Didactic Lecture Series Research Articles

SU‐E‐E‐07: When the Old Ways Are the Best Ways: In Defense of Didactic Training

Purpose:Physics education for residents has taken on a more prominent role due to the new ABR examination format. We present a curriculum for a new radiology residency entering its second year. This curriculum favors an extensive traditional didactic teaching approach. The curriculum is designed to minimize the amount of independent learning that is necessary outside the classroomMethods and Materials:idactic training repeats yearly for all four years of residency and consists of two 1‐hour lectures per week and several in‐class tests. The impact of physics on clinical practice is introduced gradually throughout the residency using specific clinical cases. The extensive time spent with the residents allows lectures to be taught at a deep (almost physicist) level and reduces the necessity of learning base concepts outside of lecture. This frees the resident to use resources (e.g., AAPM/RSNA physics modules) to cement concepts through repetition or to learn a slightly confusing concept from a different teaching perspective. Consistent testing reduces the traditional resident studying technique of physics “cramming.”Results:On average, the first year residents scored in the 98th percentile on the American College of Radiology Diagnostic Radiology In‐Service Training Exam (ACR DXIT). Feedback from the new first year residents was very positive and suggestions are constantly solicited and incorporated. For example, based on resident feedback, short‐format quizzes each lecture were eliminated and replaced interactive questions during lecture. Residents felt they have advanced rapidly and have a better understanding of radiologic physics, though they have expressed concern that the 1‐hour lecture block may not be optimal for learning physics.Conclusion:An extensive, physicist‐led series of didactic lectures is effective in the teaching of physics to residents.

Using quality improvement methods to optimize resources and maximize productivity in an anesthesia screening and consultation clinic

The anesthesia preoperative screening and evaluation of a patient prior to surgery is a critical element in the safe and effective delivery of anesthesia care. In this era of increased focus on cost containment, many anesthesia practices are looking for ways to maximize productivity while maintaining the quality of the preoperative evaluation process by harnessing and optimizing all available resources. We sought to develop a Nurse Practitioner-assisted Preoperative Anesthesia Screening process using quality improvement methods with the goal of maintaining the quality of the screening process, while at the same time redirecting anesthesiologists time for the provision of nonoperating room (OR) anesthesia. The Nurse practitioner (NP) time (approximately 10 h per week) directed to this project was gained as a result of an earlier resource utilization improvement project within the Department of Anesthesia. The goal of this improvement project was to increase the proportion of patient anesthesia screens conducted by NPs to 50% within 6 months. After discussion with key stakeholders of the process, a multidisciplinary improvement team identified a set of operational factors (key drivers) believed to be important to the success of the preoperative anesthesia screening process. These included the development of dedicated NP time for daily screening, NP competency and confidence with the screening process, effective mentoring by anesthesiologists, standardization of screening process, and communication with stakeholders of the process, that is, surgeons. These key drivers focused on the development of several interventions such as (i) NP education in the preoperative anesthesia screening for consultation process by a series of didactic lectures conducted by anesthesiologists, and NP's shadowing an anesthesiologist during the screening process, (ii) Anesthesiologist mentoring and assessment of NP screenings using the dual screening process whereby both anesthesiologists and NP conducted the screening process independently and results were compared and discussed, (iii) Examination and re-adjustment of NP schedules to provide time for daily screening while preserving other responsibilities, and (iv) Standardization through the development of guidelines for the preoperative screening process. Measures recorded included the percentage of patient anesthesia screens conducted by NP, the percentage of dual screens with MD and NP agreement regarding the screening decision, and the average times taken for the anesthesiologist and NP screening process. After implementation of these interventions, the percentage of successful NP-assisted anesthesia consultation screenings increased from 0% to 65% over a period of 6 months. The Anesthesiologists' time redirected to non-OR anesthesia averaged at least 8 h a week. The percentage of dual screens with agreement on the screening decision was 96% (goal >95%). The overall average time taken for a NP screen was 8.2 min vs 4.5 min for an anesthesiologist screen. The overall average operating room delays and cancelations for cases on the day of surgery remained the same. By applying quality improvement methods, we identified key drivers for the institution of an NP-assisted preoperative screening process and successfully implemented this process while redirecting anesthesiologists' time for the provision of non-OR anesthesia. This project was instrumental in improving the matching of provider skills with clinical need while maintaining superior outcomes at the lowest possible cost.

The Baltimore Partnership to Educate and Achieve Control of Hypertension (The BPTEACH Trial): A Randomized Trial of the Effect of Education on Improving Blood Pressure Control in a Largely African American Population

Hypertension is a major risk factor for developing cardiovascular disease and is more prevalent in African Americans compared with Caucasians. African Americans are often underrepresented in clinical trials. This study was composed of a largely urban African American cohort of hypertensive patients. This was a prospective, 4-arm, randomized controlled trial designed to evaluate the comparative effectiveness of both physician and patient education (PPE), patient education only (PAE), and physician education only (PHE) vs usual care (UC). Hypertension specialists gave a series of didactic lectures to the physicians, while a nurse educator performed the patient education. The mean adjusted difference in systolic blood pressure (SBP) from baseline in the PPE group was an average reduction of 12 mm Hg (95% confidence interval [CI], -4.5 to -19.4) at 6-months, followed by average reductions of 4.6 mm Hg (6.9 to -16.12) in the PAE group, 4.1 mm Hg (3.4 to -11.7) in the PHE group, and 2.6 mm Hg (3 to -8.2) in the UC group. The PPE group achieved a significantly better reduction in SBP compared with the UC group. Additional research should be conducted to evaluate whether the use of certified hypertension educators in collaboration with physicians will result in a similar blood pressure reduction.

Implementation Of Hematology-Oncology Lecture Series For Housestaff

Abstract Abstract 4554 BACKGROUND Currently, the hospital has a floor dedicated to cancer patients. The housestaff taking care of these patients includes three interns and one hematology-oncology fellow. In addition, there is a consult service comprising another fellow, an intern, and a resident. There was a paucity of formal, didactic, teaching in place devoted to the subjects of hematology and oncology. OBJECTIVE the development of a monthly lecture series for housestaff rotating on a hematology-oncology rotation that would focus on three key areas: a. What housestaff need to know to manage the patients on the hematology-oncology service b. What housestaff are most likely to encounter in the practice of medicine, regardless of eventual subspecialty field. c. What housestaff need to know for American Board of Internal Medicine exams. METHODS Topics were chosen based on pertinence. These included: leukemia, lymphoma, multiple myeloma, stem cell transplantation (these first four comprising at least 50% of patients on the unit), coagulation, breast cancer, lung cancer, colon cancer, gynecological malignancies, and pain management/supportive care. Potential speakers included full-time faculty as well as private physicians affiliated with the cancer center. Emails and/or phone calls were placed to the physicians and announcements made at division meetings and schedules developed. The plan was also for the development of a series of questions testing the housestaff at the start of their one month rotation and at the end of the rotation. Lectures were scheduled for afternoons if possible to avoid conflicts with morning rounds. Occasional morning talks were necessary to accommodate lecturers. Format of lectures was flexible (power point, dry-eraser board). RESULTS Overall feedback was positive for the lecture series. The two conditions affecting optimal success of the program concerned scheduling, including intern and fellow schedules as they relate to rounds and housestaff clinics and availability of when speakers could lecture and recruitment of speakers appropriate to the relevant topics. In addition, repeating the topics every month proved challenging for finding lecturing participants. The question/answer testing is still early in testing and no conclusion can be made. CONCLUSION A didactic lecture series is an important aspect of hematology-oncology education for housestaff. Repeating lectures every month is a challenge for several reasons. Possible interventions in the future may include: a. Focusing lecturing duties to full-time faculty, with an emphasis on faculty currently on service b. Creating power point presentations and handouts on file for use by multiple people so that rotating faculty may use these materials for talks c. Statistical analysis of scores from pre-rotation and post-rotation exams Disclosures: No relevant conflicts of interest to declare.

Implementation of Hematology-Oncology Lecture Series for Housestaff.

Abstract 4554 BACKGROUNDCurrently, the hospital has a floor dedicated to cancer patients. The housestaff taking care of these patients includes three interns and one hematology-oncology fellow. In addition, there is a consult service comprising another fellow, an intern, and a resident. There was a paucity of formal, didactic, teaching in place devoted to the subjects of hematology and oncology. OBJECTIVEthe development of a monthly lecture series for housestaff rotating on a hematology-oncology rotation that would focus on three key areas:a.What housestaff need to know to manage the patients on the hematology-oncology serviceb.What housestaff are most likely to encounter in the practice of medicine, regardless of eventual subspecialty field.c.What housestaff need to know for American Board of Internal Medicine exams. METHODSTopics were chosen based on pertinence. These included: leukemia, lymphoma, multiple myeloma, stem cell transplantation (these first four comprising at least 50% of patients on the unit), coagulation, breast cancer, lung cancer, colon cancer, gynecological malignancies, and pain management/supportive care. Potential speakers included full-time faculty as well as private physicians affiliated with the cancer center. Emails and/or phone calls were placed to the physicians and announcements made at division meetings and schedules developed. The plan was also for the development of a series of questions testing the housestaff at the start of their one month rotation and at the end of the rotation. Lectures were scheduled for afternoons if possible to avoid conflicts with morning rounds. Occasional morning talks were necessary to accommodate lecturers. Format of lectures was flexible (power point, dry-eraser board). RESULTSOverall feedback was positive for the lecture series. The two conditions affecting optimal success of the program concerned scheduling, including intern and fellow schedules as they relate to rounds and housestaff clinics and availability of when speakers could lecture and recruitment of speakers appropriate to the relevant topics. In addition, repeating the topics every month proved challenging for finding lecturing participants. The question/answer testing is still early in testing and no conclusion can be made. CONCLUSIONA didactic lecture series is an important aspect of hematology-oncology education for housestaff. Repeating lectures every month is a challenge for several reasons. Possible interventions in the future may include:a.Focusing lecturing duties to full-time faculty, with an emphasis on faculty currently on serviceb.Creating power point presentations and handouts on file for use by multiple people so that rotating faculty may use these materials for talksc.Statistical analysis of scores from pre-rotation and post-rotation exams Disclosures:No relevant conflicts of interest to declare.

The ED of the Future: an Interdisciplinary Graduate Course in Healthcare Design

Six faculty members from Georgia Institute of Technology, Emory University School of Medicine, Emory Healthcare, and Perkins + Will created and taught a one‐semester course titled “The Emergency Department of the Future”. The goals of the course were to provide an environment for students to be exposed to the unique challenges of healthcare design, to experience and learn techniques for successful interdisciplinary design, and to create innovations with impact. Twenty graduate students representing five disciplines (architecture, health systems, human‐computer interaction, computer science, and systems engineering) participated in this class. The course included a series of didactic lectures covering a wide range of issues including architectural design of hospitals and emergency departments, observation techniques for working environments, electronic medical records, and patient‐centered care. Lecturers included emergency physicians, nurses, architects, human‐computer interaction researchers, and design specialists. Students developed problem statements along with prototype design solutions through these lectures, direct observation, and interaction with course faculty. The resulting projects include a mobile triage chair that takes vital signs, equipment sliders for easy functional transformation, an integrated lighting design, as well as patient assistants for self registration, communication, environmental control, and discharge support. The developed projects have generated ideas to improve emergency care that may be implementable commercial products as well as fundable projects for future research. The final presentation open house attracted over a hundred visitors from local and national healthcare facilities and industry. This presentation will highlight the structure and organization of the course as well as the resulting projects.

Objective assessment of surgical decision making in trauma after a laboratory-based course: durability of cognitive skills

Background Because surgical trainees have less exposure to surgical trauma, there is a greater potential of having gaps in decision-making skills. We previously validated a novel assessment tool for decision making in surgical trauma and have documented improvement in resident decision-making skills after a hands-on course. However, brief intensive courses have been criticized for not imparting long-term changes in practice. The purpose of this study was to assess the durability of cognitive skills learned after a 2-day course. Methods Twenty-two residents participated in a 2-day interactive didactic lecture series as well as an animal laboratory focused on practical strategies in dealing with surgical trauma. All participants underwent precourse and immediate postcourse assessment of surgical decision making through a validated short-answer examination. Six months after the course, 12 of these 22 residents completed a third similar examination—the retention test. Results The retention test showed good reliability (Cronbach's α, .81) and construct validity as evidenced by a positive correlation between test scores and postgraduate year level (r = .9, P < .001). There was no significant difference between retention test scores and posttest scores. However, both were significantly higher than pretest scores ( P < .05). This did not change after adjusting for differing degrees of difficulty between the examinations. Conclusions In the context of residency trauma education, there is a measurable positive impact of an intensive, hands-on course on surgical decision making. This impact is durable and cognitive skills persist after the immediate postcourse period. These data support the continued supplementation of traditional residency experiential learning with appropriate laboratory-based skills training.

Systems-Based Practice: Education in Plastic Surgery

The current Accreditation Council for Graduate Medical Education guidelines separate residents' education into six core competencies or subjects. The authors address the least intuitive of these, systems-based practice. In systems-based practice, educators and residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Plastic surgery is a specialty that is intimately involved with the economics, coordination of care, and real-life experience of resource allocation. It should be avant-garde in the development of a systems-based educational experience and be in the forefront in creating an appropriate and well-thought-out teaching agenda for graduate medical education. The authors explain and expand this definition to include objectives for plastic surgery training, programs, and individual learning goals. A series of didactic lectures, small group discussions, and grand round presentations are suggested to fulfill and facilitate the educational objectives. A potential time allotment and method of objective and subjective evaluations are offered.

Fundamentals course for 1st-year radiology residents.

The authors set out to provide 1st-year residents with basic knowledge to make conferences more useful, to make their knowledge more uniform, and to assess their competency to begin night call. Faculty taught three afternoon sessions a week in subspecialty areas of radiology, including physics, during the 1st 6 months of residency. Material selected was believed to be essential for the understanding of that subspecialty's didactic lecture series. Emphasis was also placed on diagnoses residents would be expected to make once they began taking night call. Material was presented through lectures, images, and unknown cases. An examination was administered at the end of the course. Residents were allowed to begin night call only after completing the course and passing the final examination. All 1st-year residents completed the course and passed the examination. Their scores ranged from 70% to 83.3%. Residents liked the course and reported feeling ready to begin call. Faculty reported the residents who completed the course were more knowledgeable prior to formal rotations than residents from previous years who had not taken the course.

Should critical care medicine be a formal part of the undergraduate curriculum?

Medical students were surveyed shortly after completing the third year of medical school. TIle survey was designed to identify those areas of critical care medicine students had been exposed to and expressed interest in learning more about. In addition, the surveys sought to discern the level of confidence students felt with respect to different critical illnesses and intensive care unit (lCU) therapeutic modalities.Finally, the students were asked their opinion regarding the possibility or need for critical care medicine as pan of their medical school curriculum.The three most common topics of interest among medical students who had recently ftnished their third year in medical school were shock, hemodynamic monitoring, and mechanical ventilation. Less than 30% of the students surveyed felt "better-than-average" confidence on anyone of a number of critical care topics and treatment modalities. Of the 80% of students (n = 70) who completed the survey, 91% (n = 64) felt that critical care medicine should be made a pan of the medical school curriculum,6% (n = 4) felt it should not, and 3% (n = 2) were undecided.TIle survey results and the finding that most of the relevant literature acknowledges the need for critical care medicine in medical school has led us to conclude that a national core clerkship or a didactic lecture series in critical care medicine should be carefully designed and implemented into the undergraduate curriculum.

Milestones in Leukemia Research and Therapy

We are children of our age, but children who can never know their mother. —Lillian Smith The history of medicine is rarely taught in medical schools. Whereas didactic lecture series in pathology, microbiology, and physiology cover the significant contributions of Virchow, Pasteur, or Harvey, the more recent history of medicine is infrequently reviewed. We teach our students facts based on current medical knowledge; however, we rarely take the time to review the body of work that preceded and led to the current fund of knowledge. Admittedly, many of us do not know this history. Drs Freireich and Lemak wanted to chronicle the history of leukemia and cover the events over the last 50 years that led to the advances in diagnosis and treatment that most of us take for granted. They have written an excellent and fun-to-read chronicle of the milestones in pathogenetic understanding and therapy of leukemia. Ten chapters

The Effective Integration of PM&amp;R Faculty and Residents in the Development of a Medical Student Didactic Lecture Series

of Scientific Posters Presented at the Association of Academic Physiatrists Spring Meeting February 1991-San Diego, California: PDF Only

The integration of an educational program into a treatment facility.

This paper reviews the integration of an active teaching program into a busy treatment facility. All first and second year medical students at the University of California, San Diego take part in a series of didactic lectures and small group discussions, while third and fourth year students have the opportunity of joining a treatment team for 4 to 6 weeks. All psychiatric residents spend a minimum of 8 weeks working on the unit, and one fourth year resident is chosen to work with the staff for a year. The interactions between treatment teams and students in various stages of development help maximize enthusiasm and the commitment to the best patient care possible.

Dental radiography.

The art of radiographic interpretation is not something that can be learned as a result of a series of didactic lectures to which may be added some demonstrations. It requires a sound preliminary education in anatomy, pathology, and in the general principles of medicine and surgery. After this has been acquired, it is necessary that there be a thorough understanding of the basic principles of radiographic shadow production, both normal and abnormal. This takes years of constant application if there is to be even a moderate degree of skill in radiographic interpretation. There is no branch of surgery and few branches of medicine in which radiographic interpretation is not of importance in diagnosis. Dentistry is no exception. Indeed, there is no field in which radiography is more necessary for diagnosis and treatment. Who is responsible for the vast preponderance of dental radiographic studies? Are they individuals trained adequately to interpret the findings? The writer, who has for many years spent much time teaching dentists and students of dentistry the rudiments of radiographic interpretation, is forced to reply: “In general, no!” There are, of course, exceptions to this statement, but they are relatively few. The interpretation of dental radiographs is largely carried out by the dentists themselves, though a small proportion falls to the lot of the professional radiologist. Neither of these groups is adequately trained for the task. Dentists lack the understanding of the basic principles which are familiar to their radiological colleagues. They are also usually ill-trained in the general pathology of the jaws. Many radiologists as well have neglected to make themselves familiar with the pathological processes occurring in the teeth and jaws. While x-ray apparatus is essential in most dental offices for the satisfactory performance of the mechanical and surgical procedures to be carried out, in the majority of cases its presence has not resulted in the same degree of skill in radiographic interpretation as is provided by radiologists examining other parts of the body. What can be done to remedy this state of affairs? It is too much to expect that dental students shall take from their other studies sufficient time to achieve a firm understanding of basic radiological principles. This takes years, as every radiologist knows. Furthermore, an attempt to inculcate in these same students an adequate knowledge of the pathological conditions which may be found in the jaws is not likely to succeed, for several reasons. In most dental colleges or schools the incidence of any but the most common dental and periapical lesions is so low that there is little opportunity to demonstrate examples of the less common or grosser lesions. Even if such cases were available and the students were taught the characteristics of the more abnormal conditions, they would soon be forgotten, because they are so seldom encountered in practice.