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Author: Brian S McGowan, PhD

MANUSCRIPT: Medical Education and Professional Training— Changing the Trajectory

At least 15 reports have called for change in medical
education in the last decade ending 2010. The problems
facing medical education have been thoroughly elucidated.
There is remarkable congruence in the recommendations
of these reports. There reports have called for changes
in terms of integrating the educational continuum, need
for evaluation and research, new methods of fi nancing,
leadership importance, social accountability, use of
technology, alignment with healthcare delivery and sets
directions for the healthcare workforce reinforcing the
recommendations of CanMEDS, GMC(UK), ACGME/
ABMS and IOM highlighted earlier

 

http://www.annals.edu.sg/pdf/42VolNo2Feb2013/V42N2p99.pdf

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ABSTRACT: Mythmaking in medical education and medical practice

BACKGROUND:
Despite the emergence of evidence-based medicine, gaps in medical knowledge are filled by tradition, common sense, and experience, giving rise to medical myths.
METHODS:
We explored the origins of and evidence related to four medical myths: patients with shellfish allergies should not receive intravenous contrast, patients with atrial fibrillation of less than 48 hours’ duration do not require anticoagulation before cardioversion, patients with suspected meningitis should have a computed tomography (CT) scan before a lumbar puncture, and patients with respiratory disease should not receive β-blockers. We conducted a literature review to describe each myth’s origins and the quality of supporting evidence.
RESULTS:
All patients with allergies, including but not limited to seafood allergies, are at an increased risk for anaphylactoid reactions to radiocontrast. No conclusive studies indicate that patients with atrial fibrillation of less than 48 hours’ duration do not require anticoagulation before cardioversion. A CT scan before lumbar puncture in suspected acute bacterial meningitis is a clinically inefficient precaution. β-blockers can be safely used in patients with respiratory disease and may even prevent cardiac events in these patients.
CONCLUSIONS:
These familiar myths have maintained prominent roles in medical thinking because they represent wisdom passed down from eminent sources, they teach physiology and medical skills, and they offer physicians a sense of control in the face of uncertainty. In addition to providing scientific evidence, changing physicians’ practice requires acknowledging that even meticulous care cannot always avert bad outcomes.

via Mythmaking in medical education and medical… [Eur J Intern Med. 2013] – PubMed – NCBI.

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ABSTRACT: Promoting self-directed learning through portfolios in undergraduate medical education: the mentors’ perspective

BACKGROUND:
Medical students need to acquire self-directed learning (SDL) skills for effective lifelong learning. Portfolios allow learners to reflect on their progress, diagnose learning needs and create learning plans, all elements of SDL. While mentorship is deemed to be essential for successful portfolio use, it is not known what constitutes effective mentorship in this process. In-depth understanding of the SDL construct seems a prerequisite.
AIMS:
The aim of this study was to examine how portfolio mentors perceive and approach SDL.
METHODS:
Interviews with faculty members who mentored medical students in portfolio were audio-recorded, transcribed and analysed for themes.
RESULTS:
Eight mentors participated. Qualitative analysis revealed six major themes around mentors’ definitions of SDL, their perception of innate SDL abilities of medical students, their own approach to SDL, their understanding of the value of learning plans, their perceptions of students’ engagement with the portfolio and the impact of the portfolio process on the mentoring relationship.
CONCLUSIONS:
This study revealed tensions between mentors’ beliefs regarding the importance of SDL, their own approach to SDL and their perceptions of students’ SDL skills. Based on our analysis of these tensions, we recommend both explicit faculty development and institutional culture change for successful integration of SDL in medical education.

via Promoting self-directed learning through portfolio… [Med Teach. 2013] – PubMed – NCBI.

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ABSTRACT: The application of wiki technology in medical education

BACKGROUND, AIMS AND METHODS: Recent years have seen the introduction of web-based technologies such as the ‘wiki’, which is a webpage whose content can be edited in real time using a web browser. This article reviews the current state of knowledge about the use of wikis in education, and considers whether wiki technology has features that might prove useful in medical education.
RESULTS:
Advantages and challenges of the technology are discussed, and recommendations for use are provided. We believe that wiki technology offers a number of potential benefits for administrators, students and instructors, including the ability to share information online, to construct knowledge together, to facilitate collaboration and to enable social learning and peer feedback.
CONCLUSIONS:
We believe that with proper planning and instructional design, wiki technology can be usefully employed in medical education. We intend to continue to study the impact of wiki technology in our own programme, and we encourage others to evaluate the application of wiki technology in other areas of medical education.

via The application of wiki technology in medical educ… [Med Teach. 2013] – PubMed – NCBI.

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MANUSCRIPT: The effectiveness of continuing medical education for specialist recertification

Evolving professional, social and political pressures highlight the importance of lifelong learning for clinicians. Continuing medical education CME facilitates lifelong learning and is a fundamental factor in the maintenance of certification. The type of CME differs between surgical and non-surgical specialties. CME methods of teaching include lectures, workshops, conferences and simulation training. Interventions involving several modalities, instructional techniques and multiple exposures are more effective. The beneficial effects of CME can be maintained in the long term and can improve clinical outcome. However, quantitative evidence on validity, reliability, efficacy and cost-effectiveness of various methods is lacking. This is especially evident in urology. The effectiveness of CME interventions on maintenance of certification is also unknown. Currently, many specialists fulfil mandatory CME credit requirements opportunistically, therefore erroneously equating number of hours accumulated with competence. New CME interventions must emphasize actual performance and should correlate with clinical outcomes. Improved CME practice must in turn lead to continuing critical reflection, practice modification and implementation with a focus towards excellent patient care.

via The effectiveness of continuing medical edu… [Can Urol Assoc J. 2013] – PubMed – NCBI.

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ABSTRACT: The presentation of seizures and epilepsy in YouTube videos.

We evaluated videos on the social media website, YouTube, containing references to seizures and epilepsy. Of 100 videos, 28% contained an ictal event, and 25% featured a person with epilepsy recounting his or her personal experience. Videos most commonly fell into categories of Personal Experience/Anecdotal (44%) and Informative/Educational (38%). Fifty-one percent of videos were judged as accurate, and 9% were inaccurate; accuracy was not an applicable attribute in the remainder of the videos. Eighty-five percent of videos were sympathetic towards those with seizures or epilepsy, 9% were neutral, and only 6% were derogatory. Ninety-eight percent of videos were thought to be easily understood by a layperson. The user-generated content on YouTube appears to be more sympathetic and accurate compared to other forms of mass media. We are optimistic that with a shifting ratio towards sympathetic content about epilepsy, the amount of stigma towards epilepsy and seizures will continue to lessen.

via The presentation of seizures and epilepsy in … [Epilepsy Behav. 2013] – PubMed – NCBI.

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ABSTRACT: Exploring the use of a facebook page in anatomy education

Facebook is the most popular social media site visited by university students on a daily basis. Consequently, Facebook is the logical place to start with for integrating social media technologies into education. This study explores how a faculty-administered Facebook Page can be used to supplement anatomy education beyond the traditional classroom. Observations were made on students perceptions and effectiveness of using the Page, potential benefits and challenges of such use, and which Insights metrics best reflect users engagement. The Human Anatomy Education Page was launched on Facebook and incorporated into anatomy resources for 157 medical students during two academic years. Students use of Facebook and their perceptions of the Page were surveyed. Facebooks “Insights” tool was also used to evaluate Page performance during a period of 600 days. The majority of in-class students had a Facebook account which they adopted in education. Most students perceived Human Anatomy Education Page as effective in contributing to learning and favored “self-assessment” posts. The majority of students agreed that Facebook could be a suitable learning environment. The “Insights” tool revealed globally distributed fans with considerable Page interactions. The use of a faculty-administered Facebook Page provided a venue to enhance classroom teaching without intruding into students social life. A wider educational use of Facebook should be adopted not only because students are embracing its use, but for its inherent potentials in boosting learning. The “Insights” metrics analyzed in this study might be helpful when establishing and evaluating the performance of education-oriented Facebook Pages.

via Exploring the use of a facebook page in anatom… [Anat Sci Educ. 2013] – PubMed – NCBI.

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MANUSCRIPT: Teaching, Learning, Complexity and Health Professions Education

The purpose of this paper is to disturb the way we think about teaching and learning and to offer a view of health professions education from the perspective of complexity thinking. To discuss complexity and the profound shift it makes with current thinking it is helpful to recall that prior to the 16th century it was believed, in the Western world, that all things on earth and in the heavens were guided by a divine hand. Galileo, Newton, Copernicus, Descartes, and Bacon, among others, challenged and changed the status quo. Exploration and the gathering of evidence through experimentation, together with the rise individualism helped give birth to the scientific and industrial revolutions. Descartes wrote that everything should be broken down into its smallest component parts in order to understand the whole. This has had a profound and lasting effect palpable today in health professions education where mechanistic explanations still prevail and reductionist approaches to curriculum rooted in Cartesian and Newtonian linear causality are common. This is the dominant paradigm of western science and society. It is how we organize our schools. It is how we teach.

http://www.iamse.org/jiamse/volume20-2s/20-2s-162-165.pdf

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MANUSCRIPT: Team-based learning for psychiatry residents: a mixed methods study

Background
Team-based learning (TBL) is an effective teaching method for medical students. It improves knowledge acquisition and has benefits regarding learner engagement and teamwork skills. In medical education it is predominately used with undergraduates but has potential benefits for training clinicians. The aims of this study were to examine the impact of TBL in a sample of psychiatrists in terms of classroom engagement, attitudes towards teamwork, learner views and experiences of TBL.

Methods
Forty-four psychiatry residents participated in an Addictions Psychiatry TBL module. Mixed-methods were used for evaluation. Self-rated measures of classroom engagement (Classroom Engagement Survey, CES) were compared with conventional lectures, and attitudes regarding the value of teams (Value of Teams Scale, VTS) were compared before and after the module. Independent t-tests were used to compare `lecture? CES scores with TBL CES scores and pre and post scores for the VTS. Feedback questionnaires were completed. Interviews were conducted with a subset of residents and transcripts analysed using thematic analysis.

Results
Twenty-eight residents completed post-course measures (response rate 63.6%). Seven participants volunteered for qualitative interviews?one from each team. There was a significant difference in the mean CES score lectures compared to TBL (p?<?0.001) but no difference was found in mean VTS score pre and post for either subscale (p?=?0.519; p?=?0.809). All items on the feedback questionnaire were positively rated except two regarding session preparation. The qualitative analysis generated seven themes under four domains: `Learning in teams?, `Impact on the individual learner?, `Relationship with the teacher? and `Efficiency and effectiveness of the learning process?.

Conclusions
In this group of residents, TBL significantly improved learner-rated classroom engagement and seemed to promote interactivity between learners. TBL was generally well-received, although required learners to prepare for class which was difficult for some. TBL did not change these clinicians? views about teamwork.

via BMC Medical Education | Abstract | Team-based learning for psychiatry residents: a mixed methods study.

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MANUSCRIPT: Programmatic assessment of competency-based workplace learning: when theory meets practice

Background
In competency-based medical education emphasis has shifted towards outcomes, capabilities, and learner-centeredness. Together with a focus on sustained evidence of professional competence this calls for new methods of teaching and assessment. Recently, medical educators advocates the use of a holistic, programmatic approach towards assessment. Besides maximum facilitation of learning it should improve the validity and reliability of measurements and documentation of competence development. We explored how, in a competency-based curriculum, current theories on programmatic assessment interacted with educational practice.

Methods
In a development study including evaluation, we investigated the implementation of a theory-based programme of assessment. Between April 2011 and May 2012 quantitative evaluation data were collected and used to guide group interviews that explored the experiences of students and clinical supervisors with the assessment programme. We coded the transcripts and emerging topics were organised into a list of lessons learned.

Results
The programme mainly focuses on the integration of learning and assessment by motivating and supporting students to seek and accumulate feedback. The assessment instruments were aligned to cover predefined competencies to enable aggregation of information in a structured and meaningful way. Assessments that were designed as formative learning experiences were increasingly perceived as summative by students. Peer feedback was experienced as a valuable method for formative feedback. Social interaction and external guidance seemed to be of crucial importance to scaffold self-directed learning. Aggregating data from individual assessments into a holistic portfolio judgement required expertise and extensive training and supervision of judges.

Conclusions
A programme of assessment with low-stakes assessments providing simultaneously formative feedback and input for summative decisions proved not easy to implement. Careful preparation and guidance of the implementation process was crucial. Assessment for learning requires meaningful feedback with each assessment. Special attention should be paid to the quality of feedback at individual assessment moments. Comprehensive attention for faculty development and training for students is essential for the successful implementation of an assessment programme.

via BMC Medical Education | Abstract | Programmatic assessment of competency-based workplace learning: when theory meets practice.

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