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Author: Brian S McGowan, PhD

MANUSCRIPT: Asynchronous vs didactic education: it’s too early to throw in the towel on tradition

Background
Asynchronous, computer based instruction is cost effective, allows self-directed pacing and review, and addresses preferences of millennial learners. Current research suggests there is no significant difference in learning compared to traditional classroom instruction. Data are limited for novice learners in emergency medicine. The objective of this study was to compare asynchronous, computer-based instruction with traditional didactics for senior medical students during a week-long intensive course in acute care. We hypothesized both modalities would be equivalent.

Methods
This was a prospective observational quasi-experimental study of 4th year medical students who were novice learners with minimal prior exposure to curricular elements. We assessed baseline knowledge with an objective pre-test. The curriculum was delivered in either traditional lecture format (shock, acute abdomen, dyspnea, field trauma) or via asynchronous, computer-based modules (chest pain, EKG interpretation, pain management, trauma). An interactive review covering all topics was followed by a post-test. Knowledge retention was measured after 10 weeks. Pre and post-test items were written by a panel of medical educators and validated with a reference group of learners. Mean scores were analyzed using dependent t-test and attitudes were assessed by a 5-point Likert scale.

Results
44 of 48 students completed the protocol. Students initially acquired more knowledge from didactic education as demonstrated by mean gain scores (didactic: 28.39% +/- 18.06; asynchronous 9.93% +/- 23.22). Mean difference between didactic and asynchronous = 18.45% with 95% CI [10.40 to 26.50]; p = 0.0001. Retention testing demonstrated similar knowledge attrition: mean gain scores -14.94% (didactic); -17.61% (asynchronous), which was not significantly different: 2.68% +/- 20.85, 95% CI [-3.66 to 9.02], p = 0.399. The attitudinal survey revealed that 60.4% of students believed the asynchronous modules were educational and 95.8% enjoyed the flexibility of the method. 39.6% of students preferred asynchronous education for required didactics; 37.5% were neutral; 23% preferred traditional lectures.

Conclusions
Asynchronous, computer-based instruction was not equivalent to traditional didactics for novice learners of acute care topics. Interactive, standard didactic education was valuable. Retention rates were similar between instructional methods. Students had mixed attitudes toward asynchronous learning but enjoyed the flexibility. We urge caution in trading in traditional didactic lectures in favor of asynchronous education for novice learners in acute care.

via BMC Medical Education | Abstract | Asynchronous vs didactic education: it’s too early to throw in the towel on tradition.

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ABSTRACT: Effective leadership – The way to excellence in health professions education

The current times are witnessing an explosion of new knowledge in medicine. The demographic profile, geographic distribution of many diseases is changing, there have been dramatic shifts in the health care delivery, healthcare professionals are more socially and professionally accountable, patients have become more consumerist in their attitude. These factors coupled with the increasing demand for trained health care professionals has led to, firstly, a rapid increase in the health professionals education institutions and secondly curricular changes and adoption of newer teaching learning methodologies, to equip the graduates with the desirable outcomes. The scene in health professions education is one characterized by rapid activity and change. A time which demands effective leadership at these institutions for achieving excellence. Drawing from a decade long experience, at different medical schools in the gulf region, the author opines that it is effective leadership, as observed at the institutions where he worked, which is responsible for realization of institutional vision, rapid development and achievement of excellence.

via Effective leadership – The way to excellence in he… [Med Teach. 2013] – PubMed – NCBI.

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RESOURCE: Bullet points don’t work

At last, we have some scientifically rigorous evidence to show that slides full of bullet-points don’t work.

The research is the work of Chris Atherton, a cognitive psychologist. Chris recently delivered a presentation at the Technical Communication UK Conference and has put up her slides on slideshare. There’s been a tremendous amount of interest in them, but as they were designed to complement Chris’s talk – they only tell half the story.

In this post I’ll explain the findings of Chris’s research. I’ve written the post based on Chris’s slides and asked Chris to comment on various aspects. Chris has also reviewed this post to make sure I’ve got all the science right.

via Bullet points don’t work.

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ABSTRACT: Limitations of poster presentations reporting educational innovations at a major international medical education conference

Background: In most areas of medical research, the label of ‘quality’ is associated with well-accepted standards. Whilst its interpretation in the field of medical education is contentious, there is agreement on the key elements required when reporting novel teaching strategies. We set out to assess if these features had been fulfilled by poster presentations at a major international medical education conference. Methods: Such posters were analysed in four key areas: reporting of theoretical underpinning, explanation of instructional design methods, descriptions of the resources needed for introduction, and the offering of materials to support dissemination. Results: Three hundred and twelve posters were reviewed with 170 suitable for analysis. Forty-one percent described their methods of instruction or innovation design. Thirty-three percent gave details of equipment, and 29% of studies described resources that may be required for delivering such an intervention. Further resources to support dissemination of their innovation were offered by 36%. Twenty-three percent described the theoretical underpinning or conceptual frameworks upon which their work was based. Conclusions: These findings suggest that posters presenting educational innovation are currently limited in what they offer to educators. Presenters should seek to enhance their reporting of these crucial aspects by employing existing published guidance, and organising committees may wish to consider explicitly requesting such information at the time of initial submission.

via Limitations of poster presentations reporting educational innovations at a major international medical education conference | Gordon | Medical Education Online.

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ABSTRACT: Pediatric collaborative improvement networks: background and overview.

Multiple gaps exist in health care quality and outcomes for children, who receive <50% of recommended care. The American Board of Pediatrics has worked to develop an improvement network model for pediatric subspecialties as the optimal means to improve child health outcomes and to allow subspecialists to meet the performance in practice component of Maintenance of Certification requirements. By using successful subspecialty initiatives as exemplars, and features of the Institute for Healthcare Improvement’s Breakthrough Series model, currently 9 of 14 pediatric subspecialties have implemented collaborative network improvement efforts. Key components include a common aim to improve care; national multicenter prospective collaborative improvement efforts; reducing unnecessary variation by identifying, adopting, and testing best practices; use of shared, valid, high-quality real-time data; infrastructure support to apply improvement science; and public sharing of outcomes. As a key distinguisher from time-limited collaboratives, ongoing pediatric collaborative improvement networks begin with a plan to persist until aims are achieved and improvement is sustained. Additional evidence from within and external to health care has accrued to support the model since its proposal in 2002, including the Institute of Medicine’s vision for a Learning Healthcare System. Required network infrastructure systems and capabilities have been delineated and can be used to accelerate the spread of the model. Pediatric collaborative improvement networks can serve to close the quality gap, engage patients and caregivers in shared learning, and act as laboratories for accelerated translation of research into practice and new knowledge discovery, resulting in improved care and outcomes for children.

via Pediatric collaborative improvement networks: bac… [Pediatrics. 2013] – PubMed – NCBI.

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ABSTRACT: Collaborative networks for both improvement and research

Moving significant therapeutic discoveries beyond early biomedical translation or T1 science and into practice involves: (1) T2 science, identifying “the right treatment for the right patient in the right way at the right time” (eg, patient-centered outcomes research) and tools to implement this knowledge (eg, guidelines, registries); and (2) T3 studies addressing how to achieve health care delivery change. Collaborative improvement networks can serve as large-scale, health system laboratories to engage clinicians, researchers, patients, and parents in testing approaches to translate research into practice. Improvement networks are of particular importance for pediatric T2 and T3 research, as evidence to establish safety and efficacy of therapeutic interventions in children is often lacking. Networks for improvement and research are also consistent with the Institute of Medicine’s Learning Healthcare Systems model in which learning networks provide a system for improving care and outcomes and generate new knowledge in near real-time. Creation of total population registries in collaborative network sites provides large, representative study samples with high-quality data that can be used to generate evidence and to inform clinical decision-making. Networks use collaboration, data, and quality-improvement methods to standardize practice. Therefore, variation in outcomes due to unreliable and unnecessary care delivery is reduced, increasing statistical power, and allowing a consistent baseline from which to test new strategies. In addition, collaborative networks for improvement and research offer the opportunity to not only make improvements but also to study improvements to determine which interventions and combination of strategies work best in what settings.

via Collaborative networks for both improvement and r… [Pediatrics. 2013] – PubMed – NCBI.

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MANUSCRIPT: ‘In situ simulation’ versus ‘off site simulation’ in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial.

BACKGROUND:Unexpected obstetric emergencies threaten the safety of pregnant women. As emergencies are rare, they are difficult to learn. Therefore, simulation-based medical education (SBME) seems relevant. In non-systematic reviews on SBME, medical simulation has been suggested to be associated with improved learner outcomes. However, many questions on how SBME can be optimized remain unanswered. One unresolved issue is how ‘in situ simulation’ (ISS) versus ‘off site simulation’ (OSS) impact learning. ISS means simulation-based training in the actual patient care unit (in other words, the labor room and operating room). OSS means training in facilities away from the actual patient care unit, either at a simulation centre or in hospital rooms that have been set up for this purpose.METHODS AND DESIGN:The objective of this randomized trial is to study the effect of ISS versus OSS on individual learning outcome, safety attitude, motivation, stress, and team performance amongst multi-professional obstetric-anesthesia teams.The trial is a single-centre randomized superiority trial including 100 participants. The inclusion criteria were health-care professionals employed at the department of obstetrics or anesthesia at Rigshospitalet, Copenhagen, who were working on shifts and gave written informed consent. Exclusion criteria were managers with staff responsibilities, and staff who were actively taking part in preparation of the trial. The same obstetric multi-professional training was conducted in the two simulation settings. The experimental group was exposed to training in the ISS setting, and the control group in the OSS setting. The primary outcome is the individual score on a knowledge test. Exploratory outcomes are individual scores on a safety attitudes questionnaire, a stress inventory, salivary cortisol levels, an intrinsic motivation inventory, results from a questionnaire evaluating perceptions of the simulation and suggested changes needed in the organization, a team-based score on video-assessed team performance and on selected clinical performance.DISCUSSION:The perspective is to provide new knowledge on contextual effects of different simulation settings.

via ‘In situ simulation’ versus ‘off site simulation’ in … [Trials. 2013] – PubMed – NCBI.

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ABSTRACT: A crowdsourcing model for creating preclinical medical education study tools.

During their preclinical course work, medical students must memorize and recall substantial amounts of information. Recent trends in medical education emphasize collaboration through team-based learning. In the technology world, the trend toward collaboration has been characterized by the crowdsourcing movement. In 2011, the authors developed an innovative approach to team-based learning that combined students’ use of flashcards to master large volumes of content with a crowdsourcing model, using a simple informatics system to enable those students to share in the effort of generating concise, high-yield study materials. The authors used Google Drive and developed a simple Java software program that enabled students to simultaneously access and edit sets of questions and answers in the form of flashcards. Through this crowdsourcing model, medical students in the class of 2014 at the Johns Hopkins University School of Medicine created a database of over 16,000 questions that corresponded to the Genes to Society basic science curriculum. An analysis of exam scores revealed that students in the class of 2014 outperformed those in the class of 2013, who did not have access to the flashcard system, and a survey of students demonstrated that users were generally satisfied with the system and found it a valuable study tool. In this article, the authors describe the development and implementation of their crowdsourcing model for creating study materials, emphasize its simplicity and user-friendliness, describe its impact on students’ exam performance, and discuss how students in any educational discipline could implement a similar model of collaborative learning.

via A crowdsourcing model for creating preclinical medi… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Design, dissemination, and evaluation of an advanced communication elective at seven U.S. medical schools.

PURPOSE:
To test educational methods that continue communication training into the fourth year of medical school.
METHOD:
The authors disseminated and evaluated an advanced communication elective in seven U.S. medical schools between 2007 and 2009; a total of 9 faculty and 22 fourth-year students participated. The elective emphasized peer learning, practice with real patients, direct observation, and applications of video technology. The authors used qualitative and quantitative survey methods and video review to evaluate the experience of students and faculty.
RESULTS:
Students reported that the elective was better than most medical school clerkships they had experienced. Their self-confidence in time management and in the use of nine communication skills improved significantly. The most valued course components were video review, repeated practice with real patients, and peer observation. Analysis of student videos with real patients and in role-plays showed that some skills (e.g., agenda setting, understanding the patient perspective) were more frequently demonstrated than others (e.g., exploring family and cultural values, communication while using the electronic health record). Faculty highly valued this learner-centered model and reported that their self-awareness and communication skills grew as teachers and as clinicians.
CONCLUSIONS:
Learner-centered methods such as peer observation and video review and editing may strengthen communication training and reinforce skills introduced earlier in medical education. The course design may counteract a “hidden curriculum” that devalues respectful interactions with trainees and patients. Future research should assess the impact of course elements on skill retention, attitudes for lifelong learning, and patients’ health outcomes.

via Design, dissemination, and evaluation of an advance… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Improving clinician performance of inpatient venous thromboembolism risk assessment and prophylaxis.

Clinicians are aware of the importance of thromboprophylaxis, and that the application of measures to prevent venous thromboembolism (VTE) occurrence in hospitalized patients must be improved. To enhance clinician execution of appropriate steps to reduce the risk of inpatient VTE, a performance improvement (PI) continuing medical education (CME) initiative consisting of 3 independent tracks for hospitalized patients-patients who are medically ill, patients receiving oncology treatment, and patients undergoing major orthopedic surgery-was designed and implemented. After a baseline chart review of select evidenced-based performance measures for VTE risk stratification and prevention, participants identified ≥ 1 area of personal improvement. Participants then engaged in a period of self-improvement and reassessed their performance with a second chart review. After participating in the PI CME activity, clinician participants in the medically ill track increased their documentation of VTE risk assessments upon patient admission from baseline (56% vs 93%, n = 250; P < 0.001) and their prescription of low-molecular-weight heparin, low-dose unfractionated heparin, or fondaparinux (72% vs 88%, n = 250; P < 0.001). Orthopedic-track participants were significantly more likely to prescribe 15 to 35 days of VTE prophylaxis after total hip arthroplasty or hip fracture surgery upon patient discharge compared with baseline (51%, n = 123 vs 61%, n = 107; P < 0.001). Oncology-track participants demonstrated a nonsignificant trend for assessing and documenting bleeding risk after participation in the PI CME activity (56% vs 68%, n = 80; P = 0.143). Improvements in evidence-based strategies to reduce the risk of inpatient VTE were associated with PI CME participation. Although areas for improvement remain, increased participant identification and use of prophylactic measures can reduce the risk of VTE in hospitalized patients.

via Improving clinician performance of inpatie… [Hosp Pract (1995). 2013] – PubMed – NCBI.

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