Jocelyn Schiller

Not Another Boring Lecture: Engaging Learners with Active Learning Techniques

BACKGROUND Core content in Emergency Medicine Residency Programs is traditionally covered in didactic sessions, despite evidence suggesting that learners do not retain a significant portion of what is taught during lectures. DISCUSSION We describe techniques that medical educators can use when leading teaching sessions to foster engagement and encourage self-directed learning, based on current literature and evidence about learning. CONCLUSIONS When these techniques are incorporated, sessions can be effective in delivering core knowledge, contextualizing content, and explaining difficult concepts, leading to increased learning.

Long-Term Gain After Team-Based Learning Experience in a Pediatric Clerkship

Background: Team-based learning (TBL) increases student engagement, value of teamwork, and performance on standardized evaluations. Purpose: The authors implemented a 3rd-year pediatric TBL curriculum, evaluating its effect on satisfaction, engagement, value of teamwork, and short-term and long-term academic performance. Method: Students evaluated the TBL curriculum and core lectures through satisfaction, engagement and value of team surveys. Scores on short-term and long-term examinations were compared to historical data. Results: The first implementation year, students were less likely to enjoy TBL sessions compared to lectures. The 2nd year, this difference lessened. Through both years, students reported dramatic increases in classroom engagement during TBL compared to lecture. Students developed a greater value for teams after participating in TBL. Short-term and long-term examination scores improved significantly. Conclusions: Both short-term and long-term performance improved with implementation of TBL, emphasizing the benefits of a curriculum that allows students to critically engage with material.

Use of simulated electronic mail (e-mail) to assess medical student knowledge, professionalism, and communication skills.

Background Physicians communicate with patients using electronic mail (e-mail) with increasing frequency. Communication skills specific to e-mail do not appear to be taught explicitly in medical school. Therefore, the effect of an instructive session on effective e-mail communication was examined. Method Four simulated e-mails from a parent were developed. Students responded to an initial e-mail and then participated in a session on effective e-mail communication. Responses to a final e-mail were assessed using a rubric with subscores for medical knowledge, communication, and professionalism. Results Performance improved from the first to final e-mail response in the overall score and in each subscore. Improvement was sustained over the course of the academic year. Interrater reliability revealed good agreement. Conclusions Communicating effectively with patients via e-mail is not intuitive but can be taught. It is feasible to introduce responses to a simulated e-mail case in a clinical clerkship as an assessment tool.

Medical school handoff education improves postgraduate trainee performance and confidence

Abstract Objectives: Determine postgraduate first-year (PGY-1) trainees ability to perform patient care handoffs and associated medical school training. Methods: About 173 incoming PGY-1 trainees completed an OSCE handoff station and a survey eliciting their training and confidence in conducting handoffs. Independent t-tests compared OSCE performance of trainees who reported receiving handoff training to those who had not. Analysis of variance examined differences in performance based on prior handoff instruction and across levels of self-assessed abilities, with significance set at p < 0.05. Results: About 35% of trainees reported receiving instruction and 51% reported receiving feedback about their handoff performance in medical school. Mean handoff performance score was 69.5%. Trainees who received instruction or feedback during medical school had higher total and component handoff performance scores (p < 0.05); they were also more confident in their handoff abilities (p < 0.001). Trainees with higher self-assessed skills and preparedness performed better on the OSCE (p < 0.05). Conclusions: This study provides evidence that incoming trainees are not well prepared to perform handoffs. However, those who received instruction during medical school perform better and are more confident on standardized performance assessments. Given communication failures lead to uncertainty in patient care and increases in medical errors, medical schools should incorporate handoff training as required instruction.

Further Dissemination of Medical Education Projects After Presentation at a Pediatric National Meeting (1998-2008)

Background: Further dissemination of medical education work presented at national meetings is limited. Purposes: The purpose of this study was to explore dissemination outcomes of scholarly work in pediatric medical education. Methods: Council on Medical Student Education in Pediatrics (COMSEP) members who presented at COMSEP national meetings from 1998 to 2008 received a questionnaire about scholarly dissemination outcomes. Descriptive statistics and chi-square analysis explored variables related to dissemination. Qualitative analysis of free text comments explored barriers to dissemination. Results: Outcomes were determined for 81% of presentations (138/171). The dissemination rate was 67% (92/138 presentations), with 47 publications (34%). Dissemination rates did not vary by presentation type (poster vs. oral) or project type. There was no relationship between presentation type, project type, and dissemination method. Barriers included perceived inadequate time, mentorship, and methodological skills for scholarly work. Conclusions: Most projects were further disseminated. Additional resources including mentoring and protected time for scholarly work are needed by educators to optimize dissemination.

Handover education improves skill and confidence

Despite the frequency of patient‐care handovers and vulnerability to errors, medical schools infrequently teach handover skills. Our study evaluated the impact of a medical school handover curriculum on students’ performance, as rated by faculty members, peers and self‐assessment.

Students' educational experiences and interaction with residents on night shifts

The purpose of this mixed‐methods study was to investigate whether increased night shifts for students on paediatric rotations had any negative impact on their overall quality of educational experiences in light of the implementation of duty‐hour restrictions.

Characteristics of multi-institutional health sciences education research: a systematic review

Objectives: Multi-institutional research increases the generalizability of research findings. However, little is known about characteristics of collaborations across institutions in health sciences education research. Using a systematic review process, the authors describe characteristics of published, peer-reviewed multi-institutional health sciences education research to inform educators who are considering such projects. Methods: Two medical librarians searched MEDLINE, the Education Resources Information Center (ERIC), EMBASE, and CINAHL databases for English-language studies published between 2004 and 2013 using keyword terms related to multi-institutional systems and health sciences education. Teams of two authors reviewed each study and resolved coding discrepancies through consensus. Collected data points included funding, research network involvement, author characteristics, learner characteristics, and research methods. Data were analyzed using descriptive statistics. Results: One hundred eighteen of 310 articles met inclusion criteria. Sixty-three (53%) studies received external and/or internal financial support (87% listed external funding, 37% listed internal funding). Forty-five funded studies involved graduate medical education programs. Twenty (17%) studies involved a research or education network. Eighty-five (89%) publications listed an author with a master’s degree or doctoral degree. Ninety-two (78%) studies were descriptive, whereas 26 studies (22%) were experimental. The reported study outcomes were changes in student attitude (38%; n=44), knowledge (26%; n=31), or skill assessment (23%; n=27), as well as patient outcomes (9%; n=11). Conclusions: Multi-institutional descriptive studies reporting knowledge or attitude outcomes are highly published. Our findings indicate that funding resources are not essential to successfully undertake multi-institutional projects. Funded studies were more likely to originate from graduate medical or nursing programs.

Training may impact shift work mentality in students

care challenging. Doctors are expected to develop competencies far beyond patient care in order to succeed in modern health care delivery systems. The manager role has been defined in various competency catalogues for health care professionals. However, concrete pedagogical implementation concepts are lacking. What was tried? We established an innovative course at the Ludwig Maximilian University Medical School with the objective of preparing undergraduate medical students for their future role as managers in the health care system. At the beginning of the course, the students developed an understanding of the basic principles of the German health care system and hospital management through problem-based learning tutorials, lectures and workshops. During the second part of the course we organised a simulated hospital board meeting, with students assuming the roles of the university hospital’s supervisory board members. For this part students had the chance to gain insight into the board members’ daily work by conducting interviews with them. Subsequently they developed a viable solution for a current issue of the supervisory board and ultimately presented their results to their work-life counterparts. The course is supplemented with workshops aimed at improving soft skills, such as negotiation strategies, project management or team building. In order to assess the overall knowledge of the students about health policy and management, we used a pre-post self-assessment tool within our paper-based evaluation as well as semi-structured interviews. What lessons were learned? Twenty-four students participated and evaluated the course, using a questionnaire with a response rate of 95.8%. The course was graded with a mean of 1.08 (standard deviation 0.2) using a 6-level Likert scale (1 = excellent; 6 = poor). Concerning questions about core points of the German health care system, means prior to the course ranged from 3.17 to 4.69 (6-level Likert scale, 1 = ‘excellent knowledge’; 6 = ‘very poor knowledge’). After completion of the course, significant improvement could be detected in all core points assessed with the questionnaire (means ranged from 1.85 to 2.55). The results were triangulated with semi-structured interviews (n = 6) and thematic content analysis until saturation was reached. The findings confirmed our quantitative assessment and allowed for a deeper understanding of how students constructed the course experience. An additional outcome was the successful presentation of a realistic business plan devised by the participants to the actual supervisory board of the university hospital. This course was evaluated positively and students seem to have gained some management competencies. Nevertheless, the complexity of the structure and the personnel expense of the course make integration in the core curriculum difficult. In our setting, teaming up medical educators and management personnel has created a win–win situation. Courses such as this could initiate a broader curricular reformation, as more curricular elements for teaching the manager role are certainly needed.