Faculty Time Research Articles

Pilot virtual clerkship curriculum during the COVID-19 pandemic: Podcasts, peers and problem-solving.

Many virtual curricula for medical students focus on asynchronous assignments, text and video resources, and independent study to prepare for an examination. These methods perfectly mirror the structure of pre-clinical courses but do not reflect how knowledge is advanced in clinical workplaces, where students construct meaning through synchronous activities with peers, conversations with physicians, and feedback from teachers on their analysis of clinical problems. During the coronavirus disease 2019 (COVID-19) pandemic, new instructional approaches are necessary when we shift clerkship students online but still aim to advance their thinking as novice physicians rather than increasingly sophisticated classroom students. Our medical school suspended clerkships during the COVID-19 pandemic. Six students who had completed 14 days of an internal medicine inpatient clerkship (IC) transitioned to a virtual clerkship curriculum (VCC) for 14 days. The objective of the VCC was to advance internal medicine knowledge and three clinical reasoning skills: schema construction (formulating frameworks for clinical problems, eg, anaemia); written diagnostic arguments (articulating prioritised differential diagnoses for cases), and verbal presentations of those arguments. The conceptual frameworks for the VCC were social learning and cognitive apprenticeship. We created a learning community through twice-daily interactive sessions with students and teachers (n = 25 videoconferences). Students remotely attended two resident-level case conferences daily (n = 27 sessions). We minimised assigned reading and maximised opportunities for students to hear physician dialogue using conversation-style medical podcasts (for podcasts and schemas see www.clinicalproblemsolving.com) Students listened to a daily podcast (11 overall) to learn about a topic (eg, hypercalcaemia). They analysed 11 cases (from podcasts or worksheets) and submitted diagnostic schemas and diagnostic assessments for each case; two assignments involved peer collaboration and feedback. Students also submitted verbal presentations for three of the cases. Every submission received feedback from the authors.1 To reinforce lessons from assignments, podcasts and case conferences, the authors held 30-60-minute ‘rounds’ each morning. All six students completed a post-VCC survey with 5-point Likert responses. The most highly rated exercises were drafting schemas (5.0), writing diagnostic assessments (4.83), oral presentations (4.83), and podcasts (5.0); case conferences were rated lower (4.0). Students cited ‘major improvements’ in their diagnostic assessments and schema construction and ‘moderate improvement’ in oral presentations. They hoped for ongoing feedback on schema constructions and diagnostic assessments upon returning to IC. Five students reported receiving more feedback on their diagnostic arguments during the VCC than in IC. Four students reported better classmate co-learning and collaboration during the VCC. We learned that substantial faculty time is required to foster a remote learning community and cognitive apprenticeship. Developing coaching relationships, reanalysing case conferences, explaining unfamiliar concepts and editing written arguments cannot be rushed or scaled. Therefore, recruitment of additional faculty members or residents may be necessary. Shared schedules, collaborations and video (not audio alone) participation were essential for community building amongst the students. We did not advance skills in data gathering, physical examination or patient communication. The transformative power of a clerkship is not the medical content; it is the simultaneous engagement with peers, patients and teachers around workplace problems. VCCs can advance reasoning skills, prepare students for clerkships and highlight best practices to adopt when they arrive.

Faculty and Resident Engagement With a Workplace-Based Assessment Tool: Use of Implementation Science to Explore Enablers and Barriers.

Implementation of workplace-based assessment programs has encountered significant challenges. Faculty and residents alike often have a negative view of these programs as "tick-box" or "jump through the hoops" exercises. A number of recommendations have been made to address these challenges. To understand the experience with a workplace-based assessment tool that follows many of these recommendations, the authors conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify enablers and barriers to engagement with the tool. The Psychopharmacotherapy-Structured Clinical Observation (P-SCO) is a direct observation tool designed to assess resident performance during a psychiatric medication management visit. From August 2017 to February 2018, the P-SCO was implemented in the outpatient continuity clinics for second- and third-year residents at Zucker Hillside Hospital/Northwell Health. In February and March 2019, the authors conducted semistructured interviews of participating faculty and residents. Interview guides based on the CFIR were used to capture the enablers and barriers to engagement. Interview transcripts were independently coded. Codes were then organized into themes relevant to the domains of the CFIR. Ten faculty and 10 residents were interviewed. Overall, participants had a positive experience with the P-SCO. Enabling factors for faculty and residents included the ongoing training, design features of the P-SCO, predisposing beliefs, dedicated faculty time, and the perception that the P-SCO improved verbal feedback quality. Barriers for faculty included checklist length and discomfort with feedback that threatens identity, and barriers for residents included faculty variability in timeliness and quality of feedback and minimal review of the feedback after initial receipt. This study demonstrates that the negative experience of faculty and residents with workplace-based assessment tools shown in prior studies can be overcome, at least in part, when specific implementation strategies are pursued. The findings provide guidance for future research and implementation efforts.

Anesthesia environmental sustainability programs-a survey of Canadian department chiefs and residency program directors.

Anesthesia-related activities contribute to operating room waste impacting climate change.The aim of this study was to ascertain 1) the current existence and scope of department and education programs concerned with anesthesia "green" practice; and 2) perceived barriers to environmental sustainability efforts among Canadian anesthesia department chiefs and residency program directors. Association of Canadian University Departments of Anesthesia-affiliated anesthesiology department chiefs (n = 113) were invited to complete an online survey ascertaining current efforts in, and barriers to, environmentally sustainable anesthesia practice. Similarly, Canadian anesthesiology residency program directors (n = 17) were invited to complete an online survey delineating current educational programs on environmental sustainability and identifying interest in, and barriers to, developing a Canada-wide curriculum. The response rates for department chiefs and program directors were 23% (26/113) and 41% (7/17), respectively. Department chiefs indicated that their departments participate in sustainability efforts such as donating medical equipment (65%) and recycling (58%). Despite interest in environmental sustainability, department chiefs identified inadequate funding (72%), lack of a mandate (64%), and inadequate knowledge (60%) as barriers to implementing environmentally sustainable practices. Only 29% of responding Canadian anesthesiology programs include environmental sustainability in their curriculum. Responding residency program directors believe residents would benefit from more teaching on the topic (86%) but identified barriers including a lack of faculty expertise (100%) and time constraints (71%). Respondents (71%) also indicated an interest in developing a Canadian curriculum on the topic. Our results highlight current attitudes, gaps, and barriers to environmentally sustainable anesthesiology practice among departmental and educational leadership. Furthermore, this study identifies potential opportunities to develop cross-Canada collaborative educational programs in this field.

Implementation of a Self-guided Focused Cardiac Ultrasound Curriculum for Anesthesiology Residents.

Focused cardiac ultrasound (FoCUS) is an increasingly used diagnostic modality for anesthesiologists and intensivists. However, training residents in its use can be resource intensive. We investigated the feasibility of implementing a self-guided FoCUS curriculum for anesthesiology residents rotating in the postanesthesia care unit (PACU). We created a FoCUS curriculum with the aim of providing a consistent largely self-guided experience that would improve FoCUS knowledge and skills while minimizing ongoing time commitment from faculty. To achieve this, we used several methods: (1) developed video didactics and quizzes; (2) used an online educational delivery platform to automate delivery of educational content, monitor resident progress, and elicit feedback; (3) used the transthoracic echocardiography simulator for aided hands-on learning; (4) dedicated educational time that integrated into PACU workflow; (5) worked with a cardiac sonographer; and (6) used image storage software to facilitate remote feedback by ultrasound faculty. The response to the curriculum was evaluated using Kirkpatrick levels 1-3. Forty-one anesthesiology residents rotated through the PACU over a 1-year period and completed this weeklong self-guided FoCUS curriculum. Interesting findings include: (1) favorable evaluation from the residents and (2) improvement in image acquisition skills by objective measures. Once the curriculum was established, ongoing faculty time commitment was approximately 1 hour 20 minutes per week. The implementation of a FoCUS curriculum in the PACU resulted in favorable resident evaluation and improved FoCUS skills. The curriculum was feasible and self-sustainable because of the novel educational approach employed.

Implementation of Point-of-Care Ultrasound in a Physician Assistant Curriculum.

This study evaluated the benefits and challenges of implementing point-of-care ultrasound (POCUS) training in a physician assistant program curriculum. Physician assistant students were introduced to POCUS during 2 semesters of Physical Diagnosis. The students were assessed for understanding of applications, effectiveness in obtaining images of target anatomy, and the time required to obtain those images. Student attitudes and the cost of implementation were also recorded. After 13 hours of training, the 24 students were able to obtain all the target anatomy images and describe the associated structures with an average accuracy rating of 97%. Understanding of POCUS in clinical applications, including recognition of abnormal scan images, was assessed at an average of 85%. Student attitudes toward POCUS were assessed with 88.69% affirming "strongly agree." Although the costs associated with implementation might vary depending on the setting, they were feasible in our program. Our study confirmed that POCUS training can be effectively implemented with faculty time burdens and costs that are not prohibitive.

Maximizing the academic nursing model in the era of COVID-19 and beyond

Maximizing the academic nursing model in the era of COVID-19 and beyond

Musculoskeletal Ultrasound Instruction in Adult Rheumatology Fellowship Programs.

Musculoskeletal ultrasound (MSUS) in rheumatology in the US has advanced by way of promotion of certifications and standards of use and inclusion of core fellowship curriculum. In order to inform endeavors for curricular integration, the objectives of the present study were to assess current program needs for curricular incorporation and the teaching methods that are being employed. A needs-assessment survey (S1) was sent to 113 rheumatology fellowship program directors. For programs that taught MSUS, a curriculum survey (S2) was sent to lead faculty. Programs were stratified according to program size and use of a formal written curriculum. S1 (108 of 113 respondents; response rate 96%) revealed that 94% of programs taught MSUS, with 41% having a curriculum. Curricular implementation was unaffected by program size. Formal curricular adoption of MSUS was favored by 103 directors (95.3%), with 65.7% preferring such adoption to be optional. S2 (74 of 101 respondents; response rate 73%) showed that 41% of programs utilized a formal curriculum. Multiple teaching strategies were used, with content that was generally similar. Use of external courses, including the Ultrasound School of North American Rheumatologists course, was prevalent. Fewer barriers were noted compared to past surveys, but inadequate time, funding, and number of trained faculty still remained. Lack of divisional interest (P = 0.046) and interest of fellows (P = 0.012) were noted among programs without a formal curriculum. MSUS is taught by a significantly larger number of rheumatology fellowship programs today. Multiple teaching strategies are used with common content, and barriers still remain for some programs. Most program directors favor inclusion of a standardized MSUS curriculum, with many favoring inclusion to be optional.

Faculty time allocation in relation to work-family balance, job satisfaction, commitment, and turnover intentions

One common challenge for faculty is decisions regarding the allocation of time across research, teaching, and service tasks. We investigate faculty time allocation among typical faculty members using latent profile analysis. We examine associations between profile membership and gender and time spent in housework, childcare, and eldercare. We also use competing theories (job enrichment, the effort-reward imbalance model) to investigate profile associations with work-family balance, job satisfaction, affective commitment, and turnover intentions. Four profiles emerge: research focus, teaching focus, a “classic” dual research and teaching focus, and dual teaching and service focus. Women are more likely to be members of the teaching profile compared to the research profile, and the research profile is associated with the fewest housework hours. Classic profile members have the highest work-family balance and job satisfaction, whereas members of the teaching profile are the lowest on each correlate. Results suggest a balance of rewarding and enriching demands yields the most positive outcomes.

“OPD TRIAGE” – A novel concept for better patient management in heavily loaded orthopaedic OPDs

BackgroundA heavily loaded subsidized government run OPD at tertiary care hospital normally caters 200–300 patients daily. Constant improvement in management of OPD through new policies are essential for better patient management and for proper utilization of skill, expertises and time of senior faculty. We designed a new concept of OPD TRIAGE for the same. Material and methodsStudy was carried out on 1800 randomly selected patients, 950 each on triage & non triage interventional day.Patients were interviewed and changes in their satisfaction level were noted through a questionnaire. Senior treating faculty were also questioned about their changes in behaviour towards patient due to the intervention. ResultsOn triage days around 91% patients are satisfied with professional care, depth of relationship, doctor’s attitude, counselling from doctor. While on non triage days, this figure is only 51%. Regarding treating doctors, around 93% percent of the time, the consultants were more happy and enthusiastic to consult patients on OPD triage days. While on non triage days it was only 32%. ConclusionThe concept of OPD Triage can very efficiently be applied for better management of patients in heavily loaded government OPD setup, which will also help in proper data maintenance, increase patients satisfaction and for efficient utilization of time, skills and expertise of the treating consultant.

Comparing Case-Based with Team-Based Learning: Dental Students' Satisfaction, Level of Learning, and Resources Needed.

The aims of this study were to compare third-year dental students' satisfaction and level of learning in case-based learning (CBL) versus team-based learning (TBL) and the resources required in those two methodologies. Level of learning was assessed for both knowledge and application, and resources were defined as student and faculty time and rooms. In academic year 2018-19, all 68 third-year dental students in one U.S. dental school were enrolled in two sequential semester-long courses; the first used CBL, and the second used TBL. After each course, students and faculty facilitators completed surveys, and data from students' knowledge and application exams were collected. The student surveys asked students to report their satisfaction with the learning methodology (CBL or TBL); the faculty surveys asked the faculty facilitators to report the resources used for each methodology. Forty-five of 68 students (66%) consented to participate; however, a larger number of students completed surveys in the two semesters (69% for CBL and 87% for TBL). Fourteen of 16 (88%) faculty facilitators completed the CBL survey, and five of the six (83%) completed the TBL survey. Overall, the results showed that students' satisfaction was higher with CBL than TBL (Mann-Whitney U = 882.0; p<0.001), and students reported having a better understanding of concepts after CBL than TBL (U = 899.0; p<0.001). The students performed better on knowledge exam items in TBL than CBL (86% vs. 82%) but the same on application items (both 86%). Resource requirements for both methods were extensive, with TBL requiring fewer facilitators and rooms than CBL but requiring more time from both students (2.6 vs. 2.3 hours weekly) and faculty members (2.3 vs. 1.4 hours weekly). In this study, students preferred CBL to TBL but had higher knowledge scores in the TBL course. The resources needed for both CBL and TBL were said to be extensive, with infrastructure use higher for CBL but time for students and faculty higher for TBL.

Getting It Off the Ground: Key Factors Associated With Implementation of Wellness Programs.

Many residency programs are developing resident wellness curricula to improve resident well-being and to meet Accreditation Council for Graduate Medical Education guidelines. However, there is limited guidance on preferred curricular components and implementation. We sought to identify how specific driving factors (eg, having an identified wellness champion with a budget and protected time to develop wellness programs) impact implementation of essential elements of a resident wellness curriculum. We surveyed 608 family medicine residency program directors (PDs) in 2018-2019 on available resources for wellness programs, essential wellness elements being implemented, and satisfaction with wellness programming; 251 PDs provided complete responses (42.5% response rate). Linear and logistic regressions were conducted for main analyses. Having an identified wellness champion, protected time, and dedicated budget for wellness were associated with greater implementation of wellness programs and PD satisfaction with wellness programming; of these, funding had the strongest association. Larger programs were implementing more wellness program components. Program setting had no association with implementation. PDs in programs allocating money and/or faculty time can expect more wellness programming and greater satisfaction with how resident well-being is addressed.

The Effects of Augmented Reality on Prelicensure Nursing Students' Anxiety Levels.

Prelicensure nursing students experience high anxiety as they enter the clinical setting, which can have a negative impact on learning care performance and critical thinking. This study explored the viability of an innovative technological teaching strategy, augmented reality (AR), as a platform to prepare students and decrease their anxiety levels when entering a new environment. A pretest/posttest quasiexperimental design was used to assess the effect of AR 360 photosphere on preli-censure nursing students' anxiety levels as they entered a new clinical environment compared with anxiety levels of prelicensure nursing students who participated in the traditional faculty-led orientation method. Students from three midwestern colleges of nursing completed the State-Trait Anxiety Inventory before and after completing the AR 360 photosphere orientation or a faculty-led orientation. An independent t test revealed no difference in students' anxiety levels between the two methods of orientation. Although there were no significant differences in nursing students' anxiety levels between the two methods of clinical orientation, the AR 360 can be a valuable method of orientation that saves faculty time and ensures more consistent and uniform content compared with the traditional faculty orientation method. [J Nurs Educ. 2020;59(3):142-148.].

Development of Mobile Application for Faculty Time out Information

In the trend of mobile applications, the world is surfing through many applications for various personal and professional purposes. In every domain including the cutting-edge technology such as Machine learning, IoT (Internet of Things), representing the data to the user in a proper and understanding manner is very important. This is where mobile applications come to use. Mobile applications can be used to resolve many communication issues especially when communication is between low level to high level and vice versa. This application is made to serve as one of the best ways of communication between faculty and students especially when the faculty is not available in the cabin and the student is willing to meet the faculty at the same time. The mobile application uses Dart Language with Flutter UI Software Development.

EHR Overtime: An Analysis of Time Spent After Hours by Family Physicians.

Time spent in the electronic health record (EHR), away from direct patient care, is associated with physician burnout. Yet there is a lack of evidence quantifying EHR use among family physicians. The purpose of the study was to describe a method for quantifying habits and duration of use within the electronic health record in family medicine residents and faculty with particular attention paid to time spent after hours. We audited EHR time for family medicine residents and faculty using an EHR vendor-provided, web-based tracking system. We collected and analyzed the number of patient encounters, total time in the EHR per patient, total time in the EHR after hours by physicians for a 6-month time period. Over the 6-month period reviewed, family medicine trainees and faculty saw between one and 164 patients monthly, spent between 17 and 217 minutes in the EHR per patient, and spent between 0 and 33 hours in the EHR after hours per month. Family medicine residents spend a significant amount of time completing EHR tasks after hours. Objective EHR data can be used by family medicine residency programs to devise interventions to decrease inefficient use of the EHR, decrease after-hours EHR use, and improve well-being.

Learning Outcomes From Lecture and an Online Module in the Family Medicine Clerkship.

With younger generations of learners and readily available technology, medical educators are challenged to include active learning methods that may be better for student learning than traditional lecture. Some of these methods, like online modules, can also reduce the demands on clerkship faculty time. We examined how content delivered via interactive, online module compared to traditional lecture for student learning and satisfaction. Third-year family medicine clerkship students completed questionnaires following either an online module or lecture on orofacial pain. We conducted the study over four consecutive rotations, alternating who received the content via classroom lecture or interactive online module. Students completed a questionnaire comprised of six multiple-choice knowledge questions, five questions with a clinical vignette format to assess application of knowledge, and six questions to assess satisfaction with elements of the course. The Centers of Excellence in Pain Education developed the online module and questionnaire. We found no differences in knowledge between the in-person lecture and the online module. However, students who completed the online module performed better on the application questions. Students in the lecture group reported greater satisfaction with the course than students in the online group. Lecture resulted in adequate knowledge recall, but the interactive method resulted in better scores on applying knowledge to new situations. Providing an online module where students can practice applying knowledge is important for higher levels of learning, but it should be noted that satisfaction ratings may decline.

Changes to the ACGME Common Program Requirements and Their Potential Impact on Emergency Medicine Core Faculty Protected Time.

The Accreditation Council for Graduate Medical Education (ACGME), which regulates residency and fellowship training in the United States, recently revised the minimum standards for all training programs. These standards are codified and published as the Common Program Requirements. Recent specific revisions, particularly removing the requirement ensuring protected time for core faculty, are poised to have a substantial impact on emergency medicine training programs.A group of representatives and relevant stakeholders from national emergency medicine (EM) organizations was convened to assess the potential effects of these changes on core faculty and the training of emergency physicians. We reviewed the literature and results of surveys conducted by EM organizations to examine the role of core faculty protected time. Faculty nonclinical activities contribute greatly to the academic missions of EM training programs. Protected time and reduced clinical hours allow core faculty to engage in education and research, which are two of the three core pillars of academic EM. Loss of core faculty protected time is expected to have detrimental impacts on training programs and on EM generally. We provide consensus recommendations regarding EM core faculty clinical work hour limitations to maintain protected time for educational activities and scholarship and preserve the quality of academic EM.

Incorporation of a mock drug information telephone call exercise in a health-systems pharmacy laboratory

Background and purposeHospital pharmacists routinely receive and answer drug information questions via telephone while performing order verification. This report describes the development, implementation, and evaluation of a mock learning experience for student performance of these tasks in a health-systems pharmacy laboratory course. Educational activity and settingAn active learning skills-based exercise involving students receiving and answering a standardized drug information question via telephone during an order verification activity, referred to as a cold-call exercise, was developed and implemented. Data collected included student grades on a baseline assessment, the cold call exercise, order verification exercises, and student perceptions from a voluntary post-exercise survey. Student performance on the cold-call exercise was further evaluated via individual sections of the cold-call rubric. Data were summarized using descriptive statistics. Thematic analysis of student opinion and an estimate of faculty time were also executed. FindingsStudent grades on the cold call and order verification exercises were 86.14% and 88.8%, respectively. Students often failed to ask category-specific questions because they did not categorize the ultimate question appropriately. Students found the activity organized and applicable. Time dedicated to creation was extensive, but execution and grading were reasonable. SummaryStudents performed well on the drug information exercise as well as the order verification component. Students and faculty enjoyed the experience, and students found the exercise relevant and challenging. This exercise could be implemented into any pharmacy curriculum in order to prepare students using authentic learning experiences.

Qualitative Analysis of the Impact of Changes to the Student Evaluation of Teaching Process

Objective. To determine how changes to the student evaluation of teaching (SET) survey instrument and process at a college of pharmacy contributed to improved student response rates and to understand how the process could be further refined. Methods. Pharmacy students from the class of 2018 who had participated in both the old and new SET process were recruited to participate in one of four focus group interviews. An inductive approach was used for data collection and analysis. A focus group guide was created based on two major domains: comparing changes between the old and new SET process and survey form, and determining how the new SET process could be further refined. Results. In South Jordan, UT, six students participated in one of the focus groups and seven students participated in the other focus group. In Henderson, NV, seven students participated in each of the two focus groups. Twenty-seven total students participated in the four focus groups across two campuses. Students stated that reducing the number of questions on each SET survey instrument and using a 5-point rather than a 10-point Likert scale were positive changes. The changes also motivated them to complete the surveys, which improved overall response rates. Although students reported that the monetary incentive (contributions toward the cost of the class banquet) that had been added to the new SET process was a strong motivator, the incentive itself would have likely been insufficient without the other changes. Several participants stated that receiving feedback from faculty members on changes made to teaching materials based upon previous student evaluations was also an important motivator for students to continue completing the surveys. Conclusion. Students identified several motivators for SET participation. Improving the process for survey completion is essential to improve response rates to more accurately represent the feedback of the entire student body. Additionally, the evaluation process must ensure that the data gathered are robust, accurate, and insightful, to be of good use of student and faculty time.

Goal-Setting on a Geriatric Medicine Rotation: A Pilot Study.

Background:Formal goal-setting has been shown to enhance performance and improve educational experiences. We initiated a standardized goal-setting intervention for all residents rotating through a Geriatric Medicine rotation.Objectives:This study aims to describe the feasibility of a goal-setting intervention on a geriatric medicine rotation, the resources required, and the barriers to implementation. As well, this study aims to describe the learning goals residents created regarding content and quality.Methods:A pilot goal-setting intervention was initiated. A goal-setting form was provided at the beginning of their rotation and reviewed at the end of the rotation. Residents were invited to complete an anonymous online survey to gather feedback on the initiative. Goals were analysed for content and quality. Feedback from the survey results was incorporated into the goal-setting process.Results:Between March and December 2018, 26 of 44 residents completed the goal-setting initiative. Explanations for the poor adherence included limited protected time for faculty and residents to engage in coaching, its voluntary nature, and trainee absence during orientation. Reasons for difficulty in achieving goals included lack of faculty and trainee time and difficulty assisting residents in achieving goals when no clinical opportunities arose. Although only 59% of residents completed the intervention, if goal-setting took place, most of the goals were specific (71 of 77; 92%) and 35 of 77 (45.5%) goals were not related to medical knowledge.Conclusions:This pilot study outlines the successes and barriers of a brief goal-setting intervention during a Geriatric Medicine rotation. Adherence was limited; however, of those who did complete the intervention, the creation of specific goals with a short, structured goal-setting form was possible. To enhance the intervention, goal-setting form completion should be enforced and efforts should be made to engage in mid-rotation check-ins and coaching.

Specifications Grading: Restoring Rigor, Motivating Students, and Saving Faculty Time, by Linda B. Nilson

Specifications Grading: Restoring Rigor, Motivating Students, and Saving Faculty Time, by Linda B. Nilson