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Author: Brian S McGowan, PhD

ABSTRACT: The Value of Bedside Rounds: A Multicenter Qualitative Study

Background: Bedside rounds have decreased on teaching services, raising concern about trainees’ clinical skills and patient-physician relationships. Purpose: We sought to identify recognized bedside teachers’ perceived value of bedside rounds to assist in the promotion of bedside rounds on teaching services. Methods: Authors used a grounded theory, qualitative study design of telephone semistructured interviews with bedside teachers (n = 34) from 10 U.S. institutions (2010-2011). Main outcomes were characteristics of participants, themes pertaining to the perceived value of bedside rounds, and quotations highlighting each respective theme. Results: The mean years in academic medicine was 13.7, and 51% were associate or full professors. Six main themes emerged: (a) skill development for learners (e.g., physical examination, communication, and clinical decision-making skills); (b) observation and feedback; (c) role-modeling; (d) team building among trainees, attending, and patient; (e) improved patient care delivery through combined clinical decision-making and team consensus; and (f) the culture of medicine as patient-centered care, which was embodied in all themes. Conclusions: Bedside teachers identify potential benefits of bedside rounds, many of which align with national calls to change our approach to medical education. The practice of bedside rounds enables activities essential to high-quality patient care and education.

via The Value of Bedside Rounds… [Teach Learn Med. 2013 October-December] – PubMed – NCBI.

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ABSTRACT: Professional Identity in Medical Students: Pedagogical Challenges to Medical Education

Background: Professional identity, or how a doctor thinks of himself or herself as a doctor, is considered to be as critical to medical education as the acquisition of skills and knowledge relevant to patient care. Summary: This article examines contemporary literature on the development of professional identity within medicine. Relevant theories of identity construction are explored and their application to medical education and pedagogical approaches to enhancing students’ professional identity are proposed. The influence of communities of practice, role models, and narrative reflection within curricula are examined. Conclusions: Medical education needs to be responsive to changes in professional identity being generated from factors within medical student experiences and within contemporary society.

via Professional Identity in Me… [Teach Learn Med. 2013 October-December] – PubMed – NCBI.

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ABSTRACT: The use of simulation in teaching the basic sciences

PURPOSE OF REVIEW:To assess the current use of simulation in medical education, specifically, the teaching of the basic sciences to accomplish the goal of improved integration.RECENT FINDINGS:Simulation is increasingly being used by the institutions to teach the basic sciences. Preliminary data suggest that it is an effective tool with increased retention and learner satisfaction.SUMMARY:Medical education is undergoing tremendous change. One of the directions of that change is increasing integration of the basic and clinical sciences to improve the efficiency and quality of medical education, and ultimately to improve the patient care. Integration is thought to improve the understanding of basic science conceptual knowledge and to better prepare the learners for clinical practice. Simulation because of its unique effects on learning is currently being successfully used by many institutions as a means to produce that integration through its use in the teaching of the basic sciences. Preliminary data indicate that simulation is an effective tool for basic science education and garners high learner satisfaction.

via The use of simulation in teaching the… [Curr Opin Anaesthesiol. 2013] – PubMed – NCBI.

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FREE WEBINAR: “New Data on Clinician Learning: What does it mean for your programs?”

Please join me!

I have accepted an invitation by the team over at DLC Solutions to participate in an interview/webinar later this month. The goal of the webinar is to explore the various research questions I have been pursuing over the past 2 years and to specifically share some of the more recent data that the ArcheMedX team has collected.

For more information on the webinar click here – but in the meantime here are our highlights:

Abstract:

Research exploring clinician learning is of little value if it is not shared and leveraged broadly by those within the CME community to drive innovation and improve educational planning. This session will introduce three new and emerging data sets that have been collected by Brian S. McGowan, PhD. Dr McGowan will structure each data set to highlight the problem, the methods of exploration, and the data or conclusion that could be drawn. These new ideas will then be put into the context of the educational planning process with the goal of allowing those within the CME community to effectively leverage these data and lessons to immediately impact their planning processes.

Learning objectives:

  1. Explore recent data describing how physicians are beginning to adopt social media as an element of the lifelong learning
  2. Compare and contrast new data illustrating emerging trends in clinician preferences for different CME formats
  3. Devise a plan to leverage new data describing the learning actions that physicians use to structure new ideas and practices such that they are effectively learned and adopted into practice

Register today for this free Webinar to be held on Thursday October 24, 2013 at 2pm EST

Wordle - is learning theory enought cutom color palette

 

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RESOURCE: Improving Motivation in eLearning

Motivation has been and continues to be a widely studied area across many of life’s domains. Motivation is said to be the energizing force that initiates and sustains behavior and ultimately produces results. Many motivation theories focus on the amount of motivation, with a larger quantity said to result in improved outcomes. However, as educators we should not focus on generating more motivation from our learners but instead focus on creating conditions that facilitate the internalization of motivation from within our learners.

via elearn Magazine: Improving Motivation in eLearning.

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MANUSCRIPT: A randomized controlled pilot trial comparing the impact of access to clinical endocrinology video demonstrations with access to usual revision resources on medical student performance of clinical endocrinology skills

Background Demonstrating competence in clinical skills is key to course completion for medical students. Methods of providing clinical instruction that foster immediate learning and potentially serve as longer-term repositories for on-demand revision, such as online videos demonstrating competent performance of clinical skills, are increasingly being used. However, their impact on learning has been little studied. The aim of this study was to determine the value of adjunctive on-demand video-based training for clinical skills acquisition by medical students in endocrinology.

Methods Following an endocrinology clinical tutorial program, 2nd year medical students in the pre-assessment revision period were recruited and randomized to either a set of bespoke on-line clinical skills training videos TV, or to revision as usual RAU. The skills demonstrated on video were history taking in diabetes mellitus DMH, examination for diabetes lower limb complications LLE, and examination for signs of thyroid disease TE. Students were assessed on these clinical skills in an observed structured clinical examination two weeks after randomization. Assessors were blinded to student randomization status.

Results For both diabetes related clinical skills assessment tasks, students in the TV group performed significantly better than those in the RAU group. There were no between group differences in thyroid examination performance. For the LLE, 91.7% n?=?11/12 of students randomized to the video were rated globally as competent at the skill compared with 40% n?=?4/10 of students not randomized to the video p?=?0.024. For the DMH, 83.3% n?=?10/12 of students randomized to the video were rated globally as competent at the skill compared with 20% n?=?2/10 of students not randomized to the video p?=?0.007.

Conclusion Exposure to high quality videos demonstrating clinical skills can significantly improve medical student skill performance in an observed structured clinical examination of these skills, when used as an adjunct to clinical skills face-to-face tutorials and deliberate practice of skills in a blended learning format. Video demonstrations can provide an enduring, on-demand, portable resource for revision, which can even be used at the bedside by learners. Such resources are cost-effectively scalable for large numbers of learners.

via BMC Medical Education | Abstract | A randomized controlled pilot trial comparing the impact of access to clinical endocrinology video demonstrations with access to usual revision resources on medical student performance of clinical endocrinology skills.

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MANUSCRIPT: Medical education on a collision course: sooner rather than later?

BACKGROUND:
The escalating cost of medical education does not have transparency. This results in high percentages of medical students with progressively rising levels of indebtedness that are only exceeded by the increases in tuition. Indebtedness is a factor in specialty choice along with the “business” of medicine that reimburses procedural-based physicians much more than cognitive primary care-based services. In response to perceived increased physician demand by 2025, medical schools have increased enrollments, and new schools are online or in development. Despite the inevitable increase in medical graduates, the number of residency positions is static and may even contract. While these phenomena are being studied individually, almost no one is examining the bigger picture: increasing numbers of highly indebted students vying for static numbers of residency positions, especially in the more highly remunerative specialties. The workforce is out of balance now, and the desired workforce outcomes are not universally agreed upon, let alone how to achieve them. This collision of forces is imminent. Family medicine can become “counter culture” once again and advocate for change with education/cost data, political expertise, and outcome measures. Returning to our roots by advocating ultimately for the patient is fundamental to our discipline.

via Medical education on a collision course: sooner rath… [Fam Med. 2013] – PubMed – NCBI.

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MANUSCRIPT: Learning to collaborate: a case study of performance improvement CME [2008]

INTRODUCTION:
Performance Improvement Continuing Medical Education (PI CME) is a mechanism for joining quality improvement (QI) in health care to continuing medical education (CME) systems together. Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it requires the collaboration of CME providers and stakeholders within the health care systems who traditionally have not worked together and may not have the same understanding of QI issues to close performance gaps. This study describes how an academic institution and a community-based primary care practice collaborated to enhance patient care in the area of hypertension. It offers lessons learned from a PI CME activity in the area of hypertension.
METHODS:
This was an observational case study. Data were collected through interviews, observations of educational events, and review of documents such as learning logs, which were designed to: (1) help physicians learn and change, (2) satisfy requirements for CME credit, (3) serve as the basis for reimbursement, and (4) provide data for the case study.
RESULTS:
Nine clinicians from one clinic completed the PI CME activity, achieved measurable improvements in their practice, and contributed to systems change. The study highlighted (1) the value of shared goals and agreement on the process among the participants, planners, and others involved; (2) the advantage of a multidisciplinary approach; (3) the importance of supporting clinicians’ continuing motivation to participate; and (4) the need to allow sufficient time to enable the initiative to evolve.
DISCUSSION:
PI CME required unprecedented collaboration between CME planners and QI stakeholders to enable change in clinical practice.

via Learning to collaborate: a case st… [J Contin Educ Health Prof. 2008] – PubMed – NCBI.

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ABSTRACT: Collaborative online learning: a new approach to distance CME [2002]

OBJECTIVE:
Continuing medical education (CME) has not taken advantage of the ability to communicate and collaborate online. Collaborative learning is an important learning principle, yet online CME programs are generally completed in a one-on-one relationship between the computer and the learner. This limits opportunities for reflective learning, and does not access the rich learning available from interacting with peers. We believe online CME will benefit from interaction between learners and from opportunities for reflection.
DESCRIPTION:
We implemented a prototype online course designed to improve the skills of general practitioners (GPs) in the care of patients with type 2 diabetes. The course design reflects adult learning principles but, uniquely, applies them to online learning. Currently, 20 GPs from England are enrolled, including one based in Bosnia, and one GP from New Zealand. The course uses BlackBoard(TM) software. Participants log in twice weekly for seven weeks to study one of seven interactive modules on diabetes from evidence-based sources. Modules provide for branched learning via links to additional resources. Subsequently, GPs engage in two online discussions, which are at the learner’s convenience rather than requiring adherence to a set schedule. One discussion group is for reflection on the modules, with an assignment to discuss how the material is being applied clinically. Participants also respond to colleagues’ postings each week. In a second discussion group, learners apply concepts from the modules to the collaborative management of a problem-based case of a patient with newly diagnosed diabetes. The patient is presented via an online medical chart and streaming videos. She returns each week of the course to mimic 18 months of care. Faculty facilitate the discussion groups and provide feedback.
DISCUSSION:
We are in the last week of the class and the participant feedback has been overwhelmingly positive. Many note how well the course design and timing match their learning styles and schedule constraints. A powerful feature has been our ability to identify additional educational needs, and quickly add corresponding content online. So far, participants have provided 340 postings, which include evidence of course effectiveness and documentation of application of course objectives and disease management strategies to change actual practice patterns. GPs report changing: screening practices for diabetic renal disease; prescribing of diabetic medications; screening protocols for diabetes; and organizing practice management systems to better track diabetic care. After diagnosing and managing a new diabetic patient during the course, one participant wrote: “It was fantastic to feel that I am offering an up-to-date evidence-based approach in something that I am deskilled in.” This course is unique in online CME. It is international in scope, collaborative, asynchronous in delivery, flexible, responsive to learner needs in real time, and has yielded evidence of its effectiveness in changing the actual clinical practices of participants. It will next enroll GPs in Singapore and additional UK-based GPs. Additional CME courses will be developed using this method.

via Collaborative online learning: a new approach to di… [Acad Med. 2002] – PubMed – NCBI.

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ABSTRACT: Effect of a Performance Improvement CME Activity on Management of Patients With Diabetes.

INTRODUCTION:
Primary care in the United States faces unprecedented challenges from an aging population and the accompanying prevalence of chronic disease. In response, continuing medical education (CME) initiatives have begun to adopt the principles of performance improvement (PI) into their design, although currently there is a dearth of evidence from national initiatives supporting the effectiveness of this methodology. The specific aim of this study was to demonstrate the value of a national PI-CME activity to improve the performance of physicians treating patients with diabetes.
METHODS:
We analyzed data from the American Academy of Family Physicians’ METRIC® PI-CME activity in a cohort of family physician learners. The study utilized the 3-stage design standard approved for PI-CME. Baseline and follow-up performance data across a range of clinical and systems-based measures were compared in aggregate.
RESULTS:
Data were assessed for 509 learners who completed the activity. Statistically significant changes occurred both for self-assessment of a range of practice aspects and for diabetes care measures. Learners recognized that the organization of their practices had improved, and mechanisms were in place for better staff feedback, as well as aspects of patient self-management. Based on the clinical data obtained from 11 538 patient charts, 6 out of 8 diabetes measures were significantly improved.
DISCUSSION:
The activity appears to have had a positive, measurable impact on the medical practice of learners and suggests that, when appropriately designed and executed, PI-CME on a national scale can be a useful vehicle to influence performance change in physicians and to inform future CME activities.

via Effect of a Performance Improvemen… [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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