How Medical Educators Can Foster Equity and Inclusion in Their Teaching: A Faculty Development Workshop Series

PROBLEM

Diversity, equity, and inclusion are increasingly highlighted in medical education, but bias continues to disproportionately impact learners from racial and ethnic groups traditionally underrepresented in medicine. Many faculty struggle to engage with these concepts in their teaching and fear making mistakes, but few opportunities exist for faculty to develop their skills.

APPROACH

To advance the goal of fostering an equitable educational environment, the authors envisioned a series of faculty development workshops to cultivate faculty skills and comfort with incorporating equity and inclusion in their teaching, assessment, and curriculum development work. The authors conducted a needs assessment and followed Kern's 6-step process for curriculum development to build the workshop series.

OUTCOMES

Using local resources and expertise, the authors built a workshop series that culminated in a certificate in Teaching for Equity and Inclusion. The development process took 24 months; 22 faculty volunteered to design and teach 7 new workshops. Initial workshop offerings have reached 101 participants, and 120 faculty members have enrolled in the certificate. The workshops have been well received and are rated on par with or more highly than other faculty development offerings at the University of California, San Francisco.

NEXT STEPS

Future directions include assessing the impact of the certificate on participants and workshop faculty, creating opportunities for workshop faculty to share best practices, and exploring alternative models for participation. The authors' experience demonstrates the feasibility of creating a self-sustaining program that will advance faculty competence in the critical areas of diversity, equity, and inclusion.

Flipped classroom combined with human anatomy web-based learning system shows promising effects in anatomy education

Flipped classroom has received much attention in medical education. The aim of this study was to evaluate the efficacy of flipped classroom combing with human anatomy web-based learning system in anatomy education.A total of 89 freshmen in medical specialty were enrolled and randomly allocated into either the experimental group (receiving the flipped classroom with human anatomy web-based learning system, n = 45) or control group (receiving the traditional classroom teaching, n = 44). A pre-quiz and a post-quiz were conducted before and after the classes, respectively. The improvement in scores between groups was compared. A 5-point Likert scale questionnaire was used to evaluate perceptions and experience.The mean pre-quiz scores of the 2 groups were comparable (all P > .05). However, the mean post-quiz score in the experimental group was significantly higher than that in the control group (91.44 ± 6.25 vs 86.13 ± 11.67, P < .05). The results of questionnaires showed that 44 (97.8%) students agreed with flipped classroom combined with human anatomy web-based learning system, 43 (95.6%) students obtained improved study interest in anatomy learning, and 42 (93.3%) students felt that the interactive, applied in-class activities during the class greatly enhanced their learning.Flipped classroom combined with human anatomy web-based learning system can be used as an effective learning tool for anatomy education.

Histology and Embryology Education in China: The Current Situation and Changes Over the Past 20 Years

In mainland China, histology and embryology (HE) are taught in one course as an essential component of medical curricula. The effectiveness of HE courses directly affects the quality of medical students. To determine the present situation and changes in HE teaching in Chinese medical schools, a nationwide survey was conducted among the HE departmental leaders. In total, 66 responses were included in the study, representing prominent Chinese mainland medical schools. The results revealed that most HE teachers have medical educational backgrounds; an increasing number of teaching staff with PhDs have joined the teaching staffs. A range of 71 to 90 HE curriculum contact hours is predominant. The ratio of theory to practice for HE contact hours is 1:1 at half of the surveyed medical schools. The numbers of students in each laboratory are less than 30 and from 31 to 60 at 23 and 36 medical schools, respectively. Virtual microscopy is employed in 40% of the surveyed medical schools. Didactic teaching is the most common strategy, although new teaching approaches are being employed gradually. During the past 20 years, both the total number of HE teachers and the number of HE teachers with medical educational backgrounds have been reduced in at least half of the surveyed schools. A total of 83.33% of the surveyed schools have reduced their HE contact hours. Almost half of the Chinese medical schools remained unchanged in both their ratio of theory to practice and the number of students in each laboratory. The data derived from this study help to understand the development of the HE discipline at Chinese medical schools.

The Application of the Teaching Games for Understanding in Physical Education. Systematic Review of the Last Six Years

A systematic review of the research conducted on Teaching Games for Understanding in Physical Education in the last six years (2014–2019), updating and expanding with new categories the last published review by Harvey and Jarret in 2014. Four databases were used to select those articles that included information on the implementation of Teaching Games for Understanding in different educational stages. According to PRISMA guidelines and including the PICO strategy after the exclusion criteria, 12 articles were fully assessed based on eight criteria: (1) year and author; (2) country; (3) number of participants, educational level, and duration of implementation; (4) type of research; (5) curricular content; (6) purpose of the research; (7) most relevant results; and (8) learning environment. The results showed how research focuses on both primary and secondary education, primarily in short-term interventions. Quantitative, qualitative and mixed research is used almost equally, and dealt evenly with sports and games, leaving motor skills, physical abilities and body expression underrepresented. Regarding the goals of the studies, motor and cognitive learning were the most frequently assessed, focusing on improvement of game development, such as tactical aspects, decision-making, technical skills or level of physical activity. The implementation of the model is carried out in too short a time to achieve significant outcomes. This review can help researchers and practitioners conduct Teaching Games for Understanding intervention programs in primary and secondary Physical Education. They must be rigorous when they claim that they implement this pedagogical model in schools.

National Survey on Canadian Undergraduate Medical Programs: The Decline of the Anatomical Sciences in Canadian Medical Education

The anatomical sciences have always been regarded as an essential component of medical education. In Canada, the methodology and time dedicated to anatomy teaching are currently unknown. Two surveys were administered to course directors and discipline leaders to gain a comprehensive view of anatomical education in Canadian medical schools. Participants were queried about contact hours (classroom and laboratory), content delivery and assessment methods for gross anatomy, histology, and embryology. Twelve schools responded to both surveys, for an overall response rate of 64%. Overall, Canadian medical students spend 92.8 (± 45.4) hours (mean ± SD) studying gross anatomy, 25.2 (± 21.0) hours for histology, and 7.4 (± 4.3) hours for embryology. Gross anatomy contact hours statistically significantly exceeded those for histology and embryology. Results show that most content is delivered in the first year of medical school, as anatomy is a foundational building block for upper-year courses. Laboratory contact time for gross anatomy was 56.8 (± 30.7) hours, histology was 11.4 (± 16.2) hours, and embryology was 0.25 (± 0.6) hours. Additionally, 42% of programs predominantly used instructor/technician-made prosections, another 33% used a mix of dissection and prosections and 25% have their students complete cadaveric dissections. Teaching is either completely or partially integrated into all Canadian medical curricula. This integration trend in Canada parallels those of other medical schools around the world where programs have begun to decrease contact time in anatomy and increase integration of the anatomical sciences into other courses. Compared to published American data, Canadian schools offer less contact time. The reason for this gap is unknown. Further investigation is required to determine if the amount of anatomical science education within medical school affects students' performance in clerkship, residency and beyond.

Survey of Gross Anatomy Education in China: The Past and the Present

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990-1999, 2000-2009, and 2010-2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000-2009 to 36.10 ± 47.26 in 2010-2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990-1999 to 14.22 ± 5.0 in 2010-2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000-2009 to 1:33.2 in 2010-2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.

Increasing the availability of Tai Chi to veterans through a training of trainers course

PURPOSE

The purpose of this nurse-led project was to increase the number of interprofessional Tai Chi instructors for veterans through a 5-week (32 hours) training of trainers (ToT) course led by a Tai Chi master trainer.

METHODS

This project was designed to evaluate the effectiveness of using the ToT model to increase the availability of Tai Chi to veterans. To understand how well the ToT course met learners' needs, a two-phase course evaluation was conducted.

RESULTS

Fifteen interprofessional employees enrolled in and completed the course. Most learners were white (67%) females (67%) with a median age of 50 years. All agreed that the training provided the skills, materials, and confidence to lead Tai Chi classes. Most (93%) indicated experiencing positive health benefits from the training and none experienced any negative effects. The 3-month follow-up evaluation indicated that 10 (67%) were teaching veterans in individual or group classes with two others assisting. Twelve instructors taught more than 150 veterans.

CONCLUSIONS

Overall, learners evaluated this ToT course positively and indicated their needs were met and felt prepared to teach Tai Chi despite being inexperienced. The course was a success with 80% of new instructors teaching or coteaching Tai Chi to veterans.

Impact of whey protein isolate and eccentric training on quadriceps mass and strength in patients with anterior cruciate ligament rupture: A randomized controlled trial

OBJECTIVE

To examine the effects of combining whey protein isolate supplement with preoperative isokinetic eccentric training on quadriceps mass and strength following anterior cruciate ligament rupture.

DESIGN

Randomized controlled trial.

SUBJECTS

A total of 37 male subjects with anterior cruciate ligament rupture.

METHODS

Participants were randomly assigned to an isokinetic eccentric training group (n = 19) or an isokinetic eccentric training + whey protein isolate group (n = 18). Both groups received isokinetic eccentric training for 6 weeks. The isokinetic eccentric training + whey protein isolate group received 22 g whey protein isolate daily.

RESULTS

After the intervention, the cross-sectional area of the affected quadriceps had increased only in the isokinetic eccentric training + whey protein isolate group (7.6 ± 6.8%; p = 0.012), whereas there was no change in the isokinetic eccentric training group (3.7 ± 4.5%; p = 0.11). Both groups showed increased quadriceps strength; however, there were no further effects for the isokinetic eccentric training + whey protein isolate group. Lysholm and IKDC 2000 knee function scores increased only in the isokinetic eccentric training + whey protein isolate group (p < 0.01).

CONCLUSION

Although the study showed numerically better outcomes for the combination of whey protein isolate supplement with isokinetic eccentric training compared with isokinetic eccentric training alone, no statistically significant differences were demonstrated between the groups.

Lecture series on gender medicine at Innsbruck and Vienna medical universities: a teaching format in comparison

Introduction: Diversity-specific differences in health, illness and access to a health system have meanwhile been studied well. Educating medical students offers good leverage for broadening this knowledge within the medical professions. One approach is to use elective subjects. Project Description: The goal of this work is to compare the lecture series on Gender Medicine at the Medical Universities of Innsbruck and Vienna. Results: The cornerstones of both of these lecture series (topics that vary per semester, various lecturers speaking on a predefined cross-cutting topic) are similar. Various approaches prevail for the target groups and the lecturers as well as the question of credit for external students. Both universities tackle different medical disciplines each semester while concentrating on gender-specific questions. Teacher evaluation in Innsbruck as well as the feedback from the students in Vienna show that the lecture series have a positive impact on how the various diversity categories influence health and illness. Discussion: Ensuring that a particular leitmotif runs through the various lectures of a lecture series entails increased planning and organizational work. On the other hand, various medical disciplines and their perspectives can be presented in a lecture series. Conclusion: The lecture series are embedded in overall strategies at the two universities. Ensuring the sustainability of the integration of Gender Medicine as a cross-cutting topic in medical education is, however, only possible when combined with other efforts.

Blended learning in undergraduate nursing education - A scoping review

OBJECTIVES

To provide a comprehensive scoping review of the existing literature regarding the use of blended learning in undergraduate nursing education. To align the varied educational terms and definitions with the broad definition of blended learning.

DESIGN

Scoping review following established methodology.

DATA SOURCES

In consultation with library services, the academic literature was searched. Electronic databases searched included ERIC (OVID), Medline (OVID), PubMed, Nursing and Allied Health, and CINAHL Plus.

REVIEW METHODS

A total of 189 potentially relevant nursing research articles published between the years of 2009 and 2019. Three reviewers independently reviewed the articles, leaving 37 relevant primary articles in the nursing field to be included in the scoping review.

RESULTS

Nursing content delivered using blended learning approaches were organized into 8 themes. Themes include Professional Nursing Skills; Mental Health Nursing; Bioscience; Pharmacology, Specialty Populations; Nursing Assessment; Acute Care Nursing; and the Art of Nursing. A variety of blended learning approaches are being utilized in Undergraduate nursing education, the majority of which are happening in the classroom.

CONCLUSION

This scoping review presents explicit the degrees to which blended learning is referred to in the nursing education literature and expanded the definition of blended learning to encompass the terminology associated with distributed, decentralized, hybrid, and flexible learning. There is a wide, varied, and expanding number of blended learning approaches currently being utilized in nursing education to teach a wide range of nursing content and skills. An expanded scoping review focused on blended learning in psychiatric nursing, licenced practical nursing, nurse practitioners, and all graduate level nursing education programs is recommended as is additional research into the use of blended learning in the lab or clinical setting.

Application of Absorb-Do-Connect learning framework to foster experiential, practice, and career-ready learners

INTRODUCTION

As educators, we have the opportunity to produce experiential-ready, practice-ready, and career-ready practitioners. Student attitudes and values influence how learned knowledge and skills will be enacted, and therefore are key determinants of career-readiness. However, attitudes and values can be challenging to see and measure in learners. In this commentary, the authors propose purposeful selection and application of an educational framework to foster those less tangible, but powerful, factors.

PERSPECTIVE

To illustrate this perspective, authors describe key components of the Absorb-Do-Connect learning framework and provide rationale for the framework's alignment with self-efficacy theory. The authors propose that Absorb-Do-Connect can be applied within pharmacy education to design learning activities that establish relevance in learning and subsequently foster self-efficacy through growth in attitudes and values.

IMPLICATIONS

The Accreditation Council for Pharmacy Education Standards emphasize connecting current education to past experiences and future practice to establish relevance in learning. In this manner, authors suggest Absorb-Do-Connect can be used by schools and colleges of pharmacy to inform new innovations and revise existing coursework to meet the standards. Opportunity exists to formally assess the relationship between absorbing, engaging with and purposely connecting knowledge and skills, and the development of self-efficacy in student pharmacists.

Use of a flipped classroom in ophthalmology courses for nursing, dental and medical students: A quasi-experimental study using a mixed-methods approach

BACKGROUND

Traditional teaching is associated with dilemmas, such as low motivation to learn and passive learning. In contrast, use of a flipped classroom with the proper learning design has the potential to promote accelerated learning, bolster transmission of competencies (i.e., critical thinking, communication and problem-solving skills) and improve teamwork capacity, all of which are of great significance in professional healthcare practice, including nursing, dentistry and medicine.

OBJECTIVE

The aim of the study was to examine the effects of using a flipped classroom in ophthalmology courses for undergraduate nursing students, dental students and higher vocational medical students.

DESIGN

A quasi-experimental design was used with an intervention (n = 100) and a comparison group (n = 100), pre-/post-testing measures and a mixed-methods approach.

SETTING

A university in China.

PARTICIPANTS

A total of 200 students were included.

METHODS

Students' self-rated learning ability was measured before and after the courses, and skill exams were performed after the courses. In addition, interviews were conducted with the clinical medical students concerning their experiences of the flipped classroom.

RESULTS

Students' self-rated learning ability improved significantly more in the intervention than in the comparison group, for the total scale and the three factors 'learning goals', 'self-efficacy and social learning' and 'problem-solving'. Skill exam scores were statistically significantly better in the intervention than in the comparison group. On the whole, the clinical medicine students felt the flipped classroom had a positive impact and improved their learning ability as well as knowledge in ophthalmology.

CONCLUSIONS

Use of a flipped classroom for nursing, dental and clinical medical students in ophthalmology courses shows promising results in the form of students' skill exam scores and self-rated learning ability.

Blended learning: ten tips on how to implement it into a curriculum in healthcare education

Blended learning is a meaningful combination of online and face-to-face teaching and learning. In this article we summarize relevant aspects of this format and provide ten tips for educators and curriculum developers on implementing a blended learning curriculum in healthcare education. These general tips are derived from our experience and the available literature and cover the planning and implementation process.

The digitalization aliens

Digitization in medical education opens up numerous exciting new possibilities. It is the task of those responsible for teaching to take advantage of this opportunity and use digitization as teaching content, but also as a design option for existing teaching structures. Only through up-to-date, longitudinal knowledge transfer a change be initiated and, with the help of innovative teaching and learning concepts, teachers and students can be empowered to achieve this. The aim is to evaluate, critically question and integrate digitization into the overall context of healthcare.

Teaching Systems Improvement to Early Medical Students: Strategies and Lessons Learned

PURPOSE

Despite increasing emphasis in medical school education on quality and systems improvement, many medical schools lack sufficient faculty with expertise to teach systems improvement. Using the pedagogical content knowledge framework, this study explores how faculty engage students in systems improvement work and faculty perceptions of the outcomes for the health system and students.

METHOD

In May-June 2017, the authors interviewed 12 of 13 invited faculty with experience in teaching and engaging first-year medical students in systems improvement work, the course of students' systems improvement work over time, the impact of students' projects on health systems, and students' learning and attitudes about systems improvement. The authors conducted qualitative analysis iteratively with data collection to sufficiency.

RESULTS

Six emergent themes characterized faculty's approach to guiding students in systems improvement work: faculty-student relationship, faculty role, student role, faculty-student shared responsibility for projects, faculty and student content knowledge, and project outcomes. The faculty-student relationship was foundational for successful systems improvement work. Faculty roles included project selection, project management, and health systems interactions. Students engaged in systems improvement as their faculty leveraged their knowledge and skills and created meaningful student roles. Faculty and students shared responsibility and colearned systems improvement content knowledge. Faculty defined successful outcomes as students' learning about the systems improvement process and interprofessional collaboration.

CONCLUSIONS

Findings highlight the critical importance of pedagogical content knowledge to engage early learners in systems improvement work, understand their learning interests and needs, and manage their projects longitudinally.

Illuminating Shadows: The Power of Learning by Observing

"Shadowing" refers to the practice of a student following an instructor. Although the term implies less light, rather than more, shadowing as an instructional modality in medical education can illuminate, stimulate, and move students to emulate what they might otherwise never observe. In this Invited Commentary, the author reports on a teaching encounter in the office in which shadowing was the principal modality used. This modality is situated within the spectrum of approaches to learning-from experiential learning to passive learning. Based upon personal experience as both a teacher and learner, the author identifies the unique value of shadowing, including its value in influencing career choice.

What Makes the "Perfect" Inpatient Consultation? A Qualitative Analysis of Resident and Fellow Perspectives

PURPOSE

To characterize the methods of inpatient consult communication, given new communication modalities; to explore residents' and fellows' perspectives on the ideal consult and how this consult could affect their teaching, learning, and patient safety; and to identify barriers to and strategies for optimizing consultations.

METHOD

Using qualitative grounded theory, the authors conducted semistructured focus groups with pediatric residents and fellows at Lucile Packard Children's Hospital at Stanford University from October 2016 to September 2017, using questions developed by expert consensus to address study objectives. Sessions were audiorecorded and transcribed verbatim. Two authors independently coded the transcripts and reconciled codes to develop categories and themes using constant comparison. The third author validated the codes, categories, and themes. To ensure trustworthiness, participants edited the themes for accuracy.

RESULTS

Twenty-seven residents and 16 fellows participated in 7 focus groups (3 with residents, 4 with fellows). Four themes emerged: (1) Many forms of communication are successfully used for initial inpatient consult recommendations (in person, phone, text messages, notes in electronic medical records); (2) residents and fellows prefer in-person communication for consults, believing it leads to improved teaching, learning, and patient safety; (3) multiple strategies can optimize consults regardless of communication modality; and (4) how residents frame the initial consult affects the interaction and can increase fellow engagement, which leads to more fellow teaching, residents' improved understanding, and better patient care.

CONCLUSIONS

Residents and fellows believe that structured initial consults conducted in person improve teaching, learning, and patient care. Several strategies exist to optimize this process.

Creating and Presenting an Effective Lecture

Lectures are a key tool for large group teaching in continuing professional development and continuing medical education within the health care professions. However, many practitioners who deliver lectures have not had the time or opportunity to participate in formal training on how to give an effective presentation. In this article, we will provide a comprehensive guide for creating and presenting an effective lecture. We will discuss evidence-based principles of effective teaching, slide organization and design, active learning, and public speaking.

Signature pedagogies: An integrative review of an emerging concept in nursing education

OBJECTIVES

The aim of this paper is to provide an integrative review of the literature associated with signature pedagogies and to discover what lessons have been learned about unearthing, articulating and applying signature pedagogies across a variety of disciplines, but particularly with respect to nursing.

DESIGN

A systematic search of databases using key terms was utilised with a particular focus to papers emerging from nursing disciplines.

DATA SOURCES

The databases MEDLINE, CINAHL, ERIC, Web of Science and Google Scholar were searched for literature from 2005 to 2018 inclusive.

REVIEW METHODS

An initial examination of titles and abstracts by the authors resulted in the retrieval of 45 papers and following the application of exclusion criteria, 25 papers were included.

RESULTS AND CONCLUSIONS

Signature pedagogy literature is a developing area and scholars both in nursing disciplines and beyond, often fail to develop on Lee Shulman's framework in their identification of signature pedagogies, resulting in poorly adapted conceptions. Ways forward include closer linking with the original signature pedagogy framework in research, the development of robust evidence-based signature pedagogy identification processes in disciplines and a reconsideration of the esteem of scholars performing signature pedagogies within disciplines.

Independent and Interwoven: A Qualitative Exploration of Residents' Experiences With Educational Podcasts

PURPOSE

Educational podcasts are an increasingly popular platform for teaching and learning in health professions education. Yet it remains unclear why residents are drawn to podcasts for educational purposes, how they integrate podcasts into their broader learning experiences, and what challenges they face when using podcasts to learn.

METHOD

The authors used a constructivist grounded theory approach to explore residents' motivations and listening behaviors. They conducted 16 semistructured interviews with residents from 2 U.S. and 1 Canadian institution from March 2016 to August 2017. Interviews were recorded and transcribed. The transcripts were analyzed using constant comparison, and themes were identified iteratively, working toward an explanatory framework that illuminated relationships among themes.

RESULTS

Participants described podcasts as easy to use and engaging, enabling both broad exposure to content and targeted learning. They reported often listening to podcasts while doing other activities, being motivated by an ever-present desire to use their time productively; this practice led to challenges retaining and applying the content they learned from the podcasts to their clinical work. Listening to podcasts also fostered participants' sense of connection to their peers, supervisors, and the larger professional community, yet it created tensions in their local relationships.

CONCLUSIONS

Despite the challenges of distracted, contextually constrained listening and difficulties translating their learning into clinical practice, residents found podcasts to be an accessible and engaging learning platform that offered them broad exposure to core content and personalized learning, concurrently fostering their sense of connection to local and national professional communities.