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Author: Brian S McGowan, PhD

MANUSCRIPT: How do United Kingdom (UK) medical schools identify and support undergraduate medical students who ‘fail’ communication assessments? A national survey.

BACKGROUND:
The doctor’s ability to communicate effectively (with patients, relatives, advocates and healthcare colleagues) relates directly to health outcomes, and so is core to clinical practice. The remediation of medical students’ clinical communication ability is rarely addressed in medical education literature. There is nothing in the current literature reporting a contemporary national picture of how communication difficulties are managed, and the level of consequence (progression implications) for students of performing poorly. This survey aimed to consolidate practices for identifying and processes for managing students who ‘fail’ communication assessments across all UK medical schools.
METHODS:
Data were collected via an email survey to all leads for clinical communication in all UK Medical Schools for the UK Council for Clinical Communication in Undergraduate Medical Education.
RESULTS:
All but two participating Schools reported some means of support and/or remediation in communication. There was diversity of approach, and variance in the level of systemisation adopted. Variables such as individuality of curricula, resourcing issues, student cohort size and methodological preferences were implicated as explaining diversity. Support is relatively ad hoc, and often in the hands of a particular dedicated individual or team with an interest in communication delivery with few Schools reporting robust, centralised, school level processes.
CONCLUSIONS:
This survey has demonstrated that few Medical Schools have no identifiable system of managing their students’ clinical communication difficulties. However, some Schools reported ad hoc approaches and only a small number had a centralised programme. There is scope for discussion and benchmarking of best practice across all Schools with allocation of appropriate resources to support this.

via How do United Kingdom (UK) medical schools iden… [BMC Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: What does ‘race’ have to do with medical education research?

CONTEXT:
We live in a world of ethnoracial conflict. This is confirmed every day by opening and reading the newspaper. This everyday world seems far away in the pages of a medical education journal, but is it? The goal of this paper is to suggest that one need not look very far in medical education to encounter ethnoracial issues, and further, that research methods that are not ethnoracially biased must be employed to study these topics.
DISCUSSION:
We will draw attention to the relevance of employing an ethical conceptual approach to research involving ‘race’ by demonstrating how one author researching internationally educated health professionals has put ‘race’ front and centre in his analysis. He does this by using a postcolonial method of analysis termed a ‘doubled-research’ technique that sets up categories such as ‘race’ but then decolonizes them to avoid essentialism or stereotyping. We compare this method to another mainstream method employed for the same topic of inquiry which has sidelined ‘race’ in the analysis, potentially hiding findings about ethnoracial relations involving health professionals in our ‘multicultural’ society. This demonstration leads to the important question of whether research methods can be epistemologically racist-a question that has been raised about conventional research on education in general. Our argument is not meant to be the last word on this topic, but the first in this journal.
CONCLUSIONS:
We conclude that there is an internal ethics or axiology within research perspectives and methodologies that needs to be examined where ethnoracial issues are prominent. The use of mainstream approaches to undertake research can unintentionally ‘leave unsaid’ central aspects of what is researched while antiracist methods such as the one described in this article can open up the data to allow for a richer and deeper understanding of the problem.

via What does ‘race’ have to do with medical education … [Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: The use of social-networking sites in medical education

Background: A social-network site is a dedicated website or application which enables users to communicate with each other and share information, comments, messages, videos and images. Aims: This review aimed to ascertain if “social-networking sites have been used successfully in medical education to deliver educational material”, and whether “healthcare professionals, and students, are engaging with social-networking sites for educational purposes”. Method: A systematic-review was undertaken using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eight databases were searched with pre-defined search terms, limits and inclusion criteria. Data was extracted into a piloted data-table prior to the narrative-synthesis of the Quality, Utility, Extent, Strength, Target and Setting of the evidence. Results: 1047 articles were identified. Nine articles were reviewed with the majority assessing learner satisfaction. Higher outcome measures were rarely investigated. Educators used Facebook, Twitter, and a custom-made website, MedicineAfrica to achieve their objectives. Conclusions: Social-networking sites have been employed without problems of professionalism, and received positive feedback from learners. However, there is no solid evidence base within the literature that social-networking is equally or more effective than other media available for educational purposes

via The use of social-networking sites in medical educ… [Med Teach. 2013] – PubMed – NCBI.

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MANUSCRIPT: Evaluation of standardized doctor’s orders as an educational tool for undergraduate medical students: a prospective cohort study.

BACKGROUND:
Standardized doctor’s orders are replacing traditional order writing in teaching hospitals. The impact of this shift in practice on medical education is unknown. It is possible that preprinted orders interfere with knowledge acquisition and retention by not requiring active decision-making. The objective of the study was to evaluate the impact of standardized admission orders on disease-specific knowledge among undergraduate medical trainees.
METHODS:
This prospective cohort study enrolled Year 3 (n = 121) and Year 4 (n = 54) medical students at two academic hospitals in Toronto (Ontario, Canada) during their general internal medicine rotation. We used standardized orders for patient admissions for alcohol withdrawal (AW) and for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) as the intervention and manual order writing as the control. Educational outcomes were assessed through end-of-rotation questionnaires assessing disease-specific knowledge of AW and AECOPD.Results and discussions: Of 175 students, 105 had exposure to patients with alcohol withdrawal during their rotation, and 68 students wrote admission orders. Among these 68 students, 48 used standardized orders (intervention, n = 48) and 20 used manual order writing (control, n = 20). Only 3 students used standardized orders for AECOPD, precluding analysis. There was no significant difference found in mean total score of questionnaires between those who used AW standardized orders and those who did not (11.8 vs. 11.0, p = 0.4). Students who had direct clinical experience had significantly higher mean total scores (11.6 vs. 9.0, p < 0.0001 for AW; 13.8 vs. 12.6, p = 0.02 for AECOPD) compared to students who did not. When corrected for overall knowledge, this difference only persisted for AW.
CONCLUSIONS:
No significant differences were found in total scores between students who used standardized admission orders and traditional manual order writing. Clinical exposure was associated with increase in disease-specific knowledge.

via Evaluation of standardized doctor’s orders as a… [BMC Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume: A Multi-institutional Study

IMPORTANCE The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. OBJECTIVE To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class N = 52 with 16-hour work limit compared with the 4 preceding years 2007-2010; N = 197 without 16-hour work limit. A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. MAIN OUTCOMES AND MEASURES Total, major, first-assistant, and defined-category case totals. RESULTS As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases 65.9 vs 88.8, P = .005, a 31.8% decrease in major cases 54.9 vs 80.5, P < .001, and a 46.3% decrease in first-assistant cases 11.1 vs 20.7, P = .008. There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. CONCLUSIONS AND RELEVANCE The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.

via Effect of the 16-Hour Work Limit on General Surger… [JAMA Surg. 2013] – PubMed – NCBI.

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ABSTRACT: I feel disconnected: learning technologies in resident education

With the rapid development of technology in medical education, orthopaedic educators are recognizing that the way residents learn and access information is profoundly changing. Residency programs are faced with the challenging problem that current educational methods are not designed to take full advantage of the information explosion and rapid technologic changes. This disconnection is often seen in the potentially separate approaches to education preferred by residents and orthopaedic educators. Becoming connected with residents requires understanding the possible learning technologies available and the learners abilities, needs, and expectations. It is often assumed that approaches to strategic lifelong learning are developed by residents during their training; however, without the incorporation of technology into the learning environment, residents will not be taught the digital literacy and information management strategies that will be needed in the future. To improve learning, it is important to highlight and discuss current technologic trends in education, the possible technologic disconnection between educators and learners, the types of learning technologies available, and the potential opportunities for getting connected.

via I feel disconnected: learning technologies… [Instr Course Lect. 2013] – PubMed – NCBI.

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ABSTRACT: The Pictor Technique A Method for Exploring the Experience of Collaborative Working

Collaborative working is a crucial part of contemporary health and social care. Researching the experiences of those involved—as professionals, patients, or carers—is challenging, given the complexity of many cases and the taken-for-granted nature of roles and identities in relation to it. In this article we introduce the Pictor technique for exploring experiences of collaborative working. This is a visual technique in which participants construct a representation of roles and relationships in a particular case using arrow-shaped adhesive notes or cards. The chart so produced helps the participant tell the story of his or her experience and serves as a focus for further exploration with the researcher. We describe the background to Pictor and illustrate its use with professionals, patients, and carers, drawing on recent and current research. We examine how Pictor relates to other visual methods, and conclude by considering how the technique might be developed in the future.

via The Pictor Technique.

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MANUSCRIPT: As Facts and Chats Go Online, What Is Important for Adolescents with Type 1 Diabetes?

BACKGROUND:
Continued refinement of resources for patient information, education and support is needed. Considering the rapid development of new communication practices, the perspectives of young people themselves warrant more attention using a wide research focus. The purpose of this study was to understand information-seeking behaviours, Internet use and social networking online in adolescents with type 1 diabetes (T1DM). This applied to their everyday life, including the context of diabetes and their experiences and need of contact with T1DM peers.
METHODOLOGY/PRINCIPAL FINDINGS:
Twenty-four adolescents aged 10-17 years with T1DM were recruited from a county hospital in the south-east of Sweden. Qualitative data were obtained using eight focus groups, wherein each participant engaged in a 60-90 minute video/audio-recorded session. The focus group data were transcribed and analysed using qualitative content analysis. Some demographic and medical information was also collected. The three main categories that were identified; Aspects of Security, Updating, and Plainness and their sub-categories gave significant information about how to enhance information retrieval and peer contacts related to T1DM. Regarding the persons’ information-seeking behaviour, Internet use, and use of social media some differences could be identified depending on gender and age.
CONCLUSIONS/SIGNIFICANCE:
Sensitivity and adaptation to users’ needs and expectations seem crucial in the development of future online resources for adolescents with T1DM. To start with, this could mean applying a wider range of already existing information and communication technologies. Health practitioners need to focus on the areas of security of information and communication, frequency of updating, and simplicity of design-less is more.

via As Facts and Chats Go Online, What Is Important for… [PLoS One. 2013] – PubMed – NCBI.

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ABSTRACT: Member Awareness of Expertise, Information Sharing, Information Weighting, and Group Decision Making

One of a group’s most valuable resources is the expertise of its members. How this expertise is or is not used has a major impact on group performance. However, determining expertise is often difficult. Thus the issue of how many group members need to be aware of expertise before the benefits of recognition accrue is of great importance. For example, do all members have to be aware of expertise prior to discussion for the group to benefit, or is a subset of members sufficient? If a subset is sufficient, how large must it be? To address these questions, we manipulated the number of group members possessing foreknowledge of member expertise. We then analyzed perceived expertise, information sharing, information weighting, and group decision making using a series of planned contrasts representing common social combination models. Discussion of unique information followed a majority wins model i.e., a shift occurred when greater than half of members were made aware of expertise prior to discussion. For weighting of unique information, several models, including majority wins, fit when examining regression-based estimates of weighting whereas only the majority wins model fit when examining self-reported weighting. None of the models tested adequately explained rated expertise.

via Member Awareness of Expertise, Information Sharing, Information Weighting, and Group Decision Making.

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MANUSCRIPT: Learning styles and preferences for live and distance education: an example of a specialisation course in epidemiology

Background
Distance learning through the internet is increasingly popular in higher education. However, it is unknown how participants in epidemiology courses value live vs. distance education.

Methods
All participants of a 5-day specialisation course in epidemiology were asked to keep a diary on the number of hours they spent on course activities (both live and distance education). Attendance was not compulsory during the course and participants were therefore also asked for the reasons to attend live education (lectures and practicals). In addition, the relation between participants? learning styles (Index of Learning Styles) and their participation in live and distance education was studied.

Results
All 54 (100%) participants in the course completed the questionnaire on attendance and 46 (85%) completed the questionnaire on learning styles. The number of hours attending live education was negatively correlated with the number of hours going studying distance learning materials (Pearson correlation ?0.5; p?<?0.001). The most important reasons to attend live education was to stay focused during lectures (50%), and to ask questions during practicals (50%). A lack of time was the most important reason not to attend lectures (52%) or practicals (61%). Learning styles were not association with the number of hours spent on live or distance education.

Conclusion
Distance learning may play an important role in epidemiology courses, since it allows participants to study whenever and wherever they prefer, which provides the opportunity to combine courses with clinical duties. An important requirement for distance learning education appears to be the possibility to ask questions and to interact with instructors.

via BMC Medical Education | Abstract | Learning styles and preferences for live and distance education: an example of a specialisation course in epidemiology.

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