Feedback should facilitate learning, but within medical education it often fails to deliver on its promise. To better understand why feedback is challenging, we explored the unique perspectives of doctors who had also trained extensively in sport or music, aiming to: (i) distinguish the elements of the response to feedback that are determined by the individual learner from those determined by the learning culture, and (ii) understand how these elements interact in order to make recommendations for improving feedback in medical education.
Using a constructivist grounded theory approach, we conducted semi-structured interviews with 27 doctors or medical students who had high-level training and competitive or performance experience in sport (n = 15) or music (n = 12). Data were analysed iteratively using constant comparison. Key themes were identified and their relationships critically examined to derive a conceptual understanding of feedback and its impact.
We identified three essential sources of influence on the meaning that feedback assumed: the individual learner; the characteristics of the feedback, and the learning culture. Individual learner traits, such as motivation and orientation toward feedback, appeared stable across learning contexts. Similarly, certain feedback characteristics, including specificity, credibility and actionability, were valued in sport, music and medicine alike. Learning culture influenced feedback in three ways: (i) by defining expectations for teachers and teacher-learner relationships; (ii) by establishing norms for and expectations of feedback, and (iii) by directing teachers’ and learners’ attention toward certain dimensions of performance. Learning culture therefore neither creates motivated learners nor defines ‘good feedback’; rather, it creates the conditions and opportunities that allow good feedback to occur and learners to respond.
An adequate understanding of feedback requires an integrated approach incorporating both the individual and the learning culture. Our research offers a clear direction for medicine’s learning culture: normalise feedback; promote trusting teacher-learner relationships; define clear performance goals, and ensure that the goals of learners and teachers align.
BACKGROUND AND OBJECTIVES:
Family medicine residency programs are challenged with balancing hospital-based training with a longitudinal primary care continuity experience. In response to the Preparing the Personal Physician for Practice (P4) Initiative, the University of Missouri (MU) Family Medicine Residency Program sought to increase the presence of its residents in their continuity clinic, ie, the patient-centered medical home (PCMH). While initially successful, these efforts encountered formidable barriers with the July 2011 duty hour regulations from the Accreditation Council for Graduate Medical Education (ACGME).
PCMH hours and visit numbers were collected and analyzed for MU residents from July 2005 through June 2012.
Comparing the 2 years before the P4 schedule changes to the first 3 years after the P4 changes, MU first-year residents experienced a 27% increase in patient visits with a 13% increase in hours. In the subsequent 2 years, which incorporated compliance with the new ACGME regulations, first-year residents experienced a 33% decrease in visits with a 25% decrease in hours. This negated the increases seen with the previous P4 schedule changes, and residents in all years of training experienced less visits, less hours, and less visits per hour.
New duty hour regulations not only limit the time resident physicians spend in the hospital but also their experience in the ambulatory setting. Considering the emphasis family medicine training programs place on continuity of care and the PCMH, the new regulations will have significant implications for these programs.
Teaching programmes in medical education are now routinely employing active learning strategies to enhance the learning process and engage students in higher levels of learning. Team-based learning (TBL) is one active learning strategy that builds on individuals’ strengths by allowing them to collaborate and work as a team to achieve a common learning objective.
The present study aims to evaluate the impact of TBL on student performance. It also aims to assess students’ attitudes towards TBL and the feasibility of its incorporation into the course curriculum.
From a class of 241 students, 128 who agreed to participate in the study underwent two sessions of TBL each consisting of Individual and Group Readiness Assurance Tests (IRATs and GRATs). The readiness assurance tests each had 13 multiple choice questions (MCQ). To analyse the impact of TBL supplementation, the median sessional MCQ scores of students who underwent TBL supplementation (group 1) were compared with those who did not undergo the session (group 2). Students’ experiences with TBL and their attitudes towards incorporation of TBL into the course curriculum were analysed using a feedback questionnaire that was given to students who underwent TBL.
Students belonging to the TBL group performed significantly better than the students who did not undergo TBL (p<0.001). The median sessional MCQ score of the TBL group was seven and non-TBL group was six. The overall mean attitude score obtained from feedback questionnaires was 3.57, which indicates a positive attitude towards TBL.
The team-based learning session improved student engagement with course content. The majority of the students felt that TBL supplementation enhanced their understanding of course content and believe that it will help them perform better in their exams.
ABSTRACT: Evaluating simulation education via electronic surveys immediately following live critical events: a pilot study.
BACKGROUND AND OBJECTIVES:Simulation-based medical education has become popular in postgraduate training for medical emergencies; however, the direct impact on learners’ clinical performances during live critical events is unknown. Our goal was to evaluate the perceived impact of simulation-based education on pediatric emergencies by auditing pediatric residents immediately after involvement in actual emergency clinical events.METHODS:Weekly team-based pediatric simulation training for inpatient emergencies was implemented in an academic tertiary care hospital. Immediately after actual pediatric emergency events, each resident involved was audited regarding roles, performed tasks, and perceived effectiveness of earlier simulation-based education. The audit was performed by using a Likert scale.RESULTS:From September 2010 through August 2011, a total of 49 simulation sessions were held. During the same period, 27 pediatric emergency events occurred: 3 code events, 14 rapid response team activations, and 10 emergency transfers to the PICU. Forty-seven survey responses from 20 pediatric residents were obtained after the emergency clinical events. Fifty-three percent of residents felt well prepared, and 45% reported having experienced a similar simulation before the clinical event. A preceding similar simulation experience was perceived as helpful in improving clinical performance. Residents’ confidence levels, however, did not differ significantly between those who reported having had a preceding similar simulation and those who had not (median of 4 vs median of 3; P = .16, Wilcoxon rank-sum test).CONCLUSIONS:A novel electronic survey was successfully piloted to measure residents’ perceptions of simulation education compared with live critical events. Residents perceived that their experiences in earlier similar simulations positively affected their performances during emergencies.
Look at the definition of differentiation—in terms of what it is and is not—in this infographic to further your learning from the book.
Post it in your office, share it with your colleagues, or circulate it on social media to keep best practices for differentiating instruction to meet the needs of all students top of mind.
Most health care professionals are not adequately trained to address diet and nutrition-related issues with their patients, thus missing important opportunities to ameliorate chronic diseases and improve outcomes in acute illness. In this symposium, the speakers reviewed the status of nutrition education for health care professionals in the United States, United Kingdom, and Australia. Nutrition education is not required for educating and training physicians in many countries. Nutrition education for the spectrum of health care professionals is uncoordinated, which runs contrary to the current theme of interprofessional education. The central role of competencies in guiding medical education was emphasized and the urgent need to establish competencies in nutrition-related patient care was presented. The importance of additional strategies to improve nutrition education of health care professionals was highlighted. Public health legislation such as the Patient Protection and Affordable Care Act recognizes the role of nutrition, however, to capitalize on this increasing momentum, health care professionals must be trained to deliver needed services. Thus, there is a pressing need to garner support from stakeholders to achieve this goal. Promoting a research agenda that provides outcome-based evidence on individual and public health levels is needed to improve and sustain effective interprofessional nutrition education.
As medical education evolves, emphasis on chronic care management within the medical curriculum becomes essential. Because of the consistent lack of appropriate end-of-life care training, far too many patients die without the benefits of hospice care. This study explores the association between physician knowledge, training status, and level of comfort with hospice care referral of terminally ill patients.
In 2011, anonymous surveys were distributed to physicians in postgraduate years 1, 2, and 3; fellows; hospital attending physicians; specialists; and other healthcare professionals in five hospitals of a large health system in New York. Demographic comparisons were performed using χ2 and Fisher’s exact tests. Spearman correlations were calculated to determine if professional status and experience were associated with comfort and knowledge discussing end-of-life topics with terminal patients.
The sample consisted of 280 participants (46.7% response rate). Almost a quarter (22%) did not know key hospice referral criteria. Although 88% of respondents felt that knowledge of hospice care is an important competence, 53.2% still relinquished advance directives discussion to emergency room (ER) physicians. Fear of patient/family anger was the most frequently reported hospice referral barrier, although 96% of physicians rarely experienced reprisals. Physician comfort level discussing end-of-life issues and hospice referral was significantly associated with the number of years practicing medicine and professional status.
SIGNIFICANCE OF RESULTS:
Physicians continue to relinquish end-of-life care to ER staff and palliative care consultants. Exploring unfounded and preconceived fears associated with hospice referral needs to be integrated into the curriculum, to prepare future generations of physicians. Medical education should focus on delivering the right amount of end-of-life care training, at the right time, within the medical school and residency curriculum.
ABSTRACT: Exploring the validity of assessment in anatomy: do images influence cognitive processes used in answering extended matching questions?
Assessment is an important aspect of medical education because it tests students’ competence and motivates them to study. Various assessment methods, with and without images, are used in the study of anatomy. In this study, we investigated the use of extended matching questions (EMQs). To gain insight into the influence of images on the validity of test items, we focused on students’ cognitive processes while they answered questions with and without images. Seventeen first-year medical students answered EMQs about gross anatomy, combined with either labeled images or answer lists, while thinking aloud. The participants’ verbal reports were transcribed verbatim and then coded. Initial codes were based on a task analysis and were adapted into final codes during the coding process. Results showed that students used more cues from EMQs with images and visualized more often in EMQs with answer lists. Ready knowledge and verbal reasoning were used equally often in both conditions. In conclusion, EMQs with and without images elicit different results in this think aloud experiment, indicating different cognitive processes. They seem to measure different skills, making them valid for different testing purposes. The take-home message for anatomy teachers is that questions without images seem to test the quality of students’ mental images while questions with images test their ability to interpret visual information. It makes sense to use both response formats in tests. Using images from clinical practice instead of anatomical drawings will help to improve test validity.
BACKGROUND AND OBJECTIVES:
Limited research has been done to understand outcomes of continuing medical education offered in three-dimensional, immersive virtual worlds. We studied a case of a virtual world workshop on motivational interviewing (MI) applied to smoking cessation counseling and its educational impact.
To facilitate content development and evaluation, we specified desired MI competencies. The workshop consisted of three sessions, which included lectures, practice with standardized patients, and chat interactions. Data were collected from 13 primary care physicians and residents through workshop observation, and pre- and 3-month post-workshop telephone/Skype interviews and interactions with standardized patients. Interactions with standardized patients were assessed by an expert using a validated MI tool and by standardized patients using a tool developed for this study. For 11 participants who attended two or three sessions, we conducted paired-samples t tests comparing mean differences between the competency scores before and after the workshop.
Expert assessment showed significant improvement on six of seven MI competencies. All participants reported learning new knowledge and skills, and nine described incorporating new learning into their clinical practice. Practicing MI with standardized patients and/or observing others’ practice appeared to be the most helpful workshop component.
The evaluated workshop had positive impact on participants’ competencies and practice as related to MI applied to smoking cessation counseling. Our findings support further exploration of three-dimensional virtual worlds as learning environments for continuing medical education.
Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews (Courriels Cochrane) were disseminated by e-mail. Program participants automatically received CME credit for each Courriel Cochrane they rated. The feasibility of this program is reported (delivery, participation, and participant evaluation).
We recruited French-speaking physicians through the Canadian Medical Association. Program delivery and participation were documented. Participants rated the informational value of Courriels Cochrane using the Information Assessment Method (IAM), which documented their reflective learning (relevance, cognitive impact, use for a patient, expected health benefits). IAM responses were aggregated and analyzed.
The program was delivered as planned. Thirty Courriels Cochrane were delivered to 985 physicians, and 127 (12.9%) completed at least one IAM questionnaire. Out of 1109 Courriels Cochrane ratings, 973 (87.7%) conta-ined 1 or more types of positive cognitive impact, while 835 (75.3%) were clinically relevant. Participants reported the use of information for a patient and expected health benefits in 595 (53.7%) and 569 (51.3%) ratings, respectively.
Program delivery required partnering with 5 organizations. Participants valued Courriels Cochrane. IAM ratings documented their reflective learning. The aggregation of IAM ratings documented 3 levels of CME outcomes: participation, learning, and performance. This evaluation study demonstrates the feasibility of the Courriels Cochrane as an approach to further disseminate Cochrane systematic literature reviews to clinicians and document self-reported knowledge translation associated with Cochrane reviews.