Author: Collated Resource

ABSTRACT: Adherence to Prescription Opioid Monitoring Guidelines among Residents and Attending Physicians in the Primary Care Setting

OBJECTIVE:The aim of this study was to compare adherence to opioid prescribing guidelines and potential opioid misuse in patients of resident vs attending physicians.DESIGN:Retrospective cross-sectional study.SETTING:Large primary care practice at a safety net hospital in New England.SUBJECTS:Patients 18-89 years old, with at least one visit to the primary care clinic within the past year and were prescribed long-term opioid treatment for chronic noncancer pain.METHODS:Data were abstracted from the electronic medical record by a trained data analyst through a clinical data warehouse. The primary outcomes were adherence to any one of two American Pain Society Guidelines: 1 documentation of at least one opioid agreement contract ever and 2 any urine drug testing in the past year, and evidence of potential prescription misuse defined as ≥2 early refills. We employed logistic regression analysis to assess whether patients’ physician status predicts guideline adherence and/or potential opioid misuse.RESULTS:Similar proportions of resident and attending patients had a controlled substance agreement 45.1% of resident patients vs 42.4% of attending patient, P = 0.47 or urine drug testing 58.6% of resident patients vs 63.6% of attending patients, P = 0.16. Resident patients were more likely to have two or more early refills in the past year relative to attending patients 42.8% vs 32.5%; P = 0.004. In the adjusted regression analysis, resident patients were more likely to receive early refills odds ratio 1.82, 95% confidence interval 1.26-2.62 than attending patients.CONCLUSIONS:With some variability, residents and attending physicians were only partly compliant with national guidelines. Residents were more likely to manage patients with a higher likelihood of opioid misuse.

via Adherence to Prescription Opioid Monitoring Guidelines among Reside… – PubMed – NCBI.

ABSTRACT: A new age approach to an age old problem: using simulation to teach geriatric medicine to medical students

BACKGROUND:
simulation-based teaching is increasingly used in medical education, but no studies have evaluated its impact on learning in geriatric medicine. We developed and delivered a simulation teaching session on delirium, falls, elder abuse and breaking bad news. Simulation mannequins, professional role-players and simulated clinical documentation were all incorporated into scenarios. We evaluated the effect of this intervention on student learning and on students’ attitudes towards geriatric medicine.
METHODS:
third year Newcastle University MBBS students at Northumbria base unit received the simulation-based teaching session. Students’ knowledge was assessed using a three question test mapped to learning outcomes for the elder abuse, delirium and falls stations. Each student undertook the test on three occasions: the day before the teaching session, immediately after the session and ∼1 month later, allowing evaluation of learning over time. Test scores were also compared with those achieved by another cohort of third year MBBS students at a different base unit, who received traditional ward-based and didactic teaching but no simulation teaching.
RESULTS:
student knowledge improved significantly after the simulation session and this was maintained when reassessed a month later. Students who received the simulation-based training outperformed those who received usual teaching. Student feedback was overwhelmingly positive and the vast majority of students agreed that the session had a positive impact on their perceptions of geriatric medicine.
DISCUSSION:
our findings demonstrate the efficacy of simulation-based teaching in undergraduate geriatric medicine, its acceptability to students and its positive influence on students’ perceptions of the specialty.

via A new age approach to an age old problem: using simulation to teach… – PubMed – NCBI.

ABSTRACT: Undergraduate medical students’ perceptions on the quality of feedback received during clinical rotations

OBJECTIVE:
This study aims to report undergraduate medical students’ evaluation of the frequency and the quality of feedback received on their clinical performance during their clerkships.
METHODS:
This is a prospective observational study with a cross-sectional design including students from two cohorts (fifth and sixth years). In a structured interview, a questionnaire was used to report students’ perception on feedback.
RESULTS:
In all, 53.3% and 66% of the students (fifth, sixth years, respectively) had rarely received feedback from clinical teachers, and only around 18% of them had corrective feedback during patient encounter. Students rated feedback on domains of communication skills with patients, and investigations requested as poorly acknowledged. Students appreciate the impact of feedback, however, 85% and 94% of them (fifth, sixth years, respectively) had poor feedback seeking attitude. The overall process of feedback was rated by the two cohorts collectively as 43.6% poor and 24.5% fair.
CONCLUSION:
Results demonstrate that feedback on students’ clinical performance is often not forthcoming and when offered it is deficient and fails to concentrate on the development of different clinical skills. This highlights the critical challenges that need to be addressed by teachers, medical education unit and all hospital departments in order to enhance giving effective and structured feedback to medical students during clerkships. Results also raise the extreme need for the establishment and enhancement of a culture that supports feedback among all levels of clinical supervisors

via Undergraduate medical students’ perceptions on the quality of feedb… – PubMed – NCBI.

ABSTRACT: Using patients’ experiences in e-learning design

BACKGROUND:
Design of the undergraduate and postgraduate medical curriculum is traditionally the task of medical professionals and educationalists, with regulating bodies approving curriculum content. Although this should ensure a thorough approach to a medical model of the curriculum, it may overlook the importance of the patient’s perspective in medical education. The General Medical Council recently issued advice about patient and public involvement in all areas of medical education, including curricular design, but it is not immediately clear how this should be incorporated.
METHODS:
This article describes and analyses an innovative approach to curriculum design, in which patients’ experiences are placed at the centre of learning. Important themes identified from qualitative research with patients (and their carers) with autistic spectrum conditions were compared with a pre-established curriculum for an e-learning module by the Royal College of General Practitioners.
RESULTS:
Significant divergence was identified between the doctor-designed curriculum and the themes identified through patients’ experiences. The divergence was analysed and patients’ experiences were used to expand the proposed course.
DISCUSSION:
This research concerned e-learning about autistic spectrum conditions, but may have implications for other areas and modalities of medical education. Further research is needed to determine whether the inclusion in the curriculum of previously ignored themes, which are nevertheless important to patients, has an impact on the quality of the doctor-patient interaction and relationship.

via Using patients’ experiences in e-learning design. – PubMed – NCBI.

ABSTRACT: Development and implementation of a quality improvement curriculum for child neurology residents: lessons learned.

BACKGROUND:
Quality improvement is a major component of the Accreditation Council for Graduate Medical Education core competencies required of all medical trainees. Currently, neither the Neurology Residency Review Committee nor the Accreditation Council for Graduate Medical Education defines the process by which this competency should be taught and assessed. We developed a quality improvement curriculum that provides mentorship for resident quality improvement projects and is clinically relevant to pediatric neurologists.
METHODS:
Before and after implementation of the quality improvement curriculum, a 14-item survey assessed resident comfort with quality improvement project skills and attitudes about implementation of quality improvement in clinical practice using a 5-point Likert scale. We used the Kruskal-Wallis and Fisher exact tests to evaluate pre to post changes.
RESULTS:
Residents’ gained confidence in their abilities to identify measures (P = 0.02) and perform root cause analysis (P = 0.02). Overall, 73% of residents were satisfied or very satisfied with the quality improvement curriculum.
CONCLUSIONS:
Our child neurology quality improvement curriculum was well accepted by trainees. We report the details of this curriculum and its impact on residents and discuss its potential to meet the Accreditation Council for Graduate Medical Education’s Next Accreditation System requirements.

via Development and implementation of a quality improvement curriculum … – PubMed – NCBI.

MANUSCRIPT: Modification of Peyton’s four-step approach for small group teaching – a descriptive study

BACKGROUND:
Skills-lab training as a methodological teaching approach is nowadays part of the training programs of almost all medical faculties. Specific ingredients have been shown to contribute to a successful learning experience in skills-labs. Although it is undoubted that the instructional approach used to introduce novel clinical technical skills to learners has a decisive impact on subsequent skills performance, as yet, little is known about differential effects of varying instructional methods. An instructional approach that is becoming increasingly prevalent in medical education is “Peyton’s Four-Step Approach”. As Peyton’s Four Step Approach was designed for a 1:1 teacher : student ratio, the aim of the present study was to develop and evaluate a modified Peyton’s Approach for small group teaching.
METHODS:
The modified Peyton’s Approach was applied in three skills-lab training sessions on IV catheter insertion, each with three first- or second year medical students (n = 9), delivered by three different skills-lab teachers. The presented descriptive study investigated the practicability and subjective impressions of skills-lab trainees and tutors. Skills-lab sessions were evaluated by trainees’ self-assessment, expert ratings, and qualitative analysis of semi-standardized interviews conducted with trainees and tutors.
RESULTS:
The model was well accepted by trainees, and was rated as easy to realize, resulting in a good flow of teaching and success in attracting trainee’s attention when observed by expert raters. Qualitative semi-standardized interviews performed with all of the trainees and tutors revealed that trainees valued repeated observation, instruction of trainees and the opportunity for independent performance, while tutors stressed that trainees were highly concentrated throughout the training and that they perceived repeated observation to be a valuable preparation for their own performance.
CONCLUSION:
The modified Peyton’s Approach to instruct small groups of students in skills-lab training sessions has revealed to be practicable, well accepted by trainees, and easy for tutors to realize. Further research should address the realization of the model in larger skills-lab training groups.

via Modification of Peyton’s four-step approach for small group teachin… – PubMed – NCBI.

ABSTRACT: Emotional intelligence in medical education: a critical review

CONTEXT:
Emotional intelligence (EI) is a term used to describe people’s awareness of, and ability to respond to, emotions in themselves and other people. There is increasing research evidence that doctors’ EI influences their ability to deliver safe and compassionate health care, a particularly pertinent issue in the current health care climate.
OBJECTIVES:
This review set out to examine the value of EI as a theoretical platform on which to base selection for medicine, communication skills education and professionalism.
METHODS:
We conducted a critical review with the aim of answering questions that clinical educators wishing to increase the focus on emotions in their curriculum might ask.
RESULTS:
Although EI seems, intuitively, to be a construct that is relevant to educating safe and compassionate doctors, important questions about it remain to be answered. Research to date has not established whether EI is a trait, a learned ability or a combination of the two. Furthermore, there are methodological difficulties associated with measuring EI in a medical arena. If, as has been suggested, EI were to be used to select for medical school, there would be a real risk of including and excluding the wrong people.
CONCLUSIONS:
Emotional intelligence-based education may be able to contribute to the teaching of professionalism and communication skills in medicine, but further research is needed before its wholesale adoption in any curriculum can be recommended.

via Emotional intelligence in medical education: a critical review. – PubMed – NCBI.

MANUSCRIPT: Using cognitive theory to facilitate medical education

BACKGROUND:
Educators continue to search for better strategies for medical education. Although the unifying theme of reforms was “increasing interest in, attention to, and understanding of the knowledge base structures”, it is difficult to achieve all these aspects via a single type of instruction.
METHODS:
We used related key words to search in Google Scholar and Pubmed. Related search results on this topic were selected for discussion.
RESULTS:
Despite the range of different methods used in medical education, students are still required to memorize much of what they are taught, especially for the basic sciences. Subjects like anatomy and pathology carry a high intrinsic cognitive load mainly because of the large volume of information that must be retained. For these subjects, decreasing cognitive load is not feasible and memorizing appears to be the only strategy, yet the cognitive load makes learning a challenge for many students. Cognitive load is further increased when inappropriate use of educational methods occurs, e.g., in problem based learning which demands clinical reasoning, a high level and complex cognitive skill. It is widely known that experts are more skilled at clinical reasoning than novices because of their accumulated experiences. These experiences are based on the formation of cognitive schemata. In this paper we describe the use of cognitive schemata, developed by experts as worked examples to facilitate medical students’ learning and to promote their clinical reasoning.
CONCLUSION:
We suggest that cognitive load theory can provide a useful framework for understanding the challenges and successes associated with education of medical professionals.

via Using cognitive theory to facilitate medical education. – PubMed – NCBI.

ABSTRACT: External cues to action and influenza vaccination among post-graduate trainee physicians in Toronto, Canada

BACKGROUND:
Understanding factors affecting trainee physician choices about vaccination may permit the design of more effective vaccination programmes.
METHODS:
To identify factors associated with seasonal and pandemic influenza vaccination, an online questionnaire based on the health belief model was sent to trainee physicians registered at the post-graduate medical education office at the University of Toronto in September 2011.
RESULTS:
963 complete responses were received from 1884 trainee physicians (51%); 28 (2.9%) reported an allergy to vaccine components and were excluded from further analysis. Reported seasonal influenza vaccination rates in 2008, 2009 and 2010 were 69% (648/935), 75% (708/935) and 76% (703/935), respectively; 788 (84%) reported receiving the A(H1N1)pdm09 vaccine. In multivariable analysis, number of years of post-graduate training (OR for 4+ versus 1-3 post-graduate years 2.2 (95% CL 1.3, 3.8)) was associated with receipt of the 2009 pandemic vaccine, as were four components of the health belief model: odds ratios were 4.7 (95% CL 3.0, 7.5) for perceived severity, 1.9 (95% CL 1.2, 2.9) for perceived benefits, .35 (95% CL .21, .59) for perceived barriers, and 5.8 (95% CLI 3.6, 9.1) for external cues to action. Both vaccinated and unvaccinated respondents reported that their decisions were significantly influenced by encouragement from their colleagues, families and employers.
CONCLUSION:
Self-reported vaccination coverage among trainee physicians was high. External cues to action appear to be particularly important in trainee physician vaccination decisions: active institutional promotion may increase influenza vaccination rates in trainees.

via External cues to action and influenza vaccination among post-gradua… – PubMed – NCBI.

MANUSCRIPT: Becoming a medical educator: motivation, socialisation and navigation

BACKGROUND:
Despite an increasing concern about a future shortage of medical educators, little published research exists on career choices in medical education nor the impact of specific training posts in medical education (e.g. academic registrar/resident positions). Medical educators at all levels, from both medical and non-medical backgrounds, are crucial for the training of medical students, junior doctors and in continuing professional development. We explored the motivations and experiences of junior doctors considering an education career and undertaking a medical education registrar (MER) post.
METHODS:
Data were collected through semi-structured interviews with junior doctors and clinicians across Queensland Health. Framework analysis was used to identify themes in the data, based on our defined research questions and the medical education workforce issues prompting the study. We applied socio-cognitive career theory to guide our analysis and to explore the experience of junior doctors in medical education registrar posts as they enter, navigate and fulfil the role.
RESULTS:
We identified six key themes in the data: motivation for career choice and wanting to provide better education; personal goals, expectations and the need for self-direction; the influence of role models; defining one’s identity; support networks and the need for research as a potential barrier to pursuing a career in/with education. We also identified the similarities and differences between the MERs’ experiences to develop a composite of an MER’s journey through career choice, experience in role and outcomes.
CONCLUSIONS:
There is growing interest from junior doctors in pursuing education pathways in a clinical environment. They want to enhance clinical teaching in the hospitals and become specialists with an interest in education, and have no particular interest in research or academia. This has implications for the recruitment and training of the next generation of clinical educators.

via Becoming a medical educator: motivation, socialisation and navigation. – PubMed – NCBI.