Kathel Dunn

Practicing Physician Education in Geriatrics: Lessons Learned from a Train‐the‐Trainer Model

Evidence of poor performance in the evaluation and management of common geriatric conditions suggests the need for changing physician behavior in these areas. Traditional lecture‐style continuing medical education (CME) has not been shown to be effective. Expert faculty initially trained 60 nonexpert peer educators to conduct small‐group, learner‐centered CME using tool kits on memory loss, incontinence, and depression. Peer educators presented 109 community‐based sessions to 1,309 medical practitioners. Surveys were administered to community participants immediately and 6 months after a session. Evidence of effectiveness included statistically significant increases in self‐reported knowledge, attitudes, and office‐based practices on the target topics at the time of training and at the 6‐month follow‐up (P<.001) and two‐thirds of respondents reporting continued use of three or more tools at 6 months. Participants reported that the interactive presentation aided their understanding of and ability to use the tool kits more than an off‐the‐shelf review (mean rating±standard deviation 4.1±0.71, with 1=not at all and 5=significantly). After the formal evaluation period, additional information about the project dynamics and tool kits was obtained through a small interview sample and an on‐line survey, respectively. Receiving copies of the tool kits was an important factor in enabling educators to offer sessions. Barriers to offering sessions included finding time, an audience, and space. Findings suggest that modest positive changes in practice in relation to common geriatric problems can be achieved through peer‐led, community‐based sessions using principles of knowledge translation and evidence‐based tool kits with materials for providers and patients.

Measuring the value and impact of health sciences libraries: planning an update and replication of the Rochester Study

In 2007, the National Network of Libraries of Medicine (NN/LM), Middle Atlantic Region (MAR), formed a planning group to explore the possibility of replicating a landmark study on the value of hospital libraries and their impact on clinical care, popularly known as “the Rochester Study” [1]. The Rochester study was among the first studies to relate information services provided by librarians to patient care outcomes, and it continues to be cited as evidence of the value of library services. The purpose of this paper is to update the library community on the progress of the proposed value of libraries study.

Teaching Evidence-Based Medicine: A Regional Dissemination Model.

Background: Evidence-based medicine (EBM) is a framework for critically appraising medical literature and applying it to the care of individual patients. Lack of faculty skilled in practicing and teaching EBM limits the ability to train residents in this area. Description: A 31/2-day interactive course, called Teaching Evidence-Based Medicine, was given in 1996, 1998, and 1999. The goal of the course was to create a cadre of faculty within New York States internal medicine residency programs educated in EBM knowledge and skills who could integrate EBM into their training program. Thirty (58.8%) of 51 metropolitan New York internal medicine residency programs and three of 12 upstate programs sent participants. Evaluation: The postcourse ratings showed increased self-rated knowledge and a willingness to apply the teaching methods at their home institutions. Conclusions: There is a high demand for the opportunity to learn EBM skills and in turn to implement EBM at home institutions.

Update in medical education.

Academic general internists are integral medical educators across the entire continuum of learners. Medical education research allows us to incorporate best practices in curriculum development and assessment and to promote effective teaching behaviors. In this paper, we summarize selected articles chosen for presentation at the Update in Medical Education session at the 30th annual meeting of the Society of General Internal Medicine.

Leveraging Partnerships to Develop a Strong and Diverse Workforce

ABSTRACT With new challenges facing academic health sciences libraries in the 21st century, the profession needs to develop a workforce capable of integrating more directly into the campus organization, the research enterprise, and the clinical setting. To ensure that the profession has an expanding pool of talent with leadership capacity, the National Library of Medicine (NLM) and its outreach partners focus attention on promoting careers in health sciences librarianship and informatics among college and postmasters students. This article addresses how NLM joins forces with organizations and partners such as the Medical Library Association, the American Library Association, the Association of Academic Health Sciences Libraries, and the Association of Research Libraries to sponsor recruitment programs, midcareer leadership training, and scholarships for library school students to achieve a diverse workforce.

Update in medical education 2010-2011.

This review brings important medical education articles of 2010 to the attention of academic general internists. These studies offer methods to improve trainee supervision, continuity of care and the physical examination. The summaries also serve as a reminder of the environmental challenges facing faculty and learners, including burnout and a sense of entitlement among learners, and offer some insight in addressing both issues.

Examining the role of MEDLINE as a patient care information resource: an analysis of data from the Value of Libraries study

Objective: This study analyzed data from a study on the value of libraries to understand the specific role that the MEDLINE database plays in relation to other information resources that are available to health care providers and its role in positively impacting patient care. Methods: A previous study on the use of health information resources for patient care obtained 16,122 responses from health care providers in 56 hospitals about how providers make decisions affecting patient care and the role of information resources in that process. Respondents indicated resources used in answering a specific clinical question from a list of 19 possible resources, including MEDLINE. Study data were examined using descriptive statistics and regression analysis to determine the number of information resources used and how they were used in combination with one another. Results: Health care professionals used 3.5 resources, on average, to aid in patient care. The 2 most frequently used resources were journals (print and online) and the MEDLINE database. Using a higher number of information resources was significantly associated with a higher probability of making changes to patient care and avoiding adverse events. MEDLINE was the most likely to be among consulted resources compared to any other information resource other than journals. Conclusions: MEDLINE is a critical clinical care tool that health care professionals use to avoid adverse events, make changes to patient care, and answer clinical questions.

For the General Internist: A Review of Relevant 2013 Innovations in Medical Education

We conducted a review of articles published in 2013 to identify high-quality research in medical education that was relevant to general medicine education practice. Our review team consisted of six general internists with expertise in medical education of varying ranks, as well as a professional medical librarian. We manually searched 15 journals in pairs, and performed an online search using the PubMed search engine for all original research articles in medical education published in 2013. From the total 4,181 citations identified, we selected 65 articles considered most relevant to general medicine educational practice. Each team member then independently reviewed and rated the quality of each selected article using the modified Medical Education Research Study Quality Instrument. We then reviewed the quality and relevance of each selected study and grouped them into categories of propensity for inclusion. Nineteen studies were felt to be of adequate quality and were of moderate to high propensity for inclusion. Team members then independently voted for studies they felt to be of the highest relevance and quality within the 19 selected studies. The ten articles with the greatest number of votes were included in the review. We categorized the studies into five general themes: Improving Clinical Skills in UME, Inpatient Clinical Teaching Methods, Advancements in Continuity Clinic, Handoffs/Transitions in Care, and Trainee Assessment. Most studies in our review of the 2013 literature in general medical education were limited to single institutions and non-randomized study designs; we identified significant limitations of each study. Selected articles may inform future research and practice of medical educators.

Update in medical education 2007.

In this article, we summarize articles selected for presentation at the Update in Medical Education at the 31st annual meeting of the Society of General Internal Medicine.

The national library of medicine pill image recognition challenge: An initial report

In January 2016 the U.S. National Library of Medicine announced a challenge competition calling for the development and discovery of high-quality algorithms and software that rank how well consumer images of prescription pills match reference images of pills in its authoritative RxIMAGE collection. This challenge was motivated by the need to easily identify unknown prescription pills both by healthcare personnel and the general public. Potential benefits of this capability include confirmation of the pill in settings where the documentation and medication have been separated, such as in a disaster or emergency; and confirmation of a pill when the prescribed medication changes from brand to generic, or for any other reason the shape and color of the pill change. The data for the competition consisted of two types of images, high quality macro photographs, reference images, and consumer quality photographs of the quality we expect users of a proposed application to acquire. A training dataset consisting of 2000 reference images and 5000 corresponding consumer quality images acquired from 1000 pills was provided to challenge participants. A second dataset acquired from 1000 pills with similar distributions of shape and color was reserved as a segregated testing set. Challenge submissions were required to produce a ranking of the reference images, given a consumer quality image as input. Determination of the winning teams was done using the mean average precision quality metric, with the three winners obtaining mean average precision scores of 0.27, 0.09, and 0.08. In the retrieval results, the correct image was amongst the top five ranked images 43%, 12%, and 11% of the time, out of 5000 query/consumer images. This is an initial promising step towards development of an NLM software system and application-programming interface facilitating pill identification. The training dataset will continue to be freely available online at: http://pir.nlm.nih.gov/challenge/submission.html