Expanding the Pipeline: The New York University School of Medicine-University of Ghana School of Medicine and Dentistry Psychiatric Education Initiative

As many low- and middle-income countries (LAMICs), Ghana is affected by a severe shortage of mental health specialists: there are 11 practicing psychiatrists for a population of 25 million. The pipeline for Ghanaian psychiatrists remains restricted for the foreseeable future given the low expressed interest in the field by junior medical trainees. The few senior psychiatric specialists are overextended with clinical and professional duties leaving them with minimal time to teach and mentor trainees. This limits opportunities for mentorship, modeling, teaching, and curricular development, leaving trainees with little exposure to psychiatric practice, and therefore, little motivation to enter a highly stigmatized and underresourced field. To support the training of Ghanaian medical students in psychiatry, the New York University School of Medicine-University of Ghana School of Medicine and Dentistry (NYUSOM-UGSMD) Psychiatric Education Initiative, and the NYU Global Mental Health Elective were formed (1) to provide educational support to medical students and residents at UGSMD and (2) to provide a sustainable international experience for NYUSOM residents with a strong interest in leadership in global mental health and underserved populations.

Accelerating medical education: a survey of deans and program directors

BACKGROUND

A handful of medical schools in the U.S. are awarding medical degrees after three years. While the number of three-year pathway programs is slowly increasing there is little data on the opinions of medical education leaders on the need for shortening training.

PURPOSE

To survey deans and program directors (PDs) to understand the current status of 3-year medical degree programs and to elicit perceptions of the need for shortening medical school and the benefits and liabilities of 3-year pathway programs (3YPP).

METHODS

Online surveys were emailed to the academic deans of all U.S. medical schools and to a convenience sample of residency and fellowship PDs. Frequency distributions are reported for key survey items and content analysis was used to describe open-ended responses.

RESULTS

Of the respondents, 7% have a 3YPP, 4% were developing one, and 35% were considering development. In 2014, 47% of educational deans and 32% of PDs agreed that there may be a need to shorten medical school. From a list of benefits, both deans and PDs agreed that the greatest benefit to a 3YPP was debt reduction (68%). PDs and deans felt reduced readiness for independence, reduced exposure to complementary curricula regarding safety and quality improvement, premature commitment to a specialty, and burnout were all potential liabilities. From a list of concerns, PDs were concerned about depth of clinical exposure, direct patient care experience, ability to assume increased responsibility, level of maturity, and certainty regarding career choice.

CONCLUSIONS

Over one-third of medical schools are considering the development of a 3YPP. While there may be benefits for a select group of students, concerns regarding maturity, depth of clinical exposure, and competency must be addressed for these programs to be well received.

Comparison of the problem based learning-driven with the traditional didactic-lecture-based curricula

OBJECTIVE

To compare the Problem-based learning (PBL) with the traditional lecture-based curricula.

METHODS

The single best answer Multiple Choice Questions (MCQ) and the Objective Structured Clinical Examination (OSCE) were used to compare performance of the lecture-based curriculum with the PBL medical student groups. The reliability for the MCQs and OSCE was calculated with Kuder-Richardson formula and Cronbach's alpha, respectively. The content validity of the MCQs and OSCE were tested by the Independent Subject Experts (ISE). The Student's t-test for independent samples was used to compare the item difficulty of the MCQs and OSCE's, and the Chi-square test was used to compare the grades between the two student groups.

RESULTS

The PBL students outperformed the old curriculum students in overall grades, theoretical knowledge base (tested with K2 type MCQs) and OSCE. The number of the PBL students with scores between 80-90% (grade B) was significantly (p=0.035) higher while their number with scores between 60 to 69% (grade C) was significantly p=0.001) lower than the old curriculum students. Similarly, the mean MCQ and the OSCE scores of the new curriculum students were significantly higher (p = 0.001 and p = 0.025, respectively) than the old curriculum students. Lastly, the old curriculum students found the K2-MCQs to be more (p = 0.001) difficult than the single correct answer (K1 type) MCQs while no such difference was found by the new curriculum students.

CONCLUSIONS

Suitably designed MCQs can be used to tap the higher cognitive knowledge base acquired in the PBL setting.

Need assessment of enhancing the weightage of applied biochemistry in the undergraduate curriculum at MGIMS, sevagram

In order to review the need assessment of enhancing the weightage of Applied Biochemistry in the undergraduate curriculum at Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, a validated questionnaire was sent to 453 participants which include 387 undergraduate students, 11 interns, 23 postgraduate students, and 32 faculty members. A web-based data collection and analysis tool was designed for online questionnaire distribution, data collection, and analysis. Response rate was 100%. Most of the respondents agreed that the subject Biochemistry has relevance in clinical practice (81.24%) and applied based learning of Biochemistry by medical undergraduates would help in overall improvement in the health standards/patients care (83.44%). According to 65.12% respondents, most of the medical undergraduates read Biochemistry just for examination purpose only. Nearly half of the respondents agreed that minute details of biochemical reactions were not much useful in clinical practice (53.86%) and the vast majority of diagrammatic cycles memorized by the medical undergraduates had no relevance in clinical practice (51.21%), the decreased interest in learning the Applied Biochemistry was due to more amount of clinically irrelevant information taught to medical undergraduates (73.51%), there was a need to rethink for removing the diagrammatic biochemical cycles from curriculum for medical undergraduates (48.12%), the less learning of Applied Biochemistry or competencies would affect the clinical skills and knowledge of medical undergraduates (70.42%). The result of this study suggests that there is need for restructuring the Biochemistry curriculum with more clinical relevance. © 2016 by The International Union of Biochemistry and Molecular Biology, 44:230-240, 2016.

Activated learning; providing structure in global health education at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA)- a pilot study

BACKGROUND

Global health rotations are increasingly popular amongst medical students. The training abroad is highly variable and there is a recognized need for global health curriculum development. We sought to create and evaluate a curriculum, applicable to any global health rotation, that requires students to take an active role in their education and promotes engagement.

METHODS

Prospective, observational, mixed method study of 4th year medical students enrolled in global health courses at UCLA in 2011-12. Course directors identified 4 topics common to all rotations (traditional medicine, health systems, limited resources, pathology) and developed activities for students to complete abroad: observation, interview and reflection on resources, pathology, medical practices; and compare/contrast their experience with the US healthcare system. Students posted responses on a discussion board moderated by US faculty. After the rotation, students completed an anonymous internet-based evaluative survey. Responses were tabulated. Qualitative data from discussion board postings and free response survey items were analyzed using the framework method.

RESULTS

14 (100 %) students completed the Activated Learning assignment. 12 submitted the post rotation survey (85.7 %). Activated Learning enhanced GH education for 67 % and facilitated engagement in the local medical culture for 67 %. Qualitative analysis of discussion board posting demonstrated multiple areas of knowledge gain and analysis of free response survey items revealed 5 major themes supporting Activated Learning: guided learning, stimulation of discussion, shared interactions, cultural understanding, and knowledge of global healthcare systems. Increased interactivity emerged as the major theme for future improvement.

CONCLUSION

The results of this study suggest that an Activated Learning program may enhance education, standardize curricular objectives across multiple sites and promote engagement in local medical culture, pathology and delivery systems. Increased interaction between students and faculty may augment the impact of such a program.

Using consensus methods to develop a country-specific Master of Public Health curriculum for the Republic of Maldives

BACKGROUND

Over the last four decades, the health status of Maldivian people improved considerably, as reflected in child and maternal mortality indicators and the eradication or control of many communicable diseases. However, changing disease patterns are now undermining these successes, so the local public health practitioners need new skills to perform effectively in this changing environment. To address these needs, in 2013 the Faculty of Health Sciences of the Maldives National University developed the country's first Master of Public Health (MPH) program.

METHODS

The process commenced with a wide scoping exercise and an analysis of the curricular structure of MPH programs of high-ranking universities. Thereafter, a stakeholder consultation using consensus methods reached agreement on overall course structure and the competencies required for local MPH graduates. Subsequently, a working group developed course descriptors and identified local public health research priorities, which could be addressed by MPH students.

RESULTS

Ten semistructured interviews explored specific training needs of prospective MPH students, key public health competencies required by local employers and preferred MPH training models. The recommendations informed a nominal group meeting, where participants agreed on MPH core competencies, overall curricular structure and core subjects. The 17 public health electives put forward by the group were prioritized using an online Delphi process. Participants ranked them by their propensity to address local public health needs and the locally available teaching expertise. The first student cohort commenced their MPH studies in January 2014.

CONCLUSION

Consensus methods allowed a broad stakeholder engagement with public health curriculum development and the creation of a country-specific curriculum, informed by local realities and needs.

How do medical educators design a curriculum that facilitates student learning about professionalism?

OBJECTIVE

This study analyses the ways in which curriculum reform facilitated student learning about professionalism.

METHODS

Design-based research provided the structure for an iterative approach to curriculum change which we undertook over a 3 year period. The learning environment of the Personal and Professional Development Theme (PPD) was analysed through the sociocultural lens of Activity Theory. Lave and Wenger's and Mezirow's learning theories informed curriculum reform to support student development of a patient-centred and critically reflective professional identity. The renewed pedagogical outcomes were aligned with curriculum content, learning and teaching processes and assessment, and intense staff education was undertaken. We analysed qualitative data from tutor interviews and free-response student surveys to evaluate the impact of curriculum reform.

RESULTS

Students' and tutors' reflections on learning in PPD converged on two principle themes--'Developing a philosophy of medicine' and 'Becoming an ethical doctor'--which corresponded to the overarching PPD theme aims of communicative learning. Students and tutors emphasised the importance of the unique learning environment of PPD tutorials for nurturing personal development and the positive impact of the renewed assessment programme on learning.

CONCLUSIONS

A theory-led approach to curriculum reform resulted in student engagement in the PPD curriculum and facilitated a change in student perspective about the epistemological foundation of medicine.

Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools: A Discussion of Common Challenges and Strategies From the UMeCali Experience

Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound education in undergraduate medical education are discussed in this article: (1) initiating an ultrasound education program; (2) the role of medical student involvement; (3) integration of ultrasound in the preclinical years; (4) developing longitudinal ultrasound education; and (5) addressing competency.

Expression, purification, and characterization of a carbohydrate-active enzyme: A research-inspired methods optimization experiment for the biochemistry laboratory

The development and implementation of research-inspired, discovery-based experiences into science laboratory curricula is a proven strategy for increasing student engagement and ownership of experiments. In the novel laboratory module described herein, students learn to express, purify, and characterize a carbohydrate-active enzyme using modern techniques and instrumentation commonly found in a research laboratory. Unlike in a traditional cookbook-style experiment, students generate their own hypotheses regarding expression conditions and quantify the amount of protein isolated using their selected variables. Over the course of three 3-hour laboratory periods, students learn to use sterile technique to express a protein using recombinant DNA in E. coli, purify the resulting enzyme via affinity chromatography and dialysis, analyze the success of their purification scheme via SDS-PAGE, assess the activity of the enzyme via an HPLC-based assay, and quantify the amount of protein isolated via a Bradford assay. Following the completion of this experiment, students were asked to evaluate their experience via an optional survey. All students strongly agreed that this laboratory module was more interesting to them than traditional experiments because of its lack of a pre-determined outcome and desired additional opportunities to participate in the experimental design process. This experiment serves as an example of how research-inspired, discovery-based experiences can benefit both the students and instructor; students learned important skills necessary for real-world biochemistry research and a more concrete understanding of the research process, while generating new knowledge to enhance the scholarly endeavors of the instructor.

Asynchronous learning: student utilization out of sync with their preference

BACKGROUND

Asynchronous learning is gaining popularity. Data are limited regarding this learning method in medical students rotating in emergency medicine (EM). In EM, faculty time is limited to give in-person lectures. The authors sought to create an online curriculum that students could utilize as an additional learning modality.

OBJECTIVE

The goal was to evaluate effectiveness, participation, and preference for this mode of learning.

METHODS

We developed five online, narrated PowerPoint presentations. After orientation, access to the online curriculum was provided to the students, which they could review at their leisure.

RESULTS

One hundred and seven fourth-year medical students participated. They reported the curriculum to be of high quality. Pretest scores were similar for those that viewed all lectures - compliant group (CG) (9.5 [CI 4.8-14.1]) and those that did not view any - non-compliant group (NCG) (9.6 [CI 5.9-13.4]). There was no statistical significant difference in posttest scores between the groups although there was improvement overall: CG 14.6 (CI 6.9-22.1); NCG 11.4 (CI 5.7-17.1). A majority (69.2%) favored inclusion of asynchronous learning, but less than a quarter (22.4%) reported viewing all five modules and more than a third (36.4%) viewed none.

CONCLUSION

Despite student-expressed preference for an online curriculum, they used the online resource less than expected. This should give pause to educators looking to convert core EM topics to an online format. However, when high-quality online lectures are utilized as a learning tool, this study demonstrates that they had neither a positive nor a negative impact on test scores.

Using a Systematic Approach and Theoretical Framework to Design a Curriculum for the Shaping Healthy Choices Program

OBJECTIVE

To examine the use of a systematic approach and theoretical framework to develop an inquiry-based, garden-enhanced nutrition curriculum for the Shaping Healthy Choices Program.

METHODS

Curriculum development occurred in 3 steps: identification of learning objectives, determination of evidence of learning, and activity development. Curriculum activities were further refined through pilot-testing, which was conducted in 2 phases. Formative data collected during pilot-testing resulted in improvements to activities.

RESULTS

Using a systematic, iterative process resulted in a curriculum called Discovering Healthy Choices, which has a strong foundation in Social Cognitive Theory and constructivist learning theory. Furthermore, the Backward Design method provided the design team with a systematic approach to ensure activities addressed targeted learning objectives and overall Shaping Healthy Choices Program goals.

CONCLUSIONS AND IMPLICATIONS

The process by which a nutrition curriculum is developed may have a direct effect on student outcomes. Processes by which nutrition curricula are designed and learning objectives are selected, and how theory and pedagogy are applied should be further investigated so that effective approaches to developing garden-enhanced nutrition interventions can be determined and replicated.

Implementing and Evaluating a Four-Year Integrated End-of-Life Care Curriculum for Medical Students

PROBLEM

Meeting the needs of patients with life-limiting and terminal illness requires effectively trained physicians in all specialties to provide skillful and compassionate care. Despite mandates for end-of-life (EoL) care education, graduating medical students do not consistently feel prepared to provide this care.

INTERVENTION

We have developed a longitudinal, integrated, and developmental 4-year curriculum in EoL care. The curriculum's purpose is to teach basic competencies in EoL care. A variety of teaching strategies emphasize experiential, skill-building activities with special attention to student self-reflection. In addition, we have incorporated interprofessional learning and education on the spiritual and cultural aspects of care. We created blended learning strategies combining interactive online modules with live workshops that promote flexibility, adaptability, and interprofessional learning opportunities.

CONTEXT

The curriculum was implemented and evaluated in the 4-year program of studies at Yale School of Medicine.

OUTCOME

A mixed-method evaluation of the curriculum included reviews of student written reflections and questionnaires, graduating student surveys, and demonstration of 4th-year students' competency in palliative care with an observed structured clinical examination (OSCE). These evaluations demonstrate significant improvements in students' self-reported preparedness in EoL care and perceptions of the adequacy in their instruction in EoL and palliative care, as well as competency in primary palliative care in a newly developed OSCE.

LESSONS LEARNED

A 4-year longitudinal integrated curriculum enhances students' skills and preparedness in important aspects of EoL care. As faculty resources, clinical sites, and curricular structure vary by institution, proven and adaptable educational strategies as described in this article may be useful to address the mandate to improve EoL care education. Teaching strategies and curricular components and design as just described can be adapted to other programs.

Building and executing a research agenda toward conducting implementation science in medical education

BACKGROUND

Implementation science (IS) is the study of methods that successfully integrate best evidence into practice. Although typically applied in healthcare settings to improve patient care and subsequent outcomes, IS also has immediate and practical applications to medical education toward improving physician training and educational outcomes. The objective of this article is to illustrate how to build a research agenda that focuses on applying IS principles in medical education.

APPROACH

We examined the literature to construct a rationale for using IS to improve medical education. We then used a generalizable scenario to step through a process for applying IS to improve team-based care.

PERSPECTIVES

IS provides a valuable approach to medical educators and researchers for making improvements in medical education and overcoming institution-based challenges. It encourages medical educators to systematically build upon the research outcomes of others to guide decision-making while evaluating the successes of best practices in individual environments and generate additional research questions and findings.

CONCLUSIONS

IS can act as both a driver and a model for educational research to ensure that best educational practices are easier and faster to implement widely.

The Mastery Rubric for Evidence-Based Medicine: Institutional Validation via Multidimensional Scaling

CONSTRUCT: In this study we describe a multidimensional scaling (MDS) exercise to validate the curricular elements composing a new Mastery Rubric (MR) for a curriculum in evidence-based medicine (EBM). This MR-EBM comprises 10 elements of knowledge, skills, and abilities (KSAs) representing our institutional learning goals of career-spanning engagement with EBM. An MR also includes developmental trajectories for each KSA, beginning with medical school coursework, including residency training, and outlining the qualifications of individuals to teach and mentor in EBM. The development was not part of the validation effort, as our curriculum is focused at a single stage (undergraduate medical students).

BACKGROUND

An MR comprises the desired KSAs for an entire curriculum, together with descriptions of a learner's performance and/or capabilities as they develop from novice to proficiency of the curricular target(s). The MR construct is intended to support curriculum development or refinement by capturing the KSAs that support the articulation of concrete learning goals; it also promotes assessment that demonstrates development in the target KSAs and encourages reflection and self-directed learning throughout the learner's career. Two other MRs have been published, and this is the first one specific to teaching and learning in medicine; this is also the first one created specifically to evaluate an existing curriculum.

APPROACH

To validate the dispersion of the elements of the EBM curriculum, the nine clinical instructors in the EBM two-course curriculum completed an MDS exercise, rating the similarities of the 10 curricular elements. MDS is a mathematical approach to understanding relationships among concepts/objects when these relationships are difficult to quantify. Eliciting similarity ratings biased the responses toward the null hypothesis (that the elements are not different).

RESULTS

MDS results suggested that the MR represents 10 different, although related, facets of the construct "evidence-based medicine." The results support the makeup of the MR-EBM, and its use to revise our EBM curriculum so that it is more closely aligned with this MR.

CONCLUSIONS

An MR is a tool, and the MR-EBM that we describe can be useful to develop or evaluate a curriculum in EBM. The MR tool is particularly compatible with the objectives of training for EBM and practice and can be applied to create or evaluate a curriculum using any topical KSA framework. The MR-EBM we describe could be adopted or adapted to represent other institutional objectives for EBM training.

Combining Expertise: Reflecting on a Team Approach to Curriculum Development and Implementation

INTRODUCTION

This article discussed curriculum development and implementation using a unique collaboration of basic scientists and clinicians functioning as course co-directors. It explores the pros, cons, and unintended consequences of this integrated approach through reflections of the faculty involved.

METHODS

Ten faculty participated in semi-structured phone interviews to reflect on their experiences.

RESULTS

Analysis of interview transcripts revealed four key themes: (1) the value of the basic scientist and clinician partnership, (2) strategies for coordination, (3) balancing responsibilities, and (4) hierarchy and power.

DISCUSSION

This study identified that both basic scientists and clinicians experienced benefits from using a course co-director collaborative approach to curriculum development and implementation. While challenges are also noted, the benefits of the collaboration were evident in course organization, course evaluation reports, student feedback, and USMLE Step I pass rate.

Exploring emerging learning needs: a UK-wide consultation on environmental sustainability learning objectives for medical education

OBJECTIVE

This study aimed to engage wide-ranging stakeholders and develop consensus learning objectives for undergraduate and postgraduate medical education.

METHODS

A UK-wide consultation garnered opinions of healthcare students, healthcare educators and other key stakeholders about environmental sustainability in medical education. The policy Delphi approach informed this study. Draft learning objectives were revised iteratively during three rounds of consultation: online questionnaire or telephone interview, face-to-face seminar and email consultation.

RESULTS

Twelve draft learning objectives were developed based on review of relevant literature. In round one, 64 participants' median ratings of the learning objectives were 3.5 for relevance and 3.0 for feasibility on a Likert scale of one to four. Revisions were proposed, e.g. to highlight relevance to public health and professionalism. Thirty three participants attended round two. Conflicting opinions were explored. Added content areas included health benefits of sustainable behaviours. To enhance usability, restructuring provided three overarching learning objectives, each with subsidiary points. All participants from rounds one and two were contacted in round three, and no further edits were required.

CONCLUSIONS

This is the first attempt to define consensus learning objectives for medical students about environmental sustainability. Allowing a wide range of stakeholders to comment on multiple iterations of the document stimulated their engagement with the issues raised and ownership of the resulting learning objectives.

A Delphi Study on Staff Bereavement Training in the Intellectual and Developmental Disabilities Field

The Delphi technique was used to obtain expert panel consensus to prioritize content areas and delivery methods for developing staff grief and bereavement curriculum training in the intellectual and developmental disabilities (IDD) field. The Delphi technique was conducted with a panel of 18 experts from formal and informal disability caregiving, nursing, and hospice and bereavement service provision. Results showed that training should help staff identify and support service users experiencing grief. Importantly, staff also needs help in managing their own grief. Organizational policies and resources should be instituted to support the grief processes of both service users and staff. Practice-based applications are discussed, and research implications are presented for training evaluation.

Implementation of "social and communicative competencies" in medical education. The importance of curriculum, organisational and human resource development

Objective: With this article we want to support teachers and curriculum planners to be aware of and apply knowledge and recommendations of organisational (OD), curriculums (CD) and human resource development (HRD) ideas already in the planning phase of a project. Taking these into account can influence the process of change successfully and controlled during the introduction and establishment of curricula in the field of communication and social skills in medical education.

Approach and Results: In the context of a multi-stage developmental process, a recommendation on CD for "Communicative and social competencies" was developed. The basis for it was made during two workshops of the GMA-committee "Communicative and social competencies" and supplemented by the available literature and the experience of communication experts. The "Undeloher Recommendation" (see attachment ) includes a compilation of recommendations and guiding questions, which is geared to the various phases of CD. Additionally, general approaches and recommendations of organisational and human resource development were integrated, which turned out to be particularly relevant in the process of CD. Thus, the "Undeloher recommendation" includes an orientation for each phase of the curriculum development process, the organisation and the staff in order to successfully implement a longitudinal curriculum. In addition to theoretical models the long-term discussion process and the personal experiences of a variety of curriculum planners and teachers have been integrated.

Conclusion: The "Undeloher recommendation" can support the implementation processes of curricula in communication and social skills during development and realisation. Its application was reviewed in the context of workshops based on concrete examples. The participating teachers and curriculum planners assessed it to be very helpful. The recommendation goes beyond of what has been described in terms of content models in the CD so fare. In particular, the organisational and human resource development related aspects such as the formation of a steering committee and recommendations for the phase of sustainability.

Factors associated with medical student clinical reasoning and evidence based medicine practice

OBJECTIVES

To identify the factors associated with medical students' clinical reasoning (CR) use and evidence-based medicine (EBM) use in the clinical setting.

METHODS

Our cross-sectional study surveyed 44 final-year medical students at an emerging academic medical center in Singapore. We queried the students' EBM and CR value and experiences in the classroom and clinical settings. We compared this to their perceptions of supervisors' value and experiences using t-tests. We developed measures of teaching culture and practice culture by combining relevant questions into summary scores. Multivariate linear regression models were applied to identify factors associated with the students' CR and EBM clinical use.

RESULTS

Eighty-nine percent of students responded (n=39). Students reported valuing CR (p=0.03) and EBM (p=0.001) more than their supervisors, but practiced these skills similarly (p=0.83; p=0.82). Clinical practice culture and classroom CR experience were independently associated with students' CR clinical use (p=0.05; p=0.04), and classroom EBM experience was independently associated with students' EBM clinical use (p=0.03). Clinical teaching culture was not associated with students' CR and EBM clinical use.

CONCLUSIONS

Our study found that medical students' classroom experience and the clinical practice culture influenced their CR and EBM use. The clinical teaching culture did not. These findings suggest that in order to increase student CR and EBM use, in addition to providing classroom experience, medical educators may need to change the hospital culture by encouraging supervisors to use these skills in their clinical practice.

The pediatric hematology/oncology educational laboratory in-training examination (PHOELIX): A formative evaluation of laboratory skills for Canadian pediatric hematology/oncology trainees

BACKGROUND

Pediatric hematologists/oncologists need to be skilled clinicians, and must also be adept and knowledgeable in relevant areas of laboratory medicine. Canadian training programs in this subspecialty have a minimum requirement for 6 months of training in acquiring "relevant laboratory diagnostic skills." The Canadian pediatric hematology/oncology (PHO) national specialty society, C17, recognized the need for an assessment method in laboratory skills for fellows graduating from PHO training programs.

PROCEDURE

Canadian pediatric hematologists/oncologists were surveyed regarding what were felt to be the essential laboratory-related knowledge and skills deemed necessary for graduating pediatric hematology/oncology trainees. The PHOELIX (Pediatric hematology/oncology educational laboratory in-training examination) was then developed to provide an annual formative evaluation of laboratory skills in Canadian PHO trainees.

RESULTS

The majority of PHO respondents (89%) felt that laboratory skills are important in clinical practice. An annual formative examination including review of glass slides was implemented starting in 2010; this provides feedback regarding knowledge of laboratory medicine to both trainees and program directors (PDs).

CONCLUSIONS

We have successfully created a formative examination that can be used to evaluate and educate trainees, as well as provide PDs with a tool to gauge the effectiveness of their laboratory training curriculum. Feedback has been positive from both trainees and PDs.

What all students in healthcare training programs should learn to increase health equity: perspectives on postcolonialism and the health of Aboriginal Peoples in Canada

BACKGROUND

The ongoing role of colonialism in producing health inequities is well-known. Postcolonialism is a theoretical approach that enables healthcare providers to better understand and address health inequities in society. While the importance of postcolonialism and health (PCH) in the education of clinicians has been recognized, the literature lacks guidance on how to incorporate PCH into healthcare training programs. This study explores the perspectives of key informants regarding content related to PCH that should be included in Canadian healthcare training programs, and how this content should be delivered.

METHODS

This qualitative study involved in-depth, semi-structured interviews with nineteen individuals with insight into PCH in Canada. Data were analyzed collaboratively to identify, code and translate key emergent themes according to the six phases of the DEPICT method.

RESULTS

Three themes emerged related to incorporating PCH into Canadian healthcare training programs: (1) content related to PCH that should be taught; (2) how this content should be delivered, including teaching strategies, who should teach this content and when content should be taught, and; (3) why this content should be taught. For the Canadian context, participants advised that PCH content should include a foundational history of colonization of Aboriginal Peoples in Canada, how structures rooted in colonialism continue to produce health inequities, and how Canadian clinicians' own experiences of privilege and oppression affect their practice. Participants also advised that this content should be integrated longitudinally through a variety of interactive teaching strategies and developed in collaboration with Aboriginal partners to address health inequities.

CONCLUSIONS

These findings reinforce that clinicians and educators must understand health and healthcare as situated in social, political and historical contexts rooted in colonialism. Postcolonialism enables learners to understand and respond to how colonialism creates and sustains health inequities. This empirical study provides educators with guidance regarding PCH content and delivery strategies for healthcare training programs. More broadly, this study joins the chorus of voices calling for critical reflection on the limits and harms of an exclusively Western worldview, and the need for action to name and correct past wrongs in the spirit of reconciliation and justice for all.

Obstetric and Gynecologic Resident Ultrasound Education Project: Is the Current Level of Gynecologic Ultrasound Training in Canada Meeting the Needs of Residents and Faculty?

OBJECTIVES

Ultrasound is a critical diagnostic imaging tool in obstetrics and gynecology (Ob/Gyn). Obstetric ultrasound is taught during residency, but we suspected a gap in Gyn ultrasound education. Proficiency in Gyn ultrasound allows real-time interpretation and management of pelvic disease and facilitates technical skill development for trainees learning blinded procedures. This study sought to evaluate ultrasound education in Canada's Ob/Gyn residency programs and assess whether residents and physicians perceived a need for a formalized Gyn ultrasound curriculum.

METHODS

We distributed a needs assessment survey to residents enrolled in Canadian Ob/Gyn residency programs and to all obstetrician/gynecologists registered as members of the Society of Obstetricians and Gynaecologists of Canada. Residents were asked to specify their current training in ultrasound and to rate the adequacy of their curriculum. All respondents rated the importance of proficiency in pelvic ultrasound for practicing obstetrician/gynecologists as well as the perceived need for formalized ultrasound training in Ob/Gyn residency programs.

RESULTS

Eighty-two residents and 233 physicians completed the survey. Extents and types of ultrasound training varied across residency programs. Most residents reported inadequate exposure to Gyn ultrasound, and most residents and physicians agreed that it is important for obstetrician/gynecologists to be proficient in Gyn ultrasound and that the development of a standardized Gyn ultrasound curriculum for residency programs is important.

CONCLUSIONS

Current ultrasound education in Ob/Gyn varies across Canadian residency programs. Training in Gyn ultrasound is lacking, and both trainees and physicians confirmed the need for a standardized Gyn ultrasound curriculum for residency programs in Canada.

Incorporating resident/fellow training into a robotic surgery program

With the rapid uptake of the robotic approach in gynecologic surgery, a thorough understanding of the technology, including its uses and limitations, is critical to maximize patient outcomes and safety. This review discusses the role of training modalities and development of curricula for robotic surgery. Furthermore, methods for incorporating the entire surgical team and the process of credentialing/maintaining privileges are described.

Communication skills in psychiatry training

OBJECTIVE

Mental health clinicians can experience problems communicating distressing diagnostic information to patients and their families, especially about severe mental illnesses such as schizophrenia. Evidence suggests that interpersonal communication skills can be effectively taught, as has been demonstrated in the specialty of oncology. However, very little literature exists with respect to interpersonal communication skills training for psychiatry. This paper provides an overview of the communication skills training literature.

CONCLUSIONS

The report reveals significant gaps exist and highlights the need for advanced communication skills training for mental health clinicians, particularly about communicating a diagnosis and/or prognosis of schizophrenia. A new communication skills training framework for psychiatry is described, based on that used in oncology as a model. This model promotes applied skills and processes that are easily adapted for use in psychiatry, providing an effective platform for the development of similar training programs for psychiatric clinical practice.