Medical Education Strategies Research Articles

Conocimientos, actitudes y prácticas de la medicina basada en evidencias en médicos asistentes de un hospital público. Lima- Perú

Objetivo. Determinar los conocimientos, actitudes y prácticas en Medicina Basada en Evidencias (MBE) en médicos asistentes de un hospital público. Materiales y Métodos. Diseño analítico observacional de corte transversal, se utilizó un instrumento tipo cuestionario validado con un índice Kuder y Richarson (KR 20) de 0,79. Resultados. El conocimiento de la MBE es intermedio bajo en el 60% de los participantes. Además, existe una asociación estadística entre el número de horas dedicadas a la búsqueda de información y el nivel de conocimientos de MBE. Conclusiones. Se requiere generar estrategias metodológicas de educación médica para mejorar el conocimiento de la MBE para optimizar las actitudes y prácticas de esta actividad medica

Team based learning in medical education

Team based learning is an active, student-centered method applied in a group of 5-7 students with the management of a single trainer who is a specialist. There are three stages in the team based learning method: preparation, display of readiness and implementation. Team based learning is an active learning strategy in medical education. In this study, the structure and basic principles of team based learning, the steps of the method and assessment and evaluation are discussed.

Common Ground: Frameworks for Teaching Improvisational Ability in Medical Education

Issue: The practice of medicine is intrinsically unpredictable. Clinicians must respond skillfully to this uncertainty; therefore, medical educators are using improvisational theater training methods to teach improvisational ability in areas such as communication and professionalism. This teaching approach is called “medical improv.” Although early reports of medical improv suggest promise, the collective descriptions of curricular content lack consistency. This ambiguity creates impediments for further implementation and research of this new educational technique. To address this challenge, the author presents two unifying conceptual frameworks for medical improv curricula. Evidence: Medical improv evolved from previous work done in improvisational (improv) theater and “applied improv,” which is the broader category of improv-based training in nontheater environments. The author synthesized curricular elements from all three fields of improv into two conceptual frameworks: core curricular components (skills, principles, and exercises) and core skill groups (attunement, affirmation, and advancement). The curricular component framework simplifies terminology and clarifies a previously vague distinction between skills and principles. The skill group framework harnesses a redundant and wide-ranging list of improv skills into three categories. Together, the frameworks provide a simple structure that encompasses and organizes the core concepts of medical improv. Implications: These curricular frameworks enable educators and learners to more easily understand the scope and depth of medical improv concepts and to identify areas where medical improv could enhance existing medical education strategies. For example, there is substantial overlap between improvisation skills and current curricular objectives for communication skills, as outlined by Accreditation Council for Graduate Medical Education benchmarks (e.g., Milestones, Competencies, Entrustable Professional Activities). Medical improv courses could be an efficient way to achieve many of these objectives. In addition, improv-based exercises represent an experiential learning modality that is underutilized in communication skills training; therefore, exercises could be integrated into existing coursework to bridge the learning pathway between texts and simulation. Furthermore, the deliberate cultivation of affirmation skills could enhance resilience and wellness in clinical and learning environments. In summary, through their conceptual simplicity, these curricular frameworks for medical improv can help educators understand, study, and optimize teaching of improvisation in medical education.

Importance of Shared Decision-Making for Vulnerable Populations: Examples from Postmastectomy Breast Reconstruction.

Shared decision-making (SDM) is a process through which patients and providers collaborate to select a treatment option that aligns with patients' preferences and clinical context. SDM can improve patients' decision quality and satisfaction. However, vulnerable populations face barriers to participation in SDM, which exacerbates disparities in decision quality. This perspective article discusses SDM with vulnerable patients, using examples from patients who made decisions about postmastectomy breast reconstruction. We offer several strategies for clinical practice, medical education, and research to ensure that movements to engage patients in SDM do not exclude already marginalized groups.

Peer-Assisted and Team-Based Learning: A new hybrid strategy for Medical Education

ABSTRACT Medical education has been significantly changing in the last years, mainly due to new conceptions of the teaching-learning processes that advocate the employment of active methods of learning, such as Team-Based Learning (TBL). Peer-Assisted Learning (PAL) is a long-established strategy that has been used in several undergraduate courses. This study describes a pilot test of a new model of PAL developed with an adapted TBL strategy, that was called “PAL-TBL method”. The test occurred during Human Physiology classes with first-year Medical undergraduate students from Universidade de Pernambuco - Garanhuns Campus, Brazil. The PAL-TBL was designed as a teaching-learning methodology to improve academic education. Here, the organizational dynamics and the design of the activities carried out from 2016 to 2017 are reported. The resulting PAL-TBL methodology is characterized as the following: (i) timing I or material preparation (context/scenario) and study/analysis of the material by the participants; (ii) timing II or verification of prior knowledge (individual and team test), questioning and feedback and (iii) timing III or applying the concepts learned. It is worth mentioning that the end of timing II consisted of a moment for evaluating the team’s work and the materials used. Material production happened through the interaction between student-tutors and the (supervising) professor, aiming to share experiences as well as to elucidate the importance of using active methods during the academic development of useful competencies for medical practice. The methodology developed allowed students to reflect extensively on the problems presented in the class discussions, allowing for a richer learning experience. Further applications of PAL-TBL in advanced years of the course will be done to confirm the benefits of this hybrid strategy for medical education.

An economical strategy for early medical education in ultrasound

BackgroundA movement to include ultrasound training in undergraduate medical education is slowly taking place. However, many educational institutions are hesitant to include formal ultrasound training as a part of their curricula due to curricular time constraints, high cost of ultrasound equipment, and a lack of sufficient faculty skilled with ultrasound. We suggest that an economical ultrasound training strategy is needed to resolve these obstacles and enable hesitant medical programs to include ultrasound training.MethodsTwenty-eight first year medical students volunteered to attend extra-curricular ultrasound training sessions covering topics related to 11 commonly used sonographical imaging categories. Study assessments included subjective pre/post-training skill evaluation surveys, and objective numerical scores awarded by the session instructor during real-time evaluation of each participant’s performance in obtaining each target ultrasound view.ResultsA Wilcoxon matched-pairs signed rank test was performed to evaluate the difference between pre-training and post-training survey questions. P values < 0.05 were considered significant. Moreover, following analysis the p value for all test was found to be < 0.0001. Of the 308 total ultrasound-related tasks attempted collectively by all 28 participants, only 7 (2.3%) tasks were deemed unsuccessful by an instructor.ConclusionsThe training program presented in this study requires one faculty member, a single ultrasound machine, and time to conduct six 30-min training sessions with small groups of students over 4 weeks. Many medical schools are concerned that they don’t have adequate time or resources to include ultrasound training in their curricula. Our intention is to negate these concerns by providing a simple and practical training method that is both temporally and fiscally economical.

Gamification in Action: Theoretical and Practical Considerations for Medical Educators.

Gamification involves the application of game design elements to traditionally nongame contexts. It is increasingly being used as an adjunct to traditional teaching strategies in medical education to engage the millennial learner and enhance adult learning. The extant literature has focused on determining whether the implementation of gamification results in better learning outcomes, leading to a dearth of research examining its theoretical underpinnings within the medical education context. The authors define gamification, explore how gamification works within the medical education context using self-determination theory as an explanatory mechanism for enhanced engagement and motivation, and discuss common roadblocks and challenges to implementing gamification.Although previous gamification research has largely focused on determining whether implementation of gamification in medical education leads to better learning outcomes, the authors recommend that future research should explore how and under what conditions gamification is likely to be effective. Selective, purposeful gamification that aligns with learning goals has the potential to increase learner motivation and engagement and, ultimately, learning. In line with self-determination theory, game design elements can be used to enhance learners' feelings of relatedness, autonomy, and competence to foster learners' intrinsic motivation. Poorly applied game design elements, however, may undermine these basic psychological needs by the overjustification effect or through negative effects of competition. Educators must, therefore, clearly understand the benefits and pitfalls of gamification in curricular design, take a thoughtful approach when integrating game design elements, and consider the types of learners and overarching learning objectives.

Physical medicine and rehabilitation league of Faculdade de Medicina da Universidade de Sao Paulo: An innovative model of undergraduate teaching and learning

Current medical education strategies are based on OSCE, self-assessment, clinical teaching, lectures and textbooks. The predominant method of learning anatomy, for example, consists primarily of reading textbooks and attending classes. Recently a new model of complementary education to graduation has become popular in Brazil: the Academic Leagues of Medicine. The Physical Medicine and Rehabilitation League of the University of São Paulo Medical School (PMR League of FMUSP) aims to complement this traditional method and also provide students with practical activities to improve their knowledge in clinical practice in physical medicine and rehabilitation. We aim to describe the educational, evidence-based assistance, community extension and research experiences gained through PRM League and the rate of medical student's exposure to the field after its implementation. PMR League of FMUSP counts on teaching activities, research projects and university extension to the community. The PMR League of FMUSP promotes the development of educational materials to the population, such as the “Postures’ Manual” adopted in the social project of districts’ revitalization in São Paulo; it also promotes theoretical classes correlating anatomical data with clinical cases and patient care activities. PMR League of FMUSP students and physicians are responsible for the preparation of classes, patient care, research and innovation projects at the Institute of Physical Medicine and Rehabilitation (IMREA). Medical students from the second to fourth grade take part of the PMR League mentored by attending physicians and residents. There was a 150% (from 10 to 35 medical students) increase in the number of members during the first year of activities, with growth prospects still higher in the coming years. PMR League of FMUSP with its activities, introductory course and classes, had a positive influence on student's interest and learning. It may represent a successful initiative for enhancing physical and rehabilitation medicine teaching.

Adapting a Small Group Communication Quality Assessment to New Contexts

Objectives: Small group learning is a well-established medical education strategy for cultivating essential communication skills. Yet, how best to measure communication quality in these groups remains understudied. This study aimed to adapt a communication assessment to medical education small group settings. Methods: This was an observational study of Preclinical Medical Humanities group discussions. Audio-recordings of 12 sessions (3 groups; n=22 students and 3 facilitators) were analyzed using Communication Quality Analysis. Three coders assessed communication quality by assigning numeric scores based on how well participants accomplished communication goals within five domains: content, engagement, relationship, emotion and identity. Coder reliability was assessed using intra-class correlations. Variance components were assessed using a generalized linear model.Results: High inter-rater reliability was established for each of five communication quality domains (ICC range 0.875 to 0.98). Variability in content, emotion, and engagement domains was primarily driven by the individual subjects (nested within the three communication groups)–accounting for 49%, 57% and 78% of the variability respectively; relational and identity domain score variability was accounted for by duration of class (accounting for 66% and 47% of the variability, respectively). Considerable variability was observed between participants, suggesting that the assessment is sensitive enough to detect nuanced differences between participants.Conclusions: Our study shows that CQA is reliable when adapted to medical education small groups.With further refinement, CQA provides an important measure that could be used in medical education to evaluate the impact of novel curricular activities or varied facilitation techniques on communication quality and other educational outcomes.

Real Time Electronic Formative Assessment in Medical Education and Its Impact on Motivational Beliefs and Self-regulation Strategies

Background and Objectives: The aim of this study was to investigate the effect of real-time electronic formative assessment-based medical education on learners’ motivational beliefs and self-regulation strategies. Methods: This randomized clinical trial was conducted on 323 students studying at the Medical School of Mashhad University of Medical Sciences, Mashhad, Iran, during the first semester of the academic year of 2017-2018 using a posttest control group design. The investigation of motivational beliefs and self-regulation strategies was accomplished using the Motivated Strategies for Learning Questionnaire. The research hypotheses were studied by means of independent t-test and multivariate analysis of variance. Results: According to the results, there was a significant difference between the control and intervention groups in terms of motivational strategy subscales, namely self-efficacy, intrinsic value, test anxiety, and self-regulation (P0.05). Conclusion: As the findings indicated, the use of real-time electronic formative assessment in the educational environment can enhance students’ motivational beliefs and self-regulation strategies in medical education.

The educational effects of mobile learning on students of medical sciences: A systematic review in experimental studies.

The demand for mobile learning in the medical science educational program is increasing. The present review study gathers evidence highlighted by the experimental studies on the educational effects of mobile learning for medical science students. The study was carried out as a systematic literature search published from 2007 to July 2017 in the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Knowledge (Thomson Reuters) , Educational Resources and Information Center (ERIC), EMBASE (Elsevier), Cochrane library, PsycINFO and Google Scholar. To examine quality of the articles, a tool validated by the BEME Review was employed. Totally, 21 papers entered the study. Three main themes emerged from the content of papers: (1) improvement in student clinical competency and confidence, (2) acquisition and enhancing of students' theoretical knowledge, and (3) students' positive attitudes to and perception of mobile learning. Level 2B of Kirkpatrick hierarchy had been examined by all the papers and seven of them had reported two or more outcome levels, but level 4 was not reported in the papers. Our review showed that the students of medical sciences had positive response and attitudes to mobile learning. Moreover, implementation of mobile learning in medical sciences program might lead to valuable educational benefits and improve clinical competence and confidence along with theoretical knowledge, attitudes, and perception of mobile learning. The results indicated that mobile learning strategy in medical education can positively affect learning in all three domains of Bloom's Taxonomy.

Transformation of medical education through Decentralised Training Platforms: a scoping review

Medical education in South Africa is facing a major paradigm shift. The urgency to increase the number of suitable, qualified and socially accountable health sciences graduates has brought to the fore the need to identify alternative training platforms and learning environments, often in rural areas. Subsequently, the focus has now shifted towards strengthening primary health care and community based health services. This scoping review presents a synopsis of the existing literature on decentralized training platform (DTP) strategies for medical education internationally, outlining existing models within it and its impact. This scoping review followed Arksey and O'Malley's framework outlining five stages: (i) identification of a research question, (ii) identification of relevant studies, (iii) study selection criteria, (iv) data charting, and (v) collating, summarizing and reporting results. The literature for the scoping review was found using online databases, reference lists and hand searched journals. Data were charted and sorted inductively according to key themes. A final review included 59 articles ranging over the years 1987-2015 with the largest group of studies falling in the period 2011-2015 (47.5%). Studies mostly employed quantitative (32.2%), qualitative (20.3%), systematic/literature review (18.6%) and mixed methods research approaches (11.9%). The scoping review highlighted a range of DTP strategies for transforming medical education. These include training for rural workforce, addressing context specific competencies to promote social accountability, promoting community engagement, and medical education partnerships. Viable models of DTP include community based education, distributed community engaged learning, discipline based clinical rotations, longitudinal clerkships and dedicated tracks focusing on rural issues. Shorter rural placements and supplemental rural tracks are also described. This scoping review showed a considerable amount of literature on decentralized training platforms that highlight the necessary adaptations needed for transforming medical education. The rural context is critical for many of these. Further studies are required to address the impact of DTPs on health service outcomes and human resource outcomes.

Reform Strategies of Medical Education in Egypt

– The purpose of this paper is to explore the challenges facing medical education system in Egypt particularly in the area of education quality. It builds upon several existing studies conducted in Egypt to make the case for improving education outcomes. Design/methodology/approach – Samples were drawn from existing studies conducted in Egypt by experts in the education field. Findings – Results suggest that there is a chance for improvement of the quality of medical education in Egypt with subsequent potential increase of graduates employability and direct impact on national and global healthcare. Conclusion – Strategies of reform are suggested.

A community-based strategy in medical education of the university of the philippines manila-school of health sciences - Lessons from innovations in human resources for health development in a developing country.

After nearly four decades of testing an innovative model for training health workers for marginalized communities, the evidence base for the impact of University of the Philippines Manila-School of Health Sciences (UPM-SHS) medical program needs to address important gaps. Has it succeeded in contributing toward socially accountable medical education where medical schools will be evaluated in terms of their contribution to society's health outcomes? To answer this question, this study examined human resources for health (HRH) inequity in the Philippines and reviewed the medical school's performance in terms of addressing HRH distribution. The evaluation of the school's performance was done through two phases. Phase 1 involved generating HRH inequity metrics for the Philippines through secondary data. Phase 2 involved gathering primary data and generating performance metrics for UPM-SHS. We found challenges that UPM-SHS needs to address based on the analysis of its student admissions from 1976 to 2011: targeting the right underserved communities, especially at the municipal level; addressing issues of high leakage and undercoverage rates in the program; ensuring mechanisms for return service are in place at the community level; and tracking and measuring program outputs and impact on community health outcomes. Given this study on the performance of UPM-SHS to produce a broad range of health workforce to address the needs of marginalized communities in the Philippines and in similarly situated countries, there is a need to reassess its HRH development strategy. If it wants to build a critical mass of transformational health leaders to meet the needs of poor communities as part of its social accountability mandate, it needs to accelerate this development process.

Using parent feedback: Aqualitative study of residents' and physician-educators' perspectives.

IntroductionPatients and family members can contribute to resident assessment in competency-based medical education. However, few studies have examined the use of patient/family member feedback generated from questionnaire-based assessments. To implement appropriate assessment strategies and optimize feedback use, we need to understand how residents and physician-educators would use feedback from these stakeholders. This study aimed to understand how paediatric residents and physician-educators would use parent feedback generated from questionnaire-based assessments.MethodsThis study was conducted at a paediatric academic health science centre. We held dyadic interviews with six residents and six physician-educators. A three-step approach was used to analyze the data: data reduction, data display, and conclusions/verifications. We developed an initial coding scheme, conducted an in-depth review of the data and coded it, finalized our coding scheme, and identified categories.ResultsParticipants described that they would use parent feedback to: (a) provide additional direct observations of residents’ performances, (b) teach and coach residents, (c) assess residents’ overall performance and progression, and (d) encourage resident self-assessment and behaviour change.DiscussionParents directly observe residents as they interact with them and their children and, therefore, can provide feedback on residents’ performances. Residency programs should include parent feedback and promote and facilitate its use by residents and physician-educators.ConclusionThis study provides an initial understanding of how paediatric residents and physician-educators would use parent feedback if they were to receive it. This information, combined with future research, can inform the development and implementation of parent feedback strategies in competency-based medical education.

Academic detailers\u2019 and general practitioners\u2019 views and experiences of their academic detailing visits to improve the quality of analgesic use: process evaluation alongside a pragmatic cluster randomized controlled trial

BackgroundContinuous medical education strategies, including academic detailing (AD), have mixed effects on the quality of prescribing in general practice. Alongside a cluster-randomized controlled trial (cRCT) to assess the effectiveness of AD visits (on appropriate prescribing of analgesics for chronic pain in osteoarthritis) by Farmaka, an independent drug information center, we performed a process evaluation to identify possible barriers and success factors to improve these AD visits, both from the perspective of the academic detailers delivering the visits and the general practitioners (GPs) receiving them.MethodsWe performed semi-structured interviews with 20 GPs who participated in the cRCT and 13 academic detailers. The interviews were transcribed verbatim and analysed using thematic analysis.ResultsGPs viewed AD visits as a practical and useful CME strategy, that is less time consuming than other CME activities, and the visitors as providers of objective and independent information relevant to their daily practice with whom they can have meaningful discussion. Academic detailers saw themselves as content experts, mainly informing GPs about the topic and not emphasizing on behavior change. Both GPs and academic detailers believed that the AD visits could have better interaction and discussion if performed in small groups. According to the GPs, the visits on analgesic use provided some new and relevant information as well as clarifying some misconceptions. They increased awareness of the disadvantages of particular non-steroidal anti-inflammatory drugs and of the lower doses of paracetamol that should be prescribed for chronic use, which may have changed their beliefs and/or attitudes towards more appropriate prescribing for osteoarthritis. However, the transfer of knowledge into practice was seen as not so straightforward.ConclusionsGPs view AD visits as a credible and interesting way of CME that enhances their knowledge and increases reflection on their prescribing behavior.

Guidelines: The do's, don'ts and don't knows of direct observation of clinical skills in medical education.

IntroductionDirect observation of clinical skills is a key assessment strategy in competency-based medical education. The guidelines presented in this paper synthesize the literature on direct observation of clinical skills. The goal is to provide a practical list of Do’s, Don’ts and Don’t Knows about direct observation for supervisors who teach learners in the clinical setting and for educational leaders who are responsible for clinical training programs.MethodsWe built consensus through an iterative approach in which each author, based on their medical education and research knowledge and expertise, independently developed a list of Do’s, Don’ts, and Don’t Knows about direct observation of clinical skills. Lists were compiled, discussed and revised. We then sought and compiled evidence to support each guideline and determine the strength of each guideline.ResultsA final set of 33 Do’s, Don’ts and Don’t Knows is presented along with a summary of evidence for each guideline. Guidelines focus on two groups: individual supervisors and the educational leaders responsible for clinical training programs. Guidelines address recommendations for how to focus direct observation, select an assessment tool, promote high quality assessments, conduct rater training, and create a learning culture conducive to direct observation.ConclusionsHigh frequency, high quality direct observation of clinical skills can be challenging. These guidelines offer important evidence-based Do’s and Don’ts that can help improve the frequency and quality of direct observation. Improving direct observation requires focus not just on individual supervisors and their learners, but also on the organizations and cultures in which they work and train. Additional research to address the Don’t Knows can help educators realize the full potential of direct observation in competency-based education.

Frontline learning of medical teaching: \u201cyou pick up as you go through work and practice\u201d

BackgroundFew medical teachers have received formal teaching education. Along with individual and organizational barriers to participation in teacher training programs, increasing numbers and altered distribution of physicians away from major teaching centers have increased the difficulty of attendance. Furthermore, it is not known if traditional faculty development formats are the optimal learning options given findings from existing studies document both positive and negative outcomes. There is a gap in research that explores how medical teachers learn to teach and also limited research regarding how medical teachers actually teach.The purpose of this study was to provide insight into how physicians describe their teaching of trainees, and the nature of their teaching development and improvement to inform faculty development programs.MethodsSemi-structured interviews were conducted with 36 physicians, with a broad range of teaching experience, purposefully selected from five disciplines: Internal Medicine, Pediatrics, Psychiatry, Surgery, and Family Medicine. A qualitative, inductive approach was used to analyse the data.ResultsTeaching was described as being centered on the needs of individual trainees, but was dependent on patient presentation and environmental context. For this group of physicians learning to teach was perceived as a dynamic and evolving process influenced by multiple life experiences. The physicians had not learnt to teach through formal education and then put that learning into practice, but had learnt to teach and improve their teaching through their trial and errors teaching. Life experiences unconnected with the medical environment contributed to their knowledge of teaching along with limited formal learning to teach experiences. Teaching practice was influenced by peers and trainees, feedback, and observation. The findings suggest these medical teachers learn to teach along a continuum largely through their teaching practice.ConclusionThe findings suggested that the participants’ major resource for learning how to teach was informal experiential learning, both in and out of the workplace. This may have implications for faculty development strategies for medical teaching education.

Student- and learning-centred educational strategies in medical education: an Estonian example

Every family doctor will face death and grief in his/her work. Physicians usually manage problems related with symptom control. Challenge is often how to communicate with dying patients and their f...

Evaluating the effect of instruction and practice schedule on the acquisition of ECG interpretation skills.

IntroductionEvidence of the benefit of distributed instruction and interleaved practice comes from studies using simple materials (e. g. word pairs). Furthermore, there is currently no evidence of the combined impact of these strategies in undergraduate medical education. The present study evaluated the impact of varying both instruction and practice schedules for the acquisition of ECG interpretation skills.MethodsWe conducted a 2 × 2 factorial study with two levels of instruction (massed and distributed) and two levels of practice (interleaved and blocked). A three-module introductory course in ECG interpretation was delivered to 80 first year medical undergraduate students. Students were assigned to one of four Instruction-Practice conditions: Massed-Interleaved, Massed-Blocked, Distributed-Interleaved and Distributed-Blocked. Learning was evaluated by a multiple choice quiz at the end of each module and a final multiple choice quiz at the end of the course.ResultsEnd of module mean scores showed that distributed instruction was consistently superior to massed instruction (52% vs 42%, p < 0.01). However, there was no effect of practice and no interaction between teaching and practice methods. The delayed final test scores revealed an advantage for blocked over mixed practice (34% vs 24%, p < 0.05) and distributed over massed instruction (34% vs 24%, p < 0.05).DiscussionThese results suggest that these popular strategies may have varying effects with complex learning materials. Further research is required to understand how these strategies affect the learning of simple and very complex skills.Electronic supplementary materialThe online version of this article (doi: 10.1007/s40037-017-0365-x) contains supplementary material, which is available to authorized users.