Author: Brian S McGowan, PhD

MANUSCRIPT: Is a Three-Dimensional Printing Model Better Than a Traditional Cardiac Model for Medical Education?

BACKGROUND:
Three-dimensional (3D) printing is a newly-emerged technology converting a series of two-dimensional images to a touchable 3D model, but no studies have investigated whether or not a 3D printing model is better than a traditional cardiac model for medical education.
METHODS:
A 3D printing cardiac model was generated using multi-slice computed tomography datasets. Thirty-four medical students were randomized to either the 3D Printing Group taught with the aid of a 3D printing cardiac model or the Traditional Model Group with a commonly used plastic cardiac model. Questionnaires with 10 medical questions and 3 evaluative questions were filled in by the students.
RESULTS:
A 3D printing cardiac model was successfully generated. Students in the 3D Printing Group were slightly quicker to answer all questions when compared with the Traditional Model Group (224.53 ± 44.13 s vs. 238.71 ± 68.46 s, p = 0.09), but the total score was not significantly different (6.24 ± 1.30 vs. 7.18 ± 1.70, p = 0.12). Neither the students’satisfaction (p = 0.48) nor their understanding of cardiac structures (p = 0.24) was significantly different between two groups. More students in the 3D Printing Group believed that they had understood at least 90% of teaching content (6 vs. 1). Both groups had 12 (70.6%) students who preferred a 3D printing model for medical education.
CONCLUSIONS:
A 3D printing model was not significantly superior to a traditional model in teaching cardiac diseases in our pilot randomized controlled study, yet more studies may be conducted to validate the real effect of 3D printing on medical education.

via Is a Three-Dimensional Printing Model Better Than a Traditional Cardiac Model for Medical Education? A Pilot Randomized Controlled Study. – PubMed – NCBI.

ABSTRACT: Structured education to improve primary-care management of headache: how long do the benefits last?

BACKGROUND:
Our earlier study showed that structured education of general practitioners (GPs) improved their practice in headache management. Here we assess duration of this effect.
METHODS:
In a follow-up observational study in Southern Estonia, subjects were the same six GPs as previously, managing patients presenting with headache as the main complaint. Data reflecting their practice were collected prospectively during a 1-year period commencing 2 years after the educational intervention. The primary outcome measure was referral rate (RR) to neurological services. Comparisons were made with baseline and post-intervention data from the earlier study.
RESULTS:
In 366 patients consulting during the follow-up period, RR was 19.9%, lower than at baseline (39.5%; p<0.0001) or post-intervention (34.7%; p<0.0001). RR was diagnosis-dependent: the biggest decline was for migraine. Usage of headache diagnostic terms showed changes generally favouring specific terminology. In particular, the proportion of patients given migraine diagnoses greatly increased while use of the inappropriate M79.1 (Pericranial) myalgia almost disappeared. Requests for investigations, which had fallen from 26% (of patients seen) at baseline to 4% post-intervention [5], resurged to 23% (mostly laboratory investigations: requests for x-rays continued to dwindle). Initiation of treatment by the GPs remained at the post-intervention level of just over 80% (up from baseline 58%).
CONCLUSIONS:
Improvements in GPs’ practice after a structured educational programme mostly last for ≥3 years, some showing further betterment. A few measures suggest the beginnings of decline towards baseline levels. This policy-informing evidence for continuing medical education indicates that the educational programme needs repeating every 2-3 years. This article is protected by copyright. All rights reserved.

via Structured education to improve primary-care management of headache: how long do the benefits last? A follow-up observational study. – PubMed – NCBI.

ABSTRACT: The interrupted learner: How distractions during live and video lectures influence learning outcomes

New instructional technologies have been increasingly incorporated into the medical school learning environment, including lecture video recordings as a substitute for live lecture attendance. The literature presents varying conclusions regarding how this alternative experience impacts students’ academic success. Previously, a multi-year study of the first-year medical histology component at the University of Michigan found that live lecture attendance was positively correlated with learning success, while lecture video use was negatively correlated. Here, three cohorts of first-year medical students (N = 439 respondents, 86.6% response rate) were surveyed in greater detail regarding lecture attendance and video usage, focusing on study behaviors that may influence histology learning outcomes. Students who reported always attending lectures or viewing lecture videos had higher average histology scores than students who employed an inconsistent strategy (i.e., mixing live attendance and video lectures). Several behaviors were negatively associated with histology performance. Students who engaged in “non-lecture activities” (e.g., social media use), students who reported being interrupted while watching the lecture video, or feeling sleepy/losing focus had lower scores than their counterparts not engaging in these behaviors. This study suggests that interruptions and distractions during medical learning activities-whether live or recorded-can have an important impact on learning outcomes.

via The interrupted learner: How distractions during live and video lectures influence learning outcomes. – PubMed – NCBI.

MANUSCRIPT: The impact of web-based and face-to-face simulation on patient deterioration and patient safety: protocol for a multi-site multi-method design

BACKGROUND:
There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the ‘failure to rescue’ literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety.
METHODS/DESIGN:
In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as ‘FIRST(2)ACT’, have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST(2)ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes.
DISCUSSION:
In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards.

via The impact of web-based and face-to-face simulation on patient deterioration and patient safety: protocol for a multi-site multi-method design. – PubMed – NCBI.

RESOURCE: Mental down-time affects memory

Research has shown that recent experiences are reactivated during sleep and wakeful rest. This “downtime” recall of memories is part of the process for consolidating long-term memory and serves as memory rehearsal that can strengthen the memory. Thus, the old saying, “all work and no play makes Jack a dull boy,” might be re-framed, “all work and no rest makes Jack a poor learner.”

To expand on this idea, a study was conducted to test whether this memory enhancing effect of mental downtime applied to new learning of related material. In other words, does downtime help form memories for new experiences as well as it does for recent past experiences? The researchers hypothesized that the degree to which memory processes are engaged during mental downtime determines whether or not prior knowledge promotes or interferes with new learning.

To read the full post: Mental down-time affects memory | npj Science of Learning Community.

ABSTRACT: How cognitive engagement fluctuates during a team-based learning session and how it predicts academic achievement.

The objective of the paper is to report findings of two studies that attempted to find answers to the following questions: (1) What are the levels of cognitive engagement in TBL? (2) Are there differences between students who were more exposed to TBL than students who were less exposed to TBL? (3) To which extent does cognitive engagement fluctuate as a function of the different activities involved in TBL? And (4) How do cognitive engagement scores collected over time correlate with each other and with academic achievement? The studies were conducted with Year-1 and -2 medical students enrolled in a TBL curriculum (N = 175, 62 female). In both studies, six measurements of cognitive engagement were taken during the distinct TBL activities (preparation phase, individual/team readiness assurance test, burning questions, and application exercises). Data were analysed by means of one-way repeated-measures ANOVAs and path modelling. The results of the repeated-measures ANOVA revealed that cognitive engagement systematically fluctuated as a function of the distinct TBL activities. In addition, Year-1 students reported significantly higher levels of cognitive engagement compared to Year-2 students. Finally, cognitive engagement was a significant predictor of performance (β = .35). The studies presented in this paper are a first attempt to relate the different activities undertaken in TBL with the extent to which they arouse cognitive engagement with the task at hand. Implications of these findings for TBL are discussed.

via How cognitive engagement fluctuates during a team-based learning session and how it predicts academic achievement. – PubMed – NCBI.

MANUSCRIPT: Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study

Background: Mobile technology ownership in the general US population and medical professionals is increasing, leading to increased use in clinical settings. However, data on use of mobile technology by psychiatry residents remain unclear.
Objective: In this study, our aim was to provide data on how psychiatric residents use mobile phones in their clinical education as well as barriers relating to technology use.
Methods: An anonymous, multisite survey was given to psychiatry residents in 2 regions in the United States, including New Orleans and Boston, to understand their technology use.
Results: All participants owned mobile phones, and 79% (54/68) used them to access patient information. The majority do not use mobile phones to implement pharmacotherapy (62%, 42/68) or psychotherapy plans (90%, 61/68). The top 3 barriers to using mobile technology in clinical care were privacy concerns (56%, 38/68), lack of clinical guidance (40%, 27/68), and lack of evidence (29%, 20/68).
Conclusions: We conclude that developing a technology curriculum and engaging in research could address these barriers to using mobile phones in clinical practice.

via JMU-Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study | Gipson | JMIR mHealth and uHealth.

MANUSCRIPT: Comparison of the Impact of Wikipedia, UpToDate, and a Digital Textbook on Short-Term Knowledge Acquisition Among Medical Students

BACKGROUND:
Web-based resources are commonly used by medical students to supplement curricular material. Three commonly used resources are UpToDate (Wolters Kluwer Inc), digital textbooks, and Wikipedia; there are concerns, however, regarding Wikipedia’s reliability and accuracy.
OBJECTIVE:
The aim of this study was to evaluate the impact of Wikipedia use on medical students’ short-term knowledge acquisition compared with UpToDate and a digital textbook.
METHODS:
This was a prospective, nonblinded, three-arm randomized trial. The study was conducted from April 2014 to December 2016. Preclerkship medical students were recruited from four Canadian medical schools. Convenience sampling was used to recruit participants through word of mouth, social media, and email. Participants must have been enrolled in their first or second year of medical school at a Canadian medical school. After recruitment, participants were randomized to one of the three Web-based resources: Wikipedia, UpToDate, or a digital textbook. During testing, participants first completed a multiple-choice questionnaire (MCQ) of 25 questions emulating a Canadian medical licensing examination. During the MCQ, participants took notes on topics to research. Then, participants researched topics and took written notes using their assigned resource. They completed the same MCQ again while referencing their notes. Participants also rated the importance and availability of five factors pertinent to Web-based resources. The primary outcome measure was knowledge acquisition as measured by posttest scores. The secondary outcome measures were participants’ perceptions of importance and availability of each resource factor.
RESULTS:
A total of 116 medical students were recruited. Analysis of variance of the MCQ scores demonstrated a significant interaction between time and group effects (P<.001, ηg2=0.03), with the Wikipedia group scoring higher on the MCQ posttest compared with the textbook group (P<.001, d=0.86). Access to hyperlinks, search functions, and open-source editing were rated significantly higher by the Wikipedia group compared with the textbook group (P<.001). Additionally, the Wikipedia group rated open access editing significantly higher than the UpToDate group; expert editing and references were rated significantly higher by the UpToDate group compared with the Wikipedia group (P<.001).
CONCLUSIONS:
Medical students who used Wikipedia had superior short-term knowledge acquisition compared with those who used a digital textbook. Additionally, the Wikipedia group trended toward better posttest performance compared with the UpToDate group, though this difference was not significant. There were no significant differences between the UpToDate group and the digital textbook group. This study challenges the view that Wikipedia should be discouraged among medical students, instead suggesting a potential role in medical education.

via Comparison of the Impact of Wikipedia, UpToDate, and a Digital Textbook on Short-Term Knowledge Acquisition Among Medical Students: Randomized Cont… – PubMed – NCBI.

ABSTRACT: Learner, Patient, and Supervisor Features Are Associated With Different Types of Cognitive Load During Procedural Skills Training

PURPOSE:
Cognitive load theory, focusing on limits of the working memory, is relevant to medical education; however, factors associated with cognitive load during procedural skills training are not well characterized. The authors sought to determine how features of learners, patients/tasks, settings, and supervisors were associated with three types of cognitive load among learners performing a specific procedure, colonoscopy, to identify implications for procedural teaching.
METHOD:
Data were collected through an electronically administered survey sent to 1,061 U.S. gastroenterology fellows during the 2014-2015 academic year; 477 (45.0%) participated. Participants completed the survey immediately following a colonoscopy. Using multivariable linear regression analyses, the authors identified sets of features associated with intrinsic, extraneous, and germane loads.
RESULTS:
Features associated with intrinsic load included learners (prior experience and year in training negatively associated, fatigue positively associated) and patient/tasks (procedural complexity positively associated, better patient tolerance negatively associated). Features associated with extraneous load included learners (fatigue positively associated), setting (queue order positively associated), and supervisors (supervisor engagement and confidence negatively associated). Only one feature, supervisor engagement, was (positively) associated with germane load.
CONCLUSIONS:
These data support practical recommendations for teaching procedural skills through the lens of cognitive load theory. To optimize intrinsic load, level of experience and competence of learners should be balanced with procedural complexity; part-task approaches and scaffolding may be beneficial. To reduce extraneous load, teachers should remain engaged, and factors within the procedural setting that may interfere with learning should be minimized. To optimize germane load, teachers should remain engaged.

via Learner, Patient, and Supervisor Features Are Associated With Different Types of Cognitive Load During Procedural Skills Training: Implications for… – PubMed – NCBI.

MANUSCRIPT: Behavior change interventions and policies influencing primary healthcare professionals’ practice-an overview of reviews.

BACKGROUND:There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers.METHODS:Study design: overview of reviews.DATA SOURCE:MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015).STUDY SELECTION:two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language.DATA EXTRACTION AND SYNTHESIS:two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors’ conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.).RESULTS:Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change.CONCLUSIONS:Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.

via Behavior change interventions and policies influencing primary healthcare professionals’ practice-an overview of reviews. – PubMed – NCBI.