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Author: Brian S McGowan, PhD

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.

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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.

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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.

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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.

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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.

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MANUSCRIPT: Correlates of health-related social media use among adults

BACKGROUND:
Sixty percent of Internet users report using the Internet to look for health information. Social media sites are emerging as a potential source for online health information. However, little is known about how people use social media for such purposes.
OBJECTIVES:
The purpose of this study was two-fold: (1) to establish the frequency of various types of online health-seeking behaviors, and (2) to identify correlates of 2 health-related online activities, social networking sites (SNS) for health-related activities and consulting online user-generated content for answers about health care providers, health facilities, or medical treatment.
METHODS:
The study consisted of a telephone survey of 1745 adults who reported going online to look for health-related information. Four subscales were created to measure use of online resources for (1) using SNS for health-related activities; (2) consulting online rankings and reviews of doctors, hospitals or medical facilities, and drugs or medical treatments; (3) posting a review online of doctors, hospitals or medical facilities, and drugs or medical treatments, and (4) posting a comment or question about health or medical issues on various social media. Univariate and multivariate logistic regression analyses were performed.
RESULTS:
Respondents consulted online rankings or reviews (41.15%), used SNS for health (31.58%), posted reviews (9.9%1), and posted a comment, question, or information (15.19%). Respondents with a chronic disease were nearly twice as likely to consult online rankings (odds ratio [OR] 2.09, 95% CI 1.66-2.63, P<.001). Lower odds of consulting online reviews were associated with less formal education (OR 0.49, 95% CI 0.37-0.65, P<.001) and being male (OR 0.71, 95% CI 0.57-0.87, P<.001). Respondents with higher incomes were 1.5 times as likely to consult online rankings or reviews (OR 1.49, 95% CI 0.10-2.24, P=.05), than respondents with a regular provider (OR 2.05, 95% CI 1.52-2.78, P<.001), or living in an urban/suburban location (OR 1.61, 95% CI 1.17-2.22, P<.001). Older respondents were less likely to use SNS for health-related activities (OR 0.96, 95% CI 0.95-0.97, P<.001), as were males (OR 0.70, 95% CI 0.56-0.87, P<.001), whereas respondents with a regular provider had nearly twice the likelihood of using SNS for health-related activities (OR 1.89, 95% CI 1.43-2.52, P<.001).
CONCLUSIONS:
People are using social media for seeking health information. However, individuals are more likely to consume information than they are to contribute to the dialog. The inherent value of “social” in social media is not being captured with online health information seeking. People with a regular health care provider, chronic disease, and those in younger age groups are more likely to consult online rankings and reviews and use SNS for health-related activities.

via Correlates of health-related social media… [J Med Internet Res. 2013] – PubMed – NCBI.

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ABSTRACT: The Rapidly Increasing Usefulness of Social Media in Urogynecology

OBJECTIVE:
We assessed the availability and quality of urinary incontinence and pelvic organ prolapse information in social medias and the growth of such information in the past 13 months.
METHODS:
We focused on the most popular social medias (Facebook, Twitter, and YouTube) to evaluate the key words “urogynecology,” “pelvic organ prolapse,” “stress incontinence,” “urge incontinence,” and “incontinence.” Initial evaluation included top 30 search results for key word “incontinence” to compare with our study in 2010, followed by a secondary search using the top 100 items. Results were classified as useful or not useful and then further categorized by health care providers, others, commercial, or humorous in intent. Results with the intent of providing information were presumed to be informative.
RESULTS:
Comparative search over a 13-month period showed a stable amount of useful information, 40% to 39%, but an increase in the number of health professionals (22% vs 13%). However, of the 817 search results, 406 (50%) were medically useful. Only 28% were written by health professionals, but of the informative results, 56% were written by health professionals. Finally, specific search terms provided the highest relevant and useful information, but also limited the number of search items found.
CONCLUSIONS:
Over 13 months, there was an increase in useful information presented from health professionals. These changes may reflect the medical community’s growing awareness of the usefulness of social media. If these trends continue, we predict the use of these medias for medical purposes will continue to increase among medical professionals.

via The Rapidly Incr… [Female Pelvic Med Reconstr Surg. 2013 July/August] – PubMed – NCBI.

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ABSTRACT: Health Care Social Media: Engagement and Health Care in the Digital Era

Health care as an industry continues in reluctant participation with consumers through social networks. Factors behind health cares laggard position range from providers concerns about patient privacy and lack of personal psychic bandwidth to organizational anxiety about employee time management and liability for online behavior. Despite these concerns, our patients are spending increasing amounts of their time online, often looking for information regarding their diagnosis, treatment, care providers, and hospitals, with much of that time spent in social networks. Our real opportunity for meaningful engagement in the future may depend on our capacity to meet our patients where they are, online, utilizing the tools that they use, that is, social media.

via Health Care Social Media: Engagement and… [Clin Obstet Gynecol. 2013] – PubMed – NCBI.

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ABSTRACT: Integrating Interprofessional Education into Continuing Education: A Planning Process for Continuing Interprofessional Education Programs

Informal continuing interprofessional education (CIPE) can be traced back decades in the United States; however, interest in formal CIPE is recent. Interprofessional education (IPE) now is recognized as an important component of new approaches to continuing education (CE) that are needed to increase health professionals’ ability to improve outcomes of care. Although there are examples of CIPE programs that are being successfully implemented, a clearly articulated, step-by-step planning process to help guide educators in providing effective CIPE programs is lacking. This lack of guidance poses a significant barrier to increasing the number of CIPE programs in the United States. In this article, we describe a process for developing, implementing, and evaluating CIPE programs using the familiar systematic CE planning process. Limitations of traditional CE also are addressed, and the relationship between CIPE and other new approaches to CE is clarified. Four examples of CIPE programs are provided to illustrate how the planning process can be adapted to include IPE, while implementing recommended changes in traditional CE offerings. The article is concluded with a discussion of some of the challenges that will face CE educators in moving toward a new vision of CE integrated with IPE.

via Integrating Interprofessional Education into Continuing Education: A Planning Process for Continuing Interprofessional Education Programs – Owen – 2013 – Journal of Continuing Education in the Health Professions – Wiley Online Library.

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ABSTRACT: A Framework for Assessing Continuing Professional Development Activities for Satisfying Pharmacy Revalidation Requirements

Introduction:
The United Kingdom’s pharmacy regulator contemplated using continuing professional development (CPD) in pharmacy revalidation in 2009, simultaneously asking pharmacy professionals to demonstrate the value of their CPD by showing its relevance and impact. The idea of linking new CPD requirements with revalidation was yet to be explored. Our aim was to develop and validate a framework to guide pharmacy professionals to select CPD activities that are relevant to their work and to produce a score sheet that would make it possible to quantify the impact and relevance of CPD.

Methods:
We adapted an existing risk matrix, producing a CPD framework consisting of relevance and impact matrices. Concepts underpinning the framework were refined through feedback from 5 pharmacist teacher-practitioners. We then asked 7 pharmacists to rate the relevance of the framework’s individual elements on a 4-point scale to determine content validity. We explored views about the framework through focus groups with 6 participants and interviews with 17 participants who had used it formally in a study.

Results:
The framework’s content validity index was 0.91. Feedback about the framework related to 3 themes of penetrability of the framework, usefulness to completion of CPD, and advancement of CPD records for the purpose of revalidation.

Discussion:
The framework can help professionals better select CPD activities prospectively, and makes assessment of CPD more objective by allowing quantification, which could be helpful for revalidation. We believe the framework could potentially help other health professionals with better management of their CPD irrespective of their field of practice.

via A Framework for Assessing Continuing Professional Development Activities for Satisfying Pharmacy Revalidation Requirements – Donyai – 2013 – Journal of Continuing Education in the Health Professions – Wiley Online Library.

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