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Author: Brian S McGowan, PhD

ASTRACT: Key considerations for the success of Medical Education Research and Innovation units in Canada

Growth in the field of medical education is evidenced by the proliferation of units dedicated to advancing Medical Education Research and Innovation (MERI). While a review of the literature discovered narrative accounts of MERI unit development, we found no systematic examinations of the dimensions of and structures that facilitate the success of these units. We conducted qualitative interviews with the directors of 12 MERI units across Canada. Data were analyzed using qualitative description (Sandelowski in Res Nurs Health 23:334-340, 2000). Final analysis drew on Bourdieu’s (Outline of a theory of practice. Cambridge University Press, Cambridge, 1977; Media, culture and society: a critical reader. Sage, London, 1986; Language and symbolic power. Harvard University Press, Cambridge, 1991) concepts of field, habitus, and capital, and more recent research investigating the field of MERI (Albert in Acad Med 79:948-954, 2004; Albert et al. in Adv Health Sci Educ 12:103-115, 2007). When asked about the metrics by which they define their success, directors cited: teaching, faculty mentoring, building collaborations, delivering conference presentations, winning grant funding, and disseminating publications. Analyzed using Bourdieu’s concepts, these metrics are discussed as forms of capital that have been legitimized in the MERI field. All directors, with the exception of one, described success as being comprised of elements (capital) at both ends of the service-research spectrum (i.e., Albert’s PP-PU structure). Our analysis highlights the forms of habitus (i.e., behaviors, attitudes, demeanors) directors use to negotiate, strategize and position the unit within their local context. These findings may assist institutions in developing a new-or reorganizing an existing-MERI unit. We posit that a better understanding of these complex social structures can help units become savvy participants in the MERI field. With such insight, units can improve their academic output and their status in the MERI context-locally, nationally, and internationally.

via Key considerations for the … [Adv Health Sci Educ Theory Pract. 2014] – PubMed – NCBI.

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ABSTRACT: Paperwork versus patient care: a nationwide survey of residents’ perceptions of clinical documentation requirements and patient care.

BACKGROUND:
The current health care system requires a substantial amount of documentation by physicians, potentially limiting time spent on patient care.
OBJECTIVE:
We sought to explore trainees’ perceptions of their clinical documentation requirements and the relationship between time spent on clinical documentation versus time available for patient care.
METHODS:
An anonymous, online survey was sent to trainees in all postgraduate years of training and specialties in Accreditation Council for Graduate Medical Education-accredited programs.
RESULTS:
Over a 2-month time frame, 1515 trainees in 24 specialties completed the survey. Most (92%) reported that documentation obligations are excessive, that time spent with patients has been compromised by this (90%), and that the amount of clinical documentation has had a negative effect on patient care (73%). Most residents and fellows reported feeling rushed and frustrated because of these documentation demands. They also reported that time spent on these tasks decreased their time available for teaching others and reduced the quality of their education. Respondents reported spending more time on clinical documentation than on direct patient care (P < .001).
CONCLUSIONS:
Trainees’ current clinical documentation workload may be a barrier to optimal patient care and to resident and fellow education. Residents and fellows report that clinical documentation duties are onerous, and there is a perceived negative effect on time spent with patients, overall quality of patient care, physician well-being, time available for teaching, and quality of resident education.

via Paperwork versus patient care: a nationwide … [J Grad Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Recertification: what do specialists think about skill assessment?

BACKGROUND:
Continuing medical education and objective performance assessment remain the key components of recertification. Objective skills assessment in routine practice remains challenging due to extensive variations in case selection and treatments. This study explores expert opinions regarding objective skills assessment for specialists within the framework of recertification.
METHODS:
We used a qualitative, semi-structured interview-based approach to obtain information and suggestions about key issues and recommendations relating to specialists’ skills assessment. Twenty-two face-to-face interviews were conducted. Interviews were transcribed and analysed by two reviewers.
RESULTS:
The information from the interviews was categorized under the headings of: (1) the components of specialist-level skills, (2) the methods for assessing specialist skills, (3) the types of tools and procedures used during observational assessment, (4) the unsuccessful specialists, and (5) the selection and training of assessors for specialist assessment.
CONCLUSIONS:
Outcome-based assessment of performance followed by observation of practice, were recommended as effective modes of evaluation of performance.

via Recertification: what do specialists think about ski… [Surgeon. 2013] – PubMed – NCBI.

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ABSTRACT: The long-term impact of a performance improvement continuing medical education intervention on osteoporosis screening.

INTRODUCTION:
The purpose of this study is to determine whether a performance improvement continuing medical education (PI CME) initiative that utilizes quality improvement (QI) principles is effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis.
METHODOLOGY:
A health care center participated in a PI CME program designed to increase appropriate osteoporosis screening. There were eight 1-hour educational sessions for this activity over a 9-month period. Thirteen providers completed all 3 stages of the PI CME program. A variety of other clinicians, in addition to the 13 providers, participated in the educational sessions. Data were collected at the beginning and end of the PI CME activity and at three intervals during the 5 years after the completion of the activity.
RESULTS:
The percentage of tests for osteoporosis ordered and performed increased significantly from Stage A to Stage C of the PI CME activity and continued to increase after the completion of the PI CME activity. Follow-up data at 4 and 40 months (for ordering and performing osteoporosis screening) and 49 months (for performing the screening only) reflect the impact of the PI CME activity plus the continuing QI interventions. The percentage of BMD tests ordered continued to increase substantially over the post-PI CME periods: 4 and 40 months (F(3,46) = 4.04, p < .05). Similarly, the percentage of BMD tests performed continued to increase at 4, 40, and 49 months after the conclusion of the PI CME activity (F(4,55) = 12.55, p < .0001).
DISCUSSION:
The data indicate that PI CME utilizing QI principles can be effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis. Further research is needed to determine the extent to which such changes can be directly attributed to this type of intervention.

via The long-term impact of a performa… [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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ABSTRACT: Enhancing quality improvements in cancer care through CME activities at a nationally recognized cancer center

Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal.

via Enhancing quality improvements in cancer care … [J Cancer Educ. 2013] – PubMed – NCBI.

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ABSTRACT: The Teamwork Mini-Clinical Evaluation Exercise (T-MEX): A Workplace-Based Assessment Focusing on Collaborative Competencies in Health Care

Purpose: Teamwork is an important and challenging area of learning during the transition from medical graduate to intern. This preliminary investigation examined the psychometric and logistic properties of the Teamwork Mini-Clinical Evaluation Exercise (T-MEX) for the workplace-based assessment of key competencies in working with health care teams.

Method: The authors designed the T-MEX for direct observation and assessment of six collaborative behaviors in seven clinical situations important for teamwork, feedback, and reflection. In 2010, they tested it on University of New South Wales senior medical students during their last six-week clinical term to investigate its overall utility, including validity and reliability. Assessors rated students in different situations on the extent to which they met expectations for interns for each collaborative behavior. Both assessors and students rated the tool’s usefulness and feasibility.

Results: Assessment forms for 88 observed encounters were submitted by 25 students. The T-MEX was suited to a broad range of collaborative clinical practice situations, as evidenced by the encounter types and the behaviors assessed by health care team members. The internal structure of the behavior ratings indicated construct validity. A generalizability study found that eight encounters were adequate for high-stakes measurement purposes. The mean times for observation and feedback and the participants’ perceptions suggested usefulness for feedback and feasibility in busy clinical settings.

Conclusions: Findings suggest that the T-MEX has good utility for assessing trainee competence in working with health care teams. It fills a gap within the suite of existing tools for workplace-based assessment of professional attributes.

via The Teamwork Mini-Clinical Evaluation Exercise (T-MEX): A W… : Academic Medicine.

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ABSTRACT: Nationwide online social networking for cardiovascular care in Korea using Facebook

To examine the use of online social networking for cardiovascular care using Facebook. All posts and comments in a Facebook group between June 2011 and May 2012 were reviewed, and a survey was conducted. A total of 298 members participated. Of the 277 wall posts, 26.7% were question posts requesting rapid replies, and 50.5% were interesting cases shared with other members. The median response time for the question posts was 16 min (IQR 8-47), which tended to decrease as more members joined the group. Many members (37.4%) accessed the group more than once a day, and more than half (64%) monitored the group posts in real time with automatic notifications of new posts. Most members expressed confidence in the content posted. Facebook enables online social networking between physicians in near-real time and appears to be a useful tool for physicians to share clinical experience and request assistance in decision-making

via Nationwide online social netwo… [J Am Med Inform Assoc. 2014 Jan-Feb] – PubMed – NCBI.

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ABSTRACT: Practice improvement, part II: update on patient communication technologies

Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization’s strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support.

via Practice improvement, part II: update on patient c… [FP Essent. 2013] – PubMed – NCBI.

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ABSTRACT: Social media’s role in otolaryngology-head and neck surgery: informing clinicians, empowering patients

With the increasing availability of the Internet in the United States, patients are more frequently seeking medical information online. Oftentimes, the medical information that patients find on traditional websites is unreliable. It is a physician’s duty to ensure that patients are being educated properly. Providing sound medical information through social media websites is one way in which physicians may accomplish this goal, while also improving clinic reputation, patient volume, and doctor-patient communication.

via Social media’s role in otolaryngo… [Otolaryngol Head Neck Surg. 2013] – PubMed – NCBI.

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ABSTRACT: Social media in health care: benefits, concerns, and guidelines for use

The use of social media and other electronic communication has exploded as the number of social media outlets and applications continue to increase. These are exciting and valuable tools when used wisely, but pose risks when inappropriately used. The purpose of this article is to consider what comprises social media, its benefits and concerns, and guidelines for use that protect patients, employees, and organizations.

via Social media in health care: benefits, concerns, … [Creat Nurs. 2013] – PubMed – NCBI.

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