Author: Brian S McGowan, PhD

ABSTRACT: Application of flipped classroom pedagogy to the human gross anatomy laboratory

To improve student preparedness for anatomy laboratory dissection, the dental gross anatomy laboratory was transformed using flipped classroom pedagogy. Instead of spending class time explaining the procedures and anatomical structures for each laboratory, students were provided online materials to prepare for laboratory on their own. Eliminating in-class preparation provided the opportunity to end each period with integrative group activities that connected laboratory and lecture material and explored clinical correlations. Materials provided for prelaboratory preparation included: custom-made, three-dimensional (3D) anatomy videos, abbreviated dissection instructions, key atlas figures, and dissection videos. Data from three years of the course (n = 241 students) allowed for analysis of students’ preferences for these materials and detailed tracking of usage of 3D anatomy videos. Students reported spending an average of 27:22 (±17:56) minutes preparing for laboratory, similar to the 30 minutes previously allocated for in-class dissection preparation. The 3D anatomy videos and key atlas figures were rated the most helpful resources. Scores on laboratory examinations were compared for the three years before the curriculum change (2011-2013; n = 242) and three years after (2014-2016; n = 241). There was no change in average grades on the first and second laboratory examinations. However, on the final semi-cumulative laboratory examination, scores were significantly higher in the post-flip classes (P = 0.04). These results demonstrate an effective model for applying flipped classroom pedagogy to the gross anatomy laboratory and illustrate a meaningful role for 3D anatomy visualizations in a dissection-based course

via Application of flipped classroom pedagogy to the human gross anatomy laboratory: Student preferences and learning outcomes. – PubMed – NCBI.

Understanding Attention and eLearning: A Primer on the Science of Eye-Tracking

One of the drivers of the original Learning Actions research was a concern that in learning, as in so many facets of life, our subconscious mind undermines rational thinking, decision making, and behavior; yet the ‘adult learner’ has been (universally) seen as fully competent, autonomous, and self-directed. The premise itself seems to be irrational…perhaps the definition of irony?

In the end, my research validated that as learners attempt to consume content presented to them in learning environments that their attention, motivation, and capacity to rationally evaluate new information ebbs and flows. Explicit and implicit biases, along with countless other distractions and inefficiencies in their learning actions undermine learning – this is (and always has been) the reality of ‘adult learning’ despite what your text books might tell you.

For instructional designers, understanding and embracing the learning actions research is empowering; it provides needed perspective and makes a critical connection to closely related fields of cognitive psychology and behavioral economics. We now know that we must architect learning experiences to nudge learners to focus, to slow their thinking, and to leverage far more efficient learning actions.

In a recent Facebook conversation facilitated by Julie Dirksen, the idea was raised that eye-tracking might be used to study engagement in eLearning. For background, those in the discussion are unlikely to be familiar with the Learning Actions Model or to be practitioners of the model…yet they were exploring a topic that very much aligns with our on-going research. And the conversation moved me to dig into the evidence base a bit more and ensure I was up to speed. My guess is that there are far more robust ways to get at attention and engagement  – we have had success doing that at ArcheMedX – but there are surely some lessons to learn from the existing eye-tracking research.


While I spend a few days pulling at the threads, I thought it might help to share a variety of resources that I initially found…and perhaps there may be some others out there with a similar curiosity. Many of these are simply starting points and I’ll be working around pay-walls and fluff to find the real answers, but in the meantime, I hope this helps!


ABSTRACT: Active Learning Strategies to Enhance Nursing Students’ Knowledge of Pharmacology

This article presents the author’s experience using gaming and social media to enhance undergraduate nursing students’ pharmacology knowledge. Although gaming may help with rote learning, active participation in gaming was not associated with higher exam or final course grades. Active participation in social media, on the other hand, was associated with higher exam and final course grades.

via Active Learning Strategies to Enhance Nursing Students’ Knowledge of Pharmacology. – PubMed – NCBI.

MANUSCRIPT: Looking Within: Intentions of Practice for Person-Centered Care

n order to integrate the biological, psychological, social, and existential dimensions of care into my day-to-day clinical encounters with patients, I have worked to cultivate several intentions of practice. These intentions of practice-habits of mind that nurture my resolve to attend to patients as complex human beings- help me navigate my interactions with patients and families in ways that are simultaneously efficacious and therapeutic. When routinely recalled and adeptly implemented, they are what distinguish me as a competent and capable practitioner of person-centered care, when I am at my best, from when I am not. I present them here in hopes that others may find them useful as they progress down their ongoing paths as healing physicians.

via Looking Within: Intentions of Practice for Person-Centered Care. – PubMed – NCBI.

ABSTRACT: Flexible competency based medical education: More time efficient, higher costs

The financing of postgraduate medical education (PGME) becomes an important topic. PGME is costly, and in most western countries is partly paid by public funding. One of the models that can help to reduce costs is time-variable PGME. Moving to true outcome-based education can lead to more efficient training programs while maintaining educational quality. We analyzed the financial effects of time-variable PGME by identifying the educational activities of PGME programs and comparing the costs and revenues of these activities in gynecology training as an example. This resulted in a revenue-cost balance of PGME activities in gynecology. As gynecology consists of both surgical and non-surgical parts, this specialty is a good starting point for a training cost analysis that can be used for a more general discussion. Shortening PGME programs without losing educational quality appears to be possible with time-variable structures. However, shortening is only safely possible on those areas in which residents have already obtained the desired level of competence. This means that time can be gained at the expense of those educational activities in which residents generate the highest revenues. We therefore conclude that shorter education with the help of time-variable training schemes leads to overall higher costs at the hospital level.

via Flexible competency based medical education: More time efficient, higher costs. – PubMed – NCBI.

ABSTRACT: Resident versus faculty member simulation debriefing

Near-peer teaching is effective in graduate medical education, but it has not been compared with faculty member teaching in resident simulation. In this study, we sought to compare debriefing sessions of internal medicine (IM) intern simulation sessions led by academic faculty doctors with those led by senior IM residents in order to measure the effectiveness of near-peer teaching in this setting. Near-peer teaching is effective in graduate medical education, but has not been compared with faculty member teaching in resident simulation METHOD: Internal medicine interns participated in four simulation cases, two of which were debriefed by faculty members and two of which were debriefed by residents. Pre-simulation knowledge assessment was completed prior to the case. Following each debriefing, interns completed a Debriefing Assessment for Simulation in Healthcare (DASH) survey. Post-simulation knowledge assessments were completed 6 months after simulation. Debriefings were recorded and transcribed. Each statement made during debriefing was classified as either correct or erroneous by blinded reviewers.
Fifty interns participated in simulation, and the response rate on the DASH survey was 88%. There was no difference between DASH scores (p = 0.13), post-simulation knowledge assessments or error rates during debriefing (p = 0.31) for faculty member and resident instructors.
Our study suggests that residents and faculty members provide a similar quality of simulation instruction based on qualitative and quantitative evaluation.

via Resident versus faculty member simulation debriefing. – PubMed – NCBI.

MANUSCRIPT: Use of dictation as a tool to decrease documentation errors in electronic health records

Background: Use of Electronic Health Records is increasing. Copy-and-paste function is frequently used with higher rates of documentation errors. Studies to determine the nature of such errors are needed.Objectives: Determination of the effect of implementing a dictation system for completing notes on the quality of clinical documentation. We hypothesized that implementation of the dictation system for note writing would decrease the rate of errors in the progress notes as well as decrease the rate of copying and pasting. Design/Methods: A prospective interventional study in inpatient medical service for six months’ duration starting in July 2016. Resident physicians’ charts were reviewed by the attending physician on a daily basis. This study was done in a community based hospital affiliated to a university program. Residents’ physicians included Internal Medicine, Transitional year and Combined Internal Medicine Pediatrics residents. Charts reviewed for hospitalized patients. A total of 54 residents were offered a pre-intervention survey indicating their subjective use of copy/paste function. Response rate of 85.18%. Progress notes were reviewed on a daily basis for residents on their inpatient rotation. A total of 621 notes were reviewed. Results: Percentage of notes copied prior to the intervention was 92.73% which decreased to 49.71% post-intervention (RR of 0.54, 95% CI 0.48 0.60 Z statistic 11.005 with p-value <0.0001). Of the copied notes percentage of errors pre-intervention was 58% with no errors identified post-intervention (RR of 0.005, 95% CI 0.0003 0.0795 Z statistic 3.752 with p-value 0.0002). Most of the errors are from notes copied by the same author (85.8%). The most common documentation error was in the physical examination section. Conclusion: Implementing a dictation system eliminated documentation errors over our six months’ study. Further studies are needed to check long effects of using such systems on documentation errors.

via Use of dictation as a tool to decrease documentation errors in electronic health records. – PubMed – NCBI.

ABSTRACT: Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review

The number of trials assessing Simulation-Based Medical Education (SBME) interventions has rapidly expanded. Many studies show that potential flaws in design, conduct and reporting of randomized controlled trials (RCTs) can bias their results. We conducted a methodological review of RCTs assessing a SBME in Emergency Medicine (EM) and examined their methodological characteristics. We searched MEDLINE via PubMed for RCT that assessed a simulation intervention in EM, published in 6 general and internal medicine and in the top 10 EM journals. The Cochrane Collaboration risk of Bias tool was used to assess risk of bias, intervention reporting was evaluated based on the “template for intervention description and replication” checklist, and methodological quality was evaluated by the Medical Education Research Study Quality Instrument. Reports selection and data extraction was done by 2 independents researchers. From 1394 RCTs screened, 68 trials assessed a SBME intervention. They represent one quarter of our sample. Cardiopulmonary resuscitation (CPR) is the most frequent topic (81%). Random sequence generation and allocation concealment were performed correctly in 66 and 49% of trials. Blinding of participants and assessors was performed correctly in 19 and 68%. Risk of attrition bias was low in three-quarters of the studies (n = 51). Risk of selective reporting bias was unclear in nearly all studies. The mean MERQSI score was of 13.4/18.4% of the reports provided a description allowing the intervention replication. Trials assessing simulation represent one quarter of RCTs in EM. Their quality remains unclear, and reproducing the interventions appears challenging due to reporting issues.

via Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review. – PubMed – NCBI.

MANUSCRIPT: Meta-analysis of faculty’s teaching effectiveness: Student evaluation of teaching ratings and student learning are not related

Student evaluation of teaching (SET) ratings are used to evaluate faculty’s teaching effectiveness based on a widespread belief that students learn more from highly rated professors. The key evidence cited in support of this belief are meta-analyses of multisection studies showing small-to-moderate correlations between SET ratings and student achievement (e.g., Cohen, 1980, 1981; Feldman, 1989). We re-analyzed previously published meta-analyses of the multisection studies and found that their findings were an artifact of small sample sized studies and publication bias. Whereas the small sample sized studies showed large and moderate correlation, the large sample sized studies showed no or only minimal correlation between SET ratings and learning. Our up-to-date meta-analysis of all multisection studies revealed no significant correlations between the SET ratings and learning. These findings suggest that institutions focused on student learning and career success may want to abandon SET ratings as a measure of faculty’s teaching effectiveness


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MANUSCRIPT: Computer model for the cardiovascular system: development of an e-learning tool for teaching of medical students

This study combined themes in cardiovascular modelling, clinical cardiology and e-learning to create an on-line environment that would assist undergraduate medical students in understanding key physiological and pathophysiological processes in the cardiovascular system.
An interactive on-line environment was developed incorporating a lumped-parameter mathematical model of the human cardiovascular system. The model outputs were used to characterise the progression of key disease processes and allowed students to classify disease severity with the aim of improving their understanding of abnormal physiology in a clinical context. Access to the on-line environment was offered to students at all stages of undergraduate training as an adjunct to routine lectures and tutorials in cardiac pathophysiology. Student feedback was collected on this novel on-line material in the course of routine audits of teaching delivery.
Medical students, irrespective of their stage of undergraduate training, reported that they found the models and the environment interesting and a positive experience. After exposure to the environment, there was a statistically significant improvement in student performance on a series of 6 questions based on cardiovascular medicine, with a 33% and 22% increase in the number of questions answered correctly, p < 0.0001 and p < 0.001 respectively.
Considerable improvement was found in students’ knowledge and understanding during assessment after exposure to the e-learning environment. Opportunities exist for development of similar environments in other fields of medicine, refinement of the existing environment and further engagement with student cohorts. This work combines some exciting and developing fields in medical education, but routine adoption of these types of tool will be possible only with the engagement of all stake-holders, from educationalists, clinicians, modellers to, most importantly, medical students.

via Computer model for the cardiovascular system: development of an e-learning tool for teaching of medical students. – PubMed – NCBI.