The article summarizes a presentation reviewing the top medical education articles from 2016. It discusses how OSCE design factors like the number of competencies raters assess and station order can impact reliability. It also explores how narrative comments from standardized patients can identify problematic student behaviors not captured by checklists. A non-binary checklist was found to provide flexibility in scoring OSCE progress tests and allow feedback on partially completed tasks. The presentation aims to help educators incorporate innovations from the literature into their practice to improve assessment and training.
Efficacy of Information interventions in reducing transfer anxiety from a cri...Ambika Rai
Efficacy of Information interventions in reducing transfer anxiety from a critical care setting to a general ward: A systematic review and a meta-analysis
Outcome measures (OMs): Translation Process, barriers and facilitators to use...Saurab Sharma
Use of outcome measure is critical in clinical practice and research. To highlight this need, and to convey message about barriers and facilitators for the use of outcome measures and strategies to improve the use of outcome measures, I made this presentation with other 3 colleagues from different continents at World Confederation for Physical Therapy Conference in Cape Town in 2017.
Efficacy of Information interventions in reducing transfer anxiety from a cri...Ambika Rai
Efficacy of Information interventions in reducing transfer anxiety from a critical care setting to a general ward: A systematic review and a meta-analysis
Outcome measures (OMs): Translation Process, barriers and facilitators to use...Saurab Sharma
Use of outcome measure is critical in clinical practice and research. To highlight this need, and to convey message about barriers and facilitators for the use of outcome measures and strategies to improve the use of outcome measures, I made this presentation with other 3 colleagues from different continents at World Confederation for Physical Therapy Conference in Cape Town in 2017.
Power Point presentation about the article written by: Simonsen, B. et al. (2008). Evidence-Based in Practises in Classroom Management: Considerations for Research to Practise. Education and treatment of children, v31 nº3, 351-380
This course presents the students to the basics of the ethical practice of healthcare provision by the physician, and the professional standards that the students should meet in any of students’ future roles as a doctor. These roles include students’ duties as team-member, practitioner/clinician, researcher, manager/planner, educator, and patient advocate. The ethical issues surrounding these main domains are presented and discussed. The course also aims to enhance the ability of the students to develop and defend an ethical argument.
Basics of Publishing by Dr Animesh Jain @Pharmaquest 2021Animesh Jain
This presentation was done at Pharmaquest 2021 organized by Vydehi Medical College, Bengaluru on 5th August 2021. This was aimed at motivating and informing the undergraduates, postgraduate residents and PhD Scholars about the Basics of Publishing. This 40 minute capsule is in a simple and easy to understand format covering the Why, What, When, Where, Who and How of Publishing.
A presentation on what is a Medical Journal Club and its value in clinical and academic training with the headings necessary for inclusion in a PowerPoint presentation.
Also contains Hyperlinks to useful CAT sites.
Power Point presentation about the article written by: Simonsen, B. et al. (2008). Evidence-Based in Practises in Classroom Management: Considerations for Research to Practise. Education and treatment of children, v31 nº3, 351-380
This course presents the students to the basics of the ethical practice of healthcare provision by the physician, and the professional standards that the students should meet in any of students’ future roles as a doctor. These roles include students’ duties as team-member, practitioner/clinician, researcher, manager/planner, educator, and patient advocate. The ethical issues surrounding these main domains are presented and discussed. The course also aims to enhance the ability of the students to develop and defend an ethical argument.
Basics of Publishing by Dr Animesh Jain @Pharmaquest 2021Animesh Jain
This presentation was done at Pharmaquest 2021 organized by Vydehi Medical College, Bengaluru on 5th August 2021. This was aimed at motivating and informing the undergraduates, postgraduate residents and PhD Scholars about the Basics of Publishing. This 40 minute capsule is in a simple and easy to understand format covering the Why, What, When, Where, Who and How of Publishing.
A presentation on what is a Medical Journal Club and its value in clinical and academic training with the headings necessary for inclusion in a PowerPoint presentation.
Also contains Hyperlinks to useful CAT sites.
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General Research Perspective And Type
3. Research Design and Methodology
General Research Perspective and Type
Using a mixed quantitative and qualitative survey research design, this paper examines the trends in a written open ended survey allowing the respondents to convey their unique perspective. This will allow for a high quality of information from OT practitioners serving in different regions with varied experience. The following subquestions were asked: What are the biggest obstacles facing Occupational Therapy in the school system? Which skills are underutilized in the school system by OT practitioners? Do you feel the role of OT is understood by your co workers? Are you satisfied with your job? The answers to these sub questions are analyzed and examined in this paper.
Research Context and Participants
The mixed quantitative and qualitative surveys were completed online at random through two closed social media groups: School based Occupational Physical Therapists and Pediatric Occupational Therapists. The following criteria had to be met, 1. Participant needed to be an OT or OTA, 2. Participant needed to be practicing in a school based setting. All of the participants questions were self recorded on the online survey. Participants were free to add any additional comments to the survey.
Instruments for Data Collection
Data was collected during the online survey and added to a spreadsheet. The order of questions were given in the order provided below in a open question model with room for comments
Get more content on HelpWriting.net
Evidence-Based Professional Nursing PracticeChapte.docxturveycharlyn
Evidence-Based
Professional
Nursing Practice
Chapter 10
Evidence-Based Practice:
What Is It?
• Evidence-based practice (EBP) is a
framework used by nurses and other
healthcare professionals to deliver optimal
health care through the integration of best
current evidence, clinical expertise, and
patient/family values
Why Is EBP Relevant in Nursing? (1 of 2)
• Helps resolve problems in the clinical setting
• Results in effective patient care and better
outcomes
• Contributes to the science of nursing through
the introduction of innovation to practice
• Keeps practice current and relevant by helping
nurses deliver care based upon current best
research
Why Is EBP Relevant in Nursing? (2 of 2)
• Decreases variations in nursing care and
increases confidence in decision making
• Supports Joint Commission on Accreditation
of Healthcare Organizations (JCAHO)-
readiness since policies and procedures are
current and include the latest research
• Supports high quality patient care and
achievement of Magnet status
Steps in the EBP Process (1 of 2)
• Cultivate a spirit of inquiry and culture of EBP
among nurses and within the organization
• Identify an issue and ask the question
• Search for and collect the most relevant and
best evidence to answer the clinical question
Steps in the EBP Process (2 of 2)
• Critically appraise the evidence and synthesize
the evidence
• Integrate evidence with clinical expertise and
patient preferences to make the best clinical
decision
• Evaluate the outcome of any EBP change
• Disseminate the outcomes of the change
Barriers to EBP in Nursing (1 of 3)
• Lack of value for research in practice
• Difficulty in changing practice
• Lack of administrative support
• Lack of knowledgeable mentors
• Insufficient time
• Lack of education about the research process
• Lack of awareness about research or EBP
Barriers to EBP in Nursing (2 of 3)
• Research reports/articles not readily available
• Difficulty accessing research reports and articles
• No time on the job to read research
• Complexity of research reports
• Lack of knowledge about EBP
• Lack of knowledge about the critique of articles
Barriers to EBP in Nursing (3 of 3)
• Feeling overwhelmed by the process
• Lack of sense of control over practice
• Lack of confidence to implement change
• Lack of leadership, motivation, vision,
strategy, or direction among managers
Promoting EBP: Individual Nurse
• Educate yourself about EBP
• Conduct face-to-face or online journal clubs,
share new research reports and guidelines with
peers, and provide support to other nurses
• Share your results through posters, newsletters,
unit meetings, or a published article
• Adopt a reflective and inquiring approach to
practice
Strategies to Promote EBP:
Organizations
• Specific identification of the facilitators and
barriers to EBP
• Education and training to improve
knowle.
Evidence-Based Professional Nursing PracticeChapte.docxelbanglis
Evidence-Based
Professional
Nursing Practice
Chapter 10
Evidence-Based Practice:
What Is It?
• Evidence-based practice (EBP) is a
framework used by nurses and other
healthcare professionals to deliver optimal
health care through the integration of best
current evidence, clinical expertise, and
patient/family values
Why Is EBP Relevant in Nursing? (1 of 2)
• Helps resolve problems in the clinical setting
• Results in effective patient care and better
outcomes
• Contributes to the science of nursing through
the introduction of innovation to practice
• Keeps practice current and relevant by helping
nurses deliver care based upon current best
research
Why Is EBP Relevant in Nursing? (2 of 2)
• Decreases variations in nursing care and
increases confidence in decision making
• Supports Joint Commission on Accreditation
of Healthcare Organizations (JCAHO)-
readiness since policies and procedures are
current and include the latest research
• Supports high quality patient care and
achievement of Magnet status
Steps in the EBP Process (1 of 2)
• Cultivate a spirit of inquiry and culture of EBP
among nurses and within the organization
• Identify an issue and ask the question
• Search for and collect the most relevant and
best evidence to answer the clinical question
Steps in the EBP Process (2 of 2)
• Critically appraise the evidence and synthesize
the evidence
• Integrate evidence with clinical expertise and
patient preferences to make the best clinical
decision
• Evaluate the outcome of any EBP change
• Disseminate the outcomes of the change
Barriers to EBP in Nursing (1 of 3)
• Lack of value for research in practice
• Difficulty in changing practice
• Lack of administrative support
• Lack of knowledgeable mentors
• Insufficient time
• Lack of education about the research process
• Lack of awareness about research or EBP
Barriers to EBP in Nursing (2 of 3)
• Research reports/articles not readily available
• Difficulty accessing research reports and articles
• No time on the job to read research
• Complexity of research reports
• Lack of knowledge about EBP
• Lack of knowledge about the critique of articles
Barriers to EBP in Nursing (3 of 3)
• Feeling overwhelmed by the process
• Lack of sense of control over practice
• Lack of confidence to implement change
• Lack of leadership, motivation, vision,
strategy, or direction among managers
Promoting EBP: Individual Nurse
• Educate yourself about EBP
• Conduct face-to-face or online journal clubs,
share new research reports and guidelines with
peers, and provide support to other nurses
• Share your results through posters, newsletters,
unit meetings, or a published article
• Adopt a reflective and inquiring approach to
practice
Strategies to Promote EBP:
Organizations
• Specific identification of the facilitators and
barriers to EBP
• Education and training to improve
knowle ...
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
1. Top Articles in Medical
Education 2016: Applying the
Current Literature to
Educational Practice and
Scholarship
Donna D’Alessandro, MD
Steve Paik, MD, EdM
Mike Ryan, MD, MEHP
Teri Turner, MD, MPH, MEd
H. Barrett Fromme, MD, MHPE
Leora Mogilner, MD
Alix Darden, PhD, Med
8 May 2017
3. Goal
•Broadly review the medical education
literature of 2016 to select the top articles
that could impact practice
4. Objectives
By the end of the session, participants will be able to:
• List major thematic areas of investigation and publication
in medical education for the year 2016
• Discuss the outcomes of the top articles in medical
education in 2016
• Formulate approaches to incorporating medical education
innovations into their own practice.
• Identify areas of scholarly interest for themselves for
further reading, curricular application, and innovative
scholarship
5. Road Map for Session
•Who We Are
•Methods
•Topic Areas
•Key Point
•Methods
•Results
•Summary
•Question and Answers
6. The Team
• H. Barrett Fromme, MD, MHPE, University of Chicago
• Director of Faculty Development in Medical Education, Assoc Residency PD
• Alix Darden, PhD, MEd, University of Oklahoma Health Sciences Center
• Director of Faculty Development, Dept of Pediatrics
• Donna M D’Alessandro, MD, University of Iowa
• Educator of Residents and Students
• Michael S Ryan, MD, MEHP, Virginia Commonwealth University
• Assistant Dean for Clinical Medical Education
• Leora Mogilner, MD, Icahn School of Medicine at Mount Sinai
• Director of Advocacy and Community Pediatrics
• Teri L. Turner, MD, MPH, MEd, Baylor College of Medicine
• Vice Chair of Education, Department of Pediatrics
• Steve Paik, MD, EdM, Columbia University School of Medicine
• Pediatric Residency Program Director
7. Inclusion Criteria
•Relevant to academic pediatricians
•Could change practice at individual or
programmatic/institutional level
8. Journals Reviewed
• Academic Medicine
• Academic Pediatrics
• BMC Education
• Journal of the American Medical Association
• Journal of General Internal Medicine
• Journal of Graduate Medical Education
• Medical Education
• Medical Education Online
• Medical Science Educator - IAMSE
• Medical Teacher
• NEJM
• Pediatrics
• Teaching & Learning in Medicine
9. Methods, Stage 1
•Seven medical educators reviewed journals
•Two authors read all titles/abstracts in each
journal to find articles that met inclusion
criteria
10. Methods, Stage 1
•Two authors for each journal selected abstracts of
interest
•Each reviewed combined article titles and scored:
• 0 = not relevant
• 1 = may be relevant
• 2 = highly relevant
•All four point abstracts automatically advanced
•All three point abstracts discussed for inclusion
•Articles organized into general themes
11. Methods, Stage 2
•Each abstract assigned to two reviewers to read full
article
•Each full article was scored:
• 0 = do not consider, will not change practice
• 1 = consider, could change practice
• 2 = definitely include, will change practice
•All four points articles automatically included
•All three point articles discussed for inclusion
•Occasional two point article included if
complementary to other article
12. Final Stage
•Final articles grouped by topics
• Summary and slides created
• Peer reviewed by two members of group
13. Selection Process
6339 abstracts
13 journals
251 abstracts
selected for
discussion
56 articles
selected for
review
20 articles for
presentation
36 not presented
179 not selected
6104 not
discussed
16. Selecting and Simplifying: Rater
Performance and Behavior When
Considering Multiple Competencies
Tavares W. et al
Teaching and Learning in Medicine 2016; 28:1, 41-51
17. Key Point
•When raters are asked to consider multiple
competencies and attend to multiple issues
simultaneously, they may become
overwhelmed, which can negatively affect
the validity of the assessment
18. What They Did
•Purpose: To examine the impact of increasing task
demands on raters on rating quality
•85 experienced faculty members observed and rated 3
videotaped clinical performances
• Half rated 7 dimensions of performance (7D) and half rated 2 dimensions (2D)
• Half were also required to rate the actor’s performance in the simulation
(“distracting task”)
•Data collected:
• Interrater reliability
• Quantification of the number of behaviors used to inform ratings
• 7D participants were interviewed to explore the strategies they used when rating
under conditions that may have felt overwhelming
19. What They Found
•2D group IRR > 7D IRR
•Internal consistency similar
•2D group identified more behaviors of relevance
than the 7D group in common dimensions
• History Gathering
• Procedural Skills
20. What They Found
•7D raters identified various cognitive strategies they
used to complete the tasks
• Simplification
• Prioritization/selection
•Strategies were idiosyncratically applied and may
contribute to rater error
21. Why We Chose It
•Having to rate too many aspects of a
student’s behavior can diminish the reliability
of these ratings
•It is important to consider the rating
demands imposed on faculty when
developing assessment tools
22. Do Standardized Patients have
Concerns About Students Not
Captured by Traditional Assessment
Forms?
Blatt B. et al
Teaching and Learning in Medicine 2016;28:4, 395-405
23. Key Point
•A narrative assessment method may add
value to the traditional quantitative score by
identifying and characterizing problematic
student behaviors not captured by the
traditional assessment form
24. What They Did
• Purpose: To explore standardized patients (SP’s) "off the record"
concerns about students not captured via checklists
• Added a “Concerns” item to a traditional assessment form for an
end of third-year clinical skills examination
• SP’s asked to identify students about whom they had “gut level”
concerns and provide narrative comments to explain why
• Six SP cases were delivered to 551 students at three medical
schools
• “Concerns” data was analyzed quantitatively and qualitatively
25. What They Found
• 40% of students had one concern identified and 13% of
students had 2 or more concerns
• 3 major areas of concern: communication and interpersonal
skills (60%), history taking (23%) and physical exam (17%)
• In the group with 2 or more concerns (N=58), SP comments
identified potential clinical problems not identified by scores
on the traditional assessment form
Assessment Domain Students passing a domain on the
traditional form who had at
least 1 concern by SP
Communication/Interpersonal 84% (27/32)
History 42% (18/43)
Physical 48% (20/42)
26. Why We Chose It
•The "Concerns" item has the potential to
identify "at-risk" students not captured with
traditional forms
•These comments provide educators with a
unique assessment perspective and may
have implications for the teaching of
communication/interpersonal skills in clinical
skills courses
27. OSCE Circuit Performance Effects:
Does Circuit Order Influence Scores?
Monteiro S. et al
Medical Teacher 2016; 38:1, 98-100
28. Key Point
•The order of stations within an OSCE did not
have an impact on overall performance
29. What They Did
•Purpose: To see if order of stations in an OSCE
affects scores
•Analyzed almost 1000 exam scores from six different
OSCEs administered to undergraduate medical
students at McMaster University looking for potential
positive or negative effects of circuit order on
performance
•Conducted ANOVAs to evaluate performance
aftereffects following the highest scoring station and
the lowest scoring station
30. What They Found
•The negative or positive feedback a subject
received in one station did not have a
significant impact on subsequent
performance. Thus, there was no difference
between subjects’ scores based on circuit
order.
31. Why We Chose It
•This study reassures us that typical OSCE
design does not bias outcomes in favor of
certain groups of students
•We do not need to be overly concerned
about circuit order when designing OSCEs
32. Done or Almost Done? Improving
OSCE Checklists to Better Capture
Performance in Progress Tests
Pugh D. et al
Teaching and Learning in Medicine 2016; 28:4, 406-414
33. Key Point
•A non-binary checklist can be a useful tool for
scoring OSCE progress tests as it provides
flexibility to raters and allows for provision of
feedback about items that were attempted
versus done correctly
34. What They Did
• Purpose: To analyze the consequences of using nonbinary checklists
for scoring OSCE progress tests
• Non-binary checklists used for two Internal Medicine OSCE progress
tests (nonprocedural and procedural) at one institution; 119 tests
included
• Items were rated as either “done satisfactorily,” “attempted” or “not
done”
• Analyzed the impact of different scoring methods varying in
stringency (hawk, dove and hybrid) using these checklists;
determined which scoring method was best suited for a given task
• Compared difficulty, reliability, item-total correlations and pass rates
using the three scoring methods
35. What They Found
•Mean OSCE scores were highest when calculated
using the dove method and lowest using the hawk
method
•Overall score reliability did not differ significantly
between the three methods
•Discrimination, as measured by ITC, differed as a
function of the scoring method
•There was a main effect of PGY level regardless of
scoring method used, suggesting that all three
methods could differentiate between PGY levels
36. Why We Chose It
•OSCE progress tests, which are used to
measure the progression of clinical skills over
time, are relatively new
•This study provides insight into how to best
design and score OSCE progress tests to assess
the clinical skills of examinees at different
levels of training
37. Section Summary
• The quality of learner assessment obtained from OSCE's may
be affected by a variety of factors:
• Raters
-Having to rate too many aspects of a learner's performance
may adversely affect rating quality
• Standardized patients
-Narrative comments from standardized patients can
provide a unique assessment perspective
• Test format
-Non-binary checklists can enhance the information obtained
from OSCE’s
-Circuit order does not affect overall outcome
39. Direct Observation of Clinical Skills
Feedback Scale: Development and
Validity Evidence
Halman S, Dudek N, Wood T, et al
Teaching and learning in medicine. 2016;28(4):385-394
40. Key Finding
•The Direct Observation of Clinical Skills
Feedback Scale (DOCS-FBS) is an instrument
which can be used to assess verbal feedback in
a clinical setting.
•The authors provide validity evidence for scores
from this instrument.
41. What They Did
•Purpose: To develop and obtain validity evidence for a
rating scale designed to assess the quality of verbal
feedback provided in the clinical setting
•Three phases:
1) Determined features of high-quality feedback using
nominal group technique
2) Developed the DOCS-FBS scale
3) Assessed the DOCS-FBS scale
for validity evidence
42. What They Found
•Phase 1: Identified 12 features of highly
effective feedback
•Phase 2: Generated a 9 item scale called “The
Direct Observation of Clinical Skills Feedback
Scale” (DOCS-FBS)
•Phase 3: Demonstrated validity evidence
from 3 sources (content, response process,
and internal consistency)
43. DOCS-FBS
1. Offers the learner an opportunity to reflect before feedback is provided
1. Trainee not given
opportunity to reflect on
performance
2. Trainee asked about
performance but not given
opportunity to reflect
3. Trainee allowed to reflect on
performance and to discuss
2.Feedback was provided in a respectful manner
1. threatening, judgmental or
belittling tone
2. Non-threatening tone but
perhaps judgmental or
provided in inappropriate
environment
3. Non-threatening or judgmental,
preceptor adapts to trainee reactions,
appropriate non-verbal language and
culturally sensitive
3. Appropriate communication style
1. Preceptor delivers message
in manner that is obviously not
well understood by trainee
2. Preceptor uses appropriate
communication style but some
elements lacking
3. Preceptor involves trainee in
conversation and adapts communication
style as required
4. Feedback focused on a specific behavior
1. No specific behavior was
identified only general
statements provided
2. A modifiable behavior was
identified but no or limited
feedback was provided
3. Preceptor identifies a specific
behavior and bases feedback around
this.
44. 5. Feedback was constructive
1. No suggestions geared
toward identified behavior
2. Concise issue raised but limited
suggestions provided to trainee
3. Concise issues identified and
trainee provided with information
to close a gap in knowledge
6. Ends with an action plan with goal to modify or reinforce an observed behavior
1. Feedback terminated
with no plans for follow-up
or reevaluation.
Broad action plan is suggested but
no specific to behavior or
encounter.
Clear plan to modify or reinforce a
behavior.
7.Limited to a manageable number of points (generally 2-3)
1. No points or too many
identified.
Attempted to limit to manageable
number of points but room for
improvement
Limited to a manageable number
of points that were appropriate for
training level
8. Appropriate time allotted to give feedback
1. Feedback rushed or too
lengthy.
2. Appropriate amount of time set
aside but certain issues rushed or
belabored
3. All issues addressed with
appropriate time, opportunity to
address pertinent points raised.
9. Preceptor verifies understanding of feedback
1. No verification of
understanding of points
raised during feedback
2. Preceptor verifies
understanding but does not
provide adequate clarification as
needed
3. Preceptor verifies understanding
and offers adequate clarification as
needed
45. Why We Chose It
•High quality feedback is vitally important to trainees
learning and has been shown to improve the quality of
their work
•Many faculty do not provide high quality feedback even
when provided faculty development
•This instrument provides a valid method to easily
evaluate faculty giving feedback – providing valuable
feedback on feedback!
46. Identifying educator behaviors for
high quality verbal feedback in health
professions education: literature
review and expert refinement.
Johnson CE, Keating JL, Boud DJ, et al.
BMC Med Educ. 2016;16:96.
47. Key Finding
•Identified the key elements of an educator’s
role in high quality verbal feedback in clinical
practice
•Developed a set of observable feedback
behaviors that could engage, motivate and
enable a learner to improve their clinical
performance
48. What They Did
•Purpose: To determine the components
required by educators to engage, motivate,
and enable a learner to improve his/her skills
•Two stages:
1) Conducted literature review using a “snowball
technique”
2) Created and refined educator behaviors using a Delphi
technique
49. What They Found
•Identified 18 distinct elements and 25 educator
behaviors to facilitate effective verbal feedback in
clinical practice
•Organized in 4 themes
1. The learner has to “do the learning”
2. The learner is autonomous
3. The importance of the learner-educator relationship
4. Collaboration
50. Why We Chose It
•Effective verbal feedback is critical in work-
based learning but problems with the current
practice are common
•Evidence-based tools of observable feedback
behavior provide a systematic method to
improve work-based feedback and thus
learning.
51. Can Individualized Learning Plans in
an advanced clinical experience
course for fourth year medical
students foster Self-Directed
Learning?
Chitkara MB, Satnick D, Lu W-H, Fleit H, Go RA,
Chandran L.
BMC Med Educ. 2016;16(1):232
52. Key Finding
•Individualized learning plans (ILPs) improve
self-directed learning (SDL) strategies among
medical students.
•They may serve as useful tools to help shape
future learning goals as students transition to
residency training.
53. What They Did
• Purpose: To determine the impact of ILPs on SDL for fourth
year medical students
• Mixed methods study at Stony Brook University
• Context: Advanced Clinical Experience (ACE)
• All students given time to complete ILP
• Given 1 week to pursue independent learning goals
•Data collected from convenience sample who
completed Pediatrics or Internal Medicine ACE
• Motivated Strategies for Learning Questionnaire (MSLQ) – pre/post
• Self-report surveys
• ILP’s
• End-of-course reflective essays
54. What They Found
MSLQ self
directed learning
domains
Overall
Mean (SD)
Pediatrics
Mean (SD)
Medicine
Mean (SD)
Self-Efficacy (pre
ACE)
5.1 (.86) 5.0 (.98) 5.2 (.73)
Self-Efficacy (post
ACE)
5.4 (.85)** 5.3 (.98) 5.5 (.68)
Self-Regulation
(pre ACE)
4.9 (.83) 5.0 (.88) 4.8 (.79)
Self-Regulation
(post ACE)
5.2 (.88)** 5.3 (.87) 5.1 (.89)
**p <0.01
MSLQ results of students pre and post the ACE Course
55. What They Found
Completion of ILP and Perceptions of Preparedness
Survey items Overall (n=48)
Completely achieved ILP goals
‘No’ (n=25) ‘Yes’ (n=23)
Prepared for residency (Rate 1–5), no. (%) – Pre ACE
1-3 ratings 31 (65 %) 17 (68 %) 14 (61 %)
4-5 ratings 17 (35 %) 8 (32 %) 9 (39 %)
Prepared for residency (Rate 1–5), no. (%) – Post ACE
1-3 ratings 16 (33 %) 12 (48 %) 4 (17 %)
4-5 ratings 32 (67 %) 13 (52 %) 19 (83 %)
56. What They Found
Qualitative analysis themes
1. Identifying personal strengths and weaknesses
“It forced me to highlight some of my deficits and/or knowledge
gaps, which is something I may not have done on my own”
2. Preparation for residency
“It gave me a chance to balance the clinical duties and educational
workload of a resident with same “real-life” responsibilities I will be
facing as an intern”
3. Acknowledging challenges and limitations
“realizing that I could not fully accomplish all my goals in a 1-month
period... I overcame these challenges by telling myself to just put in
a decent effort each day without getting discouraged”
57. Why We Chose It
•Activities that require students to
reflect on their learning needs and
develop learning goals are needed
throughout their medical education.
•These activities promote of the
development of life-long learning
skills.
58. Practical Suggestions for the Creation
and Use of Meaningful Learning Goals
in Graduate Medical Education
Reed S, Lockspeiser TM, Burke A, et al
Academic Pediatrics. 2016;16(1):20-24
59. Key Finding
•The development and use of learning goals by
trainees helps develop their lifelong learning
skills.
•A variety of practical strategies for implementing
learning goals for each stakeholder is provided.
60. What They Did
•Purpose: To provide practical guidance on how to
develop and use learning goals
•Perspective from the APPD, developed from:
• Collective experiences at the local level
• Prior research of the authors
• Review of the literature
• Interviews and Focus Groups
61. What They Found
Learner Faculty Environment
• Many settings
• Specific structure
• Schedule time
• Emphasize value
• Share
• Provide questions
• Create own goals
• Role play
• Address barriers
• Documentation
• Time and resources
62. Why We Chose It
•Need to promote life-long learning skills in
trainees
•Needs to be a multipronged approach
•Knowing a variety of strategies is useful
Life-long
learner
63. Section Summary
•Quality of verbal feedback can be assessed using
the DOCS-FBS instrument
•A series of observable behaviors can be used to
engage, motivate and enable a learner to
improve his/her clinical performance
•Life-long learning skills can be developed early in
training and best practices for all stakeholders
have been identified
65. A National Survey of Pediatric Residents’
Professionalism and Social Networking:
Implications for Curriculum
Development
Kesselheim JC, at al.
Acad Peds. 2016; 16:110-114.
66. Key Finding
•Disconnect between pediatric resident
attitudes and actions in social media use
•Educational interventions for social media
use are likely increasing in pediatric
residencies
67. What They Did
•Purpose: To characterize pediatric residents’
experience related to social networking and compare
that to program director data
•Survey of categorical pediatric residents from 13
programs
•Questions regarding:
• Familiarity with social networking sites (SNS)
• Perceptions of professionalism on SNS
• Educational interventions regarding SNS
•Compared to prior PD data
68. What They Found
0% 20% 40% 60% 80% 100%
Comments about peers
Comments about staff
Comments about patients
Comments about workplace
Comments about self
Thoughts/Observations
Never
1-4 times
>4 times
How often residents’ reported incidence of inappropriate SNS
posts over the past year
69. What They Found
How often residents’ reported incidence of inappropriate SNS posts over the past year
Activity
Frequency with which other
residents engage in activity
Perceived appropriateness
Never Monthly Daily Completely
Inappropriate
In-Between Completely
Appropriate
“Friending” 2% 44% 50% 0% 9% 90%
Joining social network 9% 38% 39% 1% 11% 89%
Friending colleague or peer 2% 60% 34% 0% 13% 87%
Posting thoughts/observations 34% 41% 4% 22% 61% 17%
Posting comments re:
workplace/workplace issues
37% 54% 3% 51% 48% 1%
Friending current patients/families 86% 4% 0% 89% 10% 0%
Friending former patients/families 87% 4% 0% 72% 28% 0%
70. Why We Chose It
•SNS Education needs to be expanded that is:
•Case-based, longitudinal
•Utilizes residents in the development and
teaching
•Emphasizes peer regulation
•Models exemplary behaviors as well as what not
to do
71. Speaking up: using OSTEs to
understand how medical students
address professionalism lapses
Tucker CR, at al.
Med Educ Online. 2016; 21:1-11.
72. Key Finding
• M4 students did not consistently address
professionalism lapses by their peers when
assessed in an OSTE
• Lapses related to procedural issues or
technical skills were more likely addressed
than personal issues or cultural competency
73. What They Did
•Purpose: To determine how M4 students address
professionalism lapses when they are purposefully
incorporated into an OSTE
•Mixed methods analysis of OSTE data over 2 year
period
•OSTE structure
• M4s watched video encounter of an standardized learner (M1 level)
performing an exam
• M4 provided feedback to standardized learner
• Faculty and standardized learner completed checklist
• Debriefing sessions recorded and transcribed
75. What They Found
Easy to provide feedback Difficult to provide feedback
“Procedural” issues (e.g.
hand-washing, draping)
Interpersonal skills
History and physical
examination performance
Personal dress/attire
Cultural competency
76. Why We Chose It
•Peer feedback on professionalism is difficult
•Certain areas pose greater challenges
•Context impacts responses to
professionalism lapses
77. Section Summary
•Professionalism is a broad and diverse topic
for trainees, that goes beyond direct patient
care
•Peer regulation may be valuable, but it is
difficult
•Effective educational strategies are essential
80. Clinical Teaching As Part of Continuing
Professional Development:
Does Teaching Enhance
Clinical Performance?
Jodelyn M. Lockyer, Carol S. Hodgson, Tzu Lee, et.al.
Medical Teacher. 2016;38(8):815-22.
81. Key Finding
•Physicians who have higher clinical
performance assessments spend more time
teaching
Teaching
Patient
Care
82. What They Did
• Purpose: To determine if there were differences in
physician clinical performance based on clinical
teaching when assessed through multisource
feedback
• Quantitative study of the Physician Achievement
Review (PAR) program of the College of Physicians
and Surgeons of Alberta, Canada. Surveys of clinical
performance as evaluated by colleagues, co-workers
and patients
• PAR data was analyzed by physician specialty,
academic appointment and time teaching
83. What They Found
Academi
c Appt
None
Academic
Appt
Full Time
Academic
Appt
P Value
Teaching Percent
0%
Teaching
Percent
15%
Teaching
Percent
P value
Family
Medicine
N=1831
PAR = 13, 526
4.43 4.64 0.001 4.43 4.53 0.001
Medical
Specialists
N=1510
PAR = 11,253
4.46 4.53 0.001 4.42 4.54 0.01
Surgeons
N=542
PAR= 4073
4.52 4.63 0.01 4.57 4.58 N.S.
PAR Data for Medical Colleagues
84. Why We Chose It
•This is a large data set
from multiple sources
•It’s outcome is simple
but clearly shows an
association between
improved higher clinical
performance ratings and
teaching
Teaching
Patient
Care
85. Ward Rounds With or Without an
Attending Physician: How Interns
Learn Most Successfully
L. Barry Seltz, MD, Erin Preloger, MD, Janice L. Hanson,
PhD, EdS, Lindsay Lane, BM, BCh
Acad Pediatr. 2016 Sep-Oct;16(7):638-44.
86. Key Findings
•Notable and unique contributions to learning
occurs when the attending is present and
absent
•During rounds, interns learn best when actively
engaged
Image: Tim Foley, UVA
Magazine
87. What They Did
• Purpose
1) To explore educational value of ward rounds for interns
2) To compare value with/without the attending present
• Qualitative study of 20 Pediatric interns from University of
Colorado
• Compared experiences at 2 clinical sites
• Site 1: Interns rounded with attending in FCR format
• Site 2: Interns rounded with senior resident only
• Semi-structured interviews, using grounded theory, analyzed
using constant comparative method
88. What They Found
Theme Subthemes
What is being learned 1. Learning related to patient care
2. Learning relate to leading a team
Learning environment 1. Rounds without an attending
2. Rounds with an attending
Learning and work balance
Way interns learn 1. Self-directed learning
2. Interactive learning
3. Experiential learning
89. What They Found
Attending Present Attending Absent
• Broader concepts
• EBM
• More formal, stress may promote
learning
• Less time efficient
• Practical, day-to-day management
• Less formal may increase learning
and autonomy
• Collaborative learning
• More time efficient
“Learning is optimized from experiencing ward
rounds with and without an attending physician”
90. What They Found
Interns learn best by active engagement:
1. Patient care discussions
2. Physical examination demonstrations
3. Visual learning (e.g. radiograph review)
4. Purposeful questioning in supportive environment
5. “Short and Sweet” teaching pearls
91. Why We Chose It
•Highlights value in both
types of rounds - attending
present and absent
•Illuminates what learning
occurs on the inpatient
wards
•Implications for staffing,
faculty development, and
residents as teachers
programs
Image: Cook County Hospital
92. Promoting Resident Autonomy During
Family-Centered Rounds: A
Qualitative Study of Resident,
Hospitalist, and Subspecialty
Physicians
Jimmy Beck, MD, MEd, Terry Kind, MD, MPH, Rebecca
Meyer, MD, MEd, Priti Bhansali, MD, MEd
J Grad Med Educ. 2016 Dec;8(5):731-738.
93. Key Finding
•Attending behaviors were identified which
promote resident autonomy before, during,
and after family-centered rounds
Image: University of Michigan
94. What They Did
•Purpose: To identify strategies used by attending
physicians to promote resident autonomy during
family centered rounds (FCR)
•Qualitative study of 10 attendings and 14
residents from Children’s National Health
System
•Semi-structured interviews of attendings, focus
group discussions with residents. All coded and
themed using qualitative content analysis
95. What They Found
•Residents and attendings had similar views
on ways to promote resident autonomy
•Thirteen themes identified, organized into
categories based on timing
96. What They Found
1) Set
expectations
2) Non-verbal
signals
1) “Huddle”
2) Plan rounds
1) Deliberate
positioning
2) Orient
families
3) Relinquish
control
4) Delegate
teaching
5) Flexibility
6) Probe for
rationale
7) Use silence
1) Promote
reflection
2) Facilitate
feedback
Start of
rotation
Before FCR During FCR After FCR
97. Why We Chose It
•These strategies are easy
to understand and to
apply practically
•Could be used for faculty
development programs,
or fellow and resident
training in education
Image from University of Iowa
98. Section Summary
•Faculty – there are educational benefits to rounding
both with and without attendings
•Family – faculty have a specific behaviors that
promote resident autonomy during FCRs
99. Leveraging milestones to enhance
training outcomes across the medical
education continuum
Teri Turner, MD, MPH, MEd
100. Reporting Achievement of Medical
Student Milestones to Residency
Program Directors: An Educational
Handover
Sozener C.B. et al.
Academic Medicine. 2016; 91:676-684
101. Key Finding
•It is feasible to assess medical student attainment
of specialty specific milestones prior to the start
of residency.
•A post-match milestone assessment can provide
program directors information on strengths and
weaknesses of incoming trainees.
102. What They Did
•Purpose: To assess the feasibility of an educational
handover from UME – GME within programs at U of
Michigan
•Used existing student assessment data and mapped
to the EM milestones
•Assigned milestone achievement levels for each
student
•Sent this data as a 2nd “Dean’s letter” to program
directors post-match
103. What They Found
•Handover tool was feasible
•Assessed all but 3 of the 23 EM milestones
•PDs felt they could use handover tool for residency
intervention
0
4
1
5
1
4
0
1
2
3
4
5
Used data from current
MSPE for adapting
residency training
Handover document
provided new info
Handover document would
allow for residency
intervention
Yes No
NumberofPDs
PDs thoughts on MSPEs and New
Handover Document
104. Why We Chose It
•Method to improve communication and standardize
assessment about student competency prior to
residency training
•Provide information on strengths and weaknesses
•Allow for early intervention and thus optimization of
GME training
105. The Community Health and Advocacy
Milestones Profile (CHAMP): A Novel
Tool Linking Community Pediatrics
and Advocacy Training to Assessment
of Milestones-Based Competence in
Pediatric Residency Training
Hoffman B.D. et al.
Academic Pediatrics. 2016; 16:309-313
106. Key Finding
•A tool which connects milestones to training
objectives in community health and advocacy
•A method for program evaluation and
improvement
•A model for mapping curricula to milestones
107. What They Did
•Purpose: link Community Pediatrics and Advocacy
objectives to assessment of milestones
•10 participants in randomly selected pairs matched 250
objectives to 5 competency domains (1 pair/domain)
•18 of 41 colleagues participated in a modified Delphi
process for consensus on matches
•Removed all matches with a mean of < 3.5
•Compiled data into a Community Health and Advocacy
Milestones Profile (CHAMP) Mapping Tool
109. Why We Chose It
•No need to “reinvent the wheel”
•Assessment guide – maps
objectives in community
health/advocacy to 12 of the 21
milestones
•Helps identify gaps in training
110. Competency Evaluations in the Next
Accreditation System: Contributing to
Guidelines and Implications
Park Y.S. et al.
Teaching and Learning in Medicine. 2016; 28(2):135-145
111. Key Finding
•Assessments in GME need to be considered
within a “systems framework” to inform
competency decisions
•Ten guidelines for using end-of-rotation
evaluations for measuring and assessing
milestones
112. What They Did
•Purpose: To examine validity evidence of end-of-
rotation evaluation scores to measure competencies
and milestones
• Response process (by rater and by delays in evaluating)
• Internal structure
• Relations to other variables
• Composite score reliability in an assessment system
•Reviewed 2,701 evaluations for 142 IM residents for
21/22 IM milestones
113. What They Found
•Faculty showed the greatest ability to discriminate
differences
•Fellows and peers provide unique perspectives for
Professionalism and ICS
•Delayed evaluations - greater likelihood of raters
assigning the same scores across items
•Higher correlations between PC, MK and PBLI
•Combining rotation evaluation scores improves
reliability
114. Why We Chose It
•Provides practical and useful guidelines for workplace-
based assessment
• Obtain 10 or more evaluations for use during CCC
• Make decisions at the core-competency level
• Examine trends to project growth and identify problems
• Promote rater training
• Support data collection and monitoring
115. Section Summary
•It is feasible to handover learners from UME to GME
using specialty specific milestone based assessments
•There are tools to help us map objectives to
milestones within competency domains
•Using guidelines for end-of-rotation evaluations can
facilitate and improve decisions on resident progress
117. Number Needed to Eat:
Pizza and Resident Conference
Attendance
Michael J. Cosimini, Liza Mackintosh, Todd P. Chang
Med Educ. 2016 Dec;50(12):1204-1207
118. Key Finding
•Providing food at conferences resulted in a
modest improvement in conference attendance
•The “Number needed to eat” was 10.6
119. What They Did
• Purpose: To determine the value of providing food at resident
educational conferences
• Retrospective study at a single university-based center
• Pizza was provided 2 Fridays/month at noon conference
• Attendance tracked electronically through badge swipe
• Compared overall attendance, arrival time, and percent arriving on time
during occasions in which food was provided vs. not provided
• Number Needed to Eat = residents provided with food
additional residents present
120. What They Found
Resident Year Food
(N=20) %
No Food
(N=16) %
PL 1 (N=32) 41.8% 40.2%
PL 2 (N=31) 29.2% 25.7%
PL 3 (N=27) 33.1% 26.9%
Total (N=90) 35.0% 31.3%
• Overall attendance increased 3.7% when food was provided
= 3.33 residents, p = 0.04
• Number Needed to Eat = 10.6
• Total cost = $46/for each additional resident to attend
121. What They Found
Resident Year Food
Mean Minutes Late
No Food
Mean Minutes Late
PL 1 (N=32) 4.1 5.86
PL 2 (N=31) 3.4 3.83
PL 3 (N=27) 3.78 3.13
Total (N=90) 3.82 4.59
• On-time arrivals (before 12:05) increased 11% when food was
provided (p <0.0001)
122. What They Found
•Food increased conference attendance but was
minimally effective, probably not cost-effective
•Authors make other points by noting
• “Costs were … increased by the consumption of pizza by
financially strapped medical students and academic
paediatricians...”
• Lead author even has a conflict of interest…
123. What They Found
•The authors may be overlooking some
important points:
• Arrival times – attendees are there for more of the
conference
• Why is the high NNE of 10 bad?
• Other benefits of food – meal sharing is one of the most
fundamental social interactions among humans across time and
space
124. Why We Chose It
•Spark discussion about
the cost-benefit of this
as a strategy for an
improved educational
environment
•Lots of people would be
interested because of
the culinary theme
Image: Glassdoor
125. National Cluster-Randomized Trial of
Duty-Hour Flexibility in Surgical
Training
Bilimoria KY, et al.
N Engl J Med 2016; 374: 713-727
126. Key Finding
•Flexible duty-hour policies were non-inferior
to current ACGME (pre 2017) policies
•Patient outcomes – non-inferior
•Well-being and educational quality – no
significant difference
127. What They Did
• Purpose:
• To compare ACGME duty hour policy to a flexible
policy to evaluate
• Primary outcome: Patient safety
• Secondary outcome: Resident perception and
satisfaction for well-being, education and patient
care
• Randomized trial
• 117 General Surgery Programs
128. What They Found
•Primary Outcome:
•Dissatisfaction for well being and education
quality showed NO difference
•Secondary Outcome: Perception of Negative
effect of duty hours went Down
• Decreased: Patient safety; continuity, clinical skills, autonomy
• Increased: Time; family; rest and health
129. Why We Chose It
•Large scope of collaboration between
residency programs
•Evidence that helped to inform ACGME
•ACGME listened
130. Factors Associated With Resident
Continuity in Ambulatory Training
Practices
Fortuna RJ, et al.
J Grad Med Educ. 2016; 8(4): 532-534
131. Key Finding
•Factors that increased resident continuity in
resident practices:
• Increased faculty time
• Having Scheduling protocols
• Absence of advanced practice providers
•Increased Continuity associated with
improved quality measures
132. What They Did
•Purpose:
• To compare continuity in resident practices to nonteaching
practices to identify factors associated with continuity and
quality metrics
•4 resident primary care practices
• 26 resident teams in internal medicine, pediatric,
family medicine and medicine-pediatric
• 117,235 visits
•30 affiliate nonteaching primary care clinics
• 207242 visits
133. What They Found
• Continuity better at nonteaching vs resident practices
• Factors associated:
• Scheduling protocol
• Absence of APP
• Increased faculty clinical time
• Policies for handoff senior to intern
• Quality
• Improved rates of diabetic control, HTN, screening
colonoscopy and mammography
134. Why We Chose It
•Evidence comparing nonteaching practices vs
resident practices used to show factors that
improve continuity
•Resident practices with highest continuity
approached nonteaching practices (it can be
done!)
135. Section Summary
•Data is vital even for the most obvious things:
• Providing food is an important motivator and educational
tool
• Large collaborative research on work hours impacted
policy
• Scheduling protocols in resident clinics impact continuity
•Educational research provided evidence that had
impact at the:
• Trainee level level
• Patient outcome level
• Policy Level
136.
137. Special Thanks
• Michael Ryan, MD, MEHP, Virginia Commonwealth
University
• For being our equal partner in journal reviewing and slide editing
• The Academic Pediatric Association
• Especially the Education Committee
• Editors of Academic Pediatrics
• For allowing use of images from their articles
• The authors of the articles included here
• All medical education scholars for their amazing work