Discovering Rules from a National Exam Repository: A Use Case for Data Analysis from Iranian Medical Schools Entry Exam

Many methods have been studied to analyze and interpret patterns and relationships that are embedded in the database to discover new knowledge in educational systems. Association rule mining is a type of data mining that identifies relationships among elements of the dataset. However, because these methods often generate various rules including non-significant ones, it is important to identify the most useful rules. Therefore, evaluating and ranking rules has become a topic of interest in the decision-making process in order to represent the level of usefulness of rules. We incorporated Apriori and Eclat algorithms on an educational dataset of a national medical exam in Iran. The aim of this study is to identify the usefulness of the extracted rules. This method can reliably discover new knowledge by interpreting the prioritized rules. The results show that those who have Scored in the highest category, i.e. [407,493], are accepted and who have scored in the lowest category, i.e. [150,236), are not accepted in the exam regardless of others features. Although, the rules that implication Accept=0 occurs, find out with high confidence, due to a large number of samples in this case. The ranking rules show this method is effective in the identification of insignificant rules that have no effect on decision making.

Quality Improvement Projects as Training Tools for Family Medicine Residents and Faculty

Quality improvement (QI) is part of the future of medicine. However, QI concepts are often poorly understood by physicians. Although teaching QI is required in resident training, an effective QI curriculum is difficult to design due to competing demands from clinic schedules and required rotations. The objective of this project was to teach family medicine residents the basic concepts of QI and practical implementation skills based on use of a clinic population, electronic medical record (EMR) system, and Plan-Do-Study-Act (PDSA) cycles. To do this, the Family Medicine residents and faculty at the University of Hawai`i participated in a QI curriculum to improve diabetes care from October 2018 to February 2019 with 5 sessions consisting of lectures, videos, discussions about QI data for diabetes patients, and group activities. Residents and faculty used quality measures pulled from the EMR and PDSA cycles to discuss, select, and implement QI projects for diabetes patients. Pre- and post-tests measured participants' baseline and end QI knowledge and skills. All 18 residents and 12 faculty in the program participated in the curriculum. The pre- and post-test comparisons showed significant improvement in knowledge of QI concepts and the comfort level among residents showing a 59% average improvement in knowledge questions and a 57% average improvement in comfort level in implementing a QI project (Table 4). This study shows that a 5-session QI curriculum based on EMR and PDSA cycles successfully increased family medicine residents' and faculty's knowledge of QI concepts and skills.

3D Printing in Neurosurgery Residency Training: A Systematic Review of the Literature

BACKGROUND

The use of 3-dimensional (3D) printing in neurosurgery has become more prominent in recent years for surgical training, preoperative planning and patient-education. Several smaller studies are available using 3D printing however there is a lack of a concise review. This article provides a systematic review of current 3D models in use by neurosurgical residents with emphasis on training, learning, and simulation.

METHODS

A structured literature search of PubMed and Embase was conducted using PRISMA guidelines to identify publications specific to 3D models trialed on neurosurgical residents. Criteria for eligibility included articles discussing only neurosurgery, 3D models in neurosurgery, and models specifically tested or trialed on residents.

RESULTS

Overall a total of 40 articles were identified that met inclusion criteria. These studies encompassed different neurosurgical areas including aneurysm, spine, craniosynostosis, transsphenoidal, craniotomy, skull base, and tumor. The majority of the articles were related to brain surgery. Of these studies, vascular surgery had the highest overall with 13 out of 40 articles which include aneurysm clipping and other neurovascular surgeries. Twenty-two discussed cranial plus tumor surgeries which included skull base, craniotomy, craniosynostosis and transsphenoidal. Lastly, 5 studies were specific to spine surgeries. Subjective outcome measures of neurosurgical residents were most commonly implemented, of which results were almost unanimously positive.

CONCLUSION

3D printing technology is rapidly expanding in healthcare and neurosurgery in particular. The technology is quickly improving, and several studies have demonstrated the effectiveness of 3D printing for neurosurgical residency education and training.

Care Escalation: Teaching Residents How to Effectively Communicate Patient Care Concerns

INTRODUCTION

Care escalation for patients at risk of deterioration requires that care team members are able to effectively communicate patient care concerns to more senior team members. However, multiple factors inhibit residents from escalating their concerns, which contributes to treatment delays and sentinel events.

METHODS

We developed and implemented an annual 1- and 2-hour escalation curriculum for senior pediatric residents from the University of Colorado. The curriculum consisted of case presentations (one for the 1-hour or two for the 2-hour session), lecture, large-group discussion, and small-group activities. Faculty and fellows facilitated small groups, in which barriers to care escalation and specific tools for effective escalation were discussed. We administered precurriculum surveys for resident self-reflection and postcurriculum surveys for curriculum evaluation.

RESULTS

The curriculum was delivered to 179 residents over 3 years (2016-2018). Surveys were administered during the first 2 years, and 87% of participants completed pre- and postcurriculum surveys. Of all respondents, 88% believed that the curriculum helped them recognize care escalation barriers, and 85% believed that they learned skills for effective escalation. Resident comfort in asking for attending physician help improved from 52% to 95% (p < .001). Analysis of postsurvey open-ended responses indicated that residents valued listening to faculty share their personal experiences of escalating care.

DISCUSSION

The development and implementation of a curriculum to improve resident comfort and perceived ability to escalate patient care concerns are feasible and effective. Further work is needed to evaluate the impact of this curriculum in the clinical setting.

A Project-Based, Resident-Led Quality Improvement Curriculum Within a Pediatric Continuity Clinic

Introduction

Participation in quality improvement (QI) projects is required of pediatric residents, and evidence-based medicine has highlighted the importance of providing residents with experiential practice in this realm. Embedding QI projects within a continuity clinic provides residents an opportunity for meaningful involvement in QI efforts.

Methods

A QI curriculum was implemented within a pediatric residency program that included an introductory lecture on QI principles and participation in resident-led, team-based QI projects at an outpatient clinic. Residents designed, implemented, and analyzed projects beginning in their intern year. Projects operated on an accelerated, 6-month time frame, allowing residents to complete multiple projects over the course of their residency. Resident QI knowledge was assessed before and after an introductory lecture with the Quality Improvement Knowledge Application Tool (QIKAT). Resident feedback was solicited 1 year following curriculum implementation via anonymous online surveys.

Results

Residents completed four QI projects that produced meaningful improvements in clinic processes and patient care. QIKAT scores significantly increased after the introductory lecture. Residents reported that the curriculum afforded them increased confidence to implement plan-do-study-act cycles and improve patient care in their future practices. Qualitative feedback highlighted the team-based structure, participation in multiple projects, and visible direct impacts on patient care as strengths of the curriculum. Increased involvement of clinic staff, scheduling concerns, and improved communication were areas for improvement.

Discussion

Our model for integrating resident-led QI projects into an ambulatory clinic rotation is feasible and has been well received by residents and impactful on clinic processes and care.

Wellness Skills for Medical Learners and Teachers: Perspective Taking and Cognitive Flexibility

INTRODUCTION

Wellness insufficiency is a widespread problem in medical training programs. Recent evidence reveals that one factor contributing to physician wellness is cognitive flexibility, defined as being able to hold multiple views or to reframe a thought, situation, or perspective. While cognitive flexibility is a neurologically based, teachable skill, there is little guidance as to how to build this skill in learners (and teachers).

METHODS

This workshop introduces the concept and relevance of cognitive flexibility as a wellness skill and then utilizes the novel methodology of reverse role-play through simulated stressful everyday encounters in medical education between teachers and learners.

RESULTS

This workshop successfully improved cognitive flexibility scores in a sample of 15 family medicine residents, according to measures on the Cognitive Flexibility Scale.

DISCUSSION

By incorporating cognitive flexibility and perspective-taking skill instruction, this resource has implications for reducing conflict and stress, as well as improving the wellness levels of medical students, residents, and faculty alike.