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1.  Internet-based medical education: a realist review of what works, for whom and in what circumstances 
BMC Medical Education  2010;10:12.
Background
Educational courses for doctors and medical students are increasingly offered via the Internet. Despite much research, course developers remain unsure about what (if anything) to offer online and how. Prospective learners lack evidence-based guidance on how to choose between the options on offer. We aimed to produce theory driven criteria to guide the development and evaluation of Internet-based medical courses.
Methods
Realist review - a qualitative systematic review method whose goal is to identify and explain the interaction between context, mechanism and outcome. We searched 15 electronic databases and references of included articles, seeking to identify theoretical models of how the Internet might support learning from empirical studies which (a) used the Internet to support learning, (b) involved doctors or medical students; and (c) reported a formal evaluation. All study designs and outcomes were considered. Using immersion and interpretation, we tested theories by considering how well they explained the different outcomes achieved in different educational contexts.
Results
249 papers met our inclusion criteria. We identified two main theories of the course-in-context that explained variation in learners' satisfaction and outcomes: Davis's Technology Acceptance Model and Laurillard's model of interactive dialogue. Learners were more likely to accept a course if it offered a perceived advantage over available non-Internet alternatives, was easy to use technically, and compatible with their values and norms. 'Interactivity' led to effective learning only if learners were able to enter into a dialogue - with a tutor, fellow students or virtual tutorials - and gain formative feedback.
Conclusions
Different modes of course delivery suit different learners in different contexts. When designing or choosing an Internet-based course, attention must be given to the fit between its technical attributes and learners' needs and priorities; and to ways of providing meaningful interaction. We offer a preliminary set of questions to aid course developers and learners consider these issues.
doi:10.1186/1472-6920-10-12
PMCID: PMC2825237  PMID: 20122253
2.  Gastroenterology fellowship training: Approaches to curriculum assessment and evaluation 
BACKGROUND:
Medical education requires ongoing curriculum development and evaluation to incorporate new knowledge and competencies. The Kern model of curricular development is a generic model to guide curriculum design, whereas the Royal College of Physicians and Surgeons of Canada (RCPSC) has a specific model for curriculum development through its accreditation structure.
OBJECTIVE:
To apply the Kern model to an assessment of a residency program in gastroenterology.
METHODS:
A case study was used, which is a method of qualitative research designed to help researchers understand people and the societal contexts in which they live.
RESULTS:
The six steps involved in the Kern model of curricular development include problem identification; needs assessment; establishing objectives; establishing educational strategies; implementation; and evaluation. The steps of the RCPSC model of curriculum development include establishing an administrative structure for the program; objectives; structure and organization of the program; resources; clinical, academic and scholarly content of the program; and evaluation. Two differences between the models for curriculum development include the ability of the Kern model to conduct problem identification and learner needs assessment. Identifying problems that exist suggests a need for an educational program, such as the long wait times for gastroenterology referrals. Assessing learner needs allows for the development of a tailored curriculum for the trainee.
CONCLUSIONS:
The Kern model and RCPSC model for curriculum development are complementary. Consideration by the RCPSC should be provided to add the missing elements of curriculum design to the accreditation structure for completeness.
PMCID: PMC2660814  PMID: 18560634
Case study; Curriculum; Development; Gastroenterology
3.  Can Social Semantic Web Techniques Foster Collaborative Curriculum Mapping In Medicine? 
Background
Curriculum mapping, which is aimed at the systematic realignment of the planned, taught, and learned curriculum, is considered a challenging and ongoing effort in medical education. Second-generation curriculum managing systems foster knowledge management processes including curriculum mapping in order to give comprehensive support to learners, teachers, and administrators. The large quantity of custom-built software in this field indicates a shortcoming of available IT tools and standards.
Objective
The project reported here aims at the systematic adoption of techniques and standards of the Social Semantic Web to implement collaborative curriculum mapping for a complete medical model curriculum.
Methods
A semantic MediaWiki (SMW)-based Web application has been introduced as a platform for the elicitation and revision process of the Aachen Catalogue of Learning Objectives (ACLO). The semantic wiki uses a domain model of the curricular context and offers structured (form-based) data entry, multiple views, structured querying, semantic indexing, and commenting for learning objectives (“LOs”). Semantic indexing of learning objectives relies on both a controlled vocabulary of international medical classifications (ICD, MeSH) and a folksonomy maintained by the users. An additional module supporting the global checking of consistency complements the semantic wiki. Statements of the Object Constraint Language define the consistency criteria. We evaluated the application by a scenario-based formative usability study, where the participants solved tasks in the (fictional) context of 7 typical situations and answered a questionnaire containing Likert-scaled items and free-text questions.
Results
At present, ACLO contains roughly 5350 operational (ie, specific and measurable) objectives acquired during the last 25 months. The wiki-based user interface uses 13 online forms for data entry and 4 online forms for flexible searches of LOs, and all the forms are accessible by standard Web browsers. The formative usability study yielded positive results (median rating of 2 (“good”) in all 7 general usability items) and produced valuable qualitative feedback, especially concerning navigation and comprehensibility. Although not asked to, the participants (n=5) detected critical aspects of the curriculum (similar learning objectives addressed repeatedly and missing objectives), thus proving the system’s ability to support curriculum revision.
Conclusions
The SMW-based approach enabled an agile implementation of computer-supported knowledge management. The approach, based on standard Social Semantic Web formats and technology, represents a feasible and effectively applicable compromise between answering to the individual requirements of curriculum management at a particular medical school and using proprietary systems.
doi:10.2196/jmir.2623
PMCID: PMC3758046  PMID: 23948519
curriculum mapping; medical education; Semantic Web; Social Web
4.  Effects of a Structured Decoding Curriculum on Adult Literacy Learners’ Reading Development 
This article reports the results from a randomized control field trial that investigated the impact of an enhanced decoding and spelling curriculum on the development of adult basic education (ABE) learners’ reading skills. Sixteen ABE programs that offered class-based instruction to Low-Intermediate level learners were randomly assigned to either the treatment group or the control group. Reading instructors in the 8 treatment programs taught decoding and spelling using the study-developed curriculum, Making Sense of Decoding and Spelling (MSDS), and instructors in the 8 control programs used their existing reading instruction. A comparison group of 7 ABE programs whose instructors used K-3 structured curricula adapted for use with ABE learners were included for supplemental analyses. Seventy-one reading classes, 34 instructors, and 349 adult learners with pre- and posttests participated in the study. The study found a small but significant effect on one measure of decoding skills, which was the proximal target of the curriculum. No overall significant effects were found for word recognition, spelling, fluency, or comprehension. Pretest to posttest gains for word recognition were small to moderate, but not significantly better than the control classes. Adult learners who were born and educated outside of the U.S. made larger gains on 7 of the 11 reading measures than learners who were born and educated within the U.S. However, participation in the treatment curriculum was more beneficial for learners who were born and educated in the U.S. in developing their word recognition skills.
doi:10.1080/19345747.2011.555294
PMCID: PMC3232465  PMID: 22163055
5.  Development of a Supervisory Skills Course for Hospital Pharmacy Workplaces 
Background and Objective:
Many Canadian hospital pharmacies are experiencing difficulties recruiting supervisory personnel. It was expected that, through a “learning-by-doing” course, pharmacy staff would learn to apply basic skills in the day-to-day supervision of pharmacy operations and human resources and to apply the principles of supervisory documentation.
Methods:
A supervisory skills course targeted to pharmacy staff members was developed and implemented by the pharmacy department of a large urban health region. The course was initially offered to practising pharmacy technicians. The course design emphasized a constructivist framework incorporating authentic learning and reflective practice during seminars, with experiential and self-directed learning in the workplace. Preceptors assisted learners to achieve the course goals. Learners and preceptors provided feedback about hours spent (as the course progressed) and about their satisfaction with the course itself (at the end of the course). Learners and preceptors completed a post-program evaluation 2 months after completing the course to help in the assessment of the transfer of learning (lasting impact) associated with the course. Overall performance in the course was assessed on a pass/fail basis.
Results:
Eighteen pharmacy technicians were admitted to the program, but one withdrew because of a job change. All learners successfully completed the course. Two months after the course, learners and preceptors described enhanced organization, time management, leadership, communication, and conflict-resolution skills on the part of learners, as well as their increased confidence, maturity, and ability to supervise staff. Learners’ evaluations revealed a broadened perspective of pharmacy. The preceptors valued the enhancement of learners’ skills and their increased enthusiasm. At the time of writing, 6 of the participants had secured supervisory positions.
Conclusion:
Creating formal instruction that engages pharmacy staff to pursue management positions is challenging. Instructional design grounded in constructivist theory and incorporating authentic learning experiences and reflection resulted in high learner satisfaction with learning outcomes.
PMCID: PMC2932494  PMID: 22478992
supervisory skills; pharmacy technicians; pharmacists; professional development in the workplace; techniques d’encadrement; techniciens en pharmacie; pharmaciens; perfectionnement professionnel en milieu de travail
6.  Asynchronous vs didactic education: it’s too early to throw in the towel on tradition 
BMC Medical Education  2013;13:105.
Background
Asynchronous, computer based instruction is cost effective, allows self-directed pacing and review, and addresses preferences of millennial learners. Current research suggests there is no significant difference in learning compared to traditional classroom instruction. Data are limited for novice learners in emergency medicine. The objective of this study was to compare asynchronous, computer-based instruction with traditional didactics for senior medical students during a week-long intensive course in acute care. We hypothesized both modalities would be equivalent.
Methods
This was a prospective observational quasi-experimental study of 4th year medical students who were novice learners with minimal prior exposure to curricular elements. We assessed baseline knowledge with an objective pre-test. The curriculum was delivered in either traditional lecture format (shock, acute abdomen, dyspnea, field trauma) or via asynchronous, computer-based modules (chest pain, EKG interpretation, pain management, trauma). An interactive review covering all topics was followed by a post-test. Knowledge retention was measured after 10 weeks. Pre and post-test items were written by a panel of medical educators and validated with a reference group of learners. Mean scores were analyzed using dependent t-test and attitudes were assessed by a 5-point Likert scale.
Results
44 of 48 students completed the protocol. Students initially acquired more knowledge from didactic education as demonstrated by mean gain scores (didactic: 28.39% ± 18.06; asynchronous 9.93% ± 23.22). Mean difference between didactic and asynchronous = 18.45% with 95% CI [10.40 to 26.50]; p = 0.0001. Retention testing demonstrated similar knowledge attrition: mean gain scores −14.94% (didactic); -17.61% (asynchronous), which was not significantly different: 2.68% ± 20.85, 95% CI [−3.66 to 9.02], p = 0.399. The attitudinal survey revealed that 60.4% of students believed the asynchronous modules were educational and 95.8% enjoyed the flexibility of the method. 39.6% of students preferred asynchronous education for required didactics; 37.5% were neutral; 23% preferred traditional lectures.
Conclusions
Asynchronous, computer-based instruction was not equivalent to traditional didactics for novice learners of acute care topics. Interactive, standard didactic education was valuable. Retention rates were similar between instructional methods. Students had mixed attitudes toward asynchronous learning but enjoyed the flexibility. We urge caution in trading in traditional didactic lectures in favor of asynchronous education for novice learners in acute care.
doi:10.1186/1472-6920-13-105
PMCID: PMC3750828  PMID: 23927420
Medical student education; Emergency medicine; Computer based education; Asynchronous learning
7.  Incorporating Evidence-based Medicine into Resident Education: A CORD Survey of Faculty and Resident Expectations 
Background
The Accreditation Council for Graduate Medical Education (ACGME) invokes evidence-based medicine (EBM) principles through the practice-based learning core competency. The authors hypothesized that among a representative sample of emergency medicine (EM) residency programs, a wide variability in EBM resident training priorities, faculty expertise expectations, and curricula exists.
Objectives
The primary objective was to obtain descriptive data regarding EBM practices and expectations from EM physician educators. Our secondary objective was to assess differences in EBM educational priorities among journal club directors compared with non–journal club directors.
Methods
A 19-question survey was developed by a group of recognized EBM curriculum innovators and then disseminated to Council of Emergency Medicine Residency Directors (CORD) conference participants, assessing their opinions regarding essential EBM skill sets and EBM curricular expectations for residents and faculty at their home institutions. The survey instrument also identified the degree of interest respondents had in receiving a free monthly EBM journal club curriculum.
Results
A total of 157 individuals registered for the conference, and 98 completed the survey. Seventy-seven (77% of respondents) were either residency program directors or assistant / associate program directors. The majority of participants were from university-based programs and in practice at least 5 years. Respondents reported the ability to identify flawed research (45%), apply research findings to patient care (43%), and comprehend research methodology (33%) as the most important resident skill sets. The majority of respondents reported no formal journal club or EBM curricula (75%) and do not utilize structured critical appraisal instruments (71%) when reviewing the literature. While journal club directors believed that resident learners’ most important EBM skill is to identify secondary peer-reviewed resources, non–journal club directors identified residents’ ability to distinguish significantly flawed research as the key skill to develop. Interest in receiving a free monthly EBM journal club curriculum was widely accepted (89%).
Conclusions
Attaining EBM proficiency is an expected outcome of graduate medical education (GME) training, although the specific domains of anticipated expertise differ between faculty and residents. Few respondents currently use a formalized curriculum to guide the development of EBM skill sets. There appears to be a high level of interest in obtaining EBM journal club educational content in a structured format. Measuring the effects of providing journal club curriculum content in conjunction with other EBM interventions may warrant further investigation.
doi:10.1111/j.1553-2712.2010.00889.x
PMCID: PMC3219923  PMID: 21199085
evidence-based medicine; knowledge translation; faculty development
8.  Use of simulator-based medical procedural curriculum: the learner's perspectives 
BMC Medical Education  2010;10:77.
Background
Simulation is increasingly used for teaching medical procedures. The goal of this study was to assess learner preferences for how simulators should be used in a procedural curriculum.
Methods
A 26-item survey was constructed to assess the optimal use of simulators for the teaching of medical procedures in an internal medicine residency curriculum. Survey domains were generated independently by two investigators and validated by an expert panel (n = 7). Final survey items were revised based on pilot survey and distributed to 128 internal medicine residents.
Results
Of the 128 residents surveyed, 106 (83%) responded. Most responders felt that simulators should be used to learn technical skills (94%), refine technical skills (84%), and acquire procedural teaching skills (87%).
Respondents felt that procedures most effectively taught by simulators include: central venous catheterization, thoracentesis, intubation, lumbar puncture, and paracentesis. The majority of learners felt that teaching should be done early in residency (97%).
With regards to course format, 62% of respondents felt that no more than 3-4 learners per simulator and an instructor to learner ratio of 1:3-4 would be acceptable.
The majority felt that the role of instructors should include demonstration of technique (92%), observe learner techniques (92%), teach evidence behind procedural steps (84%) and provide feedback (89%). Commonly cited barriers to procedural teaching were limitations in time, number of instructors and simulators, and lack of realism of some simulators.
Conclusions
Our results suggest that residents value simulator-based procedural teaching in the form of small-group sessions. Simulators should be an integral part of medical procedural education.
doi:10.1186/1472-6920-10-77
PMCID: PMC2988805  PMID: 21059253
9.  Interface between problem-based learning and a learner-centered paradigm 
Background
Problem-based learning (PBL) has made a major shift in support of student learning for many medical school curricula around the world. Since curricular development of PBL in the early 1970s and its growth in the 1980s and 1990s, there have been growing numbers of publications providing positive and negative data in regard to the curricular effectiveness of PBL. The purpose of this study was to explore supportive data for the four core objectives of PBL and to identify an interface between the objectives of PBL and a learner-centered paradigm.
Methods
The four core PBL objectives, ie, structuring of knowledge and clinical context, clinical reasoning, self-directed learning, and intrinsic motivation, were used to search MEDLINE, the Education Resources Information Center, the Educator’s Reference Complete, and PsycINFO from January 1969 to January 2011. The literature search was facilitated and narrowed if the published study included the following terms: “problem-based learning”, “medical education”, “traditional curriculum”, and one of the above four PBL objectives.
Results
Through a comprehensive search analysis, one can find supportive data for the effectiveness of a PBL curriculum in achieving the four core objectives of PBL. A further analysis of these four objectives suggests that there is an interface between PBL objectives and criteria from a learner-centered paradigm. In addition, this review indicates that promotion of teamwork among students is another interface that exists between PBL and a learner-centered paradigm.
Conclusion
The desire of medical schools to enhance student learning and a need to provide an environment where students construct knowledge rather than receive knowledge have encouraged many medical schools to move into a learner-centered paradigm. Implementation of a PBL curriculum can be used as a prevailing starting point to develop not only a learner-centered paradigm, but also to facilitate a smooth curricular transition from a teacher-centered paradigm to a learner-centered paradigm.
doi:10.2147/AMEP.S12794
PMCID: PMC3661251  PMID: 23745083
problem-based learning; teamwork; learner-centered paradigm
10.  A Learner-Centered Diabetes Management Curriculum 
Diabetes Care  2012;35(11):2188-2193.
OBJECTIVE
Diabetes errors, particularly insulin administration errors, can lead to complications and death in the pediatric inpatient setting. Despite a lecture-format curriculum on diabetes management at our children’s hospital, resident diabetes-related errors persisted. We hypothesized that a multifaceted, learner-centered diabetes curriculum would help reduce pathway errors.
RESEARCH DESIGN AND METHODS
The 8-week curricular intervention consisted of 1) an online tutorial addressing residents’ baseline diabetes management knowledge, 2) an interactive diabetes pathway discussion, 3) a learner-initiated diabetes question and answer session, and 4) a case presentation featuring embedded pathway errors for residents to recognize, resolve, and prevent. Errors in the 9 months before the intervention, as identified through an incident reporting system, were compared with those in the 10 months afterward, with errors classified as relating to insulin, communication, intravenous fluids, nutrition, and discharge delay.
RESULTS
Before the curricular intervention, resident errors occurred in 28 patients (19.4% of 144 diabetes admissions) over 9 months. After the intervention, resident errors occurred in 11 patients (6.6% of 166 diabetes admissions) over 10 months, representing a statistically significant (P = 0.0007) decrease in patients with errors from before intervention to after intervention. Throughout the study, the errors were distributed into the categories as follows: insulin, 43.8%; communication, 39.6%; intravenous fluids, 14.6%; nutrition, 0%; and discharge delay, 2.1%.
CONCLUSIONS
An interactive learner-centered diabetes curriculum for pediatric residents can be effective in reducing inpatient diabetes errors in a tertiary children’s hospital. This educational model promoting proactive learning has implications for decreasing errors across other medical disciplines.
doi:10.2337/dc12-0450
PMCID: PMC3476896  PMID: 22875227
11.  Oncology education in Canadian undergraduate and postgraduate medical programs: a survey of educators and learners 
Current Oncology  2014;21(1):e75-e88.
Background
The oncology education framework currently in use in Canadian medical training programs is unknown, and the needs of learners have not been fully assessed to determine whether they are adequately prepared to manage patients with cancer.
Methods
To assess the oncology education framework currently in use at Canadian medical schools and residency training programs for family (fm) and internal medicine (im), and to evaluate opinions about the content and utility of standard oncology education objectives, a Web survey was designed and sent to educators and learners. The survey recipients included undergraduate medical education curriculum committee members (umeccms), directors of fm and im programs, oncologists, medical students, and fm and im residents.
Results
Survey responses were received from 677 educators and learners. Oncology education was felt to be inadequate in their respective programs by 58% of umeccms, 57% of fm program directors, and 50% of im program directors. For learners, oncology education was thought to be inadequate by 67% of medical students, 86% of fm residents, and 63% of im residents. When comparing teaching of medical subspecialty–related diseases, all groups agreed that their trainees were least prepared to manage patients with cancer. A standard set of oncology objectives was thought to be possibly or definitely useful for undergraduate learners by 59% of respondents overall and by 61% of postgraduate learners.
Conclusions
Oncology education in Canadian undergraduate and postgraduate fm and im training programs are currently thought to be inadequate by a majority of educators and learners. Developing a standard set of oncology objectives might address the needs of learners.
doi:10.3747/co.21.1667
PMCID: PMC3921051  PMID: 24523624
Oncology education; Canada; undergraduate medical programs; postgraduate medical programs
12.  Web-based Curriculum 
OBJECTIVE
To address the need for women's health education by designing, implementing, and evaluating a self-study, web-based women's health curriculum.
DESIGN
Cohort of students enrolled in the ambulatory portion of the medicine clerkship with comparison group of students who had not yet completed this rotation.
PARTICIPANTS/SETTING
Third- and fourth-year medical students on the required medicine clerkship (115 students completed the curriculum; 158 completed patient-related logs).
INTERVENTION
Following an extensive needs assessment and formulation of competencies and objectives, we developed a web-based women's health curriculum completed during the ambulatory portion of the medicine clerkship. The modules were case based and included web links, references, and immediate feedback on posttesting. We discuss technical issues with implementation and maintenance.
MEASUREMENTS AND MAIN RESULTS
We evaluated this curriculum using anonymous questionnaires, open-ended narrative comments, online multiple-choice tests, and personal digital assistant (PDA) logs of patient-related discussions of women's health. Students completing the curriculum valued learning women's health, preferred this self-directed learning over lecture, scored highly on knowledge tests, and were involved in more and higher-level discussions of women's health with faculty (P <.001).
CONCLUSIONS
We present a model for the systematic design of a web-based women's health curriculum as part of a medicine clerkship. The web-based instruction resolved barriers associated with limited curriculum time and faculty availability, provided an accessible and standard curriculum, and met the needs of adult learners (with their motivation to learn topics they value and apply this knowledge in their daily work). We hypothesize that our web-based curriculum spurred students to later discuss these topics with faculty. Web-based learning may be particularly suited for women's health because of its multidisciplinary nature and need for vertical integration throughout medical school curricula.
doi:10.1111/j.1525-1497.2005.40062.x
PMCID: PMC1490044  PMID: 15693931
women's health; computer-assisted instruction; medical education; adult learning; personal digital assistant
13.  Online discussion for block teaching in postgraduate health professionals’ curriculum: the Ethiopian experience 
BMC Medical Education  2014;14:29.
Background
Online discussions as a method of instruction are a new approach in Ethiopia. There is no previous study in the Ethiopian context that has assessed students’ engagement and learning experience using this instruction method, which may offer a valuable complement to other instruction methods for intensive block teaching in a resource-limited environment. The aim of this study was to assess the value of online discussions in supporting students’ engagement and interaction with their peers and teachers in a block teaching postgraduate health professionals’ curriculum.
Methods
The research was conducted at Addis Ababa University College of Health Sciences, School of Medical Laboratory Sciences (SMLS), which has structured the curriculum around intensive block teaching. Between December 2011 and February 2012, two groups of full-time (N = 21) and part-time (N = 52) postgraduate students participated in online discussions as part of a Biostatistics and Research Methods module, in addition to other instructional methods. Every week, the course instructor initiated the online discussion by posting an assignment and articles with a few discussion questions. To evaluate the participants’ collective learning experience, the content of the email messages generated during these online discussions was analyzed qualitatively.
Result
A total of 702 emails were exchanged during the three week module, of which 250 emails (35.6%) were posted by full-time students and 452 emails (64.4%) by part-time Continuing Education Program (CEP) students. During the online discussion forum, students identified different statistical data analysis tools and their application for given data sets. In terms of message contents, 67% of full-time and 64% of part-time students’ messages were classified as learning experiences. However, a slightly higher proportion of part-time students’ posts were social messages. The majority of students in both groups reported high levels of satisfaction with their online experience.
Conclusion
Online discussion could be a valuable addition to face-to-face classroom teaching to improve students’ engagement and interaction in an intensive block teaching postgraduate curriculum where learners are engaged in a full work load with academic studies.
doi:10.1186/1472-6920-14-29
PMCID: PMC3924913  PMID: 24521146
Online discussion; Block teaching; Ethiopia
14.  The Role for Clinician Educators in Implementing Healthcare Improvement 
Journal of General Internal Medicine  2010;25(Suppl 4):639-643.
ABSTRACT
Clinician educators—who work at the intersection of patient care and resident education—are well positioned to respond to calls for better, safer patient care and resident education. Explicit lessons that address implementing health care improvement and associated residency training came out of the Academic Chronic Care Collaboratives and include the importance of: (1) redesigning the clinical practice as a core component of the residency curriculum; (2) exploiting the efficiencies of the practice team; (3) replacing “faculty development” with “everyone’s a learner;” (4) linking faculty across learning communities to build expertise; and (5) using rigorous methodology to design and evaluate interventions for practice redesign. There has been progress in addressing three thorny academic faculty issues—professional satisfaction, promotion and publication. For example, consensus criteria have been proposed for both faculty promotion as well as the institutional settings that nurture academic health care improvement careers, and the SQUIRE Publication Guidelines have been developed as a general framework for scholarly improvement publications. Extensive curricular resources exist for developing the expert faculty cadre. Curricula from representative training programs include quantitative and qualitative research methods, statistical methodologies appropriate for measuring systems change, organizational culture, management, leadership and scholarly writing for the improvement literature. Clinician educators—particularly those in general internal medicine—bear the principal responsibility for both patient care and resident training in academic departments of internal medicine. The intersection of these activities presents a unique opportunity for their playing a central role in implementing health care improvement and associated residency training. However, this role in academic settings will require an unambiguous development strategy both for faculty and their institutions.
doi:10.1007/s11606-010-1448-0
PMCID: PMC2940448  PMID: 20737242
clinician educators; patient care; physician training
15.  Ten tips for receiving feedback effectively in clinical practice 
Medical Education Online  2014;19:10.3402/meo.v19.25141.
Background
Despite being recognized as a fundamental part of the educational process and emphasized for several decades in medical education, the influence of the feedback process is still suboptimal. This may not be surprising, because the focus is primarily centered on only one half of the process – the teachers. The learners are the targets of the feedback process and improvement needs to be shifted. Learners need to be empowered with the skills needed to receive and utilize feedback and compensate for less than ideal feedback delivery due to the busy clinical environment.
Methods
Based on the available feedback literature and clinical experience regarding feedback, the author developed 10 tips to empower learners with the necessary skills to seek, receive, and handle feedback effectively, regardless of how it is delivered. Although, most of the tips are directed at the individual clinical trainee, this model can be utilized by clinical educators involved in learner development and serve as a framework for educational workshops or curriculum.
Results
Ten practical tips are identified that specifically address the learner's role in the feedback process. These tips not only help the learner to ask, receive, and handle the feedback, but will also ease the process for the teachers. Collectively, these tips help to overcome most, if not all, of the barriers to feedback and bridge the gaps in busy clinical practices.
Conclusions
Feedback is a crucial element in the educational process and it is shown that we are still behind in the optimal use of it; thus, learners need to be taught how to better receive and utilize feedback. The focus in medical education needs to balance the two sides of the feedback process. It is time now to invest on the learner's development of skills that can be utilized in a busy day-to-day clinical practice.
doi:10.3402/meo.v19.25141
PMCID: PMC4116619  PMID: 25079664
feedback; self-assessment; self-awareness; career development; medical education
16.  Teaching Risk Management: Addressing ACGME Core Competencies 
Background
Risk management is an important aspect of education for all residents. Unfortunately, few curricula currently exist to fulfill this educational need.
Objective
We developed a curriculum that teaches residents basic principles of risk management with the goals of (1) educating residents about the medical-legal environment in which they operate, (2) helping residents identify common malpractice exposures, and (3) teaching practical risk management/patient safety interventions that can be implemented in their practice that could reduce malpractice exposure and improve patient safety.
Methods
The curriculum was developed by Medical Risk Management, LLC, a Connecticut-based risk management firm, in conjunction with academic leadership at the University of Connecticut. The program uses 3 learning modalities: live lectures, web-based video modules, and e-mailed learning publications. Gains in resident knowledge through participation in the curriculum were measured using pretests and posttests. Learner satisfaction with the curriculum was measured through web-based surveys.
Results
We found a significant improvement in knowledge in residents who took the pretest and posttest (P < .001). Of the survey respondents, 97% said the content was relevant to their specialty practice and 95% responded that these sessions should be held annually. Most respondents indicated they would change their practice as a result of what they learned from the live lectures.
Conclusion
This risk management curriculum has been successful in providing our residents with learning activities in risk management, improving their knowledge of risk management principles, and changing their attitudes and behaviors. These improvements may lead to fewer malpractice claims against them and the hospitals they train in.
doi:10.4300/JGME-D-10-00084.1
PMCID: PMC3010945  PMID: 22132283
17.  Vertically integrated shared learning models in general practice: a qualitative study 
BMC Family Practice  2013;14:144.
Background
The numbers of learners seeking placements in general practice is rapidly increasing as an ageing workforce impacts on General Practitioner availability. The traditional master apprentice model that involves one-to-one teaching is therefore leading to supervision capacity constraints. Vertically integrated (VI) models may provide a solution. Shared learning, in which multiple levels of learners are taught together in the same session, is one such model. This study explored stakeholders’ perceptions of shared learning in general practices in northern NSW, Australia.
Methods
A qualitative research method, involving individual semi-structured interviews with GP supervisors, GP registrars, Prevocational General Practice Placements Program trainees, medical students and practice managers situated in nine teaching practices, was used to investigate perceptions of shared learning practices. A thematic analysis was conducted on 33 transcripts by three researchers.
Results
Participants perceived many benefits to shared learning including improved collegiality, morale, financial rewards, and better sharing of resources, knowledge and experience. Additional benefits included reduced social and professional isolation, and workload. Perceived risks of shared learning included failure to meet the individual needs of all learners. Shared learning models were considered unsuitable when learners need to: receive remediation, address a specific deficit or immediate learning needs, learn communication or procedural skills, be given personalised feedback or be observed by their supervisor during consultations. Learners’ acceptance of shared learning appeared partially dependent on their supervisors’ small group teaching and facilitation skills.
Conclusions
Shared learning models may partly address supervision capacity constraints in general practice, and bring multiple benefits to the teaching environment that are lacking in the one-to-one model. However, the risks need to be managed appropriately, to ensure learning needs are met for all levels of learners. Supervisors also need to consider that one-to-one teaching may be more suitable in some instances. Policy makers, medical educators and GP training providers need to ensure that quality learning outcomes are achieved for all levels of learners. A mixture of one-to-one and shared learning would address the benefits and downsides of each model thereby maximising learners’ learning outcomes and experiences.
doi:10.1186/1471-2296-14-144
PMCID: PMC3851562  PMID: 24079420
Registrars; Prevocational trainees; Medical students; Medical education; Vertical integration; Near-peer teaching; General practice; Postgraduate training
18.  Getting Out of Silos: An Innovative Transitional Care Curriculum for Internal Medicine Residents Through Experiential Interdisciplinary Learning 
Background
Care transitions are common and highly vulnerable times during illness. Physicians need better training to improve care transitions. Existing transitional care curricula infrequently involve settings outside of the hospital or other health care disciplines.
Intervention
We created a curriculum to teach internal medicine residents how to provide better transitional care at hospital discharge through experiential, interdisciplinary learning in different care settings outside of the acute hospital, and we engaged other health care disciplines frequently involved in care transitions.
Setting/Participants
Nineteen postgraduate year-1 internal medicine trainees at an academic medical center in an urban location completed experiences in a postacute care facility, home health care, and outpatient clinics.
Program Description
The 2-week required curriculum involved teachers from geriatric medicine; physical, occupational, and speech therapy; and home health care, with both didactic and experiential components and self-reflective exercises.
Program Evaluation
The curriculum was highly rated (6.86 on a 9-point scale) and was associated with a significant increase in the rating of the overall quality of transitional care education (from 4.09 on a 5-point scale in 2011 to 4.53 in 2012) on the annual residency program survey. Learners reported improved knowledge in key curricular areas and that they would change practice as a result of the curriculum.
Conclusions
Our transitional care curriculum for internal medicine residents provides exposure to care settings and health care disciplines that patients frequently encounter. The curriculum has shown positive, short-term effects on learners' perceived knowledge and behavior.
doi:10.4300/JGME-D-12-00316.1
PMCID: PMC3886474  PMID: 24455024
19.  So much to teach, so little time: a prospective cohort study evaluating a tool to select content for a critical care curriculum 
Critical Care  2008;12(5):R127.
Introduction
Curricular content is often based on the personal opinions of a small number of individuals. Although convenient, such curricula may not meet the needs of the target learner, the program or the institution. Using an objective method to ensure content validity of a curriculum can alleviate this issue.
Methods
A form was created that listed clinical presentations relevant to residents completing intensive care unit (ICU) rotations. Twenty residents and 20 intensivists in tertiary academic multisystem ICUs ranked each presentation on three separate scales: how life-threatening each is, how commonly each is seen in critical care, and how reversible each is. Mean scores for the individual scales were calculated, and these three values were subsequently multiplied together to achieve a composite score for each presentation. The correlation between the two groups' scores for the presentations was calculated to assess reliability of the process.
Results
There was excellent agreement between the two groups for rating each presentation (correlation coefficient r = 0.94). The 10 clinical presentations with the highest composite scores formed the basis of our new curriculum.
Conclusions
We describe a method that can be used to select the content of a curriculum for learners in an ICU. Although the content that we selected to include in our curriculum may not be applicable to other ICUs, we believe that the process we used is easily applied elsewhere, and that it provides an efficient method to improve content validity of a curriculum.
doi:10.1186/cc7087
PMCID: PMC2592766  PMID: 18922170
20.  A SBIRT Curriculum for Medical Residents: Development of a Performance Feedback Tool to Build Learner Confidence 
A major barrier to actualizing the public health impact potential of screening, brief intervention, and referral to treatment (SBIRT) is the suboptimal development and implementation of evidence-based training curricula for healthcare providers. As part of a federal grant to develop and implement SBIRT training in medical residency programs, we assessed 95 internal medicine residents before they received SBIRT training to identify self-reported characteristics and behaviors that would inform curriculum development. Residents’ confidence in their SBIRT skills significantly predicted SBIRT practice. Lack of experience dealing with alcohol or drug problems and discomfort in dealing with these issues were significantly associated with low confidence. To target these barriers, we revised our SBIRT curriculum to increase resident confidence in their skills and developed an innovative SBIRT Proficiency Checklist and Feedback Protocol for skills practice observations. Qualitative feedback suggests that, despite the discomfort residents experience in being observed, a proficiency checklist and feedback protocol appear to boost learner confidence.
doi:10.1080/08897077.2011.640172
PMCID: PMC3412302  PMID: 22738001
SBIRT; curriculum; observation; feedback; confidence; graduate medical education
21.  Team-based learning for psychiatry residents: a mixed methods study 
BMC Medical Education  2013;13:124.
Background
Team-based learning (TBL) is an effective teaching method for medical students. It improves knowledge acquisition and has benefits regarding learner engagement and teamwork skills. In medical education it is predominately used with undergraduates but has potential benefits for training clinicians. The aims of this study were to examine the impact of TBL in a sample of psychiatrists in terms of classroom engagement, attitudes towards teamwork, learner views and experiences of TBL.
Methods
Forty-four psychiatry residents participated in an Addictions Psychiatry TBL module. Mixed-methods were used for evaluation. Self-rated measures of classroom engagement (Classroom Engagement Survey, CES) were compared with conventional lectures, and attitudes regarding the value of teams (Value of Teams Scale, VTS) were compared before and after the module. Independent t-tests were used to compare ‘lecture’ CES scores with TBL CES scores and pre and post scores for the VTS. Feedback questionnaires were completed. Interviews were conducted with a subset of residents and transcripts analysed using thematic analysis.
Results
Twenty-eight residents completed post-course measures (response rate 63.6%). Seven participants volunteered for qualitative interviews–one from each team. There was a significant difference in the mean CES score lectures compared to TBL (p < 0.001) but no difference was found in mean VTS score pre and post for either subscale (p = 0.519; p = 0.809). All items on the feedback questionnaire were positively rated except two regarding session preparation. The qualitative analysis generated seven themes under four domains: ‘Learning in teams’, ‘Impact on the individual learner’, ‘Relationship with the teacher’ and ‘Efficiency and effectiveness of the learning process’.
Conclusions
In this group of residents, TBL significantly improved learner-rated classroom engagement and seemed to promote interactivity between learners. TBL was generally well-received, although required learners to prepare for class which was difficult for some. TBL did not change these clinicians’ views about teamwork.
doi:10.1186/1472-6920-13-124
PMCID: PMC3847866  PMID: 24025540
Instructional methods; Team-based learning; Continuing medical education; Residents; Psychiatry
22.  Can medical learners achieve point-of-care ultrasound competency using a high-fidelity ultrasound simulator?: a pilot study 
Background
Point-of-care ultrasound (PoCUS) is currently not a universal component of curricula for medical undergraduate and postgraduate training. We designed and assessed a simulation-based PoCUS training program for medical learners, incorporating image acquisition and image interpretation for simulated emergency medical pathologies. We wished to see if learners could achieve competency in simulated ultrasound following focused training in a PoCUS protocol.
Methods
Twelve learners (clerks and residents) received standardized training consisting of online preparation materials, didactic teaching, and an interactive hands-on workshop using a high-fidelity ultrasound simulator (CAE Vimedix). We used the Abdominal and Cardiothoracic Evaluation by Sonography (ACES) protocol as the curriculum for PoCUS training. Participants were assessed during 72 simulated emergency cardiorespiratory scenarios. Their ability to complete an ACES scan independently was assessed. Data was analyzed using R software.
Results
Participants independently generated 574 (99.7%) of the 576 expected ultrasound windows during the 72 simulated scenarios and correctly interpreted 67 (93%) of the 72 goal-directed PoCUS scans.
Conclusions
Following a focused training process using medical simulation, medical learners demonstrated an ability to achieve a degree of competency to both acquire and correctly interpret cardiorespiratory PoCUS findings using a high-fidelity ultrasound simulator.
doi:10.1186/2036-7902-5-9
PMCID: PMC3843513  PMID: 24245514
Emergency medicine; Simulation; Medical education; Ultrasound; Echocardiography
23.  Global health education: a pilot in trans-disciplinary, digital instruction 
Global Health Action  2013;6:10.3402/gha.v6i0.20747.
Background
The development of new global health academic programs provides unique opportunities to create innovative educational approaches within and across universities. Recent evidence suggests that digital media technologies may provide feasible and cost-effective alternatives to traditional classroom instruction; yet, many emerging global health academic programs lag behind in the utilization of modern technologies.
Objective
We created an inter-departmental University of Southern California (USC) collaboration to develop and implement a course focused on digital media and global health.
Design
Course curriculum was based on core tenants of modern education: multi-disciplinary, technologically advanced, learner-centered, and professional application of knowledge. Student and university evaluations were reviewed to qualitatively assess course satisfaction and educational outcomes.
Results
‘New Media for Global Health’ ran for 18 weeks in the Spring 2012 semester with N=41 students (56.1% global health and 43.9% digital studies students). The course resulted in a number of high quality global health-related digital media products available at http://iml420.wordpress.com/. Challenges confronted at USC included administrative challenges related to co-teaching and frustration from students conditioned to a rigid system of teacher-led learning within a specific discipline. Quantitative and qualitative course evaluations reflected positive feedback for the course instructors and mixed reviews for the organization of the course.
Conclusion
The development of innovative educational programs in global health requires on-going experimentation and information sharing across departments and universities. Digital media technologies may have implications for future efforts to improve global health education.
doi:10.3402/gha.v6i0.20747
PMCID: PMC3644060  PMID: 23643297
academic programs; digital media; education; global health; multimedia learning; technology
24.  Lessons Learned From a 5-Year Experience With a 4-Week Experiential Quality Improvement Curriculum in a Preventive Medicine Fellowship 
Background
Competency in practice-based learning and improvement (PBLI) and systems-based practice (SBP) empowers learners with the skills to plan, lead, and execute health care systems improvement efforts. Experiences from several graduate medical education programs describe the implementation of PBLI and SBP curricula as challenging because of lack of adequate curricular time and faculty resources, as well as a perception that PBLI and SBP are not relevant to future careers. A dedicated experiential rotation that requires fellow participation in a specialty-specific quality improvement project (QIP) may address some of these challenges.
Method
We describe a retrospective analysis of our 5-year experience with a dedicated 3-week PBLI-SBP experiential curriculum in a preventive medicine fellowship program at Mayo Clinic, Rochester, Minnesota.
Results
Between 2004 and 2008, 19 learners including 7 preventive medicine fellows participated in the rotation. Using just-in-time learning, fellows work together on a relatively complex QIP of community or institutional significance. Since 2004, all 19 learners (100%) participating in this rotation have consistently demonstrated statistically significant increase in their quality improvement knowledge application tool (QIKAT) scores at the end of the rotation. At the end of the rotation, all 19 learners stated that they were either confident or very confident of making a change to improve health care in a local setting. Most of the QIPs resulted in sustainable practice improvements, and resultant solutions have been disseminated beyond the location of the original QIP.
Conclusion
A dedicated experiential rotation that requires learner participation in a QIP is one of the effective methods to address the needs of the SBP and PBLI competencies.
doi:10.4300/01.01.0015
PMCID: PMC2931202  PMID: 21975713
25.  Teaching-skills training programs for family medicine residents 
Canadian Family Physician  2009;55(9):902-903.e5.
ABSTRACT
OBJECTIVE
To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects.
DATA SOURCES
Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice.
STUDY SELECTION
The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English.
SYNTHESIS
Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs’ effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects.
CONCLUSION
Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the effects of teaching-skills training in family medicine residents are needed to stimulate development of adapted programs for the discipline. Future research should also assess how residents’ teaching-skills training can affect their learners’ clinical training and eventually patient care.
PMCID: PMC2743590  PMID: 19752261

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