Medical Education Review Research Articles

Medical Education Reviewer List 2012

Medical Education Reviewer List 2012

Masters of Radiology Panel Discussion: Hyperefficient Radiology—Can We Maintain The Pace?

Masters of Radiology Panel Discussion: Hyperefficient Radiology—Can We Maintain The Pace?Howard P. Forman1, David B. Larson2, Ella A. Kazerooni3, Alexander Norbash4, John K. Crowe5, Marcia C. Javitt6, Norman J. Beauchamp, Jr.7 and Ellen B. Mendelson8Audio Available | Share

Conducting systematic reviews in medical education: a stepwise approach

As medical education research continues to proliferate, evidence syntheses will become increasingly important. The purpose of this article is to provide a concise and practical guide to the conduct and reporting of systematic reviews. (i) Define a focused question addressing the population, intervention, comparison (if any) and outcomes. (ii) Evaluate whether a systematic review is appropriate to answer the question. Systematic and non-systematic approaches are complementary; the former summarise research on focused topics and highlight strengths and weaknesses in existing bodies of evidence, whereas the latter integrate research from diverse fields and identify new insights. (iii) Assemble a team and write a study protocol. (iv) Search for eligible studies using multiple databases (MEDLINE alone is insufficient) and other resources (article reference lists, author files, content experts). Expert assistance is helpful. (v) Decide on the inclusion or exclusion of each identified study, ideally in duplicate, using explicitly defined criteria. (vi) Abstract key information (including on study design, participants, intervention and comparison features, and outcomes) for each included article, ideally in duplicate. (vii) Analyse and synthesise the results by narrative or quantitative pooling, investigating heterogeneity, and exploring the validity and assumptions of the review itself. In addition to the seven key steps, the authors provide, information on electronic tools to facilitate the review process, practical tips to facilitate the reporting process and an annotated bibliography.

An overview of systematic reviews in medical education and a focused review in prescribing

Background: Tertiary reviews (review of reviews) in medical education tend to focus on doctors, continuing education and professional practice. This paper provides a tertiary review of all areas of medical education at all levels. An in-depth focus on prescribing is included. Methods and results: A systematic search using the keywords ‘medical education’ AND (‘systematic review’ OR ‘meta-analysis’) yielded 187 reviews. Reviews were coded by intervention, curriculum/theme, participants and outcomes, creating a systematic map. The most popular interventions and curriculum were simulation (9%) and prescribing (7%), respectively. Most reviews included multiple participant types (68%) and sought patient/health outcomes (64%). Twelve prescribing reviews included in the in-depth review found active educational strategies more effective than passive strategies. Discussion: The systematic map highlights topics and interventions, but further research should explore the cost-effectiveness of the reviews themselves. ...

The dysplastic nevus: from historical perspective to management in the modern era: part I. Historical, histologic, and clinical aspects.

Since its description in the 1970s, the dysplastic nevus has been a source of confusion, and whether it represents a precursor to melanoma remains a controversial subject. Although a Consensus Conference in 1992 recommended that the term "dysplastic nevus" no longer be used, the histologic diagnosis continues to present a therapeutic quandary for dermatologists and other physicians, and there remains significant variation in clinical management. In part I of this continuing medical education review, we will discuss the historical origins of the term, the evidence for its distinct histologic basis, and its clinical significance.

What is evidence? Reflections on the AMEE symposium, Vienna, August 2011

In this article, we present a summary of the discussion from the symposium on ‘what is evidence’, which took place at the AMEE conference in 2011. A panel of five academics and clinicians, plus the chair, considered the nature of evidence, in particular in relation to the ‘evidence’ in the best evidence medical education reviews. Evidence has multiple meanings depending on context and use, and this reflects the complex and often chaotic world in which we work and research.

The role of medical librarians in medical education review articles

Sir Isaac Newton famously wrote, in reference to building on the research of Descartes, “If I have seen further it is by standing on the shoulders of giants” [1]. Today, this familiar sentence, which appears in such conspicuous places as the Google Scholar search page, has been interpreted to mean that for scholars to further their research, they should seize the opportunity to build on the work of their predecessors. In the last decade, medical education has been recognized as a discipline of scientific inquiry [2]. With this recognition has come the call for increased publication of scientifically rigorous research in medical education because the results of research in medical education will ultimately impact patient care [3, 4]. Additional research, especially additional systematic reviews, should provide an opportunity for medical educators to “hoist themselves upon the shoulders of their colleagues” so that they too may be able to see just a bit farther [5]. However, a recent examination of medical education review articles concluded there was variability in the quality and reporting of search strategies, resulting in an inability to reproduce results [6]. That study made recommendations for conducting and reporting literature searches, including adding a librarian to research teams to design and run the search and to assist with retrieving literature and writing the manuscript. The role of the librarian as an expert in literature search and retrieval has been described in published articles for a number of years [7–10]. Sampson and McGowan reviewed the search strategies of sixty-five systematic reviews and found that most contained at least one error and the majority of these errors could affect recall, which might also affect the results of the reviews [11]. That study suggested the need to use an expert when developing a search strategy. Furthermore, the Institute of Medicine and the Agency of Healthcare Research and Quality have both recently published reports recommending that librarians be included as members of research teams [12] and that their expertise in literature searching be integrated into the research process [13]. Librarian contributions not only add to the quality of the literature search, but the resulting research as well. As a follow up to the study of search quality and reporting in medical education review articles noted above [6], the current study examined the role (if any) that was played by a librarian in medical education reviews.

Chairman of independent review of postgraduate medical education is appointed

An independent review of UK postgraduate medical training will be led by David Greenaway, vice chancellor of Nottingham University, it has been announced. The “shape of medical training” review will assess the way doctors are trained in the United Kingdom and make recommendations on the future make up and direction of that training to help ensure that the doctors of the future are equipped to meet the changing needs of …

Retrospective Data Review and Propensity Scoring

Cleveland Clinic, Cleveland, Ohio. kempenp@ccf.orgTo the Editor: A recent article presented for continuing medical education credit studied perioperative statin therapy in elective aortic surgery during 2001–2009, a period of significant advances in aortic surgery, statin use, and perioperative management.1Although propensity scoring (PS) was used to balance some variables related to the choice of statin exposure versus outcomes, validity demands that all relevant parameters be subjected to validate the methodology.2Although the authors specifically stated: “The frequency of treatment (statins) according to the year of surgery increased significantly with time” and “chronic statin therapy is used in association with other cardiovascular medications,” the year of surgery as a variable was not considered in the PS adjustment relative patient outcome.How did advances and trends toward endograft treatments (annual rates of endograft vs. open abdominal aortic aneurysm, did any patients receive endograft or were converted to open procedures?), variable aneurysm type and diameter, abdominal versus retroperitoneal approach, suprarenal cross-clamping incidence and time, surgeon experience, therapy options, blood salvage techniques, American College of Cardiology/American Heart Association guideline introduction and updates including statin and repeated revision of β-blockade recommendations (as well as Perioperative Ischemic Evaluation (POISE) study results affecting β-blockade utilization), affect any care delivered and outcomes in 2001 (before American Heart Association/American College of Cardiology guidelines) versus 2006 versus 2009! The duration and indication of preoperative statin use, time from aortic disease diagnosis to surgery, smoker versus nonsmoker (baseline carbon monoxide-hemoglobin concentration), preoperative lipid and C-reactive protein levels, as well as the frequency and quality of primary medical care before surgery, would have been additional important data to consider in applying PS. Although “all patients were screened in accordance of American College of Cardiology/American Heart Association guidelines,” the findings of Polderman's very astute Erasmus group's care raised serious questions concerning just how these guidelines are/were actually implemented, or conversely, specifically resulted in any observed increased incidence of statin-treated patients in later years.3,4The year of surgery is specifically worthy of inclusion in the study's PS analysis, given the author's own clear observation. Many other factors not analyzed would be expected to have greater effect than statin therapy itself. Are findings valid without these multiple listed considerations, yet alone those differences specifically noted but not considered by the authors?The presence of statins and other drug therapies may specifically indicate superior presurgical care states, medical and patient education advances over a period of years, or simply modern patient compliance and concern. Active patient-directed pharmaceutical advertisements are commonplace in the United States and resulted in high statin usage; is this also typical of France and Europe, leading to the very high usage today versus 2001? The 21 patient characteristics included 12 of 21 parameters, which demonstrated statistically significant differences between the groups, “equalized” by PS. What are the really important available parameters? Was PS meticulously used and how does this reflect on results, conclusions, reader's interpretations, and continuing medical education value/emphasis of the paper?“First of all, as propensity score can only remove overt (known) bias but unlike randomization it cannot be expected to remove hidden (unmeasured) bias, results from its application should be considered with caution. Interpretation will depend on the quality and amount of information about the efficacy of the treatments under evaluation.”2It may be time to introduce ongoing education regarding statistical analysis as a necessary component of the education section of this journal and a component of all continuing medical education review articles, given the important ongoing changes in statistics and importance to medical decisions and ultimately, patient care. PS should/can ultimately/only lead to randomized trials to confirm a PS suggested observation , whenever possible.5

Reproducibility of Literature Search Reporting in Medical Education Reviews

Medical education literature has been found to lack key components of scientific reporting, including adequate descriptions of literature searches, thus preventing medical educators from replicating and building on previous scholarship. The purpose of this study was to examine the reproducibility of search strategies as reported in medical education literature reviews. The authors searched for and identified literature reviews published in 2009 in Academic Medicine, Teaching and Learning in Medicine, and Medical Education. They searched for citations whose titles included the words "meta-analysis," "systematic literature review," "systematic review," or "literature review," or whose publication type MEDLINE listed as "meta-analysis" or "review." The authors created a checklist to identify key characteristics of literature searches and of literature search reporting within the full text of the reviews. The authors deemed searches reproducible only if the review reported both a search date and Boolean operators. Of the 34 reviews meeting the inclusion criteria, 19 (56%) explicitly described a literature search and mentioned MEDLINE; however, only 14 (41%) also mentioned searches of nonmedical databases. Eighteen reviews (53%) listed search terms, but only 6 (18%) listed Medical Subject Headings, and only 2 (6%) mentioned Boolean operators. Fifteen (44%) noted the use of limits. None of the reviews included reproducible searches. According to this analysis, literature search strategies in medical education reviews are highly variable and generally not reproducible. The authors provide recommendations to facilitate future high-quality, transparent, and reproducible literature searches.

Pathology subspecialty fellowship application reform 2007 to 2010

The specialty of Pathology and Laboratory Medicine has entered into a phase when the 4-year sequence of Anatomic Pathology and/or Clinical Pathology Residency Training is almost universally followed by 1 or more years of Subspecialty Fellowship Training. Such training may occur in one of the American Board of Pathology-recognized subspecialties or any number of "subspecialty fellowships" that, although not leading to subspecialty board certification, may nevertheless fall under the oversight of the local institutional Graduate Medical Education Committee and the Accreditation Council for Graduate Medical Education Review Committee for Pathology. Unlike the application process for first-year Pathology Residency, which is run through the National Resident Matching Program, applications for Subspecialty Pathology Fellowships are not coordinated by any consistent schedule. Competition for Subspecialty Pathology Fellowships has consistently resulted in undesirable drift of the fellowship application process to dates that are unacceptably early for many fellowship applicants. Responding to widespread dissatisfaction voiced by national pathology resident organizations, in 2007, the Association of Pathology Chairs began evaluation and potential intervention in the fellowship application process. Three years of intermittently intense discussion, surveys, and market analysis, have led the Council of the Association of Pathology Chairs to recommend implementation of a Pathology Subspecialty Fellowship Matching program starting in the 2011 to 2012 recruiting year, for those Applicants matriculating in fellowship programs July 2013. We report on the data that informed this decision and discuss the pros and cons that are so keenly felt by the stakeholders in this as-yet-incomplete reform process.

A guide to the ATSM in Medical Education. Article 4: quality assurance and research in medical education

Key content Quality assurance measures an institution's performance against standards of good educational practice. Primary medical educational research uses a mixture of quantitative and qualitative methodologies. Additional databases other than those for health sciences need to be searched for reviews or systematic reviews in medical education. Learning objectives For trainers and trainees to be aware of the structure of the quality assurance frameworks within which they teach. For trainees to know where to find and how to appraise educational literature critically. Trainers will be able to involve trainees in quality assurance programmes and encourage them to solve educational questions through critical appraisal of the literature. Ethical issues How responsible is a trainee for taking action if their critical appraisal of the quality of their training programmes reveals a culture of bullying? Trainees and trainers should be aware of the quality assurance programmes in place for medical education. Trainers should be able to appraise new teaching methods. Please cite this article as: Shehmar M, Khan KS. A guide to the ATSM in Medical Education. Article 4: quality assurance and research in medical education. The Obstetrician & Gynaecologist 2010;12:257–263.

To the point: reviews in medical education—taking control of the hidden curriculum

This article, the ninth in the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, discusses the role of the "hidden curriculum" in shaping the professional identity of doctors in training. The characteristics that distinguish the formal curriculum and hidden curriculum are defined. Specific examples of hidden curricula in clinical environments and the positive and negative impacts that may result are highlighted. Techniques to evaluate clinical training environments and to identify the hidden curriculum are provided and are followed by methods to promote its positive messages and lessen its negative ones.

Perspective: Private Schools of the Caribbean: Outsourcing Medical Education

Twenty-five percent of the U.S. physician workforce is made up of international medical graduates (IMGs), a growing proportion of whom (27% in 2005) are U.S. citizens. Most IMGs graduate from "offshore medical schools" (OMSs), for-profit institutions primarily located in the Caribbean region and established to train U.S. students who will return home to practice medicine. Following the recent call for a larger physician workforce, OMSs rapidly increased in number. Unlike U.S. schools, which must be accredited by the Liaison Committee on Medical Education, OMSs are recognized by their home countries and may not be subject to a rigorous accreditation process. Although gaps in specific data exist, a closer look at OMSs reveals that most enroll three groups of students per year, and many educate students initially at "offshore campuses" and later at clinical sites in the United States. Students from some OMSs are eligible for the U.S. Federal Family Education Loan Program. The lack of uniform data on OMSs is problematic for state medical boards, which struggle to assess the quality of the medical education offered at any one school and which, in some cases, disapprove a school. With the United States' continued reliance on IMGs to meet its health needs, the public and the profession will be best served by knowing more about medical education outside of the United States. Review of medical education in OMSs whose graduates will become part of U.S. health care delivery is timely as the United States reforms its health-care-delivery system.

Institute of Medicine Committee Report on Resident Duty Hours: A View From a Trench

In late 2008, the Institute of Medicine (IOM) published a report recommending more restrictive limits on resident work hours to promote patient safety. Reaction from the graduate medical education community has focused on concerns about a lack of evidence supporting the IOM's recommendations. We highlight 3 concerns with the report: 1) a disproportionate attention to resident fatigue when changes in other areas may have a larger impact on patient safety. Data supporting a causal link between resident fatigue and medical errors that harm patients are not robust. Two areas where data support a stronger impact on patient safety include resident supervision and transitions of care; 2) a "one size fits all" model when specialty-specific recommendations may be more appropriate. For example, 16 hours on task is not at all similar for residents in different specialties (ie, surgery and primary care); and 3) the absence of a process to evaluate the impact of current or potential duty hour requirements on outcomes. Because these potential impacts have not been sufficiently researched, it is premature to support additional changes at this time. TO MOVE FORWARD IN A COMPREHENSIVE MANNER, WE RECOMMEND THE FOLLOWING: 1) support more research to evaluate the effects of duty hours in conjunction with other interrelated factors on patient safety, 2) encourage individual Accreditation Council for Graduate Medical Education (ACGME) Review committees to develop specialty specific duty hour limitations, and 3) develop partnerships between the IOM, ACGME, and the institutions directly involved with medical education to study how to maximize patient safety while maintaining quality educational outcomes.

Update on WPA education programs, 2009.

It is incumbent upon those involved in training the next generation of psychiatrists and other physicians to ensure that trainees and practitioners are exposed to the widest possible range of medical and psychiatric knowledge and clinical settings, so that they can develop appropriate clinical skills based on cutting edge knowledge. It is within this context that the WPA has developed an array of educational programming geared toward ensuring that psychiatrists, other physicians, and the general public, no matter where in the world they live or train, will have the advantage of the latest understanding of psychiatric illness etiologies, diagnosis, and treatment. A variety of educational materials are available on the WPA website (www.wpanet.org). A recent education project is the WPA/International Society for the Study of Personality Disorders program on personality disorders 1,2. E. Simonsen and colleagues have produced a work that is comprehensive, but organized in a way that makes access to the material easy for individuals at any stage of their professional careers. Soon after the publication of this issue of World Psychiatry, readers will find that a new and completely revised edition of the educational program on depressive disorders 3is available on the WPA website. An important aim of the revision is to make the new materials useful in the primary care setting. Thus, an important part of the overall project will include collaboration with other organizations to develop material for use in primary care. A newly approved Education Committee statement, entitled “Recommended roles for the psychiatrist in first episode psychosis”, is available on the WPA website under “Educational Resources”. This document was prepared to provide psychiatrists with guidance about the most recent developments regarding knowledge of psychosis onset, and the implications of these findings for early detection and intervention. Another important component of the WPA Action Plan 2008-2011 is a complete revision of the WPA curricular recommendations for medical student and resident education 4. The goal of this project is to ensure that the material is useful for those teaching in a wide range of programs around the world, with extremely variable resources. In addition, the project will include sections on advances in various educational approaches, such as competency based education and evaluation, which were not covered in the previous works because these approaches did not exist at the time. Another important component of future educational programs will be to develop ways to take advantage of existing and future technologies, such as interactive computer based education and telemedicine based educational programming. As a starting point to assess the use of technology in WPA education initiatives, we plan to develop a series of online continuing medical education (CME) programs based on lectures presented at WPA World and International Congresses. We also intend to develop online, interactive continuing medical education (CME) review questions, so that psychiatrists will have the opportunity to gain CME credits. Another example of plans to use technology in education is an ongoing project of the WPA Education Committee to develop a Wikipedia based medical student textbook of psychiatry. Wikipedia is an online, free encyclopedia which has now expanded its scope to include books and textbooks. While this program has not yet received official WPA endorsement, because it is not yet complete and submitted for approval, interested individuals can visit the Wikipedia website for the present draft version, which is http://en.wikibooks.org/wiki/Textbook_of_Psychiatry. To address the ongoing concern about stigma regarding mental illnesses and psychiatrists, we have initiated the development of a new project on public education. The eventual product will be a separate section of the WPA website with materials available in the major WPA languages and with links to public education materials from WPA Member Societies, all in the languages of the home country. In addition, it is envisioned that these links will also contain WPA developed public education materials in the native language of the local country. We have an extensive and ambitious agenda for the development of our educational programs over the coming years. This is essential for the field, as the pace of change within psychiatry is rapid and dramatic. Anyone interested in assisting with any aspect of our projects is encouraged to contact me, Allan Tasman, WPA Secretary of Education, at allan.tasman@louisville.edu. These are exciting times for the future of psychiatric education, and collaboration with as many of you as possible will make our progress even more impressive.

Survey of teaching/learning of healthcare-associated infections in UK and Irish medical schools

All medical doctors have an important role to play in the diagnosis, management and prevention of healthcare-associated infection (HCAI). Strengthening the contribution of medical doctors and medical students to HCAI prevention programmes should include measures that enhance knowledge, improve practice and develop appropriate attitudes to the safety and quality of patient care. The Hospital Infection Society (HIS) funded a review of medical education on HCAI throughout medical schools in the UK and the Republic of Ireland. A questionnaire was drafted and circulated to all medical schools and 31 of 38 (82%) responded. The prevalence and transmission of HCAI were taught by 97% and 100% of medical schools, respectively, but the importance of HCAI as a quality and safety issue was covered in only 60% of medical schools. Multiple choice questions (MCQs) and objective structure clinical examinations (OSCEs) were the most popular methods of assessment. Lectures, discussion of cases and practical demonstrations were considered useful by >90% of respondents and online material and log books by 67% and 60%, respectively. More than 80% were willing to share a common pool of educational resources. An agreed curriculum should be developed for educating medical students in HCAI prevention and control, to outline optimum methods for assessment and develop a shared pool of educational resources.

Global Health in General Surgery Residency: A National Survey

Interest in global health during postgraduate training is increasing across disciplines. There are limited data from surgery residency programs on their attitudes and scope of activities in this area. This study aims to understand how global health education fits into postgraduate surgical training in the US. In 2007 to 2008, we conducted a nationwide survey of program directors at all 253 US general surgery residencies using a Web-based questionnaire modified from a previously published survey. The goals of global health activities, type of activity (ie, clinical versus research), and challenges to establishing these programs were analyzed. Seventy-three programs responded to the survey (29%). Of the respondents, 23 (33%) offered educational activities in global health and 86% (n = 18) of these offered clinical rotations abroad. The primary goals of these activities were to prepare residents for a career in global health and to improve resident recruitment. The greatest barriers to establishing these activities were time constraints for faculty and residents, lack of approval from the Accreditation Council for Graduate Medical Education and Residency Review Committee, and funding concerns. Lack of interest at the institution level was listed by only 5% of program directors. Of the 47 programs not offering such activities, 57% (n = 27) were interested in establishing them. Few general surgery residency programs currently offer clinical or other educational opportunities in global health. Most residencies that responded to our survey are interested in such activities but face many barriers, including time constraints, Residency Review Committee restrictions, and funding.

Looking to the Future

Participants of the Residency Review and Redesign (R(3)P) Project have created a challenging strategic plan for pediatric residency education. In place of a list of prescriptions for immediate change, the R(3)P Committee recommends an ongoing project of goal-directed change, a quality improvement approach to resident education. It argues for changes based on evidence of important education outcomes that improve the health of children, adolescents, and young adults. Creation and maintenance of a process of ongoing, adaptive change will depend on the combined efforts of the Association of Pediatric Program Directors, the Association of Medical School Department Chairs, the American Board of Pediatrics, the Resident Section of the American Academy of Pediatrics, and the Accreditation Council for Graduate Medical Education Review Committee for Pediatrics.

Does Faculty Development Enhance Teaching Effectiveness?

Academic dentists and members of the practice community have been hearing, for more than a decade, that our educational system is in trouble and that the profession has lost its vision and may be wavering in the achievement of its goals. A core of consistently recommended reforms has framed the discussion of future directions for dental education, but as yet, most schools report little movement toward implementation of these reforms in spite of persistent advocacy. Provision of faculty development related to teaching and assessment strategies is widely perceived to be the essential ingredient in efforts to introduce new curricular approaches and modify the educational environment in academic dentistry. Analyses of the outcomes of efforts to revise health professions curricula have identified the availability and effectiveness of faculty development as a predictor of the success or failure of reform initiatives. This article will address faculty development for purposes of enhancing teaching effectiveness and preparing instructors for potential new roles associated with curriculum changes. Its overall purpose is to provide information and insights about faculty development that may be useful to dental schools in designing professional growth opportunities for their faculty. Seven questions are addressed: 1) What is faculty development? 2) How is faculty development accomplished? 3) Why is faculty development particularly important in dental education? 4) What happens when faculty development does not accompany educational reform? 5) Why are teaching attitudes and behaviors so difficult to change? 6) What outcomes can be expected from faculty development? and 7) What does the available evidence tell us about the design of faculty development programs? Evidence from systematic reviews pertaining to the teaching of evidence-based dentistry, strategies for continuing professional education, and the Best Evidence in Medical Education review of faculty development outcomes are presented to answer this question: does faculty development enhance teaching effectiveness? Characteristics consistently associated with effective faculty development are described.