Faculty Time Research Articles

Using Technological Advances to Improve Surgery Curriculum: Experience With a Mobile Application

Our previous home-video basic surgical skills curriculum required substantial faculty time and resources, and was limited by delayed feedback and technical difficulties. Consequently, we integrated that curriculum with a mobile application platform. Our purpose is to describe this application and learner satisfaction. The mobile platform incorporates a patented pedagogical design based on Ericsson's deliberate practice and Bandura's social learning theory. Instructors built step-wise skills modules. During the challenge phase, learners watched a video of surgical tasks completed by experts and uploaded a video of themselves performing the same task. In the Peer Review phase, they used a grading rubric to provide feedback. In the Recap stage, learners received individual feedback and could review their own videos. Two groups of learners, graduating medical students and matriculating surgical residents, participated in this independent learning platform, along with 2 to 4 laboratory sessions, and completed a survey about their experience. Survey responses were summarized descriptively and comments analyzed using content analysis. Fifty learners submitted videos of assigned tasks and completed peer reviews. Learners reported positive experiences specifically for the Peer Review Stage, structured home practice, ease of mobile access to submit and review videos, and ongoing immediate feedback. Over half of the learners reported spending at least 10 to 30 minute practicing skills before recording their videos and over 80% rerecorded at least 2 times before submission. Content analysis revealed learners engaged with the educational concepts designed into the platform. Learners easily used and were satisfied with a mobile-technology teaching platform that maintained the fundamental content, educational theories, and organizational structure of our previously effective surgical skills curriculum. Prior challenges were directly addressed through the mobile application's ease of use, support of deliberate practice, and improved timeliness of feedback.

Comparing the effectiveness of self-directed video tour versus an attending-led tour in Pediatric Emergency Department Orientation

Objectives: Providing an emergency department tour to medical trainees as part of their pediatric emergency medicine clerkship orientation is important in order to teach significant location and safety features. For many years, we provided an attending-led tour, but increased faculty demands on faculty time prompted us to develop a self-directed video-based tour to replace the attending-led tour. This study compares the learning effectiveness between the two methods. Methods: A single-site quasi-experimental design study was conducted to assess knowledge acquisition and satisfaction of medical trainees between two instructional methods (an attending-led tour and a self-directed video-based tour). Groups were assigned an attending-led or self-directed video tour covering identical content. Trainees completed post-tour knowledge acquisition and satisfaction surveys. Mann-Whitney U tests were used for group comparisons of the knowledge acquisition and satisfaction total scores. Spearman correlations were used to look for a relationship between the knowledge acquisition and satisfaction scores. Chi-square and Fisher’s exact tests were used to compare groups on categorical variables. Results: A total of 62 subjects were enrolled; 31 participated in an attending-led tour, and 31 in a video tour. The knowledge acquisition survey (median score 12 vs. 11, p = 0.021) favored the attending-led tour. Total scores for the 5-point satisfaction (median score 47 vs. 40, p = 0.001) and collapsed 3-point satisfaction surveys (median score 30 vs. 29, p = 0.008) also favored the attending-led tour. Conclusions: Although medical trainees favored the attending-led tour over the video tour, the difference was not significant enough to justify terminating the video tour. We believe that this first-time implementation of a self-directed video-based tour is novel. After making further design improvements, we will continue to investigate its plausibility, since it has potential to augment in-person teaching time for educational faculty.

A Novel Approach to Medical Student Peer-assisted Learning Through Case-based Simulations.

IntroductionPeer-assisted learning (PAL) is the development of new knowledge and skills through active learning support from peers. Benefits of PAL include introduction of teaching skills for students, creation of a safe learning environment, and efficient use of faculty time. We present a novel approach to PAL in an emergency medicine (EM) clerkship curriculum using an inexpensive, tablet-based app for students to cooperatively present and perform low-fidelity, case-based simulations that promotes accountability for student learning, fosters teaching skills, and economizes faculty presence.MethodsWe developed five clinical cases in the style of EM oral boards. Fourth-year medical students were each assigned a unique case one week in advance. Students also received an instructional document and a video example detailing how to lead a case. During the 90-minute session, students were placed in small groups of 3–5 students and rotated between facilitating their assigned cases and participating as a team for the cases presented by their fellow students. Cases were supplemented with a half-mannequin that can be intubated, airway supplies, and a tablet-based app (SimMon, $22.99) to remotely display and update vital signs. One faculty member rotated among groups to provide additional assistance and clarification. Three EM faculty members iteratively developed a survey, based on the literature and pilot tested it with fourth-year medical students, to evaluate the course.Results135 medical students completed the course and course evaluation survey. Learner satisfaction was high with an overall score of 4.6 on a 5-point Likert scale. In written comments, students reported that small groups with minimal faculty involvement provided a safe learning environment and a unique opportunity to lead a group of peers. They felt that PAL was more effective than traditional simulations for learning. Faculty reported that students remained engaged and required minimal oversight.ConclusionUnlike other simulations, our combination of brief, student-assisted cases using low-fidelity simulation provides a cost-, resource- and time-effective way to implement a medical student clerkship educational experience.

Assessment methods and resource requirements for milestone reporting by an emergency medicine clinical competency committee

ABSTRACTBackground: The Accreditation Council for Graduate Medical Education (ACGME) introduced milestones for Emergency Medicine (EM) in 2012. Clinical Competency Committees (CCC) are tasked with assessing residents on milestones and reporting them to the ACGME. Appropriate workflows for CCCs are not well defined.Objective: Our objective was to compare different approaches to milestone assessment by a CCC, quantify resource requirements for each and to identify the most efficient workflow.Design: Three distinct processes for rendering milestone assessments were compared:Full milestone assessments (FMA) utilizing all available resident assessment data,Ad-hoc milestone assessments (AMA) created by multiple expert educators using their personal assessment of resident performance,Self-assessments (SMA) completed by residents.FMA were selected as the theoretical gold standard. Intraclass correlation coefficients were used to analyze for agreement between different assessment methods. Kendall’s coefficient was used to assess the inter-rater agreement for the AMA.Results: All 13 second-year residents and 7 educational faculty of an urban EM Residency Program participated in the study in 2013. Substantial or better agreement between FMA and AMA was seen for 8 of the 23 total subcompetencies (PC4, PC8, PC9, PC11, MK, PROF2, ICS2, SBP2), and for 1 subcompetency (SBP1) between FMA and SMA. Multiple AMA for individual residents demonstrated substantial or better interobserver agreement in 3 subcompetencies (PC1, PC2, and PROF2). FMA took longer to complete compared to AMA (80.9 vs. 5.3 min, p < 0.001).Conclusions: Using AMA to evaluate residents on the milestones takes significantly less time than FMA. However, AMA and SMA agree with FMA on only 8 and 1 subcompetencies, respectively. An estimated 23.5 h of faculty time are required each month to fulfill the requirement for semiannual reporting for a residency with 42 trainees.

Defining the Applicant Pool for Postgraduate Year-2 Categorical General Surgery Positions

In the spring of 2010, a categorical general surgery postgraduate year (PGY)-2 position became available at our academic medical center secondary to attrition of a PGY-1 resident. We sought to study the unique characteristics of applicants to that position and to describe the selection process with hopes to stimulate additional studies about the unique challenges of recruiting applicants into advanced standing positions. Applications were received via e-mail and reviewed to characterize the applicant pool. An Excel spreadsheet was used to organize data. Characteristics assessed included United States Medical Licensing Examination (USMLE) scores, Educational Commission for Foreign Medical Graduates status, Alpha Omega Alpha Honor Society status, sex, academic performance, number of case logs, volunteer and job experience, leadership roles, research experience including submissions, and advanced degrees. These characteristics were compared to those of the PGY-1 applicants through the Match that year. Academic medical center. Applicants for a categorical general surgery PGY-2 position in 2010. A total of 129 applicants provided the requested documents. There were 104 males, 25 females, no Alpha Omega Alpha Honor Society candidates, and 82 international candidates. Of all, 46 candidates experienced academic difficulties. Quantitative averages include USMLE 1: 214.17, USMLE 2: 215.74, American Board of Surgery In Training Examination (ABSITE) percentile = 51.96, ABSITE 2 = 46.00, grand total case log: 192.10. Advanced degrees included 2 MBAs, 6 MPHs, and 7 nonphysiology MSs. The selection process to fill the position started on 3/25/2010 when the announcement was published and ended on 5/11/2010 when the offer of acceptance was sent. The selected applicant integrated well with the peers and just graduated from our residency as one of the leaders of the graduating class. Although the attrition rate in general surgery remains high, there is a dearth of literature about how best to replace residents. The hardship of replacing residents highlights the importance of studying this group to improve the recruitment process and the quality of replacement residents. The selection process was time consuming and presented its own challenges given the lack of a computerized system for screening. It lasted nearly 7 weeks requiring faculty time commitment to mine through application data/e-mails, correspond with applicants, conduct interviews, and ultimately select an applicant for the position. This is the first study to investigate the applicant pool to advanced standing positions in general surgery and we present it as a pilot study to stimulate further research efforts.

Curriculum Using the In-Situ Operating Room Setting

The American College of Surgeons/Association of Program Directors in Surgery is a comprehensive, simulation-based curriculum for General Surgery residents which exists in 3 phases. While phases 1 and 2 deal with core skills and advanced procedures respectively, phase 3 targets team-based skills. To date, the 3rd phase of this curriculum has not seen wide scale implementation. This is a pilot study to verify the feasibility of implementing the phase 3 curriculum in the in-situ setting. In our initial attempt to implement Phase 3 at our institution, we chose to perform the training in an in-situ setting within an operating room (OR) at our main hospital, despite our having a separate simulation center. By choosing the in-situ OR environment for this training we were able to minimize concerns regarding resident and faculty availability and able to successfully complete 8 separate sessions during the academic year. During 7 sessions, 2 separate scenarios were performed while a single scenario was performed in 1 session. This single session was excluded from analysis, leaving a total of 14 scenarios to evaluate. The unique scenarios included laparoscopic crisis, postoperative myocardial infarction, anaphylaxis, and postoperative hypotension. All sessions were audiovisually recorded. In order to evaluate the effect of the training, the videos were viewed by 3 independent reviewers and all surgery, anesthesia and nursing participants were rated using the NOTECHs II scale. Degree of inter-rater agreement was established. The difference between the first and second simulations on the same day was then assessed. In addition, participant opinions of the simulations were assessed through electronic surveys following the training. Tertiary Care University Hospital. We performed a total of 8 sessions, for a total of 15 scenarios. Eight surgery residents at the postgraduate year 1 (PGY1)-PGY3 level, 16 anesthesia residents at the PGY3-PGY4 level, 16 nurses and 13 ancillary staff participated. From the first to the second scenario, the total team NOTECHs II score increased from 69.4 ± 1.4 to 77.3 ± 0.5 (p = 0.007). The NOTECHs II scores for each subteam also improved, from 24.2 ± 0.6 to 26.4 ± 0.5 (p = 0.007) for surgery residents, 23.7 ± 0.9 to 26.7 ± 0.4 (p = 0.03) for anesthesia, and 21.6 ± 0.3 to 24.3 ± 0.5 (p = 0.01) for nursing. The inter-rater reliability as measured by Kendall's coefficient of concordance was modest for the whole team score. Most of the participant responses were either favorable or strongly favorable. The in-situ OR environment is both a unique and effective setting to perform team-based training. Furthermore, training in the in-situ setting minimizes or removes many of the logistic issues involved in designing and implementing team-based training curricula for general surgery residency programs. However, we found that administrative and departmental (surgery, anesthesia, and nursing) "buy in" as well as protected faculty time for education were all necessary for in-situ training to be successful. NOTECHs II is an established scale for the evaluation of teams in this simulation setting and appears to be a valid tool based on the results of this study. However, further assessment of inter-rater reliability as well as improved training of evaluators are necessary to determine if inter-rater reliability can improve.

Online Tools to Improve Faculty Collaboration and Time Efficiency Inside and Outside the Classroom

The optimization of time is a valuable commodity to achieve scholarly and teaching goals. Embracing technology and the use of online tools can assist with focused communication and project collaboration with both students and faculty. An innovative approach to connecting virtually is more relevant today, as a majority of current pharmacy students are millennial-learners who are technologically proficient and more likely to adopt online tools. The aim of this commentary is to highlight the advantages of using such tools, while also stressing the considerations one should have when navigating the best fit to a faculty member’s needs.&#x0D; Conflict of Interest&#x0D; We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.&#x0D; &#x0D; Type: Commentary

Dyad Training: An Effective and Efficient Method of Basic Echocardiography Training for ICU Residents

SESSION TITLE: Rapid Session: Bedside Imaging SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 07:30 AM - 08:30 AM PURPOSE: Basic echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior to individual training. We aimed to validate these preliminary results in an authentic clinical context. METHODS: We conducted a quasi-experimental study within a 20-bed medical intensive care unit of a 1,250-bed university hospital from June 2016 to March 2017. RESULTS: 33 Internal Medicine junior residents received self-reading materials and underwent a knowledge test. For supervised practice, 16 residents received individual training and 17 residents received dyad training. Residents then performed at least five echoes, which were remotely scored by a blinded observer for image quality and correct interpretation. The main outcome measure, the mean composite image quality and interpretation score for the first five echoes done under indirect supervision (composite score range 1-8), did not differ between the individual and dyad training groups (6.0±0.4 versus 5.9±0.4, 95% CI of difference -0.2 to 0.4). Non-inferiority was established, assuming a 1-point non-inferiority threshold for the mean composite score. CONCLUSIONS: Dyad training for basic echocardiography training was non-inferior to individual training. If dyad training were to be adopted, faculty time for directly supervised learning would be reduced by 50%, while achieving training outcomes comparable to individual training. CLINICAL IMPLICATIONS: Teaching of basic echocardiography to intensive care unit residents can be conducted via dyad training. This training method is non-inferior to individual training and can reduce faculty time for directly supervised learning by 50%. DISCLOSURE: The following authors have nothing to disclose: Joo Wei Chua, Kay See No Product/Research Disclosure Information

A practice of e-learning platform in fostering professional development

As a result of this study, provided considerable contributions to examine the e-learning practices from the point of views and experiences of academicians who enrolled academic writing course with the support of Adobe Connect Programme during 10 weeks and also research findings revealed that authentic learning environment enriches critical friendship, dialogue however they have faced with barriers during the process. The purpose of this investigation was to examine the impact of e-learning application by using adobe program on fostering academic writing skills of adult learners as regards to their evaluation. During 10 weeks academic writing course with the support of e-learning practice, participants were asked to indicate their experiences about each of the ten barriers (1) administrative structure, (2) organizational change, (3) technical expertise, (4) social interaction and quality, (5) faculty compensation and time, (6) threat of technology, (7) legal issues, (8) evaluation/effectiveness, (9) access, and (10) student support services. Qualitative research design was employed and action research approach was implemented in this inductive process. (developed by Muilenburg and Berge). In this research, one of the qualitative research approach, the “action research” carried out within the scope of the pattern, a five-phase collaborative coaching model (FCCM) was developed to awareness regarding teaching and learning processes during the course. The process employed authentic learning criteria as critical reflection, preparation, presentation, chat, video, dialogue and facilitation tools. Self-reflection report was used as data collection technique and analysed through thematic analysis.

Engaging Millennials: Best Practice for Using Pinterest

Through a storied format, the authors show how they designed and implemented Pinterest in nursing education for use in clinical, skills laboratory, and the classroom. Supported by The 7 Principals for Good Practice in Education, pins and boards are used to encourage student and faculty contact, reciprocity, cooperation, active learning, feedback, and time management. Moreover, the combination of the 7 Principals and Pinterest addresses the diverse talents and ways of learning identified in millennial students.

A Survey of Program Directors’ Experience With Patient Safety Training Programs for Medical and Physics Radiation Oncology Residents

Current ACGME and CAMPEP guidelines expect physicians and physicists to teach quality improvement (QI) as a core element of residency curriculum in radiation oncology (RO). However, a recent national study found that most residents did not feel they had adequate safety and QI training during their residency, and the type of training most desired by the residents were practical workshops. We surveyed program directors (PDs) in RO and therapy medical physics to understand current conditions and potential ways to address this educational gap. PDs of accredited US RO and medical physics therapy programs were surveyed via email. Questions inquired about demographics, curricular elements, perceived barriers to development/improvement of safety training, and attitudes regarding training using a 5-point Likert scale. Differences in proportions of responses between medical and physics PDs were tested using chi-square. Responses were collected from 56 of 175 PDs (32%); 45% identified as medical faculty and 55% as physics faculty. Most medical (88%) and physics PDs (94%) felt that safety and QI training are an important part of resident education. More physics than medical PDs felt residents were enthusiastic about safety training (77% physics, 48% medical, P < 0.05). Likewise, more physics than medical PDs agreed that residents were well exposed (83% physics, 64% medical, P = 0.18) to safety and QI concepts and adequately prepared to meet the safety expectations of clinical practice (90% physics, 60% medical, P = 0.07), but these did not reach significance. Likewise, more physics PDs (90%) agreed that residents were adequately prepared to meet the patient safety expectations of clinical practice than medical PDs (60%) (P = 0.07). PDs most often used safety/QI publications (53%), curriculum templates (38%), and online modules/guides (36%) to create the safety training experience for residents. Common curricular elements included web-based modules (66%), patient safety rotations (61%), and clinical projects (37%, e.g., root cause analysis). The most common reported barriers to improving resident safety education were lack of resident time (38%), faculty time (27%), and faculty expertise (27%). Only a small minority (3%) felt that institutional safety culture was a barrier to improving resident safety education. The most common modes of assessing the effectiveness of a safety curriculum were resident feedback (56%), faculty feedback (37%), and assessments of resident knowledge and/or attitudes (27%). The results show that the majority of PDs feel their residents are adequately prepared for the patient safety and QI expectations of clinical practice, which is different than the results of a prior survey of residents in training. While residents most desire practical workshops, none of the programs appeared to offer this opportunity. National guidelines and resources would help PDs efficiently improve patient safety curricula in their programs.

Clinical Reasoning Workshop: Lumbosacral Spine and Hip Disorders.

Helping physicians-in-training develop effective clinical reasoning skills may facilitate progression to expertise, reduce diagnostic errors, and improve patient safety. Using our previous experience, we developed a workshop that reviews musculoskeletal lumbar spine and hip conditions. This workshop also uses deductive and inductive modes of clinical reasoning and provides opportunities for learners to practice toggling from one to another while reviewing. Using exemplar musculoskeletal vignettes, this workshop allows residents to practice engaging and toggling between both modes of information processing. This workshop also includes pre- and posttests, small-group learning, and a small-group competition. The workshop was implemented with a group of 26 physical medicine and rehabilitation residents. Although residents did well on the pretest, the workshop improved their test performance. Residents liked the workshop and thought it improved their diagnostic ability. A workshop that included team- and case-based learning, key features assessment, script theory, and gamification was effective in engaging residents and resulted in high resident satisfaction and the perception of increased ability to tackle clinical problems. Learning from our experience with the previous workshop resulted in significant reduction in faculty time required, and increased the number of residents who were able to complete both pre- and posttests.

Creating an Online Interprofessional Collaborative Team Simulation to Overcome Common Barriers of Interprofessional Education / Eine internetbasierte, interprofessionelle Teamsimulation zur Überwindung organisatorischer Hürden in der interprofessionellen Ausbildung

AbstractIntroductionCoordinating student schedules, physical space, and faculty time are commonly reported barriers to successful interprofessional education. Use of online technologies to overcome these barriers and support online team simulation is a topic that deserves serious academic review.MethodsThe Interprofessional Plan of Care - Simulated E-hEalth Delivery System (IPOC-SEEDS) is a student-directed online simulation where students experience a collaborative plan of care meeting with simultaneous team electronic health record utilization. The authors describe the IPOC-SEEDS simulation to serve as a model for replication or modification. IPOC-SEEDS objectives address Interprofessional Education Collaborative competencies (IPEC), electronic health record (EHR) navigation, simulation effectiveness, and technology utilization.ResultsOverall, IPOC-SEEDS objectives were effectively met through simulation evaluations, student-led debriefing evaluations, in-person student feedback, and faculty feedback results supporting the online simulation and technology evolutions. The objectives, based on IPEC and informatics competencies, were achieved. Students from nursing, nutrition, pharmacy, occupational therapy, and health information management participated in the simulation using EHR and online meeting software, receiving valuable interprofessional practice. Technology utilization results were adequate, but did improve in subsequent simulations after modifying the technology selected.DiscussionThe simulation provided an experience where students demonstrated interprofessional collaborative skills that they can use in their future practice. Online technologies can provide a platform for the high-quality interprofessional simulation to address common interprofessional education barriers and provide access to interprofessional education for distance-learning students and providers. Online simulation developers (hospitals, health departments, universities) can use the authors’ process steps as a model for online simulation replication.

Implementation of a skills practical to first-year pharmacy students

Background and purposeObjective structured clinical examinations (OSCEs) are being implemented in pharmacy schools across the country. As part of a new curriculum, a practical with an OSCE component was implemented for the first time at the West Virginia University School of Pharmacy. Educational activity and settingA practical with an OSCE component was developed for first-year professional pharmacy students in a foundational pharmacy skills course. The OSCE component assessed insulin and inhaler counseling and blood pressure skills. A written exam covered material from throughout the semester. FindingsA total of 76 students completed the practical. The average grade was a 27.8 out of 30 points. A total of 62 faculty hours were needed for the implementation of this OSCE. Discussion and summaryAn OSCE that assessed a variety of foundational pharmacy skills was designed and implemented to first year pharmacy students using limited faculty time and resources.

A Descriptive Survey of Anesthesiology Residency Simulation Programs: How Are Programs Preparing Residents for the New American Board of Anesthesiology APPLIED Certification Examination?

Anesthesiology residency programs may need new simulation-based programs to prepare residents for the new Objective Structured Clinical Examination (OSCE) component of the American Board of Anesthesiology (ABA) Primary Certification process. The design of such programs may require significant resources, including faculty time, expertise, and funding, as are currently needed for structured oral examination (SOE) preparation. This survey analyzed the current state of US-based anesthesiology residency programs regarding simulation-based educational programming for SOE and OSCE preparation. An online survey was distributed to every anesthesiology residency program director in the United States. The survey included 15 to 46 questions, depending on each respondent's answers. The survey queried current practices and future plans regarding resident preparation specifically for the ABA APPLIED examination, with emphasis on the OSCE. Descriptive statistics were summarized. χ and Fisher exact tests were used to test the differences in proportions across groups. Spearman rank correlation was used to examine the association between ordinal variables. The responding 66 programs (49%) were a representative sample of all anesthesiology residencies (N = 136) in terms of geographical location (χ P = .58). There was a low response rate from small programs that have 12 or fewer clinical anesthesia residents. Ninety-one percent (95% confidence interval [CI], 84%-95%) of responders agreed that it is the responsibility of the program to specifically prepare residents for primary certification, and most agreed that it is important to practice SOEs (94%; 95% CI, 88%-97%) and OSCEs (89%; 95% CI, 83%-94%). While 100% of respondents reported providing mock SOEs, only 31% (95% CI, 24%-40%) of respondents provided mock OSCE experiences. Of those without an OSCE program, 75% (95% CI, 64%-83%) reported plans to start one. The most common reasons for not having an OSCE program already in place, and the perceived challenges for implementing an OSCE program, were the same: lack of time (faculty and residents), expertise in OSCE development and assessment, and funding. The results provide data from residency programs for benchmarking their simulation curriculum and ABA APPLIED Examination preparation offerings. Despite agreement that residency programs should prepare residents for the ABA APPLIED Examination, many programs have yet to implement an OSCE preparation program, in part due to lack of financial resources, faculty expertise, and time. Additionally, in contrast to the SOE, the OSCE is a new format for ABA primary certification. As a result, the lack of consensus concerning preparation needs could be related to the amount information that is available regarding the examination content and assessment process.

Nonspecialist Raters Can Provide Reliable Assessments of Procedural Skills

Competency-based learning has become a crucial component in medical education. Despite the advantages of competency-based learning, there are still challenges that need to be addressed. Currently, the common perception is that specialist assessment is needed for evaluating procedural skills which is difficult owing to the limited availability of faculty time. The aim of this study was to explore the validity of assessments of video recorded procedures performed by nonspecialist raters. This study was a blinded observational trial. Twenty-three novices (senior medical students) and 9 experienced doctors were video recorded while each performing 2 flexible cystoscopies on patients. The recordings were anonymized and placed in random order and then rated by 2 experienced cystoscopists (specialist raters) and 2 medical students (nonspecialist raters). Flexible cystoscopy was chosen as it is a simple procedural skill that is crucial to master in a resident urology program. The internal consistency of assessments was high, Cronbach's α = 0.93 and 0.95 for nonspecialist and specialist raters, respectively (p < 0.001 for both correlations). The interrater reliability was significant (p < 0.001) with a Pearson's correlation of 0.77 for the nonspecialists and 0.75 for the specialists. The test-retest reliability showed the biggest difference between the 2 groups, 0.59 and 0.38 for the nonspecialist raters and the specialist raters, respectively (p < 0.001). Our study suggests that nonspecialist raters can provide reliable and valid assessments of video recorded cystoscopies. This could make mastery learning and competency-based education more feasible.

Learning Community as a Multipurpose Intervention: the University of Florida Experience

Collaborative learning groups have evolved into learning communities at the University of Florida College of Medicine (UF COM) as part of a new integrated curriculum. The article provides an outline of how to develop and use a learning community as a multipurpose longitudinal intervention. The structure of the learning community, including leadership, number of faculty needed, faculty time, administrative staff, and logistics are discussed. The process of integrating curricular “threads,” course content, student wellness issues, and long-term mentorship are provided for other institutions looking to develop a learning community. At present, outcome measures for program evaluation of the learning community at the UF COM have been conceptualized but capturing quantitative and qualitative data remains a challenge.

The Fourth Year of Medical School: Time for Reassessment: AOA Critical Issues.

Most U.S. medical schools follow the 4-year model, consisting of 2 preclinical years, core clinical experience, and a fourth year intended to permit students to increase clinical competency, to explore specialty areas, and to transition to residency. Although the design and delivery of Years 1 through 3 have evolved to meet new challenges and expectations, the structure of Year 4 remains largely unchanged. For most students considering a career in orthopaedics, Year 4 is a series of elective rotations in which educational objectives become secondary to interviewing for residency programs. Most accreditation bodies recognize the importance of attainment of competency over the duration of medical school as the goal of educating physicians, and thus, there is a growing interest in reexamining the traditional medical school curriculum with the goal of integrating the final phases of undergraduate education and the first phases of postgraduate education.A literature search was undertaken to identify publications on the duration of medical education. Pilot approaches to competency-based integration of undergraduate medical school and postgraduate training in orthopaedic surgery were reviewed.There have been few data suggesting that 4 years of medical education is superior to shorter-duration programs. Three approaches to competency-based integration of undergraduate medical school and postgraduate training are presented. Their goal is to use student and faculty time more effectively. Each approach offers the opportunity to lower the cost and to decrease the time required for Board Certification in Orthopaedic Surgery. Two approaches shorten the entire duration of medical school and graduate training by using various proportions of the fourth year to begin residency, and one approach expands the duration of orthopaedic training by starting in the fourth year of medical school and including training equivalent to a fellowship program into the residency experience.The effectiveness of such programs will form the basis for revisions to the current orthopaedic training paradigm, resulting in a more effective, efficient, and integrated orthopaedic training curriculum.

Influencing Factors for Adopting Technology Enhanced Learning in the Medical Schools of Punjab, Pakistan

As the successful establishment of technology supported educational systems requires wide investment in terms of finances and faculty time, this study explores the influencing factors in the adoption of Technology Enhanced Learning (TEL) and the main barriers encountered during the use of TEL in Punjab, Pakistan. Semi-structured interviews were conducted with medical educators and thematic analysis was carried out using Nvivo-10. The study participants were well aware of educational technologies and stated that the influencing factors for adoption of TEL were self-effort, motivation, a personal positive approach and departmental policy. The institutions were well equipped with resources but the main problem was the lack of faculty training and institutional support. The study concludes that pedagogy is the main driver for the use of educational technologies. At the national level, it is suggested that governing bodies can provide definite polices and guidelines for the implementation of TEL. Therefore, it is advocated that recognizing online courses can enhance potential learners' interest to enroll for e-learning programmes. At the institutional level, it is proposed to encourage the establishment of institutional policies and the organization of workshops for faculty training. At an individual level, it is stressed that there is a basic requirement to develop a technology-oriented culture partly by sharing the power and expertise among the department heads and faculty members.

Quantifying Faculty Time Commitment for Clinical Competency Committee Members Across Programs (Research Abstract)

Quantifying Faculty Time Commitment for Clinical Competency Committee Members Across Programs (Research Abstract)