Innovation In Medical Education Research Articles

“To Improve Is to Change”: Improving U.S. Healthcare

Sir Winston Churchill is quoted often to have said, “To improve is to change; to be perfect is to change often.” Given this pithy observation, can we conclude that healthcare is certainly going to improve because it is certainly changing? Medicine is experiencing rapid and often times confusing changes. Many physicians are not prepared to deal with sweeping policy changes in healthcare, such as healthcare delivery innovations, quality improvement with cost reductions, primary care and now population health, to name a few challenges. The idea for a health policy symposium in the Journal resulted from our perception that there is considerable confusion, dissatisfaction and even turmoil as physicians and health leaders react to the evolving health policy changes generated by business and political leaders. Physicians do not always welcome such change; do not often embrace health policy issues; and consider the intersection of policy and politics as something toxic to avoid, rather than something to engage, influence and guide! Several issues such as primary care, physician workforce, health disparities and physician reimbursement are recurring policy and practice concerns that we never seem to resolve fully. Still other issues have achieved heightened visibility and importance recently, such as the new focus on population health, the increasing challenges posed by the value equation (quality and cost) and the promise of improved information technology. Beyond the clinical enterprise, ongoing concerns about the slow pace of innovation in medical education and the lagging federal investment in biomedical and health-related research are again pressing policy issues. Appropriately, one might ask why we do not resolve these policy issues, or at least adopt systems approaches that address such critical issues in a constructive, proactive manner, rather than dealing with them in a recurring reactive or crisis mode. Could the answer be right in front of us? As a country, we have not implemented effective systems in healthcare, and one consequence of our disordered approach is recurring, unresolved policy challenges. For this symposium, we asked expert authors to review several health policy issues succinctly, to report on the current state of the policy issue, and to translate the policy implications or decisions into outputs or outcomes that physicians and healthcare executives find useful. Although healthcare “reform” is especially topical now, it has been on the national agenda for

Problem-based learning in resource-poor settings: lessons from a medical school in Ghana.

Problem-based learning (PBL) is arguably one of the most important innovations in medical education in the last century. The evident benefits of PBL and the changing face of medicine and medical education have led many institutions including those in resource-poor settings to consider the adoption of PBL curricula. However, experts are uncertain about how successful PBL will be in such settings, as literature on the implementation of PBL in resource-poor settings appears to be inadequate. The University of Cape Coast is located in a resource-poor setting, however, its medical school has used PBL curriculum since 2007. In a descriptive prose, this article discusses the PBL implementation processes, the challenges faced, the mitigation strategies employed, and the lessons learned at University of Cape Coast School of Medical Sciences (UCCSMS). The arguments fall under the broad themes of curricular structure, resource constraints, faculty development, and assessment. The peculiar socioeconomic situation of Ghana, challenges in funding of tertiary education, and the resource implications of PBL provided the context for the arguments. It emerged out of the discussion that PBL has to be implemented as whole curriculum to be effective. Regular faculty development activities on PBL and the alignment of assessment methods with PBL also emerged as important issues in the discussion. The article argues that in spite of its cost implication, a PBL curriculum can be successfully implemented in resource-constrained settings.

Undergraduate medical education in the U.S. and Israel: contrasts and common challenges.

In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and the financing of medical education.There are interesting parallels between the challenges facing medical education in the U.S. and in Israel: a lack of clarity regarding the optimal size for the workforce and the optimal method for enhancing the number of primary care physicians; an absence of methodologies for evaluating innovations in medical education and a lack of transparency in funds flow. However, there are also important differences, one of the most important being an absence in Israel of students’ hands-on responsibility for their patients until year six of their undergraduate medical education.The presence of a small number of medical schools with common funding and geographic proximity, in a relative sense, provides the Israeli medical schools with a unique opportunity to evaluate innovations in medical education and to set a high bar for inter-school collaboration and cooperation.

Dissemination of an innovative mastery learning curriculum grounded in implementation science principles: a case study.

Dissemination of a medical education innovation, such as mastery learning, from a setting where it has been used successfully to a new and different medical education environment is not easy. This article describes the uneven yet successful dissemination of a simulation-based mastery learning (SBML) curriculum on central venous catheter (CVC) insertion for internal medicine and emergency medicine residents across medical education settings. The dissemination program was grounded in implementation science principles. The article begins by describing implementation science which addresses the mechanisms of medical education and health care delivery. The authors then present a mastery learning case study in two phases: (1) the development, implementation, and evaluation of the SBML CVC curriculum at a tertiary care academic medical center; and (2) the dissemination of the SBML CVC curriculum to an academic community hospital setting. Contextual information about the drivers and barriers that affected the SBML CVC curriculum dissemination is presented. This work demonstrates that dissemination of mastery learning curricula, like all other medical education innovations, will fail without active educational leadership, personal contacts, dedication, hard work, rigorous measurement, and attention to implementation science principles. The article concludes by presenting a set of lessons learned about disseminating an SBML CVC curriculum across different medical education settings.

Using digital health tools for innovation in medical education

Using digital health tools for innovation in medical education

Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit).

Medical education is continuing to evolve to meet the healthcare needs of the future. The longitudinal integrated clerkship (LIC) model is an important innovation in medical education. It has in its vision and structure “patient- and learner-centered education”, using longitudinal relationships between patients and students as a foundational element in its design. LIC students have shown more patient-centered attitudes and behaviors that persist after medical school. They remain connected with the patient experience of care, which supports empathy and student moral development. The time that LIC students spend acting independently with patients also supports the development of higher order clinical and cognitive skills and professional identity formation. Student participation in a more meaningful way in the care of their patients promotes patient wellbeing, and helps patients with transitions of care, communication and preventative care. Patients report feeling empowered to be more active agents in their own care and feel an accountability and pleasure in the training of new physicians. Focusing on the patient/student relationship as a foundational element of clinical education has meaningful benefits to the patient and student with the potential to improve patient care directly and in the future, as these students become physicians.

Cultivating Medical Education Research Mentorship as a Pathway Towards High Quality Medical Education Research.

The lack of effective and consistent research mentorship and research mentor training in both undergraduate medical education (UME) and graduate medical education (GME) is a critical constraint on the development of innovative and high quality medical education research. Clinical research mentors are often not familiar with the nuances and context of conducting education research. Clinician-educators, meanwhile, often lack the skills in developing and conducting rigorous research. Mentors who are not prepared to articulate potential scholarship pathways for their mentees risk limiting the mentee's progress in early stages of their career. In fact, the relative paucity of experienced medical education research mentors arguably contributes to the perpetuation of a cycle leading to fewer well-trained researchers in medical education, a lack of high quality medical education research, and relative stagnation in medical education innovation. There is a path forward, however. Integration of doctoral-level educators, structured inter-departmental efforts, and external mentorship provide opportunities for faculty to gain traction in their medical education research efforts. An investment in medical education research mentors will ensure rigorous research for high quality innovation in medical education and patient care.

Innovation in Indigenous Health and Medical Education: The Leaders in Indigenous Medical Education (LIME) Network as a Community of Practice

Problem: The Leaders in Indigenous Medical Education (LIME) Network aims to improve the quality and effectiveness of Indigenous health in medical education as well as best practice in the recruitment, retention, and graduation of Indigenous medical students. Intervention: In this article we explore the utility of Etienne Wenger's “communities of practice” (CoP) concept in providing a theoretical framework to better understand the LIME Network as a form of social infrastructure to further knowledge and innovation in this important area of health care education reform. Context: The Network operates across all medical schools in Australia and New Zealand. Outcome: Utilizing a model of evaluation of communities of practice developed by Fung-Kee-Fung et al., we seek to analyze the outcomes of the LIME Network as a CoP and assess its approach and contribution to improving the implementation of Indigenous health in the medical curriculum and the graduation of Indigenous medical students. Lessons Learned: By reflecting on the Network through a community of practice lens, this article highlights the synthesis between the LIME Network and Wenger's theory and provides a framework with which to measure Network outputs. It also posits an opportunity to better capture the impact of Network activities into the future to ensure that it remains a relevant and sustainable entity.

The impact of intramural grants on educators' careers and on medical education innovation.

The University of California, San Francisco (UCSF), Haile T. Debas Academy of Medical Educators Innovations Funding program awards competitive grants to create novel curricula and faculty development programs, compare pedagogical approaches, and design learner assessment methods. The authors examined the principal investigators' (PIs') perceptions of the impact of these intramural grants on their careers and on medical education innovation. At 12 months (project completion) and 24 months (follow-up), PIs submit a progress report describing the impact of their grant on their careers, work with collaborators, subsequent funding, project dissemination, and the UCSF curriculum. The authors analyzed these reports using qualitative thematic analysis and achieved consensus in coding and interpretation through discussion. From 2001 to 2012, the program funded 77 PIs to lead 103 projects, awarding over $2.2 million. The authors analyzed reports from 88 grants (85.4%) awarded to 68 PIs (88.3%). PIs noted that the funding led to accelerated promotion, expanded networking opportunities, enhanced knowledge and skills, more scholarly publications and presentations, extramural funding, and local and national recognition. They also reported that the funding improved their status in their departments, enhanced their careers as medical educators, laid the foundation for subsequent projects, and engaged an array of stakeholders, including trainees and junior faculty. These modest intramural education grants not only created innovative, enduring programs but also promoted educators' professional identity formation, fostered collaborations, supported junior faculty in finding their desired career paths, provided advancement opportunities, and raised the local and national profiles of recipients.

Workplace-based assessment: a review of user perceptions and strategies to address the identified shortcomings.

Workplace based assessments (WBAs) are now commonplace in postgraduate medical training. User acceptability and engagement is essential to the success of any medical education innovation. To this end, possessing an insight into trainee and trainer perceptions towards WBAs will help identify the major problems, permitting strategies to be introduced to improve WBA implementation. A review of literature was performed to identify studies examining trainee and trainer perceptions towards WBAs. Studies were excluded if non-English or sampling a non-medical/dental population. The identified literature was synthesised for the purpose of this critical narrative review. It is clear that there is widespread negativity towards WBAs in the workplace. This has negatively impacted on the effectiveness of WBA tools as learning aids. This negativity exists in trainees but also to an extent in their trainers. Insight gained from the literature reveals three dominant problems with WBA implementation: poor understanding as to the purpose of WBAs; insufficient time available for undertaking these assessments; and inadequate training of trainers. Approaches to addressing these three problems with WBA implementation are discussed. It is likely that a variety of solutions will be required. The prevalence of negativity towards WBAs is substantial in both trainees and trainers, eroding the effectiveness of learning that is consequent upon them. The educational community must now listen to the concerns being raised by the users and consider the range of strategies being proposed to improve the experiences of trainees, and their trainers.

Effect of a Novel Interdisciplinary Teaching Program in the Care-continuum on Medical Student Knowledge and Self-Efficacy

ObjectivesMedical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Care (MedTEC) program as an educational innovation at the Cleveland Clinic to address training in the care-continuum, as well as the new medical student and physician competencies in PA/LTC. DesignMedTEC is a 7-hour interactive program that supplements standard geriatric didactics during the medical student primary care rotation. This study evaluated the performance of the program in improving medical student knowledge and attitudes on levels and transitions of care. SettingThe program occurs in a community facility that includes subacute/skilled nursing, assisted living, and nursing home care. ParticipantsFive to 8 students completing their primary care rotation at the Cleveland Clinic are required to participate in the MedTEC program each month. InterventionThe program includes up to 3 hours of interactive discussion and opportunities to meet facility staff, residents, and patients. The highlight of the program is a student-led in-service for facility staff. MeasurementsWith institutional review board approval as an exempt educational research project, pre- and postactivity surveys assessed self-efficacy and knowledge regarding levels of care for students who participated in the program and a student comparison group. The post-program knowledge test also was administered to hospital medicine staff, and test performance was compared with medical students who participated in the MedTEC program. ResultsBetween October 2011 and December 2013, approximately 100 students participated in 20 sessions of MedTEC. All students reported improved self-efficacy and attitudes regarding care of older adults and care transition management. Mean percentage correct on the knowledge test increased significantly from 59.8% to 71.2% (P = .004) for the MedTEC participants but not for the comparison group students (63.1%–58.3%, P = .47). There was no significant difference in mean percentage correct on the post-program knowledge test between MedTEC medical students and hospitalists (71.0% versus 70.3%, P = .86). Students led 8 in-service sessions for facility staff on various topics relating to the care of older adults in PA/LTC. ConclusionThe MedTEC program appears to be a successful innovation in medical student education on levels of care. It could serve as a model for building competency of health professionals on managing care transitions and determining appropriate levels of care for older adults.

Medical student education in psychiatry: opportunities and challenges.

ThisissueofAcademicPsychiatryrelatestovariousaspectsof medical student education. Most impressive to me is that the faculty members who wrote these papers are demonstrating their commitment to educate students, mentor students for careers in psychiatry, and share their ideas with the educational community. As found in the recent survey of Association of Directors of Medical Student Education in Psychiatry (ADMSEP) members [1], psychiatric educators are committed to scholarship, and it is refreshing to see so many papers in this issue of Academic Psychiatry on topics related to medical student education. From these papers, three general themes emerge: (1) innovations in medical student education, (2) recruitment of medical students into the field of psychiatry, and (3) theprevalenceofpsychiatricdisordersinmedical students. The overarching issue of stigma toward psychiatry emerges in some way in many of these papers, reminding us of this enduring challenge.

Association Between Study Quality and Publication Rates of Medical Education Abstracts Presented at the Society of General Internal Medicine Annual Meeting.

Studies reveal that 44.5% of abstracts presented at national meetings are subsequently published in indexed journals, with lower rates for abstracts of medical education scholarship. We sought to determine whether the quality of medical education abstracts is associated with subsequent publication in indexed journals, and to compare the quality of medical education abstracts presented as scientific abstracts versus innovations in medical education (IME). Retrospective cohort study. Medical education abstracts presented at the Society of General Internal Medicine (SGIM) 2009 annual meeting. Publication rates were measured using database searches for full-text publications through December 2013. Quality was assessed using the validated Medical Education Research Study Quality Instrument (MERSQI). Overall, 64 (44%) medical education abstracts presented at the 2009 SGIM annual meeting were subsequently published in indexed medical journals. The MERSQI demonstrated good inter-rater reliability (intraclass correlation range, 0.77-1.00) for grading the quality of medical education abstracts. MERSQI scores were higher for published versus unpublished abstracts (9.59 vs. 8.81, p = 0.03). Abstracts with a MERSQI score of 10 or greater were more likely to be published (OR 3.18, 95% CI 1.47-6.89, p = 0.003). ). MERSQI scores were higher for scientific versus IME abstracts (9.88 vs. 8.31, p < 0.001). Publication rates were higher for scientific abstracts (42 [66%] vs. 37 [46%], p = 0.02) and oral presentations (15 [23%] vs. 6 [8%], p = 0.01). The publication rate of medical education abstracts presented at the 2009 SGIM annual meeting was similar to reported publication rates for biomedical research abstracts, but higher than publication rates reported for medical education abstracts. MERSQI scores were associated with higher abstract publication rates, suggesting that attention to measures of quality--such as sampling, instrument validity, and data analysis--may improve the likelihood that medical education abstracts will be published.

Journal of Taibah University Medical Sciences: Ten years of existence and our special issue about innovations in medical education

Journal of Taibah University Medical Sciences: Ten years of existence and our special issue about innovations in medical education

When innovation was young

Editor – Cook and Triola write compellingly about the role of e-learning in medical education. Their paper makes the reader reflect on technology and innovation in medical education and our relationship with both. Innovation has always been a part of medical education. An innovative approach can help us find solutions to problems; however, such an approach can also generate a spirit of restlessness where there is innovation for its own sake or where there is a constant search for new innovations.

For the general internist: a review of relevant 2013 innovations in medical education.

We conducted a review of articles published in 2013 to identify high-quality research in medical education that was relevant to general medicine education practice. Our review team consisted of six general internists with expertise in medical education of varying ranks, as well as a professional medical librarian. We manually searched 15 journals in pairs, and performed an online search using the PubMed search engine for all original research articles in medical education published in 2013. From the total 4,181 citations identified, we selected 65 articles considered most relevant to general medicine educational practice. Each team member then independently reviewed and rated the quality of each selected article using the modified Medical Education Research Study Quality Instrument. We then reviewed the quality and relevance of each selected study and grouped them into categories of propensity for inclusion. Nineteen studies were felt to be of adequate quality and were of moderate to high propensity for inclusion. Team members then independently voted for studies they felt to be of the highest relevance and quality within the 19 selected studies. The ten articles with the greatest number of votes were included in the review. We categorized the studies into five general themes: Improving Clinical Skills in UME, Inpatient Clinical Teaching Methods, Advancements in Continuity Clinic, Handoffs/Transitions in Care, and Trainee Assessment. Most studies in our review of the 2013 literature in general medical education were limited to single institutions and non-randomized study designs; we identified significant limitations of each study. Selected articles may inform future research and practice of medical educators.

Using a framework to implement large-scale innovation in medical education with the intent of achieving sustainability.

BackgroundParticularly when undertaken on a large scale, implementing innovation in higher education poses many challenges. Sustaining the innovation requires early adoption of a coherent implementation strategy. Using an example from clinical education, this article describes a process used to implement a large-scale innovation with the intent of achieving sustainability.Desire to improve the effectiveness of undergraduate medical education has led to growing support for a longitudinal integrated clerkship (LIC) model. This involves a move away from the traditional clerkship of ‘block rotations’ with frequent changes in disciplines, to a focus upon clerkships with longer duration and opportunity for students to build sustained relationships with supervisors, mentors, colleagues and patients. A growing number of medical schools have adopted the LIC model for a small percentage of their students. At a time when increasing medical school numbers and class sizes are leading to competition for clinical supervisors it is however a daunting challenge to provide a longitudinal clerkship for an entire medical school class. This challenge is presented to illustrate the strategy used to implement sustainable large scale innovation.What was doneA strategy to implement and build a sustainable longitudinal integrated community-based clerkship experience for all students was derived from a framework arising from Roberto and Levesque’s research in business. The framework’s four core processes: chartering, learning, mobilising and realigning, provided guidance in preparing and rolling out the ‘whole of class’ innovation.DiscussionRoberto and Levesque’s framework proved useful for identifying the foundations of the implementation strategy, with special emphasis on the relationship building required to implement such an ambitious initiative. Although this was innovation in a new School it required change within the school, wider university and health community. Challenges encountered included some resistance to moving away from traditional hospital-centred education, initial student concern, resource limitations, workforce shortage and potential burnout of the innovators.SummaryLarge-scale innovations in medical education may productively draw upon research from other disciplines for guidance on how to lay the foundations for successfully achieving sustainability.

Pranayama: transforming medical education by igniting the inner teacher

Innovation in medical education is curriculum re-designing with system approach to motivate, to change the attitude, enhancing the skill by mentoring, facilitating and getting feedback in order to bring the unconscious competency in medical students based on Johari window leading to self-discipline, self-evaluation and self-directed learning. A 3 day Faculty Development workshop brings tremendous beneficial effect. With advanced technologies, the highly intelligent PG students can learn the basics of Faculty Development in the PG curriculum itself. We can teach this in MD course itself. Our hypothesis is mandatory research and 4 paper publications for promotion to Professor are like mandatory treating of 4 patients daily by Research Scholars. Both decisions will bring the same consequences. Basic Faculty Development workshop, Research Methodology workshop, PRANAYAMA as a health promotion in Medical Students and Mentorship can be totally done at undergraduate and PG level by Community Medicine department as an Indian Innovation in Medical Education and this will make the Community Medicine Department, the centre of attraction for Medical Students. Teaching Professionalism is challenging, because medical teachers are Medical Education Technologists. The objective is to include the theory and practice of PRANAYAMA along with the Physiology of Breathing in the 1st year MBBS course, and reinforcing it in the Community Medicine Department .

Relations between policy for medical teaching and basic need satisfaction in teaching.

Policy initiatives that aim to elevate the position of medical teaching to that of medical research could influence the satisfaction of three basic psychological needs related to motivation for medical teaching. To explore relations between the satisfaction of three basic psychological needs towards medical teaching and two policy initiatives for medical teaching: (Junior) Principal Lecturer positions [(J)PL positions] and Subsidized Innovation and Research Projects in Medical Education (SIRPMEs). An online questionnaire was used to collect data about medical teaching in the setting of a university hospital. We adapted the Work-related Basic Need Satisfaction scale (Van den Broeck et al. in J Occup Organ Psychol, 83(4):981-1002, 2010), in order to measure feelings of autonomy, competence, and relatedness in teaching. We examined the relations between (J)PL positions and SIRPMEs and the satisfaction of three basic psychological needs. A total of 767 medical teachers participated. The initiatives appear to be related to different beneficial outcomes in terms of feelings of autonomy, competence, and relatedness in medical teaching. Either a (J)PL position is obtained by teachers who feel competent and related towards medical teaching, or obtaining a (J)PL position makes teachers feel more competent and related towards teaching, or these relations could be interacting. Also, either a SIRPME is obtained by teachers who feel competent and autonomous towards medical teaching, or obtaining a SIRPME makes teachers feel more competent and autonomous towards teaching, or these relations could be interacting. Additional research needs to scrutinize the causal or interacting relations further and to determine optimal conditions for these policy initiatives more specifically. Implications for future research are discussed.

Technology innovations in global medical education

The loss of 400,00 lives annually due to preventable, adverse outcomes is believed to be the third leading cause of death in the United States, after heart disease and cancer. The leadership of the University of South Florida, Center for Advanced Medical Learning and Simulation (CAMLS) has heard this concern and developed a national model for improving medical education and patient safety, as well as aggressive and needed healthcare solutions through the use of cutting edge technology, innovation, and simulation. CAMLS' goal is to use technology, simulated environments, and team training to transition medical education from an apprenticeship model to an evidence-based competency model that improves patient outcomes and reduces medical errors. The processes used at CAMLS are reflective of the instructional design process and team training approach used successfully in aviation and the military.