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Author: Brian S McGowan, PhD

Surgical training 2.0: How contemporary developments in information technology can augment surgical training.

BACKGROUND:
The current surgical trainee is faced with reduced training time compared to predecessors as a result of changes in working practices. The past decade has seen marked developments in the information technology sector. This editorial will review how modern technological innovations could augment current surgical training.
METHODS:
We review the literature and summarize important developments in information technology that could assist the modern surgical trainee. We also look at some of the challenges faced by use of this technology.
FINDINGS:
Developments in mobile internet connectivity will improve access to online resources for the surgical trainee. Web 2.0 will revolutionise the way trainees interact with textbooks, journals, webpages and each other. Simulators could help to fill gaps created by reduced operating hours. To maximize the effectiveness of these resources they need to be accessible and incorporated into training in a structured way, ensuring patient safety and accuracy of information.
CONCLUSION:
Contemporary developments in technology offer benefits to the surgical trainee and could fill gaps left by reduced operating times. In order to ensure efficient use of technology and patient safety, bodies such as the Royal Colleges and Training Programmes must embrace these developments.

via Surgical training 2.0: How contemporary developments… [Surgeon. 2013] – PubMed – NCBI.

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Social media: the way forward or a waste of time for physicians?

Social media is everywhere; its use has grown exponentially over recent years. The prevalence of these outlets for communication raises some interesting and potentially risky issues for physicians. On the one hand, some believe that physicians should have a strong social media presence and can benefit greatly from access to a global community of peers and leaders through blogs, online forums, Facebook, Twitter and other communication channels. Dr Anne Marie Cunningham provides a strong case for the advantages of developing networks and figuring out who and what to pay attention to online. On the other hand however, others believe that the use of social media places doctors at a professional and ethical risk and is essentially a waste of time for the already time-pressured physician. Professor DeCamp argues that the risks of social media outweigh their benefits. It makes it more difficult to maintain a distinction between private and professional personas, and as we have seen, one mistyped or inappropriate comment can have potentially negative consequences when taken out of context. With an already time-pressured day, the priority should be patients, not tweets. Whatever your thoughts on the benefits and risks of social media, it is here to stay. Specific guidelines and guidance are needed to ensure that physicians who decide to join an online community reap the benefits of global communication, rather than regret it.

via Social media: the way forward or a… [J R Coll Physicians Edinb. 2013] – PubMed – NCBI.

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Basic steps in establishing effective small group teaching sessions in medical schools

Small-group teaching and learning has achieved an admirable position in medical education and has become more popular as a means of encouraging the students in their studies and enhance the process of deep learning. The main characteristics of small group teaching are active involvement of the learners in entire learning cycle and well defined task orientation with achievable specific aims and objectives in a given time period. The essential components in the development of an ideal small group teaching and learning sessions are preliminary considerations at departmental and institutional level including educational strategies, group composition, physical environment, existing resources, diagnosis of the needs, formulation of the objectives and suitable teaching outline. Small group teaching increases the student interest, teamwork ability, retention of knowledge and skills, enhance transfer of concepts to innovative issues, and improve the self-directed learning. It develops self-motivation, investigating the issues, allows the student to test their thinking and higher-order activities. It also facilitates an adult style of learning, acceptance of personal responsibility for own progress. Moreover, it enhances student-faculty and peer-peer interaction, improves communication skills and provides opportunity to share the responsibility and clarify the points of bafflement.

via Basic steps in establishing effective small gr… [Pak J Med Sci. 2013] – PubMed – NCBI.

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American board of medical specialties maintenance of certification: theory and evidence regarding the current framework

The American Board of Medical Specialties Maintenance of Certification Program (ABMS MOC) is designed to provide a comprehensive approach to physician lifelong learning, self-assessment, and quality improvement (QI) through its 4-part framework and coverage of the 6 competencies previously adopted by the ABMS and the Accreditation Council for Graduate Medical Education (ACGME). In this article, the theoretical rationale and exemplary empiric data regarding the MOC program and its individual parts are reviewed. The value of each part is considered in relation to 4 criteria about the relationship of the competencies addressed within that part to (1) patient outcomes, (2) physician performance, (3) validity of the assessment or educational methods utilized, and (4) learning or improvement potential. Overall, a sound theoretical rationale and a respectable evidence base exists to support the current structure and elements of the MOC program. However, it is incumbent on the ABMS and ABMS member boards to continue to examine their programs moving forward to assure the public and the profession that they are meeting expectations, are clinically relevant, and provide value to patients and participating physicians, and to refine and improve them as ongoing research indicates.

via American board of medical specialt… [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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The royal college experience and plans for the maintenance of certification program

The Royal College of Physicians and Surgeons of Canada, in 2001, implemented a mandatory maintenance of certification (MOC) program that is required for fellows to maintain membership and fellowship. Participation in the MOC program is one of the recognized pathways approved by provincial medical regulatory authorities in Canada by which specialists can demonstrate their commitment to continued competent performance in practice. This article traces the historical beginnings of the MOC program, highlighting the educational foundation and scientific evidence that influenced its philosophy, goals, and strategic priorities. The MOC program has evolved into a complex system of continuing professional development to facilitate and enable a “cultural shift” in how we conceptualize and support the continuing professional development (CPD) of specialists. The MOC program is an educational strategy that supports a learning culture where specialists are able to design, implement and document their accomplishments from multiple learning activities to build evidence-informed practices. In the future, the MOC Program must evolve from assisting fellows to use effective educational resources “for credit” to enable fellows, leveraging a competency-based CPD model, to demonstrate their capacity to continuously improve practice. This will require innovative methods to capture learning and practice improvements in real time, integrate learning during the delivery of health care, expand automation of reporting strategies, and facilitate new sociocultural methods of emergent learning and practice change. Collectively, these directions will require a research agenda that will generate evidence for how transformative cultural change in continuing professional education of the profession can be realized.

via The royal college experience and p… [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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What do primary care practitioners want to know? A content analysis of questions asked at the point of care

INTRODUCTION:
Assessing physician needs to develop continuing medical education (CME) activities is an integral part of CME curriculum development. The purpose of the present study was to demonstrate the feasibility of identifying areas of perceived greatest needs for continuing medical education (CME) by using questions collected electronically at the point of care.
METHODS:
This study is a secondary analysis of the “Just-in-Time” (JIT) information librarian consultation service database of questions using quantitative content analysis methods. The original JIT project demonstrated the feasibility of a real-time librarian service for answering questions asked by primary care clinicians at the point of care using a Web-based platform or handheld device. Data were collected from 88 primary care practitioners in Ontario, Canada, from October 2005 to April 2006. Questions were answered in less than 15 minutes, enabling clinicians to use the answer during patient encounters.
RESULTS:
Description of type and frequency of questions asked, including the organ system on which the questions focused, was produced using 2 classification systems, the “taxonomy of generic clinical questions” (TGCQ), and the International Classification for Primary Care version 2 (ICPC-2). Of the original 1889 questions, 1871 (99.0%) were suitable for analysis. A total of 970 (52%) of questions related to therapy; of these, 671 (69.2%) addressed questions about drug therapy, representing 36% of all questions. Questions related to diagnosis (24.8%) and epidemiology (13.5%) were also common. Organ systems questions concerning musculoskeletal, endocrine, skin, cardiac, and digestive systems were asked more than other categories.
DISCUSSION:
Questions collected at the point of care provide a valuable and unique source of information on the true learning needs of practicing clinicians. The TGCQ classification allowed us to show that a majority of questions had to do with treatment, particularly drug treatment, whereas the use of the ICPC-2 classification illustrated the great variety of questions asked about the diverse conditions encountered in primary care. It is feasible to use electronically collected questions asked by primary care clinicians in clinical practice to categorize self-identified knowledge and practice needs. This could be used to inform the development of future learning activities.

via What do primary care practitioners… [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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Palliative care education in US medical schools

CONTEXT:
Medical educators in the USA perceive the teaching of palliative care competencies as important, medical students experience it as valuable and effective, and demographic and societal forces fuel its necessity. Although it is encouraged by the Association of American Medical Colleges, the only palliative care-related mandate in US medical schools is the Liaison Committee on Medical Education directive that end-of-life (EoL) care be included in medical school curricula, reinforcing the problematic conflation of EoL and palliative care.
FINDINGS:
A review of US medical school surveys about the teaching of palliative and EoL care reveals varied and uneven approaches, ranging from 2 hours in the classroom on EoL to weeks of palliative care training or hospice-based clinical rotations.
IMPLICATIONS:
Palliative care competencies are too complex and universally important to be relegated to a minimum of classroom time, random clinical exposures, and the hidden curriculum.
RECOMMENDATIONS:
Given the reality of overstrained medical school curricula, developmentally appropriate, basic palliative care competencies should be defined and integrated into each year of the medical school curriculum, taking care to circumvent the twin threats of curricular overload and educational abandonment.

via Palliative care education in US medical schools. [Med Educ. 2014] – PubMed – NCBI.

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Quality of care of patients with non-small-cell lung cancer: a report of a performance improvement initiative

BACKGROUND:
Lung cancer is the leading cause of cancer deaths in the United States. In recent years, significant advancements have been made in the molecular characterization of tumors, and the availability of new agents to treat non-small-cell lung cancer has increased. Despite these achievements, optimal care of patients with this condition remains less than ideal. Although national quality measures and guideline recommendations provide the necessary framework for patient care, routine self-assessment of adherence to these measures is required for physician practice improvement. To this end, a performance improvement initiative that met national continuing medical education standards was designed.
METHODS:
Focusing on non-small-cell lung cancer patient care, oncologists underwent a three-step process that included a self-assessment of predetermined performance measures, the development and implementation of an actionable plan for improvement, and a second round of assessment to measure practice change.
RESULTS:
A total of 440 unique patient charts were reviewed by 22 practicing oncologists. Participants demonstrated high baseline performance levels of established quality measures, such as inclusion of the patient’s pathology report and assessment of smoking history. Significant gains were observed in the areas of supportive care, including assessment of the patient’s emotional well-being and the use of molecular markers in diagnostic and treatment decision making.
CONCLUSIONS:
Data from this study support the value of performance improvement initiatives to help increase physician delivery of evidence-based care to patients.

via Quality of care of patients with non-small-ce… [Cancer Control. 2014] – PubMed – NCBI.

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A new age approach to an age old problem: using simulation to teach geriatric medicine to medical students

BACKGROUND:
simulation-based teaching is increasingly used in medical education, but no studies have evaluated its impact on learning in geriatric medicine. We developed and delivered a simulation teaching session on delirium, falls, elder abuse and breaking bad news. Simulation mannequins, professional role-players and simulated clinical documentation were all incorporated into scenarios. We evaluated the effect of this intervention on student learning and on students’ attitudes towards geriatric medicine.
METHODS:
third year Newcastle University MBBS students at Northumbria base unit received the simulation-based teaching session. Students’ knowledge was assessed using a three question test mapped to learning outcomes for the elder abuse, delirium and falls stations. Each student undertook the test on three occasions: the day before the teaching session, immediately after the session and ∼1 month later, allowing evaluation of learning over time. Test scores were also compared with those achieved by another cohort of third year MBBS students at a different base unit, who received traditional ward-based and didactic teaching but no simulation teaching.
RESULTS:
student knowledge improved significantly after the simulation session and this was maintained when reassessed a month later. Students who received the simulation-based training outperformed those who received usual teaching. Student feedback was overwhelmingly positive and the vast majority of students agreed that the session had a positive impact on their perceptions of geriatric medicine.Discussion: our findings demonstrate the efficacy of simulation-based teaching in undergraduate geriatric medicine, its acceptability to students and its positive influence on students’ perceptions of the specialty.

via A new age approach to an age old problem: using s… [Age Ageing. 2013] – PubMed – NCBI.

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Educational testing validity and reliability in pharmacy and medical education literature

Objectives. To evaluate and compare the reliability and validity of educational testing reported in pharmacy education journals to medical education literature. Methods. Descriptions of validity evidence sources (content, construct, criterion, and reliability) were extracted from articles that reported educational testing of learners’ knowledge, skills, and/or abilities. Using educational testing, the findings of 108 pharmacy education articles were compared to the findings of 198 medical education articles. Results. For pharmacy educational testing, 14 articles (13%) reported more than 1 validity evidence source while 83 articles (77%) reported 1 validity evidence source and 11 articles (10%) did not have evidence. Among validity evidence sources, content validity was reported most frequently. Compared with pharmacy education literature, more medical education articles reported both validity and reliability (59%; p<0.001). Conclusion. While there were more scholarship of teaching and learning (SoTL) articles in pharmacy education compared to medical education, validity, and reliability reporting were limited in the pharmacy education literature.

via Educational testing validity and reliability… [Am J Pharm Educ. 2013] – PubMed – NCBI.

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