Medical Education

Teaching clinical trials electronically

by Raywat Deonandan

This ar ticle discusses the development, delivery and evaluation of an electronic extramural course, `Fundamentals of... more This ar ticle discusses the development, delivery and evaluation of an electronic extramural course, `Fundamentals of Clinical Tr ials’ , a CME course designed to reach physicians and health care researchers without easy access to a local university. Ten week-long modules of instruction were developed.These were based on a graduate course in clinical tr ials, standard textbook topics and additional course mater ials speci® cally developed for the course. Questions and course topics were to be discussed by the students, and each participant was encouraged to present an actual or proposed clinical tr ial to the vir tual class. Communication between students and tutors could be either `one to one’ or through a listserve, i.e. an automated mailing list available to all participants which copied and routed any message instantly to all participants. Ongoing evaluation of the course was accomplished by questions monitoring students’ attitudes and needs, and a more extensive on-line questionnaire administered at the end of the course. Ten students from four countr ies were accepted onto the course. Half of the students contr ibuted regularly and extensively, while the others tended to respond only when addressed directly.The students spent on average approximately 6 hours per week on the course. This differed little from regular classroom courses, but the students appreciated the ability to organize the course around their regular schedules.The students prefer red topics that encouraged discussion and differ ing opinions. From the instructors’ viewpoint, considerable time was required for course development and communication.This form of distance continuing medical education was preferr ed by all the students over regular cor respondence courses, as it allowed for more immediacy and interaction.However, the time required for developing and teaching courses over the Internet should not be underestimated.

A Student-Run Peer-Reviewed Journal- An Educational Tool for Health Sciences students

by Raywat Deonandan

Students at the University of Ottawa, a plurality of whom were targeting a career in Medicine, were surveyed to... more Students at the University of Ottawa, a plurality of whom were targeting a career in Medicine, were surveyed to determine their attitudes and expectations regarding a new student-run peer-reviewed journal for the health sciences. A plurality reported that the existence of the journal would make them more likely to take a class with a written component, while a majority would work harder on that assignment. Those intending to pursue post-graduate or professional studies were most likely to recognize the value to their careers of having a publication history. We argue that student-run medical communications endeavours such as this are beneficial both for enhancing student careers and for contributing to a more thorough educational experience.

A Pilot Study for Case-Based Learning Among Undergraduate Students in Global Health

by Raywat Deonandan

In this pilot study, students in a 4th year undergraduate course in Global Health at the University of Ottawa were... more In this pilot study, students in a 4th year undergraduate course in Global Health at the University of Ottawa were exposed to Case-Based Learning (CBL) for the first time; and their experiences were assessed via an online survey. Though the response rate was poor (21%), respondents indicated overwhelmingly that the CBL experience was enjoyable, educational and appropriate for the subject. Aside from cost, the major challenge was harmonizing student experiences across the discussion groups, which may be addressed by better leader training. Given its innate opinion-based and interdisciplinary nature, Global Health is an appropriate subject area for the application of CBL to undergraduate teaching, and expansion of this intervention must include a wider selection of cases and greater harmonization of facilitation methods and leader training across groups.

Understanding communication of health information: A lesson in health literacy for junior medical and physiotherapy students

by Frank Doyle

Journal of Health Psychology, in press

Best practice communication between healthcare professionals and patients involves using quality patient information... more Best practice communication between healthcare professionals and patients involves using quality patient information leaflets (PILs). We assessed medical and physiotherapy students’ (N = 337) ability to appraise the readability, psychology theory content and quality of nine international smoking PILs. Flesch scores ranged from 52.8–79.7% (standard to fairly easy). Students identified components of the Health Belief Model (84- 98%), Theory of Planned Behaviour (65–88%) and Transtheoretical Model (37–86%). Importantly, student-proposed additional theory-based content had no detrimental effect on readability scores. Overall quality scores indicated low–moderate quality. This assignment helped students critically evaluate the utility of PILs for communication.

The Broselow tape as an effective medication dosing instrument: A review of the literature.

by Timothy Clapper

Meguerdician, M. J., & Clapper, T. C. (2012, in press). The Broselow tape as an effective medication dosing instrument: A review of the literature. Journal of Pediatric Nursing.

The Broselow tape provides clinical providers with a method of quickly estimating medications and airway adjuncts for... more The Broselow tape provides clinical providers with a method of quickly estimating medications and airway adjuncts for pediatric patients. However, since the development of the Broselow tape, there has remained a controversy over the accuracy of the tape for estimating weight to determine pediatric resuscitation needs. Using multiple search engines, this review of the literature examined the potential of the Broselow tape to be an effective guide for emergency medicine teams. The evidence suggests that when compared with other methods of estimating medication dosing and airway equipment size, it is the most reliable predictor in most situations, especially in younger pediatric patients. Ultimately, the Broselow tape is only a guide that should be considered, whereas the final determination of drug dosage and equipment sizes will be determined by the patient situation and the clinical provider's experience and training. Objective: Pediatric emergency medicine departments can be overwhelmed with conflicting literature on the accuracy of the Broselow tape. The Broselow tape provides clinical providers with a method of quickly estimating medications and airway adjuncts for pediatric patients. We present an analysis of literature and research of the Broselow tape as a means of estimating weight in pediatric patients to address medication dosing. Methods: A systematic review was conducted using three primary search engines, including PubMed, Ebscohost, and ProQuest. Inclusion criteria included (a) peer-reviewed literature and (b) original research articles. Literature related to or appearing to have a commercial interest was not included in this review. The initial search showed 84 publications, 24 with relevance to this review. Results: Although the Broselow tape may underestimate the weight of outlier pediatric patients, it is still the most accurate tool available. In addition, it appears to be more accurate for use with younger patients. Conclusion: The evidence suggests that when compared with other methods of estimating medication dosing and airway equipment size, the Broselow tape is the most reliable predictor in most situations, especially in younger pediatric patients.

Why your TeamSTEPPS program may not be working

by Timothy Clapper

Clapper, T. C., & Ng, G. M. (2012, in press). Why your TeamSTEPPS program may not be working. Clinical Simulation in Nursing. doi:10.1016/j.ecns.2012.03.007

Co-authored with Grace Ng

Team Strategies and Tools to Enhance Performance and Patient Safety ® (TeamSTEPPS) is a patient safety tool developed... more Team Strategies and Tools to Enhance Performance and Patient Safety ® (TeamSTEPPS) is a patient safety tool developed by the defense industry and based on four competencies: leadership, communication, situational monitoring, and mutual support. Unfortunately, there are barriers that prevent TeamSTEPPS from reaching its full potential, including: (a) lack of administrative support and resources, (b) lack of training focus to address hierarchal differences and incivility at all levels of health care practice and administration, (c) inadequate TeamSTEPPS instruction and simulation practices, and (d) educators’ resistance to change from crew resource management concepts. Suggestions for improvement include providing command and health care agency emphasis for the TeamSTEPPS program, providing adequate material and personnel resources, designing training that is geared to trainer implementation at the departmental level, prioritizing and saturating training, and striving toward a just culture.

Continuing professional development through reflexive networks: Disrupting online communities of practice

by Gurmit Singh

Singh, G., McPherson, M. & Sandars, J. (2012). Continuing professional development through reflexive networks: Disrupting online communities of practice. Paper presented at ProPEL International Conference 2012, University of Stirling, UK, May 2012.

Assessment of teaching by Family Medicine Programme vocational trainees.

by Liz Farmer

Farmer E, Taylor S. Aust Fam Physician. 1990 Apr;19(4):549-50, 553, 555-7.

Family Medicine Programme vocational trainees are requested to assess by means of a detailed questionnaire the... more Family Medicine Programme vocational trainees are requested to assess by means of a detailed questionnaire the teaching they have received in their general practice training attachments. This paper describes the methods and presents the results of a survey of South Australian and Northern Territory trainees over a three year period. The results show that a survey by questionnaires is an effective method of measuring perceived standards of teaching in training practices.

The teaching of occupational and environmental medicine to medical students in Australia and New Zealand.

by Liz Farmer

Shanahan EM, Murray AM, Lillington T, Farmer EA. Occup Med (Lond). 2000 May;50(4):246-50.

All the medical schools in Australia and New Zealand were surveyed in order to determine the amount of teaching... more All the medical schools in Australia and New Zealand were surveyed in order to determine the amount of teaching devoted to occupational and environmental medicine in the medical courses in 1998. A 100% response rate was achieved. The results showed that the number of hours devoted to these topics varied widely, but averaged 12.8 h and 10.5 topics. The most significant factor accounting for the variability was the presence on the universities' teaching staff of individuals trained in the practice of occupational medicine. While our findings show a greater time devoted to these topics than those of similar studies in the United States and Britain, the absolute time remains small when compared with the prevalence of occupational medicine problems in the community. There is little congruence in terms of both content and assessment processes between schools.

Educating capable doctors - a portfolio approach. Linking learning and assessment

by Liz Farmer

J. P. Sturmberg  L. Farmer Medical Teacher Dec 23:1-5 2008

Abstract
Background: Teachers want students to focus on their learning to become capable doctors; yet, students... more Abstract
Background: Teachers want students to focus on their learning to become capable doctors; yet, students primarily want to focus on passing their exams. How much of this paradox is explained by learning and assessment being seen as two different entities rather than as the continuum of one and the same process? How may the two areas be more closely and effectively linked?

Aim: This article describes and illustrates a conceptual framework for an approach termed capability-based portfolio assessment.

Results and conclusions: Thinking about capability, i.e. the ability to perform in the real world, is needed for a contemporary curriculum and assessment design. A capability-focus will help students to integrate the foundations of medical practice with learning how to become a capable, reflective and life-long learner.

A well-structured capability portfolio, regularly presented and reviewed, will be a useful tool to guide the journey, and should have the potential to help drive deep learning and allow the assessment of capabilities that are hard to assess using conventional approaches.

Assessment based on portfolio approaches should not equate to increasing the overall assessment burden as it will reduce the need for more traditional assessment methods. 

Assessing performance 4: Reviewing communication skills

by Liz Farmer

St George I, Farmer EA New Zealand Fam Phys 31(4); 264-266

General practice research training: impact of the Australian Registrar Research Workshop on research skills, confidence, interest and involvement of participants, 2002–2006

by Liz Farmer

Karin Ried, Brett D Montgomery, Nigel P Stocks and Elizabeth A Farmer  Family Practice 2008 25(2):119-126; doi:10.1093/fampra/cmn010

Background. An intensive 3-day training programme, the ‘Registrar Research Workshop’ (RRW), has aimed to build... more Background. An intensive 3-day training programme, the ‘Registrar Research Workshop’ (RRW), has aimed to build research capacity among Australian general practice registrars since 1994.

Objectives. To investigate the impact of the RRW on participants' skills, confidence, interest in research and research activity.

Methods. Cross-sectional postal survey in 2006 of five groups of registrars who participated in the annual workshop in 2002–2006 (response rate: 64%; 77 of 121). Outcome measures included research experience and skills prior to and after the workshop; impact of the workshop on capacity, confidence, attitude and interest in research; and research involvement as measured by publications and grant funding.

Results. Self-reported research skills increased over time for the whole group (two-way analysis of variance: P = 0.047), most significantly for registrars with little or no research experience (P < 0.001) and research project participants (P = 0.003). The impact of the workshop on capacity, confidence and interest in research was rated highly (mean 3.5–4.0 ± 0.1 on a five-point scale). Two-thirds of the survey respondents had been research active, 34% presented their findings at conferences, 25% published in peer-reviewed journals and 31% received research funding. Eighty-four per cent of respondents indicated a high interest in undertaking research in the future. All survey respondents recommended the workshop to other registrars.

Conclusions. The RRW provides a useful model for effective research training for interested general practice trainees. Such training has the potential to increase knowledge of research methods, which might augment future research activity in general practice.

Patients' views on the training of medical students in Australian general practice settings.

by Liz Farmer

Salisbury K, Farmer EA, Vnuk A.Aust Fam Physician. 2004 Apr;33(4):281-3.

AIM: To explore patients' views on training medical students in their general practice. METHOD AND SETTING: Consenting... more AIM: To explore patients' views on training medical students in their general practice. METHOD AND SETTING: Consenting patients attending eight urban teaching practices completing a self administered survey before and after the consultation. RESULTS: One hundred and four patients attended for appointments: 94 consented to the involvement of a medical student, 88 completed surveys before and after their consultation (response rate 85%), 80% said the main reason for consenting was to benefit the student, and 70% said they would never refuse the presence of a medical student. Student involvement was less than that consented to: only 18 (20%) patients reported that the student independently conducted any of the consultation; 52 (59%) would accept this level of involvement in the future. DISCUSSION: Patients are a willing, but potentially under used resource for training medical students in general practice. Improved collaboration with patients would provide better teaching opportunities for students at all levels.

Selecting performance assessment methods for experienced physicians

by Liz Farmer

R B  Hays  1  H A  Davies  2  , J D  Beard  3  , L J M  Caldon  4  , E A  Farmer  5  P M  Finucane  6  , P  McCrorie  7  , D I  Newble  8  L W T  Schuwirth  9  & G R  Sibbald Medical Education Volume 36 Issue 10, Pages 910 - 917  Published Online: 17 Oct 2002

Background While much is now known about how to assess the competence of medical practitioners in a controlled... more Background While much is now known about how to assess the competence of medical practitioners in a controlled environment, less is known about how to measure the performance in practice of experienced doctors working in their own environments. The performance of doctors depends increasingly on how well they function in teams and how well the health care system around them functions.

Methods This paper reflects the combined experiences of a group of experienced education researchers and the results of literature searches on performance assessment methods.

Conclusion Measurement of competence is different to measurement of performance. Components of performance could be re-conceptualised within a different domain structure. Assessment methods may be of a different utility to that in competence assessment and, indeed, of different utility according to the purpose of the assessment. An exploration of the utility of potential performance assessment methods suggests significant gaps that indicate priority areas for research and development.

Assessing general practice knowledge base--the applied knowledge test.

by Liz Farmer

Sturmberg JP, Farmer EA Aust Fam Physician. 2008 Aug;37(8):659-61.

The Royal Australian College of General Practitioners (RACGP) Fellowship examination assesses competence for... more The Royal Australian College of General Practitioners (RACGP) Fellowship examination assesses competence for unsupervised clinical practice anywhere in Australia through three segments, each with a unique focus. The applied knowledge test (AKT) is a written examination that tests candidates' applied clinical knowledge. Other segments assess clinical problem solving skills and ability to perform in a clinical situation. Approximately 400-500 candidates sit each administration of the RACGP examination, which is held twice yearly throughout Australia.

A practical guide to assessing clinical decision-making skills using the key features approach

by Liz Farmer

Elizabeth A  Farmer  & Gordon  Page. Medical Education Volume 39 Issue 12, Pages 1188 - 1194  Published Online: 25 Nov 2005 

ABSTRACT

Aim This paper in the series on professional assessment provides a practical guide to writing key... more ABSTRACT

Aim This paper in the series on professional assessment provides a practical guide to writing key features problems (KFPs). Key features problems test clinical decision-making skills in written or computer-based formats. They are based on the concept of critical steps or 'key features' in decision making and represent an advance on the older, less reliable patient management problem (PMP) formats.

Method The practical steps in writing these problems are discussed and illustrated by examples. Steps include assembling problem-writing groups, selecting a suitable clinical scenario or problem and defining its key features, writing the questions, selecting question response formats, preparing scoring keys, reviewing item quality and item banking.

Conclusion The KFP format provides educators with a flexible approach to testing clinical decision-making skills with demonstrated validity and reliability when constructed according to the guidelines provided.

The Integration of Social Media into Courses: A Literature Review and Case Study from Experiences at Tufts University School of Medicine

by Lisa Gualtieri

In press. Co-authored with Gillian Javetski and Helen Corless

What are the benefits and drawbacks of integrating social media into higher education and, specifically, graduate... more What are the benefits and drawbacks of integrating social media into higher education and, specifically, graduate medical and health education? In order to explore the answer to this question we conducted a literature search and introduced social media into a course at Tufts University School of Medicine. We report on student surveys that were designed to uncover students’ expectations for, knowledge of, and comfort with social media. Student feedback was overwhelmingly positive when asked about the benefits to learning about social media in an academic setting, which was one of the key questions we sought to answer. We also provide an assessment of social media’s potential from the perspectives of students, faculty, administrators, and people outside the institution.

Stimulating curiosity to enhance learning

by Graham Pluck

Asynchronous Discussion In Support of Medical Education

by Martin Oliver

Oliver, M. & Shaw, G. (2003) Asynchronous Discussion In Support of Medical Education. The Journal of Asynchronous Learning Networks, 7 (1), 56-65.

Although the potential of asynchronous discussion to support learning is widely recognized, studentengagement remains... more Although the potential of asynchronous discussion to support learning is widely recognized, studentengagement remains problematic. Often, for example, students simply refuse to participate.Consequently the rich promise of asynchronous learning networks for supporting students’ learning canprove hard to achieve.After reviewing strategies for encouraging student participation in discussions in Asynchronous LearningNetworks (ALN), we present a study that investigates how these strategies influenced students’perceptions and use of the discussion area. We identify and explore factors that encouraged and inhibitedstudent participation in asynchronous discussion, and evaluate student postings to an asynchronousdiscussion group by content analysis.The results question received wisdom about some of the pedagogic techniques advocated in the literature.Instead, results support the view that the major factors for stimulating student participation inasynchronous discussion are tutor enthusiasm and expertise. It appears that the tutor may be the rootcause of engagement in discussions, an important conclusion, given that to date, the tutor’s role hasremained relatively unexamined. We also note that participation in asynchronous discussion is inhibitedwhen students allocate a low priority to participation, as may occur when participation is not assessed.Content analysis of an asynchronous discussion in this study reveals that contributions were not stronglyinteractive and that students were simply ‘playing the game’ of assessment, making postings that earnedmarks but rarely contributing otherwise. Thus the use of assessment to encourage students’ contributionsappears to be only a superficial success; it seems likely that giving credit for postings changes behavior without necessarily improving learning. This finding has significant implications for curriculum design.

[Burnout syndrome among medical residents during the influenza A H1N1 sanitary contigency in Mexico]

by Fernando Austria Corrales