Larrie W. Greenberg

Communicating bad news: a pediatric department's evaluation of a simulated intervention.

Objective. To determine if pediatric residents and emergency department (ED) fellows could improve their ability to counsel and inform standardized patients (SPs) about bad news. Methodology. A crossover, self-controlled design in which trainees were their own control individuals, and SPs provided feedback after the first interview. The setting was the consultation room in the ED of a large childrens hospital. The outcome measures included examining the counseling and informing skills of study participants. Results. Trainees improved their informing skills after being provided feedback in the broad areas of communication and follow-up and in the total number of content areas asked. Their counseling skills improved in two areas: 1) promoting more trust and 2) making parents feel less dependent. Those trainees who scored higher on counseling skills discussed more total and critical content issues with SPs in the study. Trainee feedback revealed a very high rating of the educational process, and the trainees also felt much more confident about their skills after the first and second sessions. Conclusions. Using SPs to teach residents and ED fellows to give bad news is an effective educational process that provides trainees with interactions that simulate real-life experience

The Reflective Practitioner: Reaching for Excellence in Practice

Reflection is widely accepted as a tool for learning in higher education. It has been addressed in some areas of medical education but not in the pediatric literature.1–8 It is considered essential to professional practice. Reflection allows for the interconnections between observations, past experiences, and judgment to come to the fore in clinical decision-making.9,10 Reflection gives meaning to experience and promotes a deep approach to learning because it encourages trainees to reframe problems, question their own assumptions, and look at situations from multiple perspectives as they analyze their lived experiences.6,9–14 Reflection fosters lifelong learning because it encourages trainees to recognize gaps in their own knowledge and attend to their own learning needs.6 Reflection is particularly important in medicine, in which evidence-based practice and client-centered care require the physician to analyze best evidence while considering his or her values and assumptions vis-a-vis the values, beliefs, and goals of each patient. It enables trainees to recognize their own assumptions and how those assumptions might impact the therapeutic relationship and their clinical decisions. Reflection also helps practitioners develop a questioning attitude and the skills needed to continually update their knowledge and skills, which is essential in todays rapidly changing global health care environment.6 The importance of the reflective process is further acknowledged by the Accreditation Council for Graduate Medical Education (ACGME) as underlying a number of the expected competencies is the development of reflective practitioners.15 Much has been written about reflective practice, particularly with respect to how it can be incorporated into the classroom. However, little has been written about what reflection is, how it can be assessed, or how it can be facilitated in the clinical setting. To enable pediatric academic faculty and practicing pediatricians to facilitate reflective … Address correspondence to Margaret M. Plack, PT, EdD, Program in Physical Therapy, George Washington University School of Medicine and Health Sciences, 900 23rd St NW, Suite 6145, Washington, DC 20037. E-mail: hspmxp{at}gwumc.edu

Teaching in the clinical setting: factors influencing residents’ perceptions, confidence and behaviour

Because residents are expected to assume a significant share of the teaching responsibilities of peers and students, the authors surveyed first‐, second‐ and third‐year paediatric residents at the Childrens Hospital National Medical Center in July 1979 to examine those factors influencing their perceptions, confidence and behaviour with regard to teaching. The experimental group received 8 hours of instruction on teaching and learning, which included workshops and feedback sessions. The results indicate that a limited amount of formal instruction in teaching can effect a change in the teaching attitudes and behaviour of residents in addition to their level of confidence and the way in which teachers, students and peers evaluate them.

A Review of Medical School Programs That Train Medical Students as Teachers (MED-SATS)

Background: Medical students represent medicines future teachers. The objective of this literature review was to identify programs teaching medical students how to teach (MED-SATS). Summary: Electronic searches were conducted and identified 39 programs (1966–2005). Students have assumed varied teaching roles: group facilitator, standardized patient, tutor, teaching assistant, standardized learner, course director, and peer teacher. Most participants were 4th-year students. The teaching techniques varied: group sessions, lectures, and individual teaching. To evaluate student teaching, programs used checklists, videotape review, group discussion, observation, examination scores, course grades, self-assessment exercises, and follow-up with residency training programs. Conclusions: Reports on how students are trained in medical schools to be teachers are limited. Of the programs identified, it is difficult to determine which programs are ongoing. Data on MED-SATS graduates teaching skills as resident and attending teachers are lacking. These issues present some challenges for future study.

A randomized multicenter trial to improve resident teaching with written feedback

Background: Residents have an important role as teachers of medical students. Purpose: This study addressed assessment of the impact of written learner feedback on resident teaching. Methods: Senior residents (N = 30) were randomized into either an experimental group receiving feedback or a control group receiving no feedback. Team members were interviewed to identify the residents’ teaching strengths and weaknesses, and rate residents on overall teaching effectiveness and on eight specific teaching characteristics. Residents received a one‐page summary of interview comments and mean rating scores for three consecutive rotations. Results: Over a 1‐year period, there was a significant difference between the mean group ratings for the teaching characteristics Establishes Rapport (p < .01) and Provides Direction and Feedback (p < .05). Overall Teaching Effectiveness tended to improve for the experimental group over the year and remain stable for the control group (p = .07). Conclusions: Written feedback to s...

Verbal interaction analysis: viewing feedback through a different lens.

Background: Verbal interaction analysis, though seldom applied to the feedback-giving process, can be used to assess feedback dimensions not easily assessed by other means. Description: The purpose of this study was to explore verbal interaction analysis as a method to assess feedback interactions between senior medical students trained as teachers and their sophomore learners. We randomly selected 14 videotaped encounters of senior teachers giving feedback to sophomore learners and classified 417 utterances to address (a) verbal dominance, (b) feedback balance, and (c) cognitive level. Evaluation: Teachers did most of the talking (65.2%). Although some feedback was corrective (20.6%), teacher utterances were mostly positive (33.5%) or neutral (45.9%). Cognitively, the teacher utterances occurred largely at the factual (lowest) level (74.3%). Conclusions: Interaction analysis enabled us to describe 3 dimensions of teacher–learner feedback not easily assessed by other means: verbal dominance, positive-corrective balance, and cognitive level. Assessing these dimensions provides information about two theoretically important indices of feedback-giving effectiveness: learner involvement and feedback balance. Future study of verbal interaction analysis in this and other populations is warranted to further evaluate its usefulness.

Counseling parents of a child dead on arrival: A survey of emergency departments☆☆☆

The purposes of this study were to (1) document whether or not responding emergency departments (EDs) have a process and/or team to interact with parents of children dead on arrival (DOA); (2) conduct a needs assessment to determine what information is essential to convey to a family of a child DOA; and (3) determine what EDs are doing to their residents/fellows in crisis counseling. A survey instrument was developed using input from key health care professionals at Childrens Hospital who are involved in the acute care of children and their families. This survey was sent to directors of EDs in all childrens hospitals and those general hospitals with more than 400 beds. Respondents identified themselves as ED directors at childrens hospitals or general hospitals throughout the United States. The survey documented the lack of a process or team approach to counseling the family of a child who presents DOA. Often, the most inexperienced physicians are expected to provide this information and to counsel parents. Few EDs reported offering communication skills training in this area. Many respondents expressed dissatisfaction about the lack of a process or team regarding patients who present DOA and recognize the need for improvement.

Development and Evaluation of a CD-ROM Computer Program to Teach Residents Telephone Management

Objective. Under managed care, telephone management is crucial to pediatric practice, but an effective method is needed to teach residents telephone skills. Our objective was to design an interactive CD-ROM program to teach residents an organized, consistent approach to telephone complaints and to determine whether use of the program was associated with better subsequent telephone management than reading the same information. Setting. The general pediatric ambulatory center of a tertiary care childrens hospital. Participants.  A total of 24 PL-2 and PL-3 pediatric residents. Design. A randomized, prospective, controlled comparison was conducted of resident management of two telephone calls: a 5-year-old with cough and trouble breathing, and a 7-year-old with fever. Thirteen residents were randomized to the computer group and 11 to the reading control group. Intervention. Scripts, scoring, and feedback for 10 CD-ROM-simulated calls were developed from texts and pediatrician survey using a modified Delphi technique. Volunteers acted out the callers role in scenario scripts and were recorded onto a CD-ROM. The computer simulated calls by recognizing questions typed in a free-form format and answering with a voice response. Feedback was provided for omissions in history-taking and errors in assessment, triage, and home management. The computer group worked through the CD-ROM calls while the control group had equal time to read the same information. Evaluation Measures. A trained, standardized patient acted as the mother in pretest calls placed at the beginning of the month and posttest calls at the end. Calls were recorded and scored in a blinded manner using scoring templates and on interpersonal skills using the Patient Perception Questionnaire. Results. Pretest scores for the two calls were similar in the computer versus the control group (cough, 70.33% ± 8.36 vs 68.46% ± 6.73; fever, 75.64% ± 9.82 vs 73.59% ± 9.06). Posttest scores were significantly higher in the computer group than in the control group on both calls (cough, 79.08% ± 8.17 vs 69 ± 13.3; fever: 83.33% ± 9.96 vs 70.35% ± 9.66). Interpersonal skills also were similar pretest (19 ± 3.4 vs 20 ± 2.7). There was modest improvement in both groups without a statistically significant difference in posttest scores (24.2 ± 2.9 vs 22.5 ± 3.1). Conclusions. Use of this CD-ROM telephone management program was associated with better postintervention telephone management. The program augments faculty instruction by teaching a consistent, general approach to telephone management.

Residents-as-Teachers Publications: What Can Programs Learn From the Literature When Starting a New or Refining an Established Curriculum?

BACKGROUND Teaching residents how to teach is a critical part of resident education because residents are often the major teachers of medical students. The importance of formal residents-as-teachers (RAT) curricula has been emphasized throughout the literature, yet not all residency programs have such a curriculum in place. OBJECTIVE The purpose of our study was to (1) review the medical education literature for established RAT curricula, (2) assess published curriculas reproducibility, (3) evaluate the type of outcomes achieved using the Kirkpatrick model of evaluation, and (4) identify curricula that training programs could feasibly adopt. METHODS We performed a literature review using PubMed, Medline, Scopus, PsycINFO, ERIC, and Embase. Key search words included residents, residents as teachers, teaching, internship and residency, and curriculum. In addition, a search of MedEdPORTAL was performed using the same key terms. Articles were evaluated based on the reproducibility of curricula and the assessment tools. Evaluation of educational outcomes was performed using the Kirkpatrick model. RESULTS Thirty-nine articles were deemed appropriate for review. Interventions and evaluation techniques varied greatly. Only 1 article from the literature was deemed to have both curricula and assessments that would be fully reproducible by other programs. CONCLUSIONS A literature review on RAT curricula found few articles that would be easily reproduced for residency programs that want to start or improve their own RAT curricula. It also demonstrated the difficulty and lack of rigorous outcome measurements for most curricula.

Preparing students to be academicians: A national student-led summer program in teaching, leadership, scholarship, and academic medical career-building

Medical schools have the responsibility of producing future leaders in academic medicine, yet few students choose academic medicine as a career. In 2009, the American Medical Student Association (AMSA) and the George Washington University School of Medicine and Health Sciences joined forces to provide students with a comprehensive introduction to careers in academic medicine through the redesign of an existing annual summer program for medical students. Since 2004, AMSA had hosted the Medical Education Leadership Institute, a weeklong program that attracted medical students from across the country who were interested in gaining teaching skills. In the redesigned sixth annual program, the authors expanded the curriculum to include principles of leadership, of medical education scholarship (or project development), and of academic medicine career-building. The purpose of this article is to describe the features of this comprehensive program and to share the lessons learned from its development and implementation. The authors also describe the multifaceted approach they used to evaluate the program, which featured a rubric they derived from social cognitive career theory.