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Author: Brian S McGowan, PhD

MANUSCRIPT: The characteristics of a good clinical teacher as perceived by resident physicians in Japan: a qualitative study.

BACKGROUND:
It is not known whether the characteristics of a good clinical teacher as perceived by resident physicians are the same in Western countries as in non-Western countries including Japan. The objective of this study was to identify the characteristics of a good clinical teacher as perceived by resident physicians in Japan, a non-Western country, and to compare the results with those obtained in Western countries.
METHODS:
Data for this qualitative research were collected using semi-structured focus group interviews. Focus group transcripts were independently analyzed and coded by three authors. Residents were recruited by maximum variation sampling until thematic saturation was achieved.
RESULTS:
Twenty-three residents participated in five focus group interviews regarding the perceived characteristics of a good clinical teacher in Japan. The 197 descriptions of characteristics that were identified were grouped into 30 themes. The most commonly identified theme was “provided sufficient support”, followed by “presented residents with chances to think”, “provided feedback”, and “provided specific indications of areas needing improvement”. Using Sutkin’s main categories (teacher, physician, and human characteristics), 24 of the 30 themes were categorized as teacher characteristics, 6 as physician characteristics, and none as human characteristics.
CONCLUSIONS:
“Medical knowledge” of teachers was not identified as a concern of residents, and “clinical competence of teachers” was not emphasized, whereas these were the two most commonly recorded themes in Sutkin’s study. Our results suggest that Japanese and Western resident physicians place emphasis on different characteristics of their teachers. We speculate that such perceptions are influenced by educational systems, educational settings, and culture. Globalization of medical education is important, but it is also important to consider differences in educational systems, local settings, and culture when evaluating clinical teachers.

via The characteristics of a good clinical teacher … [BMC Med Educ. 2013] – PubMed – NCBI.

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MANUSCRIPT: Feasibility of scenario-based simulation training versus traditional workshops in continuing medical education: a randomized controlled trial.

Introduction : Although simulation-based training is increasingly used for medical education, its benefits in continuing medical education (CME) are less established. This study seeks to evaluate the feasibility of incorporating simulation-based training into a CME conference and compare its effectiveness with the traditional workshop in improving knowledge and self-reported confidence. Methods : Participants (N=27) were group randomized to either a simulation-based workshop or a traditional case-based workshop. Results : Post-training, knowledge assessment score neither did increase significantly in the traditional group (d=0.13; p=0.76) nor did significantly decrease in the simulation group (d= – 0.44; p=0.19). Self-reported comfort in patient assessment parameters increased in both groups (p<0.05 in all). However, only the simulation group reported an increase in comfort in patient management (d=1.1, p=0.051 for the traditional group and d=1.3; p= 0.0003 for the simulation group). At 1 month, comfort measures in the traditional group increased consistently over time while these measures in the simulation group increased post-workshop but decreased by 1 month, suggesting that some of the effects of training with simulation may be short lived. Discussion : The use of simulation-based training was not associated with benefits in knowledge acquisition, knowledge retention, or comfort in patient assessment. It was associated with superior outcomes in comfort in patient management, but this benefit may be short-lived. Further studies are required to better define the conditions under which simulation-based training is beneficial.

via Feasibility of scenario-based simulation tra… [Med Educ Online. 2013] – PubMed – NCBI.

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ABSTRACT: Surgical residents’ perceptions of 2011 Accreditation Council for Graduate Medical Education duty hour regulations.

IMPORTANCE:
In 2010, the Accreditation Council for Graduate Medical Education (ACGME) proposed increased regulation of work hours and supervision for residents. New Common Program requirements that took effect in July 2011 dramatically changed the customary 24-hour in-house call schedule. Surgical residents are more likely to be affected by these duty hour restrictions.
OBJECTIVE:
To examine surgical residents’ views of the 2011 ACGME Common Program requirements after implementation in July 2011.
DESIGN:
A 20-question electronic survey was administered 6 months after implementation of 2011 ACGME regulations to 123 participating institutions.
SETTING:
ACGME-accredited teaching hospitals in the United States and US territories.
PARTICIPANTS:
The total sample was 1013 voluntarily participating residents in general surgery and surgical specialties at ACGME-accredited institutions.
MAIN OUTCOMES AND MEASURES:
Residents’ perceptions of changes in education, patient care, and quality of life after institution of 2011 ACGME duty hour regulations and their compliance with these rules.
RESULTS:
A subset of 1013 residents training in general surgery or a surgical subspecialty was identified from a demographically representative sample of 6202 survey respondents. Most surgical residents indicated that education (55.1%), preparation for senior roles (68.4%), and work schedules (50.7%) are worse after implementation of the 2011 regulations. They reported no change in supervision (80.8%), safety of patient care (53.4%), or amount of rest (57.8%). Although quality of life is perceived as better for interns (61.9%), most residents believe that it is worse for senior residents (54.4%). A majority report increased handoffs (78.2%) and a shift of junior-level responsibilities to senior residents (68.7%). Finally, many residents report noncompliance (67.6%) and duty hour falsification (62.1%).
CONCLUSIONS AND RELEVANCE:
A majority of surgical residents disapprove of 2011 ACGME Common Program requirements (65.9%). The proposed benefits of the increased duty hour restrictions-improved education, patient care, and quality of life-have ostensibly not borne out in surgical training. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the 2011 ACGME regulations.

via Surgical residents’ perceptions of 2011 Accreditat… [JAMA Surg. 2013] – PubMed – NCBI.

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ABSTRACT: How to Teach Medication Management: A Review of Novel Educational Materials in Geriatrics.

Medication management is an important component of medical education, particularly in the field of geriatrics. The Association of American Medical Colleges has put forth 26 minimum geriatrics competencies under eight domains for graduating medical students; medication management is one of these domains. The Portal of Geriatric Online education (www.POGOe.org) is an online public repository of geriatrics educational materials and modules developed by geriatrics educators and academicians in the United States, freely available for use by educators and learners in the field. The three POGOe materials presented in this review showcase pearls of medication management for medical and other professional students in novel learning formats that can be administered without major prior preparation. The review compares and contrasts the three materials in descriptive and tabular formats to enable its appropriate use by educators in promoting self-learning or group learning among their learners.

via How to Teach Medication Management: A Revie… [J Am Geriatr Soc. 2013] – PubMed – NCBI.

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MANUSCRIPT: Improving antibiotic prescribing in acute respiratory tract infections: cluster randomised trial from Norwegian general practice (prescription peer academic detailing (Rx-PAD) study).

OBJECTIVE:
To assess the effects of a multifaceted educational intervention in Norwegian general practice aiming to reduce antibiotic prescription rates for acute respiratory tract infections and to reduce the use of broad spectrum antibiotics.
DESIGN:
Cluster randomised controlled study.
SETTING:
Existing continuing medical education groups were recruited and randomised to intervention or control.
PARTICIPANTS:
79 groups, comprising 382 general practitioners, completed the interventions and data extractions.
INTERVENTIONS:
The intervention groups had two visits by peer academic detailers, the first presenting the national clinical guidelines for antibiotic use and recent research evidence on acute respiratory tract infections, the second based on feedback reports on each general practitioner’s antibiotic prescribing profile from the preceding year. Regional one day seminars were arranged as a supplement. The control arm received a different intervention targeting prescribing practice for older patients.
MAIN OUTCOME MEASURES:
Prescription rates and proportion of non-penicillin V antibiotics prescribed at the group level before and after the intervention, compared with corresponding data from the controls.
RESULTS:
In an adjusted, multilevel model, the effect of the intervention on the 39 intervention groups (183 general practitioners) was a reduction (odds ratio 0.72, 95% confidence interval 0.61 to 0.84) in prescribing of antibiotics for acute respiratory tract infections compared with the controls (40 continuing medical education groups with 199 general practitioners). A corresponding reduction was seen in the odds (0.64, 0.49 to 0.82) for prescribing a non-penicillin V antibiotic when an antibiotic was issued. Prescriptions per 1000 listed patients increased from 80.3 to 84.6 in the intervention arm and from 80.9 to 89.0 in the control arm, but this reflects a greater incidence of infections (particularly pneumonia) that needed treating in the intervention arm.
CONCLUSIONS:
The intervention led to improved antibiotic prescribing for respiratory tract infections in a representative sample of Norwegian general practitioners, and the courses were feasible to the general practitioners.

via Improving antibiotic prescribing in acute respiratory tr… [BMJ. 2013] – PubMed – NCBI.

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ABSTRACT: How we used two social media tools to enhance aspects of active learning during lectures.

Background: Medical education is evolving to include active learning approaches, yet some courses will remain lecture-based. Social media tools used by students may foster collaborative learning during lectures. Aim: We present preliminary results from a pilot study that integrated two social technologies, Google Docs and SurveyMonkey, into 22 hour-long lectures for a course called “Social Influences on Health” attended by 154 students. Methods: At the conclusion of the semester, we reviewed student usage patterns with both technologies and collected data from students via course evaluations that included a standard Likert Scale. We used thematic analysis to identify emergent themes from evaluations. Results: On average, students contributed 6 comments/questions to the Google Doc in each lecture, and 35 students participated in SurveyMonkey. Engagement with both technologies increased throughout the semester and no unprofessional incidents were observed. The mean student rating for integration of Google Docs and SurveyMonkey was 3.4 or “above average” SD = 1.17. Thematic analysis identified perceived strengths of this approach as well as areas for improvement. Conclusions: Social media such as Google Docs and SurveyMonkey can facilitate interaction and provide students with control over content and flow of lecture-based courses, but educators must be mindful of practical and conceptual limitations.

via How we used two social media tools to enhance aspe… [Med Teach. 2013] – PubMed – NCBI.

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ABSTRACT: A Randomized Trial of Two e-Learning Strategies for Teaching Substance Abuse Management Skills to Physicians.

PURPOSE:
To compare the educational effectiveness of two virtual patient (VP)-based e-learning strategies, versus no training, in improving physicians’ substance abuse management knowledge, attitudes, self-reported behaviors, and decision making.
METHOD:
The 2011-2012 study was a posttest-only, three-arm, randomized controlled trial in 90 resident and 30 faculty physicians from five adult medicine primary care training programs. The intervention was one of two 2-hour VP-based e-learning programs, designed by national experts to teach structured screening, brief interventions, referral, and treatment skills. One used traditional problem solving with feedback (unworked example), and the other incorporated an expert demonstration first, followed by problem solving with feedback (worked example). The main outcome measure was performance on the Physicians’ Competence in Substance Abuse Test (P-CSAT, maximum score = 315), a self-administered, previously validated measure of physicians’ competence in managing substance abuse. The survey was completed at the outset of the study and two months later.
RESULTS:
Overall P-CSAT scores were virtually identical (202-211, P > .05) between both intervention groups and the no-training control group at both times. Average faculty P-CSAT scores (221.9, 224.6) were significantly higher (P < .01) than resident scores (203.7, 202.5) at both times.
CONCLUSIONS:
This study did not provide evidence that a brief, worked example, VP-based e-learning program or a traditional, unworked, VP-based e-learning program was superior to no training in improving physicians’ substance abuse management skills. The study did provide additional evidence that the P-CSAT distinguishes between physicians who should possess different levels of substance abuse management skills.

via A Randomized Trial of Two e-Learning Strategies for… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Reframing Clinical Workplace Learning Using the Theory of Distributed Cognition

In medicine, knowledge is embodied and socially, temporally, spatially, and culturally distributed between actors and their environment. In addition, clinicians increasingly are using technology in their daily work to gain and share knowledge. Despite these characteristics, surprisingly few studies have incorporated the theory of distributed cognition (DCog), which emphasizes how cognition is distributed in a wider system in the form of multimodal representations (e.g., clinical images, speech, gazes, and gestures) between social actors (e.g., doctors and patients) in the physical environment (e.g., with technological instruments and computers). In this article, the authors provide an example of an interaction between medical actors. Using that example, they then introduce the important concepts of the DCog theory, identifying five characteristics of clinical representations-that they are interwoven, co-constructed, redundantly accessed, intersubjectively shared, and substantiated-and discuss their value for learning. By contrasting these DCog perspectives with studies from the field of medical education, the authors argue that researchers should focus future medical education scholarship on the ways in which medical actors use and connect speech, bodily movements (e.g., gestures), and the visual and haptic structures of their own bodies and of artifacts, such as technological instruments and computers, to construct complex, multimodal representations. They also argue that future scholarship should “zoom in” on detailed, moment-by-moment analysis and, at the same time, “zoom out” following the distribution of cognition through an overall system to develop a more integrated view of clinical workplace learning.

via Reframing Clinical Workplace Learning Using the The… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Building Learning Communities: Evolution of the Colleges at Vanderbilt University School of Medicine

Learning communities, which are an emerging trend in medical education, create a foundation for professional and academic development through the establishment of longitudinal relationships between students and faculty. In this article, the authors describe the robust learning community system at Vanderbilt University School of Medicine, which encompasses wellness, career planning, professional development, and academics.The Vanderbilt Advisory Colleges Program introduced in 2006 initially focused on two goals: promoting wellness and providing career advising. In the 2011-2012 academic year, the focus of the colleges expanded to incorporate an enhanced level of personal career advising and an academic component. In the four-year College Colloquium course, faculty selected as college mentors teach the medical humanities and lead sessions dedicated to student professional development in the areas of leadership, research, and service-learning. This academic and professional development program builds on the existing strengths of the colleges and has transformed the colleges into learning communities.The authors reflect on lessons learned and discuss future plans. They report that internal data and data from the Association of American Medical Colleges Medical School Graduation Questionnaire support consistently high and increasing satisfaction among Vanderbilt medical students, across the metrics of personal counseling, faculty mentoring, and career planning.

via Building Learning Communities: Evolution of the Col… [Acad Med. 2013] – PubMed – NCBI.

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MANUSCRIPT: Social media use among patients and caregivers: a scoping review.

OBJECTIVE:
To map the state of the existing literature evaluating the use of social media in patient and caregiver populations.
DESIGN:
Scoping review.
DATA SOURCES:
Medline, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge and ProQuest (2000-2012).
STUDY SELECTION:
Studies reporting primary research on the use of social media (collaborative projects, blogs/microblogs, content communities, social networking sites, virtual worlds) by patients or caregivers.
DATA EXTRACTION:
Two reviewers screened studies for eligibility; one reviewer extracted data from relevant studies and a second performed verification for accuracy and completeness on a 10% sample. Data were analysed to describe which social media tools are being used, by whom, for what purpose and how they are being evaluated.
RESULTS:
Two hundred eighty-four studies were included. Discussion forums were highly prevalent and constitute 66.6% of the sample. Social networking sites (14.8%) and blogs/microblogs (14.1%) were the next most commonly used tools. The intended purpose of the tool was to facilitate self-care in 77.1% of studies. While there were clusters of studies that focused on similar conditions (eg, lifestyle/weight loss (12.7%), cancer (11.3%)), there were no patterns in the objectives or tools used. A large proportion of the studies were descriptive (42.3%); however, there were also 48 (16.9%) randomised controlled trials (RCTs). Among the RCTs, 35.4% reported statistically significant results favouring the social media intervention being evaluated; however, 72.9% presented positive conclusions regarding the use of social media.
CONCLUSIONS:
There is an extensive body of literature examining the use of social media in patient and caregiver populations. Much of this work is descriptive; however, with such widespread use, evaluations of effectiveness are required. In studies that have examined effectiveness, positive conclusions are often reported, despite non-significant findings.

via Social media use among patients and caregivers: a s… [BMJ Open. 2013] – PubMed – NCBI.

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