Heeyoung Han

Writing and reading in the electronic health record: an entirely new world

Background : Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians’ electronic health record (EHR)-writing and -reading competence. Purposes : This study aims to investigate physicians’ self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Methods : Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Results : Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= − 0.33, p<0.001) and narrative (r= − 0.36, p<0.001) EHR notes than physicians with lower perceived EHR competence. Physicians’ perceived EHR-writing and -reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001). Conclusions : Writing and reading EHR documentation is different for physicians. Maximizing navigation skills can optimize non-linear EHR writing and reading. Pedagogical questions remain related to how physicians and medical students are able to retrieve correct information effectively and to understand thought patterns in collectively lengthier and sometimes fragmented EHR chart notes.

Should caring be viewed as a competence? (Re-)Opening the dialogue over the limitations of competency frameworks in HRD

The recent review article in this journal by Delamare Le Deist and Winterton (2005) on ‘what is competence?’ is a most useful explication of the various meanings and usages of a core concept in HRD and related fields. Delamare Le Deist and Winterton trace the history of the ‘fuzzy concept’ against the backdrop of economic, political and social factors of the past 25 years, detail the range of understandings within various social science fields, provide an insightful and contrasting description of different traditions and meanings in the US, UK and continental Europe and propose a multi-dimensional ‘holistic’ model that encompasses cognitive, functional and social aspects with a set of meta-competences. While the article refers briefly to criticism leveled against the competence approach, such as the oversimplification of work complexity, and while it acknowledges the rift between the rationalist and interpretative approaches, a more fundamental assessment of the competence logic was outside of the scope of the article. In this brief piece, the authors wish to extend an invitation to continued dialogue by summarizing what should be seen as the limitations of the competency-based approach in particular with respect to training and development. Fundamental critiques have, in fact, been raised from various corners of the academic and professional education and training world almost since the inception of the competency-based education and training (CBET) movement, and these voices have been, arguably, by and large ignored in much of the extant scholarship in HRD. While a fully developed review of these literatures is beyond the scope of a

The Flipped Classroom in Medical Education: Engaging Students to Build Competency

The flipped classroom represents an essential component in curricular reform. Technological advances enabling asynchronous and distributed learning are facilitating the movement to a competency-based paradigm in healthcare education. At its most basic level, flipping the classroom is the practice of assigning students didactic material, traditionally covered in lectures, to be learned before class while using face-to-face time for more engaging and active learning strategies. The development of more complex learning systems is creating new opportunities for learning across the continuum of medical education as well as interprofessional education. As medical educators engage in the process of successfully flipping a lecture, they gain new teaching perspectives, which are foundational to effectively engage in curricular reform. The purpose of this article is to build a pedagogical and technological understanding of the flipped classroom framework and to articulate strategies for implementing it in medical education to build competency.

South Korean women leaders’ struggles for a work and family balance

The purpose of this study was to explore the lived experience of women in leadership in Korea and to identify challenges and opportunities that they face in the process of balancing work and family life and developing leadership as women in the uniquely challenging Korean workplace where they face organizational and cultural constraints. Critical to this investigation was the understanding of concepts frequently represented in the previous literature about women in leadership: work–family life balance, women’s leadership development, and the cultural context. In-depth interviews were conducted with 18 women leaders selected through a purposeful and snowball sampling method. A thematic analysis of the interview data generated six themes including: (a) commitment to work, (b) struggles for a balance, (c) defining success, (d) gender identity, (e) being a role model, and (f) need for support. Based on the findings, we provide implications for research and practice.

Learning in the real place: medical students' learning and socialization in clerkships at one medical school.

Purpose To understand medical students’ learning experiences in clerkships: learning expectations (what they expect to learn), learning process (how they learn), and learning outcomes (what they learn). Method Using a longitudinal qualitative research design, the authors followed the experiences of 12 participants across their clerkship year (2011–2012) at the Southern Illinois University School of Medicine. Interview data from each participant were collected at three points (preclerkship, midclerkship, and postclerkship) and analyzed using a grounded theory approach. Additionally, the authors observed participants through a full clerkship day to augment the interviews. Results Before clerkships, students expected to have more hands-on experiences and become more knowledgeable by translating textbook knowledge to real patients and practicing diagnostic thinking. During clerkships, students experienced ambiguity and subjectivity of attending physicians’ expectations and evaluation criteria. They perceived that impression management was important to ensure that they received learning opportunities and good evaluations. After clerkships, students perceived that their confidence increased in navigating the health care environments and interacting with patients, attendings, and residents. However, they felt that there were limited opportunities to practice diagnostic thinking. Students could not clearly discern the decision-making processes used by attending physicians. Although they saw many patients, they perceived that their learning was at the surface level. Conclusions Students’ experiential learning in clerkships occurred through impression management as a function of dynamic social and reciprocal relationships between students and attendings or residents. Students reported that they did not learn comprehensive clinical reasoning skills to the degree they expected in clerkships.

Educational Technology in Medical Education

This article aims to review the past practices of educational technology and envision future directions for medical education. The discussion starts with a historical review of definitions and perspectives of educational technology, in which the authors propose that educators adopt a broader process-oriented understanding of educational technology. Future directions of e-learning, simulation, and health information technology are discussed based on a systems view of the technological process. As new technologies continue to arise, this process-oriented understanding and outcome-based expectations of educational technology should be embraced. With this view, educational technology should be valued in terms of how well the technological process informs and facilitates learning, and the acquisition and maintenance of clinical expertise.

Postmodernism and HRD Theory: Current Status and Prospects

With posttraditionalism and postmodern frames of reference firmly established in social theory and many of the applied social sciences, including management, the question of the role of postmodernism in human resource development (HRD) theory needs to be asked. The purpose of the article is to explicate the contribution of postmodernism to HRD, distinguish posttraditionalism from the recently emerged stream of critical perspectives on HRD, and to argue for the contribution of postmodern readings of HRD theory to better understand the complex landscape of contemporary organizations, employees, and learning and development functions. Starting with a historical analysis of the meaning of the Enlightenment, and various modernist perspectives, the article describes the central tenets of postmodern theory and their implications for the theory and practice of HRD and argue for its important role in broadening and enriching the field of HRD.

A Blended Approach to Learning in an Obstetrics and Gynecology Residency Program: Proof of Concept

Problem Graduate medical education programs are expected to educate residents to be able to manage critically ill patients. Most obstetrics and gynecology (OB/GYN) graduate medical education programs provide education primarily in a didactic format in a traditional face-to-face setting. Busy clinical responsibilities tend to limit resident engagement during these educational sessions. The revision of the training paradigm to a more learner-centered approach is suggested. Intervention A blended learning education program was designed and implemented to facilitate the teaching and learning of obstetric emergencies, specifically diabetic ketoacidosis and acute-onset severe hypertension in pregnancy. The program incorporated tools to foster a community of inquiry. Multimedia presentations were also utilized as the main modality to provide instruction. The blended learning course was designed in accordance with the cognitive theory of multimedia learning. Context This intervention was carried out in the Department of Obstetrics and Gynecology, Southern Illinois University. All 15 OB/GYN residents were enrolled in this course as part of their educational curriculum. First, face-to-face instructions were given in detail about the blended learning process, course content, and online website. The residents were then assigned tasks related to completing the online component of the course, including watching multimedia presentations, reading the resources placed online, and participating in online asynchronous discussions. The course culminated with a face-to-face session to clarify misconceptions. Pre- and postcourse quizzes were administered to the residents to assess their retention and understanding. Outcome Objective analysis demonstrated significant improvements in retention and understanding after participating in the course. The blended learning format was well received by the residents. Resident perception of social presence in the asynchronous online discussions was demonstrative of low scores relating to peer-to-peer interaction. The multimedia presentations and the availability of learning resources were well received. Lessons Learned Outcomes of this study suggest that blended learning is a viable tool to support teaching and learning of obstetric emergencies in an OB/GYN residency program.

Looking into the labyrinth of gender inequality: women physicians in academic medicine

Gender inequality remains prevalent worldwide in academic medicine. A closer look into women physicians’ gendered experiences through the lens of culture is necessary to advance understanding of gender inequality in this context. Relatively few studies, however, have investigated how social and cultural practices implicitly yet significantly affect gender inequality throughout women physicians’ careers.

The Most Common Feedback Themes in Communication Skills Training in an Internal Medicine Residency Program: Lessons from the Resident Audio-Recording Project

ABSTRACT Individualized structured feedback is an integral part of a resident’s learning in communication skills. However, it is not clear what feedback residents receive for their communication skills development in real patient care. We will identify the most common feedback topics given to residents regarding communication skills during Internal Medicine residency training. We analyzed Resident Audio-recording Project feedback data from 2008 to 2013 by using a content analysis approach. Using open coding and an iterative categorization process, we identified 15 emerging themes for both positive and negative feedback. The most recurrent feedback topics were Patient education, Thoroughness, Organization, Questioning strategy, and Management. The residents were guided to improve their communication skills regarding Patient education, Thoroughness, Management, and Holistic exploration of patient’s problem. Thoroughness and Communication intelligibility were newly identified themes that were rarely discussed in existing frameworks. Assessment rubrics serve as a lens through which we assess the adequacy of the residents’ communication skills. Rather than sticking to a specific rubric, we chose to let the rubric evolve through our experience.