REQUEST DEMO
MENUCLOSE

 

REQUEST DEMO
Clinical Operations
Commercial Teams
Resources
Medical Education
About Us
Connect with us
Facebook-f Twitter Linkedin-in
Sign in

Author: Brian S McGowan, PhD

ABSTRACT: Keynote address: the focus on competencies and individual learner assessment as emerging themes in medical education research.

This article describes opportunities for scholarship in medical education, based on a brief overview of recent changes in medical education. The implications arising from these changes are discussed, with recommendations for focus, and suggestions and examples for making progress in this field. The author discusses 1) the historical context of the current shift toward competency-based medical education, 2) the potential contribution of social and behavioral sciences to medical education scholarship, 3) methods and approaches for supporting scholarship in medical education, and very briefly 4) trends in simulation. The author concludes with a call for quality in medical education scholarship and argues that the most promising and fruitful area of medical education scholarship for the future lies in the field of assessment of individual competence.

via Keynote address: the focus on competencies an… [Acad Emerg Med. 2012] – PubMed – NCBI.

Continue Reading

ABSTRACT: Integrating continuing medical education and faculty development into a single course: Effects on participants’ behavior.

Background: Integrating continuing medical education (CME) and faculty development (FD) into a single course can save time for physicians with teaching responsibilities. However, little is known about the effectiveness of integrated courses. Aim: To determine if there are differences in effectiveness between the CME and FD items as they were integrated in one course. Methods: Using the commitment-to-change model to assess plans for change from all participants and reported implementation of plans three month after courses. This model is suitable for stimulating and assessing effectiveness of CME. Unplanned changes were also recorded. Results: One hundred and twenty-seven respondents (of 182 participants) referred to 266 planned changes (out of 384), of which 168 (63%) were reported as implemented. Furthermore, 83 non-planned changes were indicated. In total 251 changes were reported and demonstrated that CME as well as FD items were effective. Conclusions: This study reveals that integrating CME and FD into a single course is highly effective in changing physicians’ medical practice as well as teaching practice. Although all course items were effective, participants choose more FD items than CME, so future research has to focus on which variables determine those choices.

via Integrating continuing medical education and facul… [Med Teach. 2013] – PubMed – NCBI.

Continue Reading

ABSTRACT: Interventions to Modify Health Care Provider Adherence to Asthma Guidelines [Internet].

OBJECTIVES:To synthesize the published literature on the effect of interventions designed to improve health care providers’ adherence to asthma guidelines on: (1) health care process outcomes (Key Question 1); (2) clinical outcomes (Key Question 2); (3) health care processes that subsequently impact clinical outcomes (Key Question 3).DATA SOURCES:Reports of studies from MEDLINE®, Embase®, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL®), Educational Resources Information Center (ERICsm), PsycINFO®, and Research and Development Resource Base in Continuing Medical Education (RDRB/CME), up to July 2012.REVIEW METHODS:Paired investigators independently reviewed each title, abstract, and full-text article to assess eligibility. Only comparative studies were eligible. Investigators abstracted data sequentially and independently graded the evidence.RESULTS:A total of 73 studies were eligible for review. A slight majority of studies were conducted in the U.S. (n=38). We classified studies as assessing eight types of interventions: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement (QI)/pay-for-performance, multicomponent, and information only. Half of the studies were randomized trials (n=34), 29 were pre-post, and the remaining 10 were a variety of nonrandomized study designs. The studies took place exclusively in primary care settings. The most frequently cited health care process outcome was prescription of asthma controller medication (n=41), followed by provision of an asthma action plan (n=18), prescription of a peak flow meter (n=17), and self-management education (n=12). Common clinical outcomes included emergency department (ED) visits (n=30) and hospitalizations (n=27), followed by use of short-acting β2 agonists (n=9), missed school days (n=8), lung function tests (n=6), symptom days (n=6), quality of life (n=5), and urgent doctor visits (n=5). We identified 4 critical outcomes for which 68 studies provided information. There was moderate evidence for increased prescriptions of asthma controller medications using decision support, feedback and audit, and clinical pharmacy support interventions and low grade evidence for organizational change, multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans; for the same outcome, low grade evidence supports the use of organizational change, feedback and audit, education only, quality improvement, and multicomponent interventions. Moderate grade evidence supports use of decision support tools to reduce ED visits/hospitalizations while low grade evidence suggests there is no benefit associated with organizational change, education only, and QI/pay-for-performance. Organizational change interventions provided no benefit for lost days of work/school. The evidence for the remainder of interventions was insufficient or low in strength.CONCLUSIONS:There is low to moderate evidence to support the use of decision support tools, feedback and audit, and clinical pharmacy support to improve the adherence of health care providers to asthma guidelines, as measured through health care process outcomes, and to improve clinical outcomes. There is a need to further evaluate health care provider-targeted interventions with a focus on standardized measures of outcomes and more rigorous study designs.

via Interventions to Modify Health Care Provider Adherence to Ast… [2013] – PubMed – NCBI.

Continue Reading

ABSTRACT: Can a brief two-hour interdisciplinary communication skills training be successful in undergraduate medical education?

OBJECTIVE:
To pilot-test feasibility, acceptance and learning-outcomes of a brief interdisciplinary communication skills training program in undergraduate medical education.
METHODS:
A two-hour interdisciplinary communication skills program with simulated patients was developed and pilot-tested with clinical students at Hamburg University. Five psychosocial specialties facilitated the training. Composite effects were measured qualitatively and quantitatively.
RESULTS:
Eighty students volunteered to participate in the pilot-program (intervention-group). Their evaluations of the program were very positive (1.1 on a six-point scale). Benefits were seen in feedback, increase of self-confidence, cross-disciplinary clinical and communication experience. Students who did not volunteer (n=206) served as the control-group. The intervention-group performed significantly better (p=0.023) in a primary care communication examination and female students performed better than males. Clinical teachers evaluated the pilot-training very positively with regard to learning-outcomes and feasibility. The positive results from the pilot-training led to implementation into the regular curriculum.
CONCLUSIONS:
A two-hour interdisciplinary communication skills training program is beneficial for medical students with regard to communication competencies, self-confidence and learning-outcomes.
PRACTICE IMPLICATION:
The training is feasible within given time-frames and limited staff resources. The high teaching load for small-group-training are split between five specialties. The concept might be an interesting option for other faculties.

via Can a brief two-hour interdisciplinary co… [Patient Educ Couns. 2013] – PubMed – NCBI.

Continue Reading

ABSTRACT: From Flexner to Competencies: Reflections on a Decade and the Journey Ahead

This article is a sequel to one published in 2002 only a few years after the initiation of the shift to competency-based medical education (CBME). The authors reflect on the major forces that have influenced the movement and tipped the balance toward widespread adoption of CBME in the United States, primarily in graduate medical education. These forces include regulatory bodies, international counterparts, and the general public.The authors highlight the most important lessons learned over the decade. These include (1) the need for standardization of language to develop a shared vision of the path ahead, (2) the power of direct observation in assessment, (3) the challenge of developing meaningful measures of performance, (4) desired outcomes as the starting point for curriculum development, (5) dependence on reflection in the development of expertise, (6) the need for exploiting the role of learners in their learning, and (7) competent clinical systems as the required learning environment for producing competent physicians.The authors speculate on why this most recent attempt to shift to CBME differs from previous aborted attempts. They conclude by explaining how the recent lessons learned inform the vision of what successful implementation of CBME would look like, and discussing the importance of milestones, entrustable professional activities, and an integrated, rather than a reductionist, approach to assessment of competence. The fundamental question at each step along the way in implementing CBME should be “How do we improve medical education to provide better care for patients?”

via From Flexner to Competencies: Reflections on a Deca… [Acad Med. 2013] – PubMed – NCBI.

Continue Reading

ABSTRACT: Mastery Learning for Health Professionals Using Technology-Enhanced Simulation: A Systematic Review and Meta-Analysis

PURPOSE:
Competency-based education requires individualization of instruction. Mastery learning, an instructional approach requiring learners to achieve a defined proficiency before proceeding to the next instructional objective, offers one approach to individualization. The authors sought to summarize the quantitative outcomes of mastery learning simulation-based medical education (SBME) in comparison with no intervention and nonmastery instruction, and to determine what features of mastery SBME make it effective.
METHOD:
The authors searched MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous review bibliographies through May 2011. They included original research in any language evaluating mastery SBME, in comparison with any intervention or no intervention, for practicing and student physicians, nurses, and other health professionals. Working in duplicate, they abstracted information on trainees, instructional design (interactivity, feedback, repetitions, and learning time), study design, and outcomes.
RESULTS:
They identified 82 studies evaluating mastery SBME. In comparison with no intervention, mastery SBME was associated with large effects on skills (41 studies; effect size [ES] 1.29 [95% confidence interval, 1.08-1.50]) and moderate effects on patient outcomes (11 studies; ES 0.73 [95% CI, 0.36-1.10]). In comparison with nonmastery SBME instruction, mastery learning was associated with large benefit in skills (3 studies; effect size 1.17 [95% CI, 0.29-2.05]) but required more time. Pretraining and additional practice improved outcomes but, again, took longer. Studies exploring enhanced feedback and self-regulated learning in the mastery model showed mixed results.
CONCLUSIONS:
Limited evidence suggests that mastery learning SBME is superior to nonmastery instruction but takes more time.

via Mastery Learning for Health Professionals Using Tec… [Acad Med. 2013] – PubMed – NCBI.

Continue Reading

ABSTRACT: Medical Education and Cognitive Continuum Theory: An Alternative Perspective on Medical Problem Solving and Clinical Reasoning

Recently, human reasoning, problem solving, and decision making have been viewed as products of two separate systems: “System 1,” the unconscious, intuitive, or nonanalytic system, and “System 2,” the conscious, analytic, or reflective system. This view has penetrated the medical education literature, yet the idea of two independent dichotomous cognitive systems is not entirely without problems.This article outlines the difficulties of this “two-system view” and presents an alternative, developed by K.R. Hammond and colleagues, called cognitive continuum theory (CCT). CCT is featured by three key assumptions. First, human reasoning, problem solving, and decision making can be arranged on a cognitive continuum, with pure intuition at one end, pure analysis at the other, and a large middle ground called “quasirationality.” Second, the nature and requirements of the cognitive task, as perceived by the person performing the task, determine to a large extent whether a task will be approached more intuitively or more analytically. Third, for optimal task performance, this approach needs to match the cognitive properties and requirements of the task. Finally, the author makes a case that CCT is better able than a two-system view to describe medical problem solving and clinical reasoning and that it provides clear clues for how to organize training in clinical reasoning

via Medical Education and Cognitive Continuum Theory: A… [Acad Med. 2013] – PubMed – NCBI.

Continue Reading

ABSTRACT: Toward a Common Taxonomy of Competency Domains for the Health Professions and Competencies for Physicians.

Although health professions worldwide are shifting to competency-based education, no common taxonomy for domains of competence and specific competencies currently exists. In this article, the authors describe their work to (1) identify domains of competence that could accommodate any health care profession and (2) extract a common set of competencies for physicians from existing health professions’ competency frameworks that would be robust enough to provide a single, relevant infrastructure for curricular resources in the Association of American Medical Colleges’ (AAMC’s) MedEdPORTAL and Curriculum Inventory and Reports (CIR) sites.The authors used the Accreditation Council for Graduate Medical Education (ACGME)/American Board of Medical Specialties six domains of competence and 36 competencies delineated by the ACGME as their foundational reference list. They added two domains described by other groups after the original six domains were introduced: Interprofessional Collaboration (4 competencies) and Personal and Professional Development (8 competencies). They compared the expanded reference list (48 competencies within eight domains) with 153 competency lists from across the medical education continuum, physician specialties and subspecialties, countries, and health care professions. Comparison analysis led them to add 13 “new” competencies and to conflate 6 competencies into 3 to eliminate redundancy.The AAMC will use the resulting “Reference List of General Physician Competencies” (58 competencies in eight domains) to categorize resources for MedEdPORTAL and CIR. The authors hope that researchers and educators within medicine and other health professions will consider using this reference list when applicable to move toward a common taxonomy of competencies.

via Toward a Common Taxonomy of Competency Domains for … [Acad Med. 2013] – PubMed – NCBI.

Continue Reading

ABSTRACT: How Do Medical Students Navigate the Interplay of Explicit Curricula, Implicit Curricula, and Extracurricula to Learn Curricular Objectives?

PURPOSE:
Current focus in medical education on competencies and curricular objectives draws attention to boundaries rather than the openness inherent in the learning process. This qualitative study explored the tension between boundedness (mandated curricular objectives) and openness (variability in learning experience as students traverse the explicit, implicit, and extracurriculum) in the curriculum.
METHOD:
Following the revision and implementation of 10 curricular objectives for Columbia University College of Physicians and Surgeons, the authors interviewed 18 fourth-year medical students in spring 2011. For each objective, students indicated the relative influence of the explicit curriculum, implicit curriculum, and extracurriculum on their learning. Students were asked to think aloud and assign points as they made these judgments. Quantitative and qualitative data were analyzed to understand students’ perceptions of learning across curricula and for each curricular objective.
RESULTS:
There was marked variability in students’ learning experience. For two objectives, students perceived that learning occurred mainly in the explicit curriculum and consumed a disproportionate amount of study time. For two other objectives, students perceived that learning occurred mainly in the extracurriculum because opportunities to learn these objectives in the implicit and explicit curricula were sparse. For six objectives, students perceived that learning occurred mostly in the implicit curriculum, often through “watching” or interacting with peers.
CONCLUSIONS:
The findings can inform discussions about how to balance the boundedness of curricular mandates with the inherent openness of students’ learning experiences

via How Do Medical Students Navigate the Interplay of E… [Acad Med. 2013] – PubMed – NCBI.

Continue Reading

MANUSCRIPT: Quantifying short-term dynamics of Parkinson’s disease using self-reported symptom data from an Internet social network.

BACKGROUND:
Parkinson’s disease (PD) is an incurable neurological disease with approximately 0.3% prevalence. The hallmark symptom is gradual movement deterioration. Current scientific consensus about disease progression holds that symptoms will worsen smoothly over time unless treated. Accurate information about symptom dynamics is of critical importance to patients, caregivers, and the scientific community for the design of new treatments, clinical decision making, and individual disease management. Long-term studies characterize the typical time course of the disease as an early linear progression gradually reaching a plateau in later stages. However, symptom dynamics over durations of days to weeks remains unquantified. Currently, there is a scarcity of objective clinical information about symptom dynamics at intervals shorter than 3 months stretching over several years, but Internet-based patient self-report platforms may change this.
OBJECTIVE:
To assess the clinical value of online self-reported PD symptom data recorded by users of the health-focused Internet social research platform PatientsLikeMe (PLM), in which patients quantify their symptoms on a regular basis on a subset of the Unified Parkinson’s Disease Ratings Scale (UPDRS). By analyzing this data, we aim for a scientific window on the nature of symptom dynamics for assessment intervals shorter than 3 months over durations of several years.
METHODS:
Online self-reported data was validated against the gold standard Parkinson’s Disease Data and Organizing Center (PD-DOC) database, containing clinical symptom data at intervals greater than 3 months. The data were compared visually using quantile-quantile plots, and numerically using the Kolmogorov-Smirnov test. By using a simple piecewise linear trend estimation algorithm, the PLM data was smoothed to separate random fluctuations from continuous symptom dynamics. Subtracting the trends from the original data revealed random fluctuations in symptom severity. The average magnitude of fluctuations versus time since diagnosis was modeled by using a gamma generalized linear model.
RESULTS:
Distributions of ages at diagnosis and UPDRS in the PLM and PD-DOC databases were broadly consistent. The PLM patients were systematically younger than the PD-DOC patients and showed increased symptom severity in the PD off state. The average fluctuation in symptoms (UPDRS Parts I and II) was 2.6 points at the time of diagnosis, rising to 5.9 points 16 years after diagnosis. This fluctuation exceeds the estimated minimal and moderate clinically important differences, respectively. Not all patients conformed to the current clinical picture of gradual, smooth changes: many patients had regimes where symptom severity varied in an unpredictable manner, or underwent large rapid changes in an otherwise more stable progression.
CONCLUSIONS:
This information about short-term PD symptom dynamics contributes new scientific understanding about the disease progression, currently very costly to obtain without self-administered Internet-based reporting. This understanding should have implications for the optimization of clinical trials into new treatments and for the choice of treatment decision timescales.

via Quantifying short-term dynamics of Parkin… [J Med Internet Res. 2013] – PubMed – NCBI.

Continue Reading
Social
Facebook-f Twitter Linkedin-in
Recent News
Contact Us

300 E Main Street, Suite 101 Charlottesville, VA 22902

+1-434-260-1850

Email Us

About Us

ArcheMedX helps life sciences and healthcare organizations to better equip, evaluate, and predict team and clinician performance

ArcheMedX Privacy Policy