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Author: Brian S McGowan, PhD

ABSTRACT: Educational Experiences Residents Perceive As Most Helpful for the Acquisition of the ACGME Competencies

BACKGROUND:
The Accreditation Council for Graduate Medical Education (ACGME) requires physicians in training to be educated in 6 competencies considered important for independent medical practice. There is little information about the experiences that residents feel contribute most to the acquisition of the competencies.
OBJECTIVE:
To understand how residents perceive their learning of the ACGME competencies and to determine which educational activities were most helpful in acquiring these competencies.
METHOD:
A web-based survey created by the graduate medical education office for institutional program monitoring and evaluation was sent to all residents in ACGME-accredited programs at the David Geffen School of Medicine, University of California-Los Angeles, from 2007 to 2010. Residents responded to questions about the adequacy of their learning for each of the 6 competencies and which learning activities were most helpful in competency acquisition.
RESULTS:
We analyzed 1378 responses collected from postgraduate year-1 (PGY-1) to PGY-3 residents in 12 different residency programs, surveyed between 2007 and 2010. The overall response rate varied by year (66%-82%). Most residents (80%-97%) stated that their learning of the 6 ACGME competencies was “adequate.” Patient care activities and observation of attending physicians and peers were listed as the 2 most helpful learning activities for acquiring the 6 competencies.
CONCLUSION:
Our findings reinforce the importance of learning from role models during patient care activities and the heterogeneity of learning activities needed for acquiring all 6 competencies.

via Educational Experiences Residents Perceive A… [J Grad Med Educ. 2012] – PubMed – NCBI.

MANUSCRIPT: Use of a structured template to facilitate practice-based learning and improvement projects

BACKGROUND:
The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents’ competency in practice-based learning and improvement (PBLI) is particularly challenging.
PURPOSE:
We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning.
METHODS:
We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008-2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure.
RESULTS:
An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template.
DISCUSSION:
The development of the tool generated program leaders’ support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.

via Use of a structured template to facilitate p… [J Grad Med Educ. 2012] – PubMed – NCBI.

ABSTRACT: Social networking profiles and professionalism issues in residency applicants: an original study-cohort study.

OBJECTIVE:
To determine the frequency of social networking, the degree of information publicly disclosed, and whether unprofessional content was identified in applicants from the 2010 Residency Match.
BACKGROUND:
Medical professionalism is an essential competency for physicians to learn, and information found on social networking sites may be hazardous to the doctor-patient relationship and an institution’s public perception. No study has analyzed the social network content of applicants applying for residency.
METHODS:
Online review of social networking Facebook profiles of graduating medical students applying for a residency in orthopedic surgery. Evidence of unprofessional content was based upon Accreditation Council for Graduate Medical Education guidelines. Additional recorded applicant data included as follows: age, United States Medical Licensing Examination part I score, and residency composite score. Relationship between professionalism score and recorded data points was evaluated using an analysis of variance.
RESULTS:
Nearly half of all applicants, 46% (200/431), had a Facebook profile. The majority of profiles (85%) did not restrict online access to their profile. Unprofessional content was identified in 16% of resident applicant profiles. Variables associated with lower professionalism scores included unmarried relationship status and lower residency composite scores.
CONCLUSION:
It is critical for healthcare professionals to recognize both the benefits and risks present with electronic communication and to vigorously protect the content of material allowed to be publically accessed through the Internet.

via Social networking profiles and professio… [J Surg Educ. 2013 Jul-Aug] – PubMed – NCBI.

MAUNSCRIPT: The next accreditation system: stakeholder expectations and dialogue with the community

In February 2012, in an article in the New England Journal of Medicine,1 the Accreditation Council for Graduate Medical Education ACGME provided an initial description and the rationale for the Next Accreditation System NAS. We follow up with this piece, which reflects on questions about the NAS, as a starting point for a dialogue with the community, and as the first in a series of articles that will describe key attributes of the NAS, offer practical guidance to programs and sponsoring institutions, and solicit stakeholder input. Dialogue with the community will be helpful in answering questions and in allowing the ACGME to clarify and refine certain elements of the NAS. This dialogue needs to be mindful that many details of the NAS are yet to be finalized. In communicating about the NAS, ACGME, thus, must balance a timely response to the communitys desire to learn more and the need to have details well established to avoid a need to make changes after details have been released to stakeholders and the public.

via The next accreditation system: stakeholder e… [J Grad Med Educ. 2012] – PubMed – NCBI.

ABSTRACT: Imaging informatics for consumer health: towards a radiology patient portal

Objective With the increased routine use of advanced imaging in clinical diagnosis and treatment, it has become imperative to provide patients with a means to view and understand their imaging studies. We illustrate the feasibility of a patient portal that automatically structures and integrates radiology reports with corresponding imaging studies according to several information orientations tailored for the layperson.Methods The imaging patient portal is composed of an image processing module for the creation of a timeline that illustrates the progression of disease, a natural language processing module to extract salient concepts from radiology reports 73% accuracy, F1 score of 0.67, and an interactive user interface navigable by an imaging findings list. The portal was developed as a Java-based web application and is demonstrated for patients with brain cancer.Results and discussion The system was exhibited at an international radiology conference to solicit feedback from a diverse group of healthcare professionals. There was wide support for educating patients about their imaging studies, and an appreciation for the informatics tools used to simplify images and reports for consumer interpretation. Primary concerns included the possibility of patients misunderstanding their results, as well as worries regarding accidental improper disclosure of medical information.Conclusions Radiologic imaging composes a significant amount of the evidence used to make diagnostic and treatment decisions, yet there are few tools for explaining this information to patients. The proposed radiology patient portal provides a framework for organizing radiologic results into several information orientations to support patient education.

via Imaging informatics for consumer health: towards a radiology patient portal — Arnold et al. — Journal of the American Medical Informatics Association.

ABSTRACT: Goal Instructions, Response Format, and Idea Generation in Groups

This study examined the separate and joint impact of two standard, but seemingly conflicting brainstorming rules on idea generation in interacting and nominal groups: the free-wheeeling rule, which calls for the production of dissimilar ideas, and the build-on rule, which encourages idea combination and improvement. We also tested whether the superior performance of interacting groups found in several previous studies using a brainwriting technique may have been due to the different response formats employed by groups and individuals. Interacting groups and individuals generated ideas for improving their university under one of three sets of instructions. In one condition, participants were given the build-on rule, but not the free-wheeling rule, and in another condition, the reverse was true. In the third condition, both rules were provided. When the two rules were presented separately, interacting and nominal groups responded similarly, generating ideas from more semantic categories in response to the free-wheeling rule, and generating more practical ideas in response to the build-on rule. But when those rules were presented simultaneously, interacting groups generated ideas from fewer semantic categories than did nominal groups. In addition, interacting groups produced more ideas overall than nominal groups, but only when the two used different response formats.

via Goal Instructions, Response Format, and Idea Generation in Groups.

ABSTRACT: Experiential Learning in an Undergraduate Course in Group Communication and Decision Making

The innovative structure of an undergraduate course on communication and decision making in small groups, based on the framework of Kolb’s experiential learning theory, is described. The course involves doing in-class exercises that replicate published research about a given topic. Exercises involve completion of a group task, the manipulation of variables, and collection and analysis of data. Following each exercise, the students read the original research and other relevant materials. In the subsequent class, the students are debriefed through an examination of the class data and a discussion of the reading materials and potential practical applications. This sequence of experiment replication and discussion is repeated with a different exercise each week. The in-class activities are supplemented with written analysis assignments. Variations on the basic course module and other course components are described, and factors guiding design choices are discussed. Evidence of student learning relevant to course objectives is presented.

via Experiential Learning in an Undergraduate Course in Group Communication and Decision Making.

ABSTRACT: Social Learning Theory and the Health Belief Model

The Health Belief Model, social learning theory (recently relabelled social cognitive theory), self-efficacy, and locus of control have all been applied with varying success to problems of explaining, predicting, and influencing behavior. Yet, there is con ceptual confusion among researchers and practitioners about the interrelationships of these theories and variables. This article attempts to show how these explanatory fac tors may be related, and in so doing, posits a revised explanatory model which incor porates self-efficacy into the Health Belief Model. Specifically, self-efficacy is pro posed as a separate independent variable along with the traditional health belief var iables of perceived susceptibility, severity, benefits, and barriers. Incentive to behave (health motivation) is also a component of the model. Locus of control is not included explicitly because it is believed to be incorporated within other elements of the model. It is predicted that the new formulation will more fully account for health-related behavior than did earlier formulations, and will suggest more effective behavioral interventions than have hitherto been available to health educators.

via Social Learning Theory and the Health Belief Model.

MANUSCRIPT: Making psychological theory useful for implementing evidence based practice: a consensus approach — Michie et al. 14 (1): 26 — BMJ Quality and Safety

Background: Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience.

Methods: Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a “psychological theory” group (n = 18), a “health services research” group (n = 13), and a “health psychology” group (n = 30).

Results: Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour.

Conclusions: A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.

via Making psychological theory useful for implementing evidence based practice: a consensus approach — Michie et al. 14 (1): 26 — BMJ Quality and Safety.

ABSTRACT: Broadening conceptions of learning in medical education: the message from teamworking – Bleakley – 2006 – Medical Education – Wiley Online Library

Background  There is a mismatch between the broad range of learning theories offered in the wider education literature and a relatively narrow range of theories privileged in the medical education literature. The latter are usually described under the heading of ‘adult learning theory’.

Methods  This paper critically addresses the limitations of the current dominant learning theories informing medical education. An argument is made that such theories, which address how an individual learns, fail to explain how learning occurs in dynamic, complex and unstable systems such as fluid clinical teams.

Results  Models of learning that take into account distributed knowing, learning through time as well as space, and the complexity of a learning environment including relationships between persons and artefacts, are more powerful in explaining and predicting how learning occurs in clinical teams. Learning theories may be privileged for ideological reasons, such as medicine’s concern with autonomy.

Conclusions  Where an increasing amount of medical education occurs in workplace contexts, sociocultural learning theories offer a best-fit exploration and explanation of such learning. We need to continue to develop testable models of learning that inform safe work practice. One type of learning theory will not inform all practice contexts and we need to think about a range of fit-for-purpose theories that are testable in practice. Exciting current developments include dynamicist models of learning drawing on complexity theory.

via Broadening conceptions of learning in medical education: the message from teamworking – Bleakley – 2006 – Medical Education – Wiley Online Library.