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Author: Brian S McGowan, PhD

Educating the Patient for Health Care Communication in the Age of the World Wide Web: A Qualitative Study

PURPOSE:
Communication skills teaching in medical education has yet to acknowledge the impact of the Internet on physician-patient communication. The authors present a conceptual model showing the variables influencing how and to what extent physicians and patients discuss Internet-sourced health information as part of the consultation with the purpose of educating the patient.
METHOD:
A study exploring the role physicians play in patient education mediated through health information available on the Internet provided the foundation for the conceptual model. Twenty-one physicians participated in semistructured interviews between 2011 and 2013. Participants were from Australia and Switzerland, whose citizens demonstrate different degrees of Internet usage and who differ culturally and ethnically. The authors analyzed the interviews thematically and iteratively. The themes as well as their interrelationships informed the components of the conceptual model.
RESULTS:
The intrinsic elements of the conceptual model are the physician, the patient, and Internet based health information. The extrinsic variables of setting, time, and communication activities as well as the quality, availability, and usability of the Internet-based health information influenced the degree to which physicians engaged with, and were engaged by, their patients about Internet-based health information.
CONCLUSIONS:
The empirically informed model provides a means of understanding the environment, enablers, and constraints of discussing Internet-based health information, as well as the benefits for patients’ understanding of their health. It also provides medical educators with a conceptual tool to engage and support physicians in their activities of communicating health information to patients.

via Educating the Patient for Health Care Communication… [Acad Med. 2013] – PubMed – NCBI.

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QNOTE: an instrument for measuring the quality of EHR clinical notes

Background and objective The outpatient clinical note documents the clinician’s information collection, problem assessment, and patient management, yet there is currently no validated instrument to measure the quality of the electronic clinical note. This study evaluated the validity of the QNOTE instrument, which assesses 12 elements in the clinical note, for measuring the quality of clinical notes. It also compared its performance with a global instrument that assesses the clinical note as a whole.

Materials and methods Retrospective multicenter blinded study of the clinical notes of 100 outpatients with type 2 diabetes mellitus who had been seen in clinic on at least three occasions. The 300 notes were rated by eight general internal medicine and eight family medicine practicing physicians. The QNOTE instrument scored the quality of the note as the sum of a set of 12 note element scores, and its inter-rater agreement was measured by the intraclass correlation coefficient. The Global instrument scored the note in its entirety, and its inter-rater agreement was measured by the Fleiss κ.

Results The overall QNOTE inter-rater agreement was 0.82 (CI 0.80 to 0.84), and its note quality score was 65 (CI 64 to 66). The Global inter-rater agreement was 0.24 (CI 0.19 to 0.29), and its note quality score was 52 (CI 49 to 55). The QNOTE quality scores were consistent, and the overall QNOTE score was significantly higher than the overall Global score (p=0.04).

Conclusions We found the QNOTE to be a valid instrument for evaluating the quality of electronic clinical notes, and its performance was superior to that of the Global instrument.

via QNOTE: an instrument for measuring the quality of EHR clinical notes — Burke et al. — Journal of the American Medical Informatics Association.

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A comprehensive model to build improvement capability in a pediatric academic medical center.

Cincinnati Children’s Hospital Medical Center developed a comprehensive model to build quality improvement (QI) capability to support its goal to transform its delivery system through a series of training courses. Two online modules orient staff to basic concepts and terminology and prepare them to participate more effectively in QI teams. The basic program (Rapid Cycle Improvement Collaborative, RCIC) is focused on developing the capability to use basic QI tools and complete a narrow-scoped project in approximately 120 days. The Intermediate Improvement Science Series (I(2)S(2)) program is a leadership course focusing on improvement skills and developing a broader and deeper understanding of QI in the context of the organization and external environment. The Advanced Improvement Methods (AIM) course and Quality Scholars Program stimulate the use of more sophisticated methods and prepare Cincinnati Children’s Hospital Medical Center (CCHMC) and external faculty to undertake QI research. The Advanced Improvement Leadership Systems (AILS) sessions enable interprofessional care delivery system leadership teams to effectively lead a system of care, manage a portfolio of projects, and to deliver on CCHMC’s strategic plan. Implementing these programs has shown us that 1) a multilevel curricular approach to building improvement capability is pragmatic and effective, 2) an interprofessional learning environment is critical to shifting mental models, 3) repetition of project experience with coaching and feedback solidifies critical skills, knowledge and behaviors, and 4) focusing first on developing capable interprofessional improvement leaders, versus engaging in broad general QI training across the whole organization, is effective.

via A comprehensive model to build improvem… [Acad Pediatr. 2014 Jan-Feb] – PubMed – NCBI.

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Neurohospitalists: perceived need and training requirements in academic neurology.

BACKGROUND AND PURPOSE:
We sought to determine the current practices and plans for departmental hiring of neurohospitalists at academic medical centers and to identify the core features of a neurohospitalist training program.
METHODS:
We surveyed department chairs or residency program directors at 123 Accreditation Council for Graduate Medical Education (ACGME)-accredited US adult neurology training programs.
RESULTS:
Sixty-three(51% response rate) responded, 76% of whom were program directors. In all, 24 (38%) academic neurology departments reported employing neurohospitalists, and an additional 10 departments have plans to hire neurohospitalists in the next year. In all, 4 academic neurology departments have created a neurohospitalist training program, and 10 have plans to create a training program within the next 2 years. Hospitals were the most frequent source of funding for established and planned programs (93% of those reporting). Most (n = 39; 65%) respondents felt that neurohospitalist neurology should be an ACGME-accredited fellowship. The highest priority neurohospitalist training elements among respondents included stroke, epilepsy, and consult neurology as well as patient safety and cost-effective inpatient care. The most important procedural skills for a neurohospitalist, as identified by respondents, include performance of brain death evaluations, lumbar punctures, and electroencephalogram interpretation.
CONCLUSIONS:
Neurohospitalists have emerged as subspecialists within neurology, growing both in number and in scope of responsibilities in practice. Neurohospitalists are in demand among academic departments, with many departments developing their existing presence or establishing a new presence in the field. A neurohospitalist training program may encompass training in stroke, epilepsy, and consult neurology with additional focus on patient safety and cost-effective care.

via Neurohospitalists: perceived need and train… [Neurohospitalist. 2014] – PubMed – NCBI.

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Quality improvement in childhood obesity management through the maintenance of certification process.

To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics.
STUDY DESIGN:
Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses.
RESULTS:
The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time.
CONCLUSIONS:
Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth.

via Quality improvement in childhood obesity managemen… [J Pediatr. 2013] – PubMed – NCBI.

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Improving the effect of FDA-mandated drug safety alerts with Internet-based continuing medical education.

The US Food and Drug Administration (FDA) requires risk communication as an element of Risk Evaluation and Mitigation Strategies (REMS) to alert and educate healthcare providers about severe toxicities associated with approved drugs. The educational effectiveness of this approach has not been evaluated. To support the communication plan element of the ipilimumab REMS, a Medscape Safe Use Alert (SUA) letter was distributed by Medscape via email and mobile device distribution to clinicians specified in the REMS. This alert contained the FDA-approved Dear Healthcare Provider (DHCP) letter mandated for distribution. A continuing medical education (CME) activity describing ipilimumab toxicities and the appropriate management was simultaneously posted on the website and distributed to Medscape members. Data were collected over a 6-month period regarding the handling of the letter and the responses to pre- and post-test questions for those who participated in the CME activity. Analysis of the answers to the pre- and posttest questions showed that participation in the CME activity resulted in an improvement in correct answer responses of 47%. Our experience shows that there are likely distinct information sources that are utilized by different HCP groups. The ready availability of a brief CME activity was utilized by 24,063 individuals, the majority of whom showed enhanced understanding of ipilimumab toxicity by improvement in post-test scores, educational data that are not available via implementation of standard safety alert communications. These results demonstrate that improvement in understanding of specific drug toxicities is enhanced by a CME intervention.

via Improving the effect of FDA-mandated drug safe… [Curr Drug Saf. 2013] – PubMed – NCBI.

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Study Skills Science: Investigating Memory Mnemonics

Have you ever needed to remember a long list of words, such as state capitals or items on a shopping list? Even if a list can be full of interesting facts, it can still be hard to remember. But there are some memory techniques that can help a person to better recall a list. In this science activity youll try out a technique called mnemonics—a memory boosting strategy. Youll investigate whether using mnemonics can help you and your friends or family members remember lists of words.

via Study Skills Science: Investigating Memory Mnemonics: Scientific American.

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Personal Learning Network (PLN): A How To Guide

I have spoken a lot about personal learning networks over the years, in fact I wax poetic about them in my book, #socialQI: Simple Solutions for Improving Your Healthcare. More recently as part of an EdTech session that I am participating in early next year I was asked to put together a set of ‘how to’ videos that explore how I structure my lifelong learning and my own PLN. This video resource set is intended to be distributed as a ‘flipped resource’ for that meeting, but I thought, since the content might be useful to those not attending the January meeting, that there may be some benefit in posting the resource set here too.

As you work through the videos think about whether there are other technologies that I might add (I have a few in mind) and I will append the series over time.

Enjoy!

Personal Learning Network Introduction

How to use  Twitter and Hootsuite to Enhance Your PLN

How to use  Google Alerts to Enhance Your PLN

How to use  PubMed and MyNCBI to Enhance Your PLN

How to use  a Blog Archive to Enhance Your PLN

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RESOURCE: Age of Distraction: Why It’s Crucial for Students to Learn to Focus

Digital classroom tools like computers, tablets and smartphones offer exciting opportunities to deepen learning through creativity, collaboration and connection, but those very devices can also be distracting to students. Similarly, parents complain that when students are required to complete homework assignments online, it’s a challenge for students to remain on task. The ubiquity of digital technology in all realms of life isn’t going away, but if students don’t learn how to concentrate and shut out distractions, research shows they’ll have a much harder time succeeding in almost every area.“The real message is because attention is under siege more than it has ever been in human history, we have more distractions than ever before, we have to be more focused on cultivating the skills of attention,” said Daniel Goleman, a psychologist and author of Focus: The Hidden Driver of Excellence and other books about social and emotional learning on KQED’s Forum program.“Children I’m particularly worried about because the brain is the last organ of the body to become anatomically mature. It keeps growing until the mid-20s,” Goleman said. If young students don’t build up the neural circuitry that focused attention requires, they could have problems controlling their emotions and being empathetic.

via Age of Distraction: Why It’s Crucial for Students to Learn to Focus | MindShift.

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ABSTRACT: Critical pedagogy in health education

Objective: This review investigated how the three-phase model of critical pedagogy, based on the writings of Paulo Freire, can be put into practice in health education.
Design: The study considers literature related to the fields of health education, health promotion and critical pedagogy.
Setting: The study is a scholarly review completed as part of a larger academic study.
Method: A library search was conducted of relevant books, journal articles and theses using keyword searches including health education, health promotion, critical pedagogy and Freire. Ideas from the literature and from teaching experience were integrated to consider how the three-phase model of critical pedagogy might be of benefit to health education.
Result: The review makes a case for the use of critical pedagogy in health education and discusses how Freire’s ideas can be combined with pedagogical techniques to overcome the difficulties of encouraging students and teachers to be co-learners in a power sharing arrangement, negotiating the content of the learning, ensuring that discussion is inclusive of a range of voices, perspectives and points of view, and dealing with the conflict which may be caused by the political nature of the teaching and learning.
Conclusion: The three-phase model of critical pedagogy, based on the writings of Freire, is advocated for use in health education because it ensures that learners have an opportunity to critically engage with health information rather than to simply be passive recipients of it. It aims to focus learning on the problems, issues and real world experience of the learners, facilitates problem-posing education, and challenges the learner to question practices that support inequality. The three phases are: listening and naming; dialogue and reflection; the promoting of transformative social action.

via Critical pedagogy in health education.

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