Ellen F. Goldman

The state of ultrasound education in U.S. medical schools: results of a national survey.

Purpose To determine the state of ultrasound education in U.S. medical schools and assess curricular administrators’ opinions on its integration in undergraduate medical education (UME). Method In 2012, curricular administrators at 134 U.S. MD-granting medical schools were surveyed concerning the nature of ultrasound education in medical school. The questionnaire sought ultrasound education program characteristics, structures, and objectives. It also sought respondents’ opinions on the role of ultrasound education in UME and barriers to its integration. Frequency and distribution analyses were conducted for survey responses; Rasch analysis was performed for barrier responses. Results Responses were received from 82 (61.2%) medical schools; these institutions were representative of the U.S. medical school population. Fifty-one respondents (62.2%) reported ultrasound training was integrated into their UME curriculum. Ultrasound was most commonly taught in the third year (38/82; 46.3%), and the purpose of training varied by curricular year. There was agreement that ultrasound should be part of the UME curriculum (56/71; 78.9%), but few respondents reported it was a priority at their institution (13/70; 18.6%). Respondents perceived lack of space in the curriculum (logit = +0.49; standard error [SE] = 0.11) and lack of financial support (logit = +0.42; SE = 0.11) as the most significant barriers to integration. Conclusions Despite a general consensus that ultrasound is an important skill to teach in medical school, the integration of ultrasound education in U.S. schools is highly variable. This study indicates a need for national standards to guide the integration of ultrasound education into U.S. medical school curricula.

The Reflective Writing Class Blog: Using Technology to Promote Reflection and Professional Development

ABSTRACTINTRODUCTIONThe hidden (informal) curriculum is blamed for its negative effects on students’ humanism and professional development. To combat this, educational initiatives employing mentored reflective practice, faculty role-modeling, and feedback have been advocated.AIMPromote reflection on professional development using collaborative, web-based technology.SETTINGFour-week basic medicine clerkship rotation at an academic institution over a one-year period.PROGRAM DESCRIPTIONStudents were asked to contribute two reflective postings to a class web log (blog) during their rotation. They were able to read each other’s postings and leave feedback in a comment section. An instructor provided feedback on entries, aimed to stimulate further reflection. Students could choose anonymous names if desired.PROGRAM EVALUATIONNinety-one students wrote 177 posts. One-third of students left feedback comments. The majority of students enjoyed the activity and found the instructor’s feedback helpful. Assessment of the posts revealed reflections on experience, heavily concerned with behavior and affect. A minority were not reflective. In some cases, the instructor’s feedback stimulated additional reflection. Certain posts provided insight to the hidden curriculum.DISCUSSIONWe have discovered that blogs can promote reflection, uncover elements of the hidden curriculum, and provide opportunities to promote professional development.

It's your own risk: medical students' perspectives on online professionalism.

Background U.S. medical schools have reported unprofessional online content by medical students. To inform institutional policies and curricula, we conducted a qualitative study exploring medical student perspectives on online posting. Method Six focus groups were conducted with students from a single institution in November 2009. Interviews were recorded, transcribed, and analyzed using qualitative methods. Results Sixty-four students participated. Besides HIPAA violations and illegal activities, students disagreed as to what was inappropriate to post. They experienced online identity conflicts and described ambivalence toward Facebook. Students were concerned about online activity risks and lack of personal control. Their postings were guided by common sense and what they believed was expected from medical students. Students desired recommendations for appropriate content and suggested raising awareness through discussion. Conclusions Medical students viewed online postings through a lens of personal risk. They desired recommendations but were sensitive to feeling controlled by their school.

Enhancing the ability to think strategically: A learning model

The ability to think strategically is critical for managers at multiple organizational levels, yet we know little about how this ability develops in individuals. Drawing on literature in strategy, cognitive science and adult learning, we propose a model of learning to think strategically that follows the ‘learning school’ of strategy making (Mintzberg et al., 1998). The model depicts a dynamic, interactive, and iterative experiential learning process. It identifies individual factors, work experiences and organizational factors that contribute knowledge and act together to develop the ability to think strategically. Areas for research are suggested to better understand the learning process.

Learning in a chaotic environment

Purpose – The purpose of this study is to understand how, when, and why emergency medicine residents learn while working in the chaotic environment of a hospital emergency room.Design/methodology/approach – This research used a qualitative interview methodology with thematic data analysis that was verified with the entire population of learners.Findings – Analysis of the data revealed four different types of learning episodes, each with facilitating factors. The episodes varied in intensity, duration, and the degree of motivation and self‐direction required of the learner. One episode could prompt another. Learning occurred both individually and in social interaction in the workplace during the episode, as well as outside of the workplace environment after the experience had occurred.Research limitation/implications – Recommendations for individuals to maximize their learning related to this chaotic work environment are identified, along with associated implications for their trainers. These suggestions a...

Building a Culture That Encourages Strategic Thinking

The ability to think strategically is critical for leaders and managers at multiple organizational levels. Specific work experiences can contribute to the development of an individual’s strategic thinking ability. Culture, among other organizational factors, can either encourage or limit those contributions. Leaders, as culture constructors and transformers, can act to maximize the relationship between organizational culture and the process of learning to think strategically. A cadre of formal training, developmental activities, and self-directed learning initiatives can provide leaders with the skills to enhance the strategic thinking of those they lead.

Perspective: Deconstructing integration: A framework for the rational application of integration as a guiding curricular strategy

In response to historical criticism, evolving accreditation standards, and recent reports on curricula, medical educators and medical schools have been eagerly pursuing integration as a goal of curricular reform. The general education literature broadly considers integration to be the deliberate unification of separate areas of knowledge, and it provides support for the concept that integration better meets the needs of adult learners in professional education. The use of integration as a curricular goal is not without its critics, however, nor is it free of difficulties in implementation. In this perspective, the authors propose that most of these difficulties arise from a failure to recognize that integration is a strategy for curricular development rather than a goal in itself, and they argue that adopting a systematic approach to integration offers many potential benefits. They articulate the conceptual and practical issues that they believe are critical to consider in order to achieve successful curricular integration, and they suggest that integration should be approached as a subset of broader curriculum development decisions. They propose a three-level framework for applying integration as a guiding curricular strategy, in which decisions about integration must follow curricular decisions made at the program level, the course level, and then the individual session level.

Experiences that develop the ability to think strategically.

&NA; The ability to think strategically is an admired and a sought‐after leadership require requirement, yet we know little about how it develops. The purpose of this study is to iden identify specific experiences that contribute to the development of an individuals ability to think strategically. We identified eight work experiences, including different types of organizational projects, processes, and relationships, that contribute to an individuals strategic thinking ability. We also delineate specific characteristics material to each experi experience. These characteristics indicate that considerable time and focus are required to develop the ability to think strategically. In addition, the experiences are not all accessed equally: Women are less likely to have nonrelational experiences, while chief executive officers are more likely to have the most challenging ones. In addi addition, we found differences regarding work‐related continuing education activities. Respondents rated nonhealthcare conferences and reading behind all other identified experiences that contribute to strategic thinking ability. Individuals can implement several strategies to improve their strategic thinking ability, including deliberately incorporating the requisite experiences into their devel development plans, ensuring that the experiences incorporate the required characteristics, and improving the benefit received from attending educational programs in non nonhealthcare industries. Organizations can implement several strategies to ensure the experiences are as effective as possible, such as appraising gender differences across the experiences and reviewing the organizations strategic planning processes for the characteristics that best encourage strategic thinking.

A Qualitative Study of the Meaning of Physical Examination Teaching for Patients

BACKGROUNDPhysical examination teaching using actual patients is an important part of medical training. The patient experience undergoing this type of teaching is not well-understood.OBJECTIVETo understand the meaning of physical examination teaching for patients.DESIGNPhenomenological qualitative study using semi-structured interviews.PARTICIPANTSPatients who underwent a physical examination-based teaching session at an urban Veterans Affairs Medical Center.APPROACHA purposive sampling strategy was used to include a diversity of patient teaching experiences. Multiple interviewers triangulated data collection. Interviews continued until new themes were no longer heard (total of 12 interviews). Interviews were recorded and transcribed verbatim. Coding was performed by two investigators and peer-checked. Themes were identified and meanings extracted from themes.KEY RESULTSSeven themes emerged from the data: positive impression of students; participation considered part of the program; expect students to do their job: hands-on learning; interaction with students is positive; some aspects of encounter unexpected; range of benefits to participation; improve convenience and interaction. Physical examination teaching had four possible meanings for patients: Tolerance, Helping, Social, and Learning. We found it possible for a patient to move from one meaning to another, based on the teaching session experience.CONCLUSIONSPhysical examination teaching can benefit patients. Patients have the potential to gain more value from the experience based on the group interaction.

How learning transfers: A study of how graduates of a faculty education fellowship influenced the behaviors and practices of their peers and organizations

Purpose Faculty development programs have been criticized for their limited assessment methods, focused only on the learners and limited to satisfaction measures or self-reported behavior changes. Assessment of organizational impact is lacking. This study explored the impact of faculty education fellowship graduates on their organization and how that impact occurred. Method The design was a qualitative study of 13 departments across three institutions, partnered with the George Washington University School of Medicine and Health Sciences. In-depth interviews with 13 supervisors and 25 peers of graduates were conducted in fall 2012 to examine graduates’ organizational impact related to program purposes: enhancing teaching skills, pursuing scholarship in education, and developing leadership potential. Triangulation, purposive sampling, rich descriptions, and member checks minimized bias and optimized transferability. Results A model of how graduates of a faculty education fellowship transfer learning to peers and their organizations emerged. Analysis of interview responses showed that in the presence of environmental facilitators, graduates exhibited enhanced confidence and five new behaviors. Graduates raised peer awareness, leading to changes in individual and group practices and development of shared peer understanding. Analysis suggests they facilitated a culture of continuous learning around teaching, scholarship, and leadership. Conclusions This study enhances traditional assessment of faculty education fellowship programs by examining the impact that graduates had on peers and work groups. A model is proposed for how graduates interact with and impact work group processes and practices. This model can facilitate more comprehensive program assessments, which can demonstrate program impact beyond the individual participant.