonymous case submission, with 10% (15/151) maintaining complete anonymity during the presentation and 21% (31/151) maintaining partial anonymity. Forty-seven percent (71/151) of programs report a formal process to follow up on systems issues identified at M+M. Forty-four percent (67/151) of programs report regular debriefing with residents who have had their cases presented.
CONCLUSION:
The structure and goals of M+Ms in EM residencies vary widely. Many programs lack features of M+M that promote a non-punitive response to error, such as anonymity. Other programs lack features that support strong safety cultures, such as following up on systems issues or reporting back to residents on improvements. Further research is warranted to determine if M+M structure is related to patient safety culture in residency programs.

via Morbidity and Mortality Conference in Emergency Medicine Residencies and the Culture of Safety. – PubMed – NCBI.

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ABSTRACT: An investigation into the optimal number of distractors in single-best answer exams

In UK medical schools, five-option single-best answer (SBA) questions are the most widely accepted format of summative knowledge assessment. However, writing SBA questions with four effective incorrect options is difficult and time consuming, and consequently, many SBAs contain a high frequency of implausible distractors. Previous research has suggested that fewer than five-options could hence be used for assessment, without deterioration in quality. Despite an existing body of empirical research in this area however, evidence from undergraduate medical education is sparse. The study investigated the frequency of non-functioning distractors in a sample of 480 summative SBA questions at Cardiff University. Distractor functionality was analysed, and then various question models were tested to investigate the impact of reducing the number of distractors per question on examination difficulty, reliability, discrimination and pass rates. A survey questionnaire was additionally administered to 108 students (33 % response rate) to gain insight into their perceptions of these models. The simulation of various exam models revealed that, for four and three-option SBA models, pass rates, reliability, and mean item discrimination remained relatively constant. The average percentage mark however consistently increased by 1-3 % with the four and three-option models, respectively. The questionnaire survey revealed that the student body had mixed views towards the proposed format change. This study is one of the first to comprehensively investigate distractor performance in SBA examinations in undergraduate medical education. It provides evidence to suggest that using three-option SBA questions would maximise efficiency whilst maintaining, or possibly improving, psychometric quality, through allowing a greater number of questions per exam paper.

via An investigation into the optimal number of distractors in single-best answer exams. – PubMed – NCBI.

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