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Author: Brian S McGowan, PhD

ABSTRACT: Medical education and cognitive continuum theory: an alternative perspective on medical problem solving and clinical reasoning

Recently, human reasoning, problem solving, and decision making have been viewed as products of two separate systems: “System 1,” the unconscious, intuitive, or nonanalytic system, and “System 2,” the conscious, analytic, or reflective system. This view has penetrated the medical education literature, yet the idea of two independent dichotomous cognitive systems is not entirely without problems.This article outlines the difficulties of this “two-system view” and presents an alternative, developed by K.R. Hammond and colleagues, called cognitive continuum theory (CCT). CCT is featured by three key assumptions. First, human reasoning, problem solving, and decision making can be arranged on a cognitive continuum, with pure intuition at one end, pure analysis at the other, and a large middle ground called “quasirationality.” Second, the nature and requirements of the cognitive task, as perceived by the person performing the task, determine to a large extent whether a task will be approached more intuitively or more analytically. Third, for optimal task performance, this approach needs to match the cognitive properties and requirements of the task. Finally, the author makes a case that CCT is better able than a two-system view to describe medical problem solving and clinical reasoning and that it provides clear clues for how to organize training in clinical reasoning.

via Medical education and cognitive continuum theory: a… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Toward a common taxonomy of competency domains for the health professions and competencies for physicians

Although health professions worldwide are shifting to competency-based education, no common taxonomy for domains of competence and specific competencies currently exists. In this article, the authors describe their work to (1) identify domains of competence that could accommodate any health care profession and (2) extract a common set of competencies for physicians from existing health professions’ competency frameworks that would be robust enough to provide a single, relevant infrastructure for curricular resources in the Association of American Medical Colleges’ (AAMC’s) MedEdPORTAL and Curriculum Inventory and Reports (CIR) sites. The authors used the Accreditation Council for Graduate Medical Education (ACGME)/American Board of Medical Specialties six domains of competence and 36 competencies delineated by the ACGME as their foundational reference list. They added two domains described by other groups after the original six domains were introduced: Interprofessional Collaboration (4 competencies) and Personal and Professional Development (8 competencies). They compared the expanded reference list (48 competencies within eight domains) with 153 competency lists from across the medical education continuum, physician specialties and subspecialties, countries, and health care professions. Comparison analysis led them to add 13 “new” competencies and to conflate 6 competencies into 3 to eliminate redundancy. The AAMC will use the resulting “Reference List of General Physician Competencies” (58 competencies in eight domains) to categorize resources for MedEdPORTAL and CIR. The authors hope that researchers and educators within medicine and other health professions will consider using this reference list when applicable to move toward a common taxonomy of competencies.

via Toward a common taxonomy of competency domains for … [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Believing is seeing: how people’s beliefs influence goals, emotions and behaviour.

INTRODUCTION:
Health care professionals work and learn in complex environments. Some are able to continue learning from their practice and the challenges it presents, whereas others refrain from investing more effort when faced with setbacks. This paper discusses a social cognitive model of motivation that helps to explain the different kinds of behaviour that emerge when individuals are confronted with challenges.
SELF-THEORIES:
Self-theories (people’s theories on what competence is and means for the self) play a major role in establishing the goals people set for themselves, the emotions they experience and the meanings they attach to situations. These self-views are often not explicitly articulated and are therefore called ‘implicit’ (‘self-‘) theories. Social cognitive research suggests there are two distinct ways of thinking about one’s personal attributes: entity theorists view a trait as a fixed, concrete internal entity, whereas incremental theorists instead believe a trait to be something malleable that can be developed or cultivated through effort. Holding an entity theory leads one to set performance goals and to harbour concerns about performing well and making a good impression. Holding an incremental theory tends to lead one to set learning goals, and to focus less on performance and more on spending time and effort in determining which strategies work.
DISCUSSION:
The current literature on self-theories is used to explore the relevance of these theories in medical education in three contexts: (i) it is argued that, in order to support lifelong learning, both individual and organisational efforts fit best with an incremental outlook on professional development; (ii) if it is to move forward in the domain of feedback-seeking behaviour, medical education might benefit from a better understanding of the interactions among self-theories, feedback behaviour, and the pervading role of organisational culture, and (iii) the impact of self-theories on assessors’ evaluations of performance.

via Believing is seeing: how people’s beliefs influence… [Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Design and Development of a Virtual Reality Simulator for Advanced Cardiac Life Support Training.

The use of Virtual Reality (VR) training tools for medical education could lead to improvements in the skills of clinicians while providing economic incentives for healthcare institutions. The use of VR tools can also mitigate some of the drawbacks currently associated with providing medical training in a traditional clinical environment such as scheduling conflicts and the need for specialized equipment (e.g. high-fidelity manikins). This paper presents the details of the framework and the development methodology associated with a VR based training simulator for Advanced Cardiac Life Support (ACLS), a time critical, team based medical scenario. In addition, we also report the key findings of a usability study conducted to assess the efficacy of various features of this VR simulator through a postuse questionnaire administered to various care providers. The usability questionnaires were completed by two groups that used two different versions of the VR simulator. One version consisted of the VR trainer with it all its features and a minified version with certain immersive features disabled. We found an increase in usability scores from the minified group to the full VR group.

via Design and Development of a Virt… [IEEE J Biomed Health Inform. 2013] – PubMed – NCBI.

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MANUSCRIPT: Context dependent memory in two learning environments: the tutorial room and the operating theatre

BACKGROUND:
Psychologists have previously demonstrated that information recall is context dependent. However, how this influences the way we deliver medical education is unclear. This study aimed to determine if changing the recall context from the learning context affects the ability of medical students to recall information.
METHODS:
Using a free recall experimental model, fourteen medical student participants were administered audio lists of 30 words in two separate learning environments, a tutorial room and an operating theatre. They were then asked to recall the words in both environments. While in the operating theatre participants wore appropriate surgical clothing and assembled around an operating table. While in the tutorial room, participants dressed casually and were seated around a table. Students experienced the same duration (15 minutes) and disruption in both environments.
RESULTS:
The mean recall score from the 28 tests performed in the same environment was 12.96 +/- 3.93 (mean, SD). The mean recall score from the 28 tests performed in an alternative environment to the learning episode was 13.5 +/- 5.31(mean, SD), indicating that changing the recall environment from the learning environment does not cause any statistical difference (p=0.58). The average recall score of participants who learned and recalled in the tutorial room was 13.0 +/- 3.84 (mean, SD). The average recall score of participants who learnt and recalled in the operating theatre was 12.92 +/- 4.18 (mean, SD), representing no significant difference between the two environments for learning (p=0.4792).
CONCLUSIONS:
The results support the continued use of tutorial rooms and operating theatres as appropriate environments in which to teach medical students, with no significant difference in information recall seen either due to a same context effect or specific context effect.

via Context dependent memory in two learning enviro… [BMC Med Educ. 2013] – PubMed – NCBI.

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MANUSCRIPT: Effect of a web-based curriculum on primary care practice: basic skin cancer triage trial

BACKGROUND AND OBJECTIVES:
Primary care physicians (PCPs) are uniquely positioned to detect melanoma. Effective educational interventions targeted at PCPs may improve early melanoma detection. A previous in-person Basic Skin Cancer Triage (BSCT) 2-hour course demonstrated significant short-term improvement in provider practices, attitudes, ability, confidence, and knowledge. We conducted a randomized trial to test the efficacy of the BSCT course implemented as a web-based learning program, compared to a similar (control) web-based course on weight assessment.
METHODS:
We recruited a sample of 57 PCPs and 3,341 of their patients from four geographically diverse centers. Skin cancer control activities by PCPs were assessed by physician survey and by chart review and patient telephone interview about their recent visit to their PCP at baseline and at 1–2 months and 12 months after course completion.
RESULTS:
Some effect of intervention on skin cancer parameters was self-reported by physicians; this was not confirmed by patient survey or chart-extracted data. Rates of skin cancer control practices by PCPs were low across both groups before and after intervention. The positive changes in physician-reported behaviors (total body skin examination [TBSE]), intentions (discuss skin cancer detection), confidence (performing TBSE), office practices, and knowledge (58% skin versus 49% control) were neither matched by differences in practice reported by their patients, nor persisted in a longer term follow-up, hence may be attributable to physician recall bias due to the experience of the course or desire to please study investigators and were less dramatic as compared to our previously reported in-person BSCT intervention. Thus this approach by itself appears unlikely to result in improved PCP handling of skin cancer issues.
CONCLUSIONS:
Given previous success with our in-person course, the features required to make WBL a more effective tool for medical education must be further explored.

via Effect of a web-based curriculum on primary care pra… [Fam Med. 2013] – PubMed – NCBI.

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MANUSCRIPT: Entry of US Medical School Graduates Into Family Medicine Residencies: 2012–2013.

BACKGROUND:
Analyzing the US medical school origin of family medicine residents highlights schools, states, or regions that have higher entrance rates into family medicine.
METHODS:
The American Academy of Family Physicians (AAFP) 2013 Residency Census has a 100% response rate and lists information for family medicine residents who entered training July 2012. MD graduates are verified through medical school registrars or the American Medical Association’s Physicians Masterfile data. The American Association of Colleges of Osteopathic Medicine provides data on DO graduates. Three-year rolling averages of graduates entering family medicine are calculated for Liaison Committee of Medical Education (LCME)-accredited medical schools.
RESULTS:
In July 2012, 3,523 first-year residents entered Accreditation Council for Graduation Medical Education (ACGME)-accredited family medicine residencies. Medical students from LCME-accredited schools account for less than half of the family medicine residents (46%). Public MD-granting medical schools graduate almost threefold more students into family medicine residencies than do private schools (1,101 versus 380). The Mountain, West North Central, and Pacific regions of the United States have the highest percentage of MD graduates (13.5%, 12.3%, and 11.4%, respectively) entering family medicine. Forty-five percent of MD medical students enter a family medicine residency in the state in which they attended medical school.
CONCLUSIONS:
LCME-accredited medical schools with lower percentages of graduates entering family medicine should examine the economic, environmental, and academic factors that may be causing low numbers of their students graduating and entering family medicine residencies.

via Entry of US Medical School Graduates Into Family Med… [Fam Med. 2013] – PubMed – NCBI.

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MANUSCRIPT: Teaching by example: educating medical students through a weight management experience.

BACKGROUND AND OBJECTIVES:Surgeons General, the Institute of Medicine, and others have called for physicians to be role models for meeting the obesity epidemic. There are few published reports describing undergraduate medical education obesity curriculum elements. Physician experiences, knowledge, and attitudes have been shown to affect patient counseling behavior of physicians.METHODS:Required and extra credit obesity educational interventions were designed for third-year family medicine clerkship. For extra credit, students completed a personal weight management experience that spanned at least 4 weeks, included calculations of body mass index BMI, waist circumference, caloric needs, description of eating and physical activity and monitoring plan, and a final report and reflection.RESULTS:During 2011–2012, 72% of the students completed this extra credit activity with almost all losing or maintaining their weight. Most reflected gratitude for this opportunity and their increased empathy for patients as they struggle with weight issues.CONCLUSIONS:Medical students completing a weight management experience during their third-year clerkship can see the effects on their own health while developing empathy for and understanding of the weight management struggles of their patients. Minimal faculty time commitment is required.

via Teaching by example: educating medical students thro… [Fam Med. 2013] – PubMed – NCBI.

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Educational content must breathe…

Back in the ol’ days when producing content was a specialized competency, educational planners had little choice but to develop content, package it into slides, or a monograph, or a video and then sit back and hope it had the impact that was intended. Certainly in live meetings, or in a series of live meetings, content could be adjusted dynamically over time, but even then it seems that this opportunity was rarely leveraged and more often than not the content being presented in the 8th meeting of a series differed little from that presented in the 1st meeting in the series.

It seems that (historically) the broadly held cultural expectation was that educational content was an end-product of educational planning. Period.

But times have changed – the act of producing content is no longer a specialized competency – creating, refining, and optimizing content CAN BE done with little effort and this COULD significantly change the impact of an activity, an initiative, or an educational program.

I emphasize the words “CAN BE” and “COULD” because it seems that though technology has provided the educational community with the opportunity to breathe new life into their content overtime, the culture of educational planning has not appeared to change.

Over the past few months of extolling the virtues of our learning architecture models I have heard time and time and time again that the ability to create rapid feedback loops where real-time learning action data can be leveraged to update, refine, and optimize content is a game changer. Learners love the idea that the content they are exploring is dynamic. Supporters of medical education are enthralled with the idea that education content can be as relevant 12 months after it was launched as it was on day one. And, educational planners and faculty seem to genuinely understand how this simple innovation may allow them to educate and empower clinicians which much greater flexibility and fidelity.

So the question to be asked is, ‘how can we ensure that the vision for what could be in medical education is not limited by the culture of what has always been?’

At this moment I do not have the definitive answer to this question, but trust that we are spending a lot of time engineering solutions that address this very question.Just Breathe

While it is one thing to acknowledge that your educational content can and must breathe, it is another thing to change the cultural expectation that content is created once. To get from here to there educational planning models must change, expectations must change, and culture must change.

Simply put, for medical education to have the impact that is needed, the community must transform our educational planning process from an inorganic set-it-and-forget-it model to an organic, breathing, dynamic model…a task that despite vast technological innovation will ultimately depend on individual within the community accepting the challenge.

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ABSTRACT: Building an open academic environment – a new approach to empowering students in their learning of anatomy through ‘Shadow Modules’

Teaching and learning in anatomy is undertaken by a variety of methodologies, yet all of these pedagogies benefit from students discussing and reflecting upon their learning activities. An approach of particular potency is peer-mediated learning, through either peer-teaching or collaborative peer-learning. Collaborative, peer-mediated, learning activities help promote deep learning approaches and foster communities of practice in learning. Students generally flourish in collaborative learning settings but there are limitations to the benefits of collaborative learning undertaken solely within the confines of modular curricula. We describe the development of peer-mediated learning through student-focused and student-led study groups we have termed ‘Shadow Modules’. The ‘Shadow Module’ takes place parallel to the formal academically taught module and facilitates collaboration between students to support their learning for that module. In ‘Shadow Module’ activities, students collaborate towards curating existing online open resources as well as developing learning resources of their own to support their study. Through the use of communication technologies and Web 2.0 tools these resources are able to be shared with their peers, thus enhancing the learning experience of all students following the module. The Shadow Module activities have the potential to lead to participants feeling a greater sense of engagement with the subject material, as well as improving their study and group-working skills and developing digital literacy. The outputs from Shadow Module collaborative work are open-source and may be utilised by subsequent student cohorts, thus building up a repository of learning resources designed by and for students. Shadow Module activities would benefit all pedagogies in the study of anatomy, and support students moving from being passive consumers to active participants in learning.

via Building an open academic environment – a new approac… [J Anat. 2013] – PubMed – NCBI.

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