Caring for Children With Medical Complexity: A Clinical, Patient-Focused Curriculum

Introduction

Caring for children with medical complexity (CMC) requires specialized knowledge and skills. However, no standardized curricula are used across training programs as institutions have varying needs and resources.

Methods

We created a patient-focused, interactive curriculum for two CMC topics: feeding/nutrition and pain/irritability. We integrated the 45-minute sessions into morning protected patient-care time on an inpatient pediatric team at an urban tertiary care hospital. Targeted toward all pediatric residents and medical students rotating in inpatient pediatrics over a 12-month period, the sessions used a mix of didactic, discussion, and hands-on activities. Learners on one of two inpatient teams received the curriculum, while those on the other received a curriculum unrelated to CMC and served as a control group. Both groups completed retrospective pre/post self-assessments to evaluate self-efficacy with respect to the learning objectives.

Results

Over the 12-month period, 72 surveys were completed for the feeding/nutrition session, 78 surveys for the pain/irritability session, and 42 control surveys. The intervention group saw the greatest increase in self-efficacy scores generally in the feeding/nutrition session. All eight learning objectives saw significant improvement in self-efficacy scores for the intervention group. There was significantly greater improvement in self-efficacy for the intervention group compared to the control for all eight learning objectives.

Discussion

Through this patient-focused curriculum, learners had improved self-efficacy scores compared to the natural learning occurring on the inpatient service. The curriculum could be adapted to fit the needs of other institutions and provides a practical, hands-on approach to learning about caring for CMC.

12 tips for developing Physician Education

The education of a physician is a life-long process. Healthcare is a dynamic field characterized by continuous advancements in medicine, evolving treatment options, changing regulations, care models, and technology. Physicians must keep up-to-date with new practices, procedures, medications, and diseases and fulfill the educational requirements to maintain their medical licensure. Continuing education for physicians serves the essential purpose of nurturing lifelong learning, ensuring that medical practices align with the latest standards, and ultimately enhancing the quality of patient care and outcomes. In a broader context, physician education encompasses all activities designed to enhance skills, professional performance, and relationships that physicians employ to provide services to patients and the public and to improve collaborations within the field. This paper outlines a step-by-step plan for designing high-quality education programs for physicians. It aims to assist in ongoing education, aligning their practices with the latest medical care standards, and optimizing their clinical performance to improve patient and community health.

Implementation and Evaluation of a Novel Media Education Curriculum for Pediatric Residents

Introduction

Despite increasing awareness of media exposure to children and adolescents and the known value of media education for physicians, residency programs lack formal media education.

Methods

We designed an interactive curriculum for pediatric residents to teach health effects of media as well as screening and counseling strategies. Instructional methods were based on constructivism, experiential learning, and situated learning theories. Participants independently reflected on a media viewing, then participated in two facilitator-led 1-hour workshops of two to three residents. Facilitators received speaker notes based on American Academy of Pediatrics media guidelines. Changes in knowledge, reported skills, and attitudes were assessed by pre- and posttests.

Results

Twenty-one residents completed the curriculum from September 2021 through April 2022. Knowledge improved after the curriculum as the median score increased from 3 to 5 out of 6, although 4 months later it was insignificant. Reported skills in screening did not significantly change. Residents strongly agreed that media use was an important health issue, with medians of 9 or 10 out of 10 on all tests. Attitudes regarding residency preparedness and confidence in screening and counseling significantly improved from pretest medians of 6 and 6 out of 10, respectively, to posttest medians of 8 and 9 to 4-month posttest medians of 6 and 8.

Discussion

A media curriculum for pediatric residents resulted in improved knowledge and attitudes. Enhanced attitudes demonstrated sustainability. All participants found the curriculum relevant and engaging and felt it should be continued.

Team-Based Learning Intervention to Improve Obesity Education in Medical School

Introduction

Obesity is a multifactorial chronic disease and a major contributor to numerous health conditions. Despite the high prevalence, costs, and health effects of obesity, physicians are largely unprepared to treat it. Most medical students and residents lack sufficient training in obesity and obesity management.

Methods

We evaluated a two-part team-based learning seminar (TBL) on obesity pathogenesis and treatment for first-year medical students at Case Western Reserve University School of Medicine (CWRU SOM). A questionnaire on attitudes toward obesity and self-perceived knowledge of obesity was administered before and after the TBL, utilizing Likert scales.

Results

Of 183 medical students who attended both TBLs, 155 (85%) completed the baseline questionnaire, and 127 (69%) completed the postintervention questionnaire. Confidence in treating obesity increased significantly from preintervention (M = 2.7, SD = 1.0) to postintervention (M = 3.7, SD = 0.8). The attitude that obesity is caused by poor personal choices decreased significantly from preintervention (M = 2.8, SD = 0.9) to postintervention (M = 2.1, SD = 0.9). Self-perceived knowledge of obesity in all nine areas-epidemiology, energy homeostasis, etiologies, nutrition, physical activity, behavior, pharmacology, surgery, and language-increased significantly.

Discussion

Despite obesity being one of the most prevalent health concerns, obesity education in medical school is scant. This TBL resulted in improved attitudes toward obesity and self-perceived knowledge of obesity among first-year medical students at CWRU SOM and offers a practical mechanism to introduce more obesity education into undergraduate medical curricula.

DARE Training: Teaching Educators How to Revise Internal Medicine Residency Lectures by Using an Anti-racism Framework

Introduction

Systemic inequities and provider-held biases reinforce racism and further disparities in graduate medical education. We developed the Department of Medicine Anti-Racism and Equity Educational Initiative (DARE) to improve internal medicine residency conferences. We trained faculty and residents to serve as coaches to support other faculty in delivering lectures. The training leveraged a best-practices checklist to revise existing lectures.

Methods

We recruited internal medicine faculty and residents to serve as DARE coaches, who supported educators in improving lectures' anti-racism content. During the training, coaches watched a videotaped didactic presentation that we created about health equity and anti-racism frameworks. DARE coaches then participated in a workshop where they engaged in case-based learning and small-group discussion to apply the DARE best-practices checklist to sample lecture slides. To assess training effectiveness, coaches completed pre- and posttraining assessments in which they edited different sample lecture slides. Our training took 1 hour to complete.

Results

Thirty-four individuals completed DARE training. Following the training, the sample slides were significantly improved with respect to diversity of graphics (p < .001), discussion of research participant demographics (p < .001), and discussion of the impact of racism/bias on health disparities (p = .03). After DARE training, 23 of 24 participants (96%) endorsed feeling more prepared to bring an anti-racist framework to lectures and to support colleagues in doing the same.

Discussion

Training residents and faculty to use DARE principles in delivering internal medicine lectures is an innovative and effective way to integrate anti-racism into internal medicine residency conferences.

Needs Assessment for the Development of Training Curricula for Internal Medicine Residents

BACKGROUND

Patient-centered outcomes can be achieved when common core and specialist competencies are achieved in a balanced manner. This study was conducted to assess the need to fill the gap between the defined competencies and learners' achievement, in order to improve the internal medicine (IM) training education curriculum for promoting patient-centered outcomes.

METHODS

A cross-sectional online survey was conducted. The participants were 202 IM specialists who obtained board certification in 2020-2021. We developed a questionnaire to investigate the self-evaluation of common core competencies and achievement level of IM essential competencies. For analysis, frequency tests, paired t-test, Borich priority formula, and χ² were performed.

RESULTS

In common core competencies, IM specialists recognized that their achievement levels in all competency categories were lower than their importance level (P < 0.001), and the highest educational demands were related to self-management. They assessed their five essential procedure skill levels as novice or advanced beginner status. The achievement level for the essential symptoms and signs that IM specialists should be able to manage was predominantly competent level. However, on average, 34.9% answered that they had never assessed during training for essential skills, and 29.7% answered the same for essential symptoms and signs.

CONCLUSION

We identified the priorities of core competencies, the level of achievement in essential procedures and patient care with essential symptoms and signs for IM training, and the related educational methods and assessment status. This study is expected to be used as basic data for developing and revising IM training educational curriculum.

Evaluating a novel intervention in undergraduate medicine: an MBBS Curriculum Map

BACKGROUND

Following student feedback, a Curriculum Map (CM) was commissioned in 2018 at UCL Medical School (UCLMS). After exploring key requirements of a CM, the second phase focused on building a prototype before its launch. This study evaluates this novel pedagogical intervention following its implementation, from the perspective of its primary users, UCL medical students.

METHODS

This multi-method study was conducted two months after the CM's launch in 2019. Quantitative and qualitative data was gathered via a survey and focus groups across four domains: usefulness, satisfaction, appearance, and content. Reflective Thematic Analysis was used to analyse the qualitative data to build themes.

RESULTS

One hundred ninety five participants (195/1347, 14%) responded to the survey and two focus groups were held. Higher rates of satisfaction were seen among later years compared to early years students. Five key themes emerged on the CM as a: UCLMS textbook; learning aid for assessments; tool for capturing scientific content; modern learning technology and tool for 'levelling the playing field'. Key findings suggest that while students welcomed a centralised resource to create transparency, there were clear differences between early and later years students, with the former preferring a more prescriptive approach. Learning was assessment-driven across all years and students highlighted their desire for greater clarity on the importance of curricular content for summative assessments.

CONCLUSION

A CM provides a benchmark for medical educators on the undergraduate curriculum, which must be balanced with its limitations; a CM cannot provide an exhaustive syllabus and needs to be supplemented with self-directed learning and clinical preparation for practice.

NeuroStudies: A Model of an Interdisciplinary Neuroscience Studies Minor

With nationwide demand for neuroscience programs increasing, faculty and administrators at a public institution with a liberal arts curriculum sought to develop a distinctive program building on existing strengths that would best fit our primarily undergraduate population. The creation of an interdisciplinary Neuroscience Studies minor was the result of collaborations with university stakeholders. Students taking Longwood University's Neuroscience Studies minor are trained to incorporate neuroscience into their areas of interest. Students take three core courses in neuroscience, including an introductory course, laboratory course, and interdisciplinary capstone experience. Additionally, students select three neuroscience-related courses from their major discipline. To gain broad support, the program was intentionally designed to support the university's mission, academic strategic plan, and several key university initiatives. Importantly for our smaller institution, the minor was implemented using existing university faculty, university resources, and a single hire. Since starting in 2015, the minor has quickly become the third largest on campus with increasing popularity among honors students. Program graduates have applied their training to careers paths as neuroscience Ph.D. candidates, master's degrees in a range of fields such as counseling, speech pathology, nursing, education, and neuropsychology, and others have benefited upon entering the workforce. Longwood's success developing an interdisciplinary Neuroscience Studies minor represents a blueprint for smaller institutions with limited resources, to provide students with an opportunity to learn about neuroscience and prepare for the future job market.

A Scoring Rubric for the Knowledge Section of the Systems Quality Improvement Training and Assessment Tool

INTRODUCTION

Quality improvement (QI) competencies for health professions trainees were developed to address health care quality. Strategies to integrate QI into curricula exist, but methods for assessing interdisciplinary learners' competency are less developed. We refined the Knowledge section scoring rubric of the Systems Quality Improvement Training and Assessment Tool (SQI TAT) and examined its validity evidence.

METHODS

In 2017, the SQI TAT Knowledge section was expanded to cover seven core QI concepts, and the scoring rubric was refined. Three coders independently scored 35 SQI TAT Knowledge sections (18 pretests, 17 posttests). Interrater reliability was assessed by percent agreement and Cohen's kappa for individual variables and by Lin's concordance correlation for total scores for knowledge and application. Concurrent validity was assessed by comparing responses from two groups with different QI exposure and evaluating whether differences in exposure were measured.

RESULTS

Total-score interrater reliability average measures of concordance were .89 for all coders and >.70 for six of seven concept scores. The total score discriminated the two groups (p <. 05), and five of seven concept scores were higher for the group with more QI experience. Total scores were significantly higher posttest than pretest (p < .001), with improvement in posttest knowledge scores.

DISCUSSION

The SQI TAT Knowledge section provides a comprehensive assessment of QI knowledge. The scoring rubric was able to discriminate QI knowledge along a continuum. The SQI TAT Knowledge section is not linked to a clinical context, making it useful for assessing interprofessional learners and varying education levels.

What Happened and Why: Responding to Racism, Discrimination, and Microaggressions in the Clinical Learning Environment

INTRODUCTION

Within clinical learning environments, medical students are uniquely faced with power differentials that make acts of racism, discrimination, and microaggressions (RDM) challenging to address. Experiences of microaggressions and mistreatment are correlated with higher rates of positive depression screening and lower satisfaction with medical training. We developed a curriculum for medical students beginning clerkship rotations to promote the recognition of and response to RDM.

METHODS

Guided by generalized and targeted needs assessments, we created a case-based curriculum to practice communication responses to address RDM. The communication framework, a 6Ds approach, was developed through adaptation and expansion of established and previously learned communication upstander frameworks. Cases were collected through volunteer submission and revised to maintain anonymity. Faculty and senior medical students cofacilitated the small-group sessions. During the sessions, students reviewed the communication framework, explored their natural response strategies, and practiced all response strategies.

RESULTS

Of 196 workshop participants, 152 (78%) completed the evaluation surveys. Pre- and postsession survey cohort comparison demonstrated a significant increase in students' awareness of instances of RDM (from 34% to 46%), knowledge of communication strategies to mitigate RDM (presession M = 3.4, postsession M = 4.6, p < .01), and confidence to address RDM (presession M = 3.0, postsession M = 4.4, p < .01).

DISCUSSION

Students gained valuable communication skills from interactive sessions addressing RDM using empathy, reflection, and relatability. The workshop empowered students to feel prepared to enter professional teams and effectively mitigate harmful discourse.

Bridging gaps in oral health education in a medical school in the United States: a pilot study

BACKGROUND

Oral health is an important component of medical education given its connection to overall health and quality of life; however, oral health is infrequently incorporated into medical school curricula in the United States. The aim of this study was to pilot a novel oral health care clerkship for United States medical students that implemented the Smiles for Life (SFL) curriculum, in-person clinical activities, and pre and post curricula assessments to assess knowledge acquisition, attitude change, and clinical skill development.

METHODS

Third year medical students at Albert Einstein College of Medicine, Bronx, New York, volunteered (n = 37) for a clerkship in oral health. Students completed the Smiles For Life National Oral Health Curriculum and participated in three half-day clinical sessions in a hospital-based dental clinic. The participants were evaluated on knowledge acquisition, attitude change, and clinical skill development through a pre and post clerkship assessment in order to assess the efficacy of the intervention.

RESULTS

There was a 23.4% increase in oral health knowledge (p < 0.001) following participation in the online modules and clerkship. Additionally, attitudes in the following domains showed improved familiarity and proficiency: causes and prevention of dental caries (78.4%, p < 0.001) and periodontal disease (83.8%, p < 0.001), provision of oral health information to patients (67.6%, p < 0.001), and ability to conduct an oral examination (62.2%, p < 0.001).

CONCLUSIONS

Third year medical students who participated in a novel oral health clerkship demonstrated significant increases in basic oral health knowledge and reported increased comfort in providing oral examinations and anticipatory guidance to patients. The results support the feasibility of this approach to incorporating oral health education into a medical school curriculum in the United States.

Clinical research capability enhanced for medical undergraduates: an innovative simulation-based clinical research curriculum development

BACKGROUND

Clinical research has frequently not been taught in a practical way, often resulting in a very didactic approach rendering it not very accessible for medical undergraduates. Simulation can provide an immersive, interactive, and reflective experience and may be applied to the clinical research curriculum.

METHODS

A 7-step model, modified from Kern's six-step approach and Khamis's stepwise model, was used to develop the curriculum. A questionnaire survey on undergraduates' attitude towards, knowledge and practice of clinical research and simulation education was conducted to generate a targeted needs assessment. The simulation framework was integrated into the development of educational strategies. Experts were consulted to assess the curriculum prior to implementation.

RESULTS

Talent construction in China needs an innovative capability-enhanced clinical research curriculum. Sixty-six clinical undergraduates in our school completed the survey. 89.39% (59/66) of them hadn't participated in clinical research, while 93.94% (62/66) would like to conduct clinical trials if possible. 75.76% of respondents didn't have knowledge of or practical abilities in clinical trials. The mean score for practical ability (2.02 ± 0.92) was lower than that of knowledge (2.20 ± 0.93) (P < 0.01). The dimension of case report form got the lowest score among the five dimensions. Participating in clinical research (P = 0.04) and learning for themselves (P < 0.01) by a few students may have increased the total score. The curriculum was designed to simulate the whole process from protocol writing, registration, ethical approval, implementation, and data analysis to reporting based on one case study, and was divided into two parts to simulate different types of research: randomized controlled trials and observational studies. It was conducted in semesters 5 and 7 respectively, both including 16 sessions. After expert consultation, one session having a 29.01% coefficient of variation was adjusted and replaced. The final simulation class design scenario scripts are provided for reference.

CONCLUSIONS

The targeted needs assessment exposed medical undergraduates' poor knowledge of and abilities in clinical research. This is the first report of a simulation-based clinical research curriculum developed in China, and adds curriculum development and design details to the limited related published studies.

Time Management and Task Prioritization Curriculum for Pediatric and Internal Medicine Subinternship Students

INTRODUCTION

As a physician, it is important to develop time management and task prioritization skills early to promote future career success. In medical education, there is minimal structured time to teach these skills prior to residency. Stephen Covey's Time Management Matrix Technique (TMMT) is one strategy that can be used to develop these skills. This technique categorizes tasks into a four-quadrant table based on importance and urgency. Using this technique as a model, the authors developed a workshop for medical students on an inpatient pediatric or internal medicine subinternship.

METHODS

Prior to the workshop, students read an article and completed a survey and two self-directed exercises. The exercises asked students to create a list of tasks, develop an individualized TMMT model, and review specialty-specific patient cases. The workshop consisted of discussions on the presession work and group exercises on prioritizing tasks and responding to patient-related pages. Students evaluated the curriculum after the workshop with a survey.

RESULTS

Most participants (82%) strongly agreed or agreed that the workshop improved their ability to manage time effectively and prioritize tasks on a clinical rotation. There was a statistically significant increase in both median time management and task prioritization confidence scores after completion of the workshop (p < .05).

DISCUSSION

This workshop provides one strategy that can be implemented within undergraduate medical education to enhance time management skills prior to residency. Future studies should be aimed at evaluating these skills within the clinical setting.

Clinical Skills Tutoring Program (CSTP): Developing a Curriculum for Medical Student Clinical Skills Peer Tutors

INTRODUCTION

There are few curriculum materials designed to provide training and support for peer tutors to become effective clinical skills teachers. We designed the Clinical Skills Tutoring Program (CSTP) curriculum to guide tutors to help their students reflect on clinical skills performance, create an individualized learning plan, and engage in improvement based on feedback to achieve clinical skills competencies.

METHODS

Curriculum content was delivered through an in-person training session, formal curriculum written content, online resources, and longitudinal support from faculty directors. Tutors (fourth-year medical students) received surveys to evaluate the in-person training session, curriculum resources, and overall program experience. Student participants (medical students of any year) completed a survey to rate their satisfaction in working with their tutors.

RESULTS

There were 12 tutors in cohort 1 and 18 tutors in cohort 2. Survey response rates ranged from 50% to 70% among tutors. The tutors were satisfied with the in-person training session, program experience, curriculum resources, support from directors, development of learning goals with the student, and clinical skills practice with the student (mean Likert ratings greater than 4 out of 5). Student participants were satisfied with their experience creating learning goals and receiving feedback from their tutors.

DISCUSSION

The tutor curriculum fills a gap by training and supporting tutors before and during their work with students needing further resources and remediation in one or more clinical skills domains. The curriculum can be implemented and further adapted by other tutoring programs locally and nationally.

Job-Readiness After Pediatric Neuroradiology Training: Defining Trainee Needs

RATIONALE AND OBJECTIVES

To describe and analyze the pediatric neuroradiology implicit curriculum for general-pediatric and neuro-pediatric radiology fellowship training in order to define specific trainee needs and inform an explicit pediatric neuroradiology curriculum.

MATERIALS AND METHODS

A focus group of pediatric radiologists, pediatric neuroradiologists and fellows was conducted to create a needs assessment questionnaire that focused on training experience, current job, and a list of essential competency items. The questionnaire was distributed to 175 members of the Society for Pediatric Radiology. Data were derived from categorical and continuous survey variables. Using an inductive approach, we analyzed and systematically inspected the data to derive themes regarding trainee needs and how they might inform an explicit curriculum.

RESULTS

Fifty-seven pediatric radiologists (response rate of 33%) responded to the survey. Sixty-three percent of respondents were fellowship trained in general pediatric radiology, 21% in pediatric neuroradiology, and 16% in both. In their current jobs, 75% of respondents were responsible for interpreting some pediatric neuroradiology. 50% or greater reported limited or no fellowship instruction in five areas of imaging interpretation: fetal neuroimaging; ear and/or nose and/or throat imaging; head and neck imaging; neuroembryology; neuro-spectroscopy and four areas of technical skills and/or image quality: reducing imaging time; choice of contrast agents; sedation; understanding clinical management pathways.

CONCLUSION

Trainees endorse inadequate training in certain aspects of imaging interpretation and technical skills which are known to remain a significant and vital aspect of pediatric neuroradiology practice, revealing an opportunity to emphasize these aspects in an explicit curriculum and dedicate educational resources towards this cause.

Problem-Based Learning Discussion to Introduce Quality Improvement to Residents in the Perioperative Setting

INTRODUCTION

Quality improvement (QI) is a growing and critical part of perioperative medical practice. However, there are few examples of educational tools to introduce new learners from anesthesiology to QI. This may contribute to a lack of enthusiasm to learn about and apply these concepts.

METHODS

This problem-based learning discussion (PBLD) was designed to teach anesthesiology residents about QI in a way allowing for the application of core concepts in a group setting. We created this PBLD using available literature on QI in the perioperative setting. Basic concepts and terminology necessary for new learners to communicate about QI were specifically addressed. Feedback from staff anesthesiologists and resident participants in the PBLD was used to tailor it to the needs of the target learners and to reach the educational objectives.

RESULTS

We delivered this PBLD in two separate learning sessions both to board-certified anesthesiologists (N = 10) and to resident anesthesiologists (N = 19) at our institution. The exercise was reviewed anonymously, and qualitative feedback was used to improve updated versions. Respondents felt that the PBLD would be improved by avoiding jargon-based humor, considering the systemic implications of QI, and limiting the overall length of the learning tool. The PBLD has been adopted as a starting point for discussions about QI in our training program.

DISCUSSION

We feel this PBLD can introduce new learners to the learning objectives. This tool has provided an alternative to lectures or computer-based modules for teaching QI.

Changing the Status Quo: Developing a Virtual Sub-Internship in the Era of COVID-19

PROBLEM

Subinternships are integral to medical education as tools for teaching and assessing fourth-year medical students. Social distancing due to COVID-19 has precluded the ability to offer in-person subinternships - negatively impacting medical education and creating uncertainty surrounding the residency match. With no precedent for the development and implementation of virtual subinternships, the Society of Academic Urologists (SAU) developed an innovative and standardized curriculum for the Virtual Subinternship in Urology (vSIU).

METHODS

The vSIU committee's mandate was to create a standardized curriculum for teaching foundational urology and assessing student performance. Thirty-three members from 23 institutions were divided into working groups and given 3 weeks to develop 10 modules based on urologic subspecialties, Accreditation Council for Graduate Medical Education core competencies, technical skills training and student assessment. Working groups were encouraged to develop innovative learning approaches. The final curriculum was assembled into the "vSIU Guidebook."

RESULTS

The vSIU Guidebook contains 212 pages - 64 pages core content and 2 appendices (patient cases and evaluations). It outlines a detailed 4-week curriculum with a sufficient volume of resources to offer a completely adaptable virtual course with the same rigor as a traditional subinternship. Modules contain curated teaching resources including journal articles, lectures, surgical videos and simulated clinical scenarios. Innovative learning tools include reflective writing, mentorship guidelines, videoconference-based didactics, surgical simulcasting and virtual technical skills training. The guidebook was disseminated to program directors nationally.

NEXT STEPS

The vSIU is the first virtual subinternship in any specialty to be standardized and offered nationally, and it was implemented by at least 19 urology programs. This curriculum serves as a template for other specialties looking to develop virtual programs and feedback from educators and students will allow the curriculum to evolve. As the pandemic continues to challenge our paradigm, this rapid and innovative response exemplifies that the medical community will continue to meet the needs of an ever-changing educational landscape.

Curriculum Design and Scholarship for New Educators: A Professional Development Workshop for Medical Students

INTRODUCTION

Medical students' professional development includes their role as educators. Despite greater opportunities to join medical education curriculum development, medical students' engagement in these activities remains limited. A recent national study on student leadership in curricular change revealed a formal lack of leadership and training in medical education as significant barriers. Medical students' unawareness of how to disseminate curricula as educational scholarship and its value to their careers also restricts the fullness of their formation as educators.

METHODS

We designed a 3-hour, interactive, project-focused conference workshop for medical students without prior knowledge in curriculum development. Of participants, 64 worked in 10 groups creating medical curricula using Kern's six-step approach in student-facilitated breakout sessions. Completed group projects were presented, including brief action plans for transforming their work into scholarship. The workshop was evaluated using a mixed-methods approach.

RESULTS

Of survey respondents, 44 mostly medical students, faculty, and administrators from different institutions rated the workshop as a very positive experience, and the pacing of the breakout groups as effective. A notable increase in self-reported mastery, as measured by learning objectives aligned with Kern's six-step model, was recorded from student respondents as compared to faculty. A sense of readiness to participate in curricular decisions either at the home institution or in individual career paths was evident from narrative comments.

DISCUSSION

Our workshop provided medical students with a foundation in curriculum development and educational scholarship. Session design provided flexibility in the pace of breakout sessions and allowed in-depth discussion of educational topics.

You Can Teach Every Patient: A Health Literacy and Clear Communication Curriculum for Pediatric Clerkship Students

INTRODUCTION

Poor health literacy has a negative impact on various health care outcomes. Medical schools are not consistently providing health literacy training; when they do, they overly rely on didactics.

METHODS

Our curriculum for third-year pediatric clerkship students taught principles of health literacy and evidence-supported clear communication strategies. Communication skills were structured on a novel mnemonic: CTEP (clear language, teach-back, effectively encouraging questions, and pictures). The curriculum included a 30-minute didactic, followed 1-2 weeks later by a 90-minute interactive workshop. All 188 clerkship students attended the didactic lecture; approximately half (90) attended the follow-up workshop. All students completed a formative objective structured clinical encounter. Standardized patients then evaluated students' use of the four clear communication skills. Students completed a survey to assess confidence, knowledge, and use of the skills.

RESULTS

Compared to the didactic-only group, students in the didactic + workshop group more frequently used teach-back (53% vs. 27%, p < .01) and pictures (46% vs. 10%, p < .01). In addition, the didactic + workshop group had improved recall, self-reported use, and comfort with the skills. The didactic + workshop group solicited questions from the standardized patient less often, and there was no difference in use of clear language between the two groups.

DISCUSSION

An interactive curriculum in health literacy and clear communication for pediatric clerkship students was superior to a didactic alone. Optimizing instructional methods for health literacy skills can help future physicians properly communicate with their patients to improve health outcomes.

An Interactive Mock Paging Curriculum to Prepare New Internal Medicine Interns for Inpatient Wards

INTRODUCTION

The July effect refers to an increase in adverse outcomes during periods of physician trainee turnover in teaching hospitals. We created an interactive resident-led curriculum to train new internal medicine interns for routine encounters on inpatient wards by role-playing through mock paging scenarios and focusing on practical information relevant to intern year.

METHODS

A formal assessment of the academic year 2018 intern boot camp curriculum revealed that interns preferred sessions that involved active learning strategies and covered common issues. In the first week of academic year 2019, interns participated in two 1-hour small-group sessions involving mock paging scenarios. Interns were divided into small groups with one facilitator who was a senior medicine resident. Within these groups, facilitators acted as the nurse and provided pages. Interns took turns answering these mock pages based on a sign-out of patients. The facilitator emphasized desired learner actions and teaching points using a provided guide.

RESULTS

Twenty interns participated in the curriculum. Interns rated the curriculum highly and felt that the sessions improved their knowledge, comfort, and skills in managing routine inpatient encounters. On a 2-week follow-up knowledge test to determine if they retained the information from the curriculum, interns scored an average of 85% (response rate: 60%, N = 12), indicating that they could apply the knowledge/skills learned to new scenarios.

DISCUSSION

This curriculum prepares medicine interns to manage common inpatient issues at the beginning of their residency. After completing the curriculum, interns reported increased confidence in handling these issues.

A Curriculum Innovation on Writing Simulated Patient Cases for Communication Skills Education

INTRODUCTION

Facilitated communication practice with simulated patients (SPs) is a highly effective form of communication training. Unfortunately, little guidance exists on writing SP cases.

METHODS

We created a curriculum composed of a case-development workbook and case-writing session with input from national communication educators. In November 2017, we implemented the curriculum in a Teaching Communication Skills course for medical educators. Educators divided into four groups to write cases. Primary outcome was the number of criteria that cases fulfilled. Secondary outcomes were SP evaluation and educator-reported confidence and satisfaction.

RESULTS

Seventeen medical educators (including 15 fellows) completed the curriculum. Four new cases were analyzed against 24 criteria and compared to eight cases written by educators following a previous curriculum. An SP evaluated ease of portrayal for all 12 cases on a 5-point Likert scale (1 = poor, 5 = excellent). Educators completed precurriculum and postcurriculum surveys. Compared to the previous curriculum, cases based on the new curriculum incorporated 26% more case criteria (70% or 16.8 criteria/case vs. 96% or 23.0 criteria/case, p < .01). Ease-of-portrayal rating improved but did not differ statistically (mean: 2.8 vs. 4.5, p = .11). A moderate correlation was found between number of included case criteria and Likert-scale rating (r_s = .61, p = .03). Pre- and postcurriculum, educators reported significant increases in confidence (mean: 1.9 vs. 4.0, p < .01) and high curricular satisfaction (mean: 4.8).

DISCUSSION

A case-development workbook and case-writing session increased the quality of newly developed SP cases as assessed by prespecified case criteria.

How to Create and Evaluate a Resident-Led Audio Program: Six Clinical Podcasts for Medicine House Staff

INTRODUCTION

Podcasting in medical education has grown substantially. However, podcasts focused on internal medicine topics are relatively uncommon, and those created by or designed for medicine residents are rare. We investigated the feasibility and utilization of an open-access resident-created podcast targeted to the educational needs of internal medicine house staff.

METHODS

We distributed a needs assessment to 184 internal medicine residents at the University of Washington to assess podcast preferences and clinical scenarios perceived to be challenging. Based on the results, we developed a standardized method for podcast development and production. We created six episodes, utilizing a web-based podcasting platform. For outcome measures, we collected the number of unique downloads, and the perception of the podcast was evaluated by residents in comparison to other residency-sponsored educational activities with a survey.

RESULTS

Eighty-one residents (44%) completed the needs assessment, with participants expressing interest in resident-focused podcasts and a preference for relatively short episodes focused on high-yield clinical information. The episodes were downloaded 661 times. Residents gave the podcast an average rating of 4.32 out of 5 (n = 22), among the highest of educational modalities surveyed. Our podcasting development process also resulted in a generalized, reusable schema.

DISCUSSION

Our resident-generated podcasts were desired, feasible, and well utilized. They were also rated highly compared to more traditional educational modalities. Our podcast-creation schema serves as a road map for trainees to develop podcasts. Podcasting can be a resource for resident education and an opportunity for residents to grow as medical educators.

Fostering Interprofessional Geriatric Patient Care Skills for Health Professions Students Through a Nursing Facility-Based Immersion Rotation

INTRODUCTION

Interprofessional (IP) clinical care is ideally taught in authentic environments; however, training programs often lack authentic opportunities for health professions students to practice IP patient care. Skilled nursing facilities (SNFs) can offer such opportunities, particularly for geriatric patient care, but are underutilized as training sites. We present an IP nursing facility rotation (IP-SNF) in which medical, pharmacy, and physical therapy students provided collaborative geriatric patient care.

METHODS

Our 10-day immersion rotation focused on four geriatric competencies common to all three professions: appropriate/hazardous medications, patient self-care capacity, evaluating and treating falls, and IP collaboration. Activities included conducting medication reviews, quarterly care planning, evaluating functional status/fall risk, and presenting team recommendations at SNF meetings. Facility faculty/staff provided preceptorship and assessed team presentations. Course evaluations included students' pre/post objective-based self-assessment, as well as facility faculty/staff evaluations of interactions with students.

RESULTS

Thirty-two students (15 medical, 12 pharmacy, five physical therapy) participated in the first 2 years. Evaluations (n = 31) suggested IP-SNF filled gaps in students' geriatrics and IP education. Pre/post self-assessment showed significant improvement (p < .001) in self-confidence related to course objectives. Faculty/staff indicated students added value to SNF patient care. Challenges included maximizing patient care experiences while allowing adequate team work time.

DISCUSSION

IP-SNF showcases the feasibility of, and potential for, engaging learners in real-world IP geriatric patient care in a SNF. Activities and materials must be carefully designed and implemented to engage all levels/types of IP learners and ensure valuable learning experiences.

Clinical Coaching Cards: A Game of Active Learning Theory and Teaching Techniques

INTRODUCTION

Clinical Coaching Cards is a serious game for faculty development in which players take turns as Teacher and Coach to apply teaching techniques on game cards to identify new approaches to teaching in the clinical environment. The game employs active learning theory and coaching frameworks.

METHODS

Based on a literature search and local faculty practices, we identified 14 techniques for clinical teaching and created a deck of cards summarizing each. We adapted rules from social judgment games so that participants proposed and selected techniques for applicability to their own teaching. The game was presented as a subsession of larger faculty development workshops hosted by the University of Washington, and players included faculty, residents, and medical students. Evaluations focused on the applicability of techniques to participants' clinical practice and preferred new techniques.

RESULTS

Seventy-four players provided evaluations out of over 150 participants across six workshops. Participants rated the session as mostly or very organized in 70 of 74 evaluations (95%), the introductory material as mostly or very relevant in 67 evaluations (91%), and the teaching techniques as most or several being useful in 69 evaluations (93%). Although some techniques were more popular than others, every technique was selected as a Top 3 technique for future practice.

DISCUSSION

Clinical Coaching Cards is a card game that applies active learning within a framework of peer coaching to teach bedside and clinical teaching techniques.

Understanding Sexual Complaints and History Taking: A Standardized Patient Case on Dyspareunia for Obstetrics and Gynecology Clerkship Students

INTRODUCTION

Learning to elicit a sexual history and counsel patients on sexual pain aligns with the Association of Professors of Gynecology and Obstetrics clerkship objectives. This topic can be challenging to cover due to lack of exposure in clinical encounters and inadequate coverage in preclinical studies.

METHODS

Second-year medical students in the OB/GYN clerkship participated in a standardized patient (SP) encounter on dyspareunia, receiving formative feedback on sexual history taking, differential diagnosis and management plan, and their SP's comfort during the encounter. Student feedback was obtained mid- and postclerkship. Summary statistics and regression models comparing SP encounter scores with shelf exam and clerkship scores are reported.

RESULTS

From September 2018 through July 2019, 101 students completed the encounter. Students asked an average of 3.9 of 13 sexual history questions. Sixty-six percent of students identified a correct diagnosis; 48% provided a management plan. The majority of students were very good or excellent at creating a safe environment. Most reported the encounter enhanced their learning (62%) and identified knowledge gaps (72%). SP encounter score was not associated with shelf exam score or clerkship letter grade but was associated with final clerkship score (unadjusted ß = 0.2, p = .009; adjusted ß = 0.1, p = .2). A summary didactic session was developed following student feedback.

DISCUSSION

This SP encounter and summary didactic session allowed students to improve their sexual history taking and may be associated with clerkship performance. These skills are necessary to advocate for patients with sensitive complaints across specialties.

Training Medical Students to Create and Collaboratively Review Multiple-Choice Questions: A Comprehensive Workshop

INTRODUCTION

Multiple-choice question (MCQ) creation is an infrequently used active-learning strategy. Previous studies demonstrated that medical students find value in the process, but have minimal training, which may limit potential learning benefits. We therefore developed a process for question-creation that required students to complete in-depth training, in addition to collaborative question-writing and editing.

METHODS

We created a question-writing workshop consisting of three components: (1) training in MCQ writing utilizing NBME online modules, a practice MCQ-writing session, and a training session, (2) writing MCQs independently after choosing topics from an institutionally generated blueprint, and (3) reviewing and editing MCQs via an in-person session. To understand students' perceptions, we held two four-student focus groups and recorded/transcribed the data. We iteratively reviewed the transcripts to generate a codebook and corresponding themes. We used the focus group data to generate a survey with Likert-scale questions, which we sent to the remaining 10 students and analyzed using Microsoft Excel.

RESULTS

Eighteen second-year medical students participated in this workshop. Students perceived that question-writing training (3.7/5.0±0.5) and question writing (3.9/5.0±0.3) benefitted their learning. Students perceived that MCQ writing required concept integration (4.1/5.0±0.6). Students described how question writing allowed them to recognize subtle distinctions between therapies and diagnoses. Each MCQ required about 1.5 hours to write and collaboratively edit.

DISCUSSION

Our results demonstrated that students perceived question writing to benefit their learning. More importantly, students felt that question writing actively engaged them to integrate content and compare concepts; students' engagement suggests that they learned from this question-writing activity.

Promoting Quality Improvement in Primary Care Through a Longitudinal, Project-Based, Interprofessional Curriculum

INTRODUCTION

Health professionals must demonstrate competencies in quality improvement (QI) and interprofessional (IP) practice. Yet few curricula are designed to address these competencies in an integrated, longitudinal way. Our experiential IP QI curriculum addresses this gap.

METHODS

The IP QI curriculum was part of a San Francisco VA Health Care System training program for second-year internal medicine residents and adult gerontology primary care nurse practitioner students, pharmacy residents, and postdoctoral psychology fellows. Trainees worked in mentored IP teams to select, design, implement, evaluate, and present a project as part of a 9-month curriculum. Teaching methodologies included didactics and project-based skills application. Curriculum evaluation included trainees' QI knowledge and skills self-assessments, trainee satisfaction, mentor appraisals, and project results and impact assessments.

RESULTS

From 2011-2012 to 2017-2018, 242 trainees completed the curriculum and 41 QI projects. Trainees reported high satisfaction with the introductory sessions (M = 4.4, SD = 0.7). They also reported improvement in comfort with QI knowledge and skills by the curriculum's completion. QI mentors (n = 23) observed growth in trainees' QI knowledge and skills, felt confident in trainees' ability to orchestrate a QI initiative, and believed their mentored QI projects added value to the organization. Thirty-eight projects resulted in system modifications.

DISCUSSION

This IP QI curriculum offers team-based, workplace experiences for trainees to learn and apply QI knowledge and skills. Leading factors for successful implementation included attention to team-building and faculty development. Challenges included reliably collecting evaluation data, accurately measuring ongoing systems changes, and variable trainee engagement.

The Mental Status Exam: An Online Teaching Exercise Using Video-Based Depictions by Simulated Patients

INTRODUCTION

The mental status exam (MSE) is a structured approach to gathering a patient's behavioral and cognitive information. Analogous to the physical exam, it provides a template to collect clinical data in a systematic fashion. The MSE is a core competency of undergraduate medical education (UME) and an entrustable professional activity in clinical psychiatry.

METHODS

We developed video clips of simulated patients depicting three adults respectively diagnosed with schizophrenia, obsessive-compulsive disorder, and bipolar disorder. We used three short video clips per condition to demonstrate an incremental number of psychiatric signs and symptoms. We used the nine video clips as calibrated stimuli for learners to identify components of the MSE using an online tool.

RESULTS

We piloted this online exercise among 37 volunteer students. Experienced learners performed better than novice ones on overall identification of MSE components (p <.001). Specifically, they were able to identify elements of the MSE following an ABC-STAMPS (appearance, behavior, cooperation; and speech, thought process and content, affect, mood, perceptions, suicidality) rubric.

DISCUSSION

This video-based scoring tool was easy to implement in a UME setting and well received by students as a formative didactic exercise and educational complement.

The Life Sciences Learning Center: An Evolving Model for a Sustainable STEM Outreach Program

The Life Sciences Learning Center (LSLC) is a hands-on science outreach center located at the University of Rochester's School of Medicine and Dentistry (UR-SMD) in Rochester, NY. The LSLC provides hands-on, case-based learning to boost science literacy and increase enthusiasm toward science learning. The LSLC offers on-site and in-school programs for secondary students (grades 6-12) and has developed a wide variety of online curriculum materials that can be used in science classrooms and informal education settings. The LSLC is a model for sustainability with over 20 years of funding through a combination of sources including numerous grant awards from National Institutes of Health (NIH) and private foundations. The LSLC was awarded its first of five NIH Science Education Partnership Awards (SEPA) in 1998, which would prove to be a key funding source for sustainability. The LSLC has widely disseminated its curriculum materials nationwide through teacher professional development programs and online. An ongoing partnership with Science Take-Out has led to further dissemination of LSLC's curriculum materials and has strengthened LSLC's model for curriculum development and evaluation. The LSLC has evolved over the years to meet the changing needs of teachers and their students and the increased demands for hands-on, inquiry-based learning that focuses on real-life issues in STEM.

Pathophysiology for the Pediatric Critical Care Fellow: Three Representative Simulation Cases

INTRODUCTION

During the course of fellowship training, pediatric critical care fellows are expected to develop a broad and in-depth understanding of the pathophysiology of multiple disease processes. The simulation-based pediatric critical care pathophysiology curriculum we present uses scenarios created by pediatric critical care fellows to teach complex pathophysiology.

METHODS

Each of the three representative cases presented covered a specific pathophysiologic process and required participants to acutely manage (1) an 18-year-old patient with altered mental status in the setting of hepatic encephalopathy; (2) an 8-year-old patient with sepsis, coagulopathy, and acute kidney injury; or (3) a 12-year-old patient with status epilepticus. Each case could be conducted in a simulation suite or an acute care unit bed. We assessed learners' knowledge and attitudes at the end of these simulations with a structured debriefing session and via completion of an evaluation form. The simulations were then followed by a 30-minute interactive didactic session on the topic.

RESULTS

Each scenario had six fellow participants who completed evaluations. After completing each of the three case scenarios presented, the majority of participating pediatric critical care fellows indicated that the content was relevant and sufficiently challenging. They also indicated that these simulation scenarios would improve their clinical practice.

DISCUSSION

This fellow-developed simulation curriculum is novel, highlighting the relevance for critical care fellows' understanding of realistic clinical scenarios while promoting advanced management skills with a pathophysiology focus.

A Mastery Learning Module on Sterile Technique to Prepare Graduating Medical Students for Internship

INTRODUCTION

Sterile technique is a basic technical skill used for a number of bedside procedures. Proper use of sterile technique improves patient safety by reducing infection risk.

METHODS

We applied the principles of mastery learning to develop a simulation-based mastery learning module for sterile technique that was used as part of a 2-week internship preparatory course for fourth-year medical students. Forty-one medical students entering surgical or emergency medicine internships completed the module. Learners demonstrated baseline skills with a pretest, watched a didactic online video, participated in supervised deliberate practice sessions, and then completed a posttest. Physicians evaluated performance using a nine-item mastery checklist validated by a multispecialty panel of board-certified physicians. Learners who did not demonstrate mastery by correctly performing all nine checklist items received formative feedback and repeated the posttest as needed until mastery was achieved.

RESULTS

No learners demonstrated mastery of sterile technique during pretesting. A total of 100% of learners demonstrated mastery of sterile technique during either their first or second attempt of the posttest. The learners reported statistically significantly higher levels of confidence at the end of the module.

DISCUSSION

Our module highlights the skills gap that exists in the transition from undergraduate to graduate medical education and offers a cheap, effective, and easily reproducible curriculum for sterile technique that could be widely adopted for many learner populations.

A Novel Intimate Partner Violence Curriculum for Internal Medicine Residents: Development, Implementation, and Evaluation

INTRODUCTION

Intimate partner violence (IPV) is a prevalent problem with profound health consequences. Research suggests that internal medicine (IM) residents are unprepared to screen for and address IPV. We designed a curriculum to improve IM residents' knowledge, attitudes, and practices in caring for IPV survivors.

METHODS

The curriculum was delivered to first-year IM residents from 2016 to 2017 at Johns Hopkins Bayview. Part 1 was 60 minutes long, with a video, evidence-based didactic teaching, and case-based discussion. Part 2 was 90 minutes long, with evidence-based didactic teaching, role-play of patient-provider conversations about IPV, and debriefing about strategies for discussing IPV. We evaluated knowledge, confidence, and self-reported behaviors pre- and postintervention using two-tailed paired t tests.

RESULTS

Thirty-two residents received IPV training. In comparing precurriculum (n = 29, 91% of total participants) and postcurriculum (n = 28, 88% of total participants) surveys, there was significant improvement in knowledge about IPV (p < .001). Postcurriculum, learners reported greater confidence in detecting IPV (p < .001), documenting IPV (p < .001), and referring to resources (p < .001). Participants reported increased comfort with managing difficult emotions about IPV in patients (p < .01) and themselves (p < .001) and increased comfort in discussing IPV with female (p < .001) and male (p < .001) patients. Postcurriculum, all respondents felt they were more skillful in discussing IPV and would be more likely to screen for IPV.

DISCUSSION

Our curriculum improved residents' knowledge, confidence, comfort, and preparedness in screening for and discussing IPV.

Building a Tool Kit for Medical and Dental Students: Addressing Microaggressions and Discrimination on the Wards

INTRODUCTION

Microaggressions, subtle slights related to characteristics such as race, gender, or sexual orientation, in a clinical setting can sabotage the therapeutic alliance. Curricula tailored specifically towards medical students that raise awareness of microaggressions and aim to change behavior are absent.

METHODS

We created a 2-hour workshop to prepare preclinical medical and dental students to recognize and respond to microaggressions in clinical practice. The workshop consisted of a didactic portion describing microaggressions and strategies for responding to them and a case-based small-group portion to practice strategies. Participants completed electronic pre- and postworkshop surveys.

RESULTS

Of 163 students participating in the workshop, 121 (74%) completed the preworkshop survey, 105 (64%) completed the postworkshop survey, and 81 (50%) completed both. Preworkshop, 48% reported female gender, and 36% reported underrepresented in medicine status. The majority (77%) had witnessed or experienced microaggressions in the clinical setting, and 69% reported very good or excellent familiarity with the concept of microaggressions. The curriculum appeared to significantly mitigate challenges associated with microaggressions, including reductions in perceived difficulty in identifying microaggressions (p < .001), being unsure what to do or say (p < .001), improvements in familiarity with institutional support systems (p < .001), and awareness of the clinical relevance of microaggressions (p < .001).

DISCUSSION

Given the high self-reported prevalence of microaggressions in the clinical setting, students need the skills to respond. This innovative session improves readiness to address microaggressions by helping participants build and practice these skills in a supportive environment.

Students' response to a Massage & Meditation medical school course elective

This article was migrated. The article was marked as recommended. Objectives: Due to high incidence of medical student and physician burnout, medical education needs to include skills for life-work balance. Patients complain that clinicians depend on technology during clinic visits, and use less touch. To address this educational need, we designed an 18-hour curriculum that combines massage (to reduce anxiety and teach skillful touch) and meditation (for burnout prevention). We explored whether learning basics of massage and meditation could give medical students tools for self-care and skillful touch. Methods: The curriculum was implemented as an elective at the Medical School since 14 years. We collected 181 anonymous student evaluations and conducted pre-post surveys to evaluate the curriculum. We assess mindful bodily awareness (by Multidimensional Assessment of Interoceptive Awareness questionnaire) and conducted thematic analysis of students' comments. Results: Students appeared highly satisfied with the class (4.94 [Range 1-5]) and reported confidence in being able to apply massage and meditation in their personal and professional life. They commented on the importance of skillful touch and gained more confidence in using touch in clinical care. The pre-post survey showed improvements in interoceptive bodily awareness. Students felt that they developed new skills for self-care and stress management, experienced a sense of community among peers, and stated that the class provided necessary teaching complementary to the mandatory medical school curriculum. Conclusions: A course of Meditation and Massage may be a valuable complementary elective to medical school education, supporting self-care and stress management in preparation for a demanding profession, and may improve palpatory examination skills.

Building a Boot Camp: Pediatric Residency Preparatory Course Design Workshop and Tool Kit

INTRODUCTION

Although many medical schools are adding residency preparatory courses or boot camps to their curricula, there is little published guidance for faculty tasked with designing them. We developed a workshop and accompanying boot camp course design tool kit to assist faculty in creating a pediatric boot camp course following the initial steps of Kern's framework for curriculum development.

METHODS

Learners participated in a 2-hour workshop incorporating short didactics, guided independent reflection, and group discussions. Workshop facilitators guided faculty through the tool kit materials including a literature overview, a needs assessment worksheet, session prioritization and schedule planning worksheets, a module design worksheet, and implementation strategies.

RESULTS

Twenty-seven attendees at a national meeting of undergraduate pediatric educators participated in the workshop. Feedback was solicited via an anonymous electronic survey (41% completion rate), which indicated that attendees' self-assessed confidence significantly increased for each component of the tool kit. For the five tool kit components surveyed, average confidence increased 26% (range: 17.5%-37.1%) after completing the workshop. All respondents also indicated that the tool kit would be moderately helpful to very helpful as a stand-alone resource for independent faculty use, corresponding to a 3.57 out of 5 weighted average for this Likert-scale question.

DISCUSSION

We developed a pediatric boot camp course design workshop and tool kit to assist faculty in developing pediatric boot camps. Initial implementation was through a workshop, but the resource could be used individually and also adapted for use by other specialties.

Cardiac Auscultation Lab Using a Heart Sounds Auscultation Simulation Manikin

INTRODUCTION

Cardiac auscultation skills are essential to the development of a competent physician. We created a hypothesis-driven cardiac auscultation laboratory session utilizing a high-fidelity simulator to teach these skills to second-year medical students at our institution. This program was grounded in deliberate practice opportunities to aid in the acquisition of cardiac auscultation skills.

METHODS

This session aimed to help students identify and discriminate between normal and pathologic heart sounds in the context of a clinical vignette. Faculty facilitators guided students through unknown patient cases and utilized the auscultation manikin to simulate corresponding heart sounds. Time was also allotted for students to auscultate the manikins and practice their cardiac physical examination skills.

RESULTS

This program has been in place at our institution since 2016 and has been well received by students and facilitators. Since its initial introduction in 2016, 183 second-year medical students have completed the cardiac auscultation lab session each year, for a total of 549 students. Evaluations of the session have improved as faculty have become more familiar with the mechanics of operating the auscultation manikin.

DISCUSSION

The cardiac exam and heart sounds lab can be adapted to any simulator model that is capable of producing heart sounds and can be done in a large- or small-group format. Enough time should be allotted to adequately work through all components of the laboratory. Student and faculty feedback has helped us further refine the session since its initial introduction to the curriculum.

Collecting Validity Evidence: A Hands-on Workshop for Medical Education Assessment Instruments

INTRODUCTION

There is an increasing call for developing validity evidence in medical education assessment. The literature lacks a practical resource regarding an actual development process. Our workshop teaches how to apply principles of validity evidence to existing assessment instruments and how to develop new instruments that will yield valid data.

METHODS

The literature, consensus findings of curricula and content experts, and principles of adult learning guided the content and methodology of the workshop. The workshop underwent stringent peer review prior to presentation at one international and three national academic conferences. In the interactive workshop, selected domains of validity evidence were taught with sequential cycles of didactics, demonstration, and deliberate practice with facilitated feedback. An exercise guide steered participants through a stepwise approach. Using Likert-scale items and open-response questions, an evaluation form rated the workshop's effectiveness, captured details of how learners reached the objectives, and determined participants' plans for future work.

RESULTS

The workshop demonstrated generalizability with successful implementation in diverse settings. Sixty-five learners, the majority being clinician-educators, completed evaluations. Learners rated the workshop favorably for each prompt. Qualitative comments corroborated the workshop's effectiveness. The active application and facilitated feedback components allowed learners to reflect in real time as to how they were meeting a particular objective.

DISCUSSION

This feasible and practical educational intervention fills a literature gap by showing the medical educator how to apply validity evidence to both existing and in-development assessment instruments. Thus, it holds the potential to significantly impact learner and, subsequently, patient outcomes.

Tell Me Straight: Teaching Residents to Disclose Adverse Events in Surgery

OBJECTIVE

The purpose of this effort was to create an educational experience that provided learners a realistic disclosure experience and improved resident confidence discussing an adverse outcome with a patient and family.

DESIGN

Residents practiced disclosing a surgical complication to a patient/family with simulated patients (SPs). We paired professional SPs with former patient SPs to present a realistic case. Junior residents were given extra training time before their disclosure of a laparoscopic cholecystectomy conversion to an open procedure; senior residents disclosed a bile duct injury. Residents rated pre and post-module confidence levels, and skills performance using the Disclosure of a Complication Checklist.

SETTING

900-bed tertiary care hospital with surgical residency program and simulation center.

PARTICIPANTS

General surgery residents (PGY 1-5).

RESULTS

Eighteen residents participated in the disclosure module. Analysis of the medians and interquartile ranges of pre and post-module confidence scores showed significant improvement for each individual item and mean score of learners. Residents assessed their completion rates of individual Checklist tasks positively. For example, 94% self-endorsed completion of "explanation of facts," 89% self-endorsed "took responsibility," and 78% self-endorsed "apologized sincerely." Self-rated competence scores from the Checklist were low: 7% indicated they would be "extremely comfortable" entrusting their loved one's care to themselves, 11% rated their ability to explain the facts as "outstanding," and 12% felt they were "outstanding" in their "ability to disclose a complication in a professional manner."

CONCLUSION

Residents received important skills practice in our disclosure training; disclosure confidence increased after participation. Residents scored high on completion of disclosure tasks and low on comfort and proficiency of those tasks. The Checklist provided a useful set of tasks to review and complete in the exercise. Separating residents by PGY level enabled senior residents to experience a more complex scenario and junior residents extra time to practice.

Teaching for Critical Thinking: A Study of Teaching Strategies Employed by Instructors in Ontario Colleges Through General Education Courses

It has been sixteen years since the New College Charter introduced general education courses into Ontario college programs with the purpose of strengthening student's communication skills, problem solving ability, critical thinking, and to provide some breadth of knowledge beyond their program's vocational field of study. There are no past or current evaluation tools used to determine whether these skills are, indeed, strengthened through general education courses. Despite the lack of measurement, we can examine the educational conditions under which general education courses are taught and determine whether those are the same conditions that strengthen or develop these skills. Specifically, this study examines the curriculum development and teaching strategies used by general education instructors at an Ontario college to determine whether the strategies coincide with those that adult education literature would suggest to strengthen or develop student's critical thinking skills.

A Joint Quality Improvement and High-Value Care Curriculum in a Limited-Resource Setting

INTRODUCTION

Since the release of the Institute of Medicine's To Err Is Human, there has been an increased focus on quality improvement (QI). QI training is now a requirement monitored via ACGME's clinical learning environment review committees. Given the significant cost of health care waste, teaching physicians to incorporate costs and value into medical decision making is crucial. Increasing information is available on methods to teach high-value care (HVC), but there is little information on combining HVC with QI. As these topics are intimately linked in efforts to provide effective, efficient care, a joint curriculum is a feasible solution.

METHODS

We adapted material from two online resources-(1) Institute of Healthcare Improvement Open School and (2) American College of Physicians High Value Cost-Conscious Care Curriculum-to create a combined curriculum for use in a limited-resource setting. Our curriculum is divided into 10 seminars, each including both QI techniques and HVC theories, which are reinforced using a series of patient scenarios. Residents apply their knowledge in self-directed projects presented in the final seminar. Evaluation includes a pre-/postexposure QI knowledge application test, survey of self-assessed knowledge, and anonymous course feedback.

RESULTS

For the 46 residents who completed the series, a statistically significant improvement in both tests was measured, and feedback was positive overall. Tailoring our in-seminar patient scenarios allowed residents to demonstrate their HVC knowledge acquisition.

DISCUSSION

This seminar-based curriculum can be adapted to the time availability in any residency program and transfer to other disciplines with modification of the patient scenarios.

Introduction to Curriculum Development and Medical Education Scholarship for Resident Trainees: A Webinar Series

INTRODUCTION

A common career aspiration among residents is to become a clinician-educator, though standard postgraduate training may not prepare trainees for the academic and scholarly requirements of this career. To address this need, we designed and implemented an asynchronous, interactive webinar series detailing a systematic approach to medical education research and scholarship. The series was piloted as part of a new track at the University of Chicago for residents interested in additional training and completing an educational learning project in medical education.

METHODS

We aimed to use this series to introduce relevant frameworks in curriculum development, program evaluation, and learning theory. Materials associated with this publication include six webinars and corresponding summary reference handouts, discussion assignments, and answer keys. Additional materials include a faculty course director packet and sample feedback for discussion assignments. Each webinar is an 8- to 20-minute narrated presentation with goals and objectives, an overview of each session's content, and example vignettes. Residents viewed presentations and completed a two-part discussion assignment for each webinar, which included reflection on the educational material and vignettes, faculty feedback on this reflection, and application of webinar material and faculty feedback to their own experiences in medical education.

RESULTS

All residents in the pilot completed the webinars and assignments. Residents' reactions to the webinar series have been positive, and residents have commented that self-paced learning with directed faculty feedback is a desirable instructional method for this material.

DISCUSSION

This series is well suited to introduce fundamental concepts in medical education scholarship and inspire self-directed study for motivated learners.

[Competence-based catalogue of learning objectives for conducting medical consultations]

ISSUE

In 2012 the German medical licensure regulations (Approbationsordnung) made teaching and assessing the conduction of medical consultations a mandatory part of medical education. A catalogue of learning objectives (LO) based on existing references was developed to assist medical schools in meeting this requirement.

METHODS

A body of relevant material was compiled using literature research and surveying experts. Then, in a multiphase Delphi process, this was evaluated and condensed by an interdisciplinary working group in dialogue with external (clinical) experts. Competence levels and examples of clinical application were assigned to enhance implementation. The catalogue was revised by the medical faculties, professional associations and the BVMD.

RESULTS

This learning catalogue comprised 116 learning objectives for the specific skills necessary to conducting medical consultations as well as exemplary application contexts. The catalogue proved to be practical in terms of developing curricula and networking at medical schools.

DISCUSSION

This catalogue of learning objectives can serve as the basis for developing a sample communication curriculum for use by medical faculties.

Removable Partial Denture Components and Applications: A Team-Based Learning Module

INTRODUCTION

The process of learning the removable partial denture (RPD) requires that students first acquire fundamental concepts and then use critical thinking skills to apply that knowledge to different clinical scenarios. We believed this course posed a perfect opportunity to transition to an active learning method, namely team-based learning (TBL).

METHODS

In each TBL session the instructor creates adequate teams and assigns reading materials to the students in preparation for the readiness assurance process. While in class, individual students complete a case-based, multiple-choice examination to ensure their readiness to apply their foundational knowledge. Once all individual members of each team complete their individual tests, they retake the same examination as a team. During this process, they must reach consensus on their answers, which promotes discussion, debate, and learning. This module also presents an application assignment. Every team is presented with the same significant problem, is asked to come up with a specific answer, and reports simultaneously with the other teams, which results in a productive and vigorous debate.

RESULTS

The shift to the TBL format resulted in a lower quantitative overall course evaluation compared to prior years, yet paradoxically, students' comments reflected a change in their attitudes and knowledge gain. From an administrative perspective, the shift added substantial value since there were 2 fewer hours of student class contact time and 98 fewer hours of faculty time assigned to the course.

DISCUSSION

The RPD course transition to active learning was supported by our College Curriculum Committee goals. Placing the responsibility for learning on the student enhances his/her learning ability and allows time for instructors to teach at another level.

Nursing curriculum development in remote southwest Uganda

PURPOSE/AIM

To describe an intercollaborative outreach between the USA and a school of nursing in Uganda.

INTRODUCTION

Ugandan nurses are essential providers of health care in remote regions. High vacancy rates in health centers impacts care in rural areas.

BACKGROUND

A 112-bed health center in southwest Uganda supports village health teams that visit remote villages and provides medical, surgical, and maternal-child services to a population of 250,000. A new Ugandan school of nursing has aligned with the hospital to prepare graduates to provide primary care in remote villages. A team from the USA visited the school and hospital to assess the curriculum and offer educational strategies and support to the school's leadership.

EVIDENCE

Provision of primary health care in the developing world is a longstanding global priority. Nurses are at the center of primary care in remote regions. Educational support for advanced nursing and strategic international relationships can positively impact nursing education in both high and low-income countries.

DISCUSSION

The USA team took part in assessments, teaching, simulation, and remote village outreach. Educational strategies and modalities were shared.

CONCLUSIONS

The Ugandan nursing school is established and affiliated with another Ugandan university. Standardized curriculum is in place, however continued collaboration is needed for program adaptation to accommodate the unique border region environment.

IMPLICATIONS FOR HEALTH POLICY AND NURSING

Intercollaborative sharing of information and resources between schools of nursing can have a direct impact on global health initiatives in both high-income and low-income countries.

Clerkship maturity: does the idea of training clinical skills work?

BACKGROUND

With the reformed curriculum "4C", the Medical Faculty of the University of Cologne has started to systematically plan practical skills training, for which Clerkship Maturity is the first step. The key guidelines along which the curriculum was development were developed by experts. This approach has now been validated.

MATERIALS AND METHODS

Both students and teachers were asked to fill in a questionnaire regarding preclinical practical skills training to confirm the concept of Clerkship Maturity.

RESULTS AND DISCUSSION

The Cologne training program Clerkship Maturity can be validated empirically overall through the activities of the students awaiting the clerkship framework and through the evaluation by the medical staff providing the training. The subjective ratings of the advantages of the training by the students leave room for improvement. Apart from minor improvements to the program, the most likely solution providing sustainable results will involve an over-regional strategy for establishing skills training planned as part of the curriculum.