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Author: Brian S McGowan, PhD

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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ABSTRACT: Integrating Actors into a Simulation Program: A Primer

We describe our more than 10 years’ experience working with actors and provide a “how-to” guide to recruiting, auditioning, hiring, training, and mentoring actors for work as simulated patients in simulation programs. We contend that trained actors add great realism, richness, and depth to simulation-based training programs. The actors experience satisfaction from their contributions, and their skill and improvisational talent allow programs to offer ethical and relational training, customized to a wide range of practitioners and adapted across a variety of health care conversations. Such learning opportunities can directly address Accreditation Council for Graduate Medical Education core competencies in preparing capable, confident, and empathic health care practitioners

via Integrating Actors into a Simulation Program: … [Simul Healthc. 2013] – PubMed – NCBI.

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ABSTRACT: Effect of Medical Education on Students’ Attitudes Toward Psychiatry and Individuals With Mental Disorders

OBJECTIVE This study aimed to explore the effect of medical education on students’ attitudes toward psychiatry and psychiatric patients, and examined the usefulness of a new evaluation tool: the Psychiatric Experience, Attitudes, and Knowledge: 6 Items (PEAK-6). METHOD Authors studied the attitudes of 116 medical students toward psychiatry and individuals with mental disorders, using two questionnaires before and after a 12-week module of “psychosocial medicine.” Results of the questionnaire Attitudes Toward Psychiatry: 30 Items (ATP-30) were compared with the results of PEAK-6. RESULTS With the ATP-30, no change in attitudes toward psychiatry was observed at the end of the module. With the PEAK-6, the item “attitude toward psychiatry” significantly improved. Knowledge of and experience with psychiatry as well as knowledge of and experience with individuals with mental disorders improved significantly; however, attitudes toward individuals with mental disorders did not improve. CONCLUSION PEAK-6 seems to be a promising tool with regard to nuanced information about psychiatric learning experiences. Participation in a psychiatric module may be associated with a positive effect on students’ knowledge about, experience with, and attitudes toward psychiatry, but not attitudes toward psychiatric patients.

via Effect of Medical Education on Students’ Att… [Acad Psychiatry. 2013] – PubMed – NCBI.

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MANUSCRIPT: The transformation of continuing medical education (CME) in the United States

This article describes five major themes that inform and highlight the transformation of continuing medical education in the USA. Over the past decade, the Institute of Medicine (IOM) and other national entities have voiced concern over the cost of health care, prevalence of medical errors, fragmentation of care, commercial influence, and competence of health professionals. The recommendations from these entities, as well as the work of other regulatory, professional, academic, and government organizations, have fostered discussion and development of strategies to address these challenges. The five themes in this paper reflect the changing expectations of multiple stakeholders engaged in health care. Each theme is grounded in educational, politico-economic priorities for health care in the USA. The themes include (1) a shift in expectation from simple attendance or a time-based metric (credit) to a measurement that infers competence in performance for successful continuing professional development (CPD); (2) an increased focus on interprofessional education to augment profession-specific continuing education; (3) the integration of CPD with quality improvement; (4) the expansion of CPD to address population and public health issues; and (5) identification and standardization of continuing education (CE) professional competencies. The CE profession plays an essential role in the transformation of the US CPD system for health professionals. Coordination of the five themes described in this paper will foster an improved, effective, and efficient health system that truly meets the needs of patients.

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791543/pdf/amep-4-171.pdf

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ABSTRACT: Impact of an Online Survivorship Primer on Clinician Knowledge and Intended Practice Changes

The number of adult cancer survivors in the USA is expected to double by the year 2050. A call for increased survivorship care and provider training came from the Institute of Medicine (IOM) in the form of a landmark report in 2006. A shortage of physicians complicates the burden of survivorship care. The purpose of this effort was to design, develop, and evaluate a fully accredited, evidence-based continuing medical education (CME) and continuing education (CE) intervention to address the established knowledge gap for breast cancer, prostate cancer, colorectal cancer, and non-Hodgkin lymphoma survivorship education. Delivered through the Medscape Education (WebMD) platform, the course covered epidemiology, survivor issues, and currently available guidelines using illustrative patient cases. Knowledge gain was evaluated using a pretest-posttest design. Program evaluation was assessed by survey. Additional areas examined included post-intervention inquiry regarding expected changes to clinical practice. The results of this educational intervention demonstrated the effectiveness of internet-based CME/CE for cancer survivorship. Learning gain was significant (p < 0.0005). Effect size (d = 1.71) suggested extremely high practical significance, as the difference between the means was larger than 1 standard deviation. Significant knowledge gains were observed for each survivorship knowledge question across all clinical specialties studied. Nearly 100 % of participants agreed that the course contributed to survivorship care and was organized effectively. Participants reported that the course was designed effectively (97.2 %), and 68.1 % responded in favor of adopting alternative communication strategies with patients and families upon completion of the course.

via Impact of an Online Survivorship Primer on Cli… [J Cancer Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Multidisciplinary Team Training to Enhance Family Communication in the ICU

OBJECTIVES::
Current guidelines from the U.S. Society for Critical Care Medicine state that training in “good communication skills…should become a standard component of medical education and … available for all ICU caregivers”. We sought to train multidisciplinary teams of ICU caregivers in communicating with the families of critically ill patients to improve staff confidence in communicating with families, as well as family satisfaction with their experiences in the ICU.
DESIGN::
Pre- and postintervention design.
SETTING::
Community hospital medical and surgical ICUs.
PATIENTS::
All patients admitted to ICU during the two time periods.
INTERVENTION::
Ninety-eight caregivers in multidisciplinary teams of five to eight individuals trained in a standardized approach to communicating with families of ICU patients using the Setup, Perception, Invitation, Knowledge, Emotions, Strategy (or Subsequent) (SPIKES) protocol followed by participation in a simulated family conference.
MEASUREMENTS::
Staff confidence in communicating with family members of critically ill patients was measured immediately before and 6-8 weeks after training sessions using a validated tool. Family satisfaction using seven items measuring effectiveness of communication from the Family Satisfaction in the ICU (24) tool in surveys received from family members of 121 patients admitted to the ICU before and 121 patients admitted to the ICU after trainings was completed.
MAIN RESULTS::
Using 46 matched pre- and postsurveys, staff confidence in communicating with family members of critically ill patients increased significantly (p < 0.001) in each of 21 separate measures. Family satisfaction with communication showed significant (p < 0.05 or better) improvement in three of seven individual items compared with those same items pretraining. There was no decline in any individual item.
CONCLUSIONS::
A simple intervention resulted in improvement in staff confidence, as well as in multiple measures of family satisfaction with communication. This intervention is easily reproduced.

via Multidisciplinary Team Training to Enhance Fam… [Crit Care Med. 2013] – PubMed – NCBI.

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