Lori R. Newman

Twelve tips for facilitating Millennials’ learning

Background: The current, so-called “Millennial” generation of learners is frequently characterized as having deep understanding of, and appreciation for, technology and social connectedness. This generation of learners has also been molded by a unique set of cultural influences that are essential for medical educators to consider in all aspects of their teaching, including curriculum design, student assessment, and interactions between faculty and learners. Aim: The following tips outline an approach to facilitating learning of our current generation of medical trainees. Method: The method is based on the available literature and the authors’ experiences with Millennial Learners in medical training. Results: The 12 tips provide detailed approaches and specific strategies for understanding and engaging Millennial Learners and enhancing their learning. Conclusion: With an increased understanding of the characteristics of the current generation of medical trainees, faculty will be better able to facilitate learning and optimize interactions with Millennial Learners.

Procedural Competence in Internal Medicine Residents: Validity of a Central Venous Catheter Insertion Assessment Instrument

Purpose Despite mandates from accreditation bodies for programs to ensure procedural competence, standardized measures do not exist to assess residents’ skills in performing central venous catheter (CVC) insertion. The objective of the present study was to develop an instrument to assess residents in subclavian (SC) CVC insertion, to set performance standards, and to validate the tool using performance data. Method In 2007, the authors convened experts to create an assessment tool for CVC insertion using a modified Delphi method. They applied the Angoff method to a second set of experts to determine minimum passing scores (MPSs) for both the borderline trainee and the competent trainee. Two faculty evaluators then used the checklist to assess residents performing CVCs on simulators. Results The authors created and experts confirmed a 24-item checklist. Using the Angoff method, the MPS required completion of 10 major and 2 minor criteria for a trainee to show borderline proficiency with CVC insertion under supervision. This MPS was correlated with a global rating of 2 on a 5-point scale. The MPS for competence was 17 major and 5 minor criteria. None of the residents deemed competent on a global rating scale achieved the MPS for competence. Conclusions The authors were able to create and validate a consensus-driven procedural assessment tool with data-driven standards for basic proficiency and competence that faculty can use to assess residents as they perform CVC insertion.

Simulation training and its effect on long-term resident performance in central venous catheterization

Introduction: Simulation is a safe alternative to practicing procedural skills on patients. However, few published studies have examined the long-term effect of simulation technology on bedside procedures such as central venous catheter (CVC) insertion. Methods: To determine whether simulation-based teaching improves procedural comfort, performance, and clinical events in CVC insertion, over traditional methods of procedural teaching, and to assess the long-term effect of this training, we conducted a prospective, randomized controlled trial with 53 postgraduate year-1 and postgraduate year-2 medical residents at a tertiary-care teaching hospital. At the start of the study, we assessed all residents’ procedural comfort and previous training and experience with CVCs. We then measured their baseline performance in placing CVCs on simulators, using a validated assessment tool (pretest). For the intervention group, we reassessed performance immediately after simulation training (posttest). All subjects then placed actual CVCs as clinically indicated while on their medical intensive care unit rotations, under the supervision of critical care faculty. We measured clinical events associated with these CVCs. After their medical intensive care unit rotations, we reassessed CVC insertion skills on simulators and procedural comfort of all subjects (delayed posttest). Results: Intervention subjects demonstrated a significant improvement in skills immediately after simulation training. At delayed posttesting, performance diminished somewhat in the intervention subjects and was not significantly different from control subjects; however, a significant increase over pretest scores persisted in both groups. Conclusions: A CVC insertion simulation course improves procedural skills. These skills decline over time, and simulation conferred no long-term additional benefit over traditional methods of procedural teaching.

The academic health center coming of age: helping faculty become better teachers and agents of educational change.

There is a growing appreciation of the need for educational faculty development within medical education. The authors describe the establishment and subsequent expansion of one such fellowship in medical education that arose from the cooperative efforts of Harvard Medical School, Beth Israel Deaconess Medical Center, and Mount Auburn Hospital. Three resultant fellowships are outlined that share the common goals of enhancing the skills of the faculty as educators, providing an opportunity to conduct scholarly educational research, supporting the fellows as change agents, and fostering the creation of a supportive community dedicated to enhancing the field of medical education. Curricular structure and content are outlined as well as current approaches to curricular and programmatic evaluation. The fellowships have been well received and are widely perceived as transformative for the faculty, many of whom have assumed increased roles of organizational and educational leadership. Lastly, future directions for these fellowships are presented.

Developing a peer assessment of lecturing instrument: lessons learned.

Peer assessment of teaching can improve the quality of instruction and contribute to summative evaluation of teaching effectiveness integral to high-stakes decision making. There is, however, a paucity of validated, criterion-based peer assessment instruments. The authors describe development and pilot testing of one such instrument and share lessons learned. The report provides a description of how a task force of the Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center used the Delphi method to engage academic faculty leaders to develop a new instrument for peer assessment of medical lecturing. The authors describe how they used consensus building to determine the criteria, scoring rubric, and behavioral anchors for the rating scale. To pilot test the instrument, participants assessed a series of medical school lectures. Statistical analysis revealed high internal consistency of the instrument’s scores (alpha = 0.87, 95% bootstrap confidence interval [BCI] = 0.80 to 0.91), yet low interrater agreement across all criteria and the global measure (intraclass correlation coefficient = 0.27, 95% BCI = −0.08 to 0.44). The authors describe the importance of faculty involvement in determining a cohesive set of criteria to assess lectures. They discuss how providing evidence that a peer assessment instrument is credible and reliable increases the faculty’s trust in feedback. The authors point to the need for proper peer rater training to obtain high interrater agreement measures, and posit that once such measures are obtained, reliable and accurate peer assessment of teaching could be used to inform the academic promotion process.

Strategies for creating a faculty fellowship in medical education: report of a 10-year experience.

The authors present 10 strategies, plus challenges and opportunities, that have informed three well-established, yearlong medical education fellowships (defined as single cohorts of medical teaching faculty who participate in extended faculty development activities) during the period 1998 to 2008. These strategies include (1) defining an operating philosophy, values, and goals, (2) establishing a curriculum that reflects the roles and responsibilities of fellows and faculty, (3) employing a basic approach to adult learning, (4) striving to achieve a balance between stated objectives and openness of discussion, (5) creating optimum learning opportunities for the fellows to acquire and practice skills delineated in the curriculum, (6) fostering interdisciplinary communication, team development, and the creation of a learning community, (7) developing mindfulness and critical self-reflection, (8) systematically reviewing each session, (9) evaluating fellowship outcomes, and (10) planning for the future. This in-depth look presents both curricular content and process, providing a useful starting point from which those who develop and conduct educational faculty development activities at medical schools and academic medical centers may fashion and implement a local curriculum.

Critical Thinking in Health Professions Education: Summary and Consensus Statements of the Millennium Conference 2011

Purpose: Critical thinking is central to the function of health care professionals. However, this topic is not explicitly taught or assessed within current programs, yet the need is greater than ever, in an era of information explosion, spiraling health care costs, and increased understanding about metacognition. To address the importance of teaching critical thinking in health professions education, the Shapiro Institute for Education and Research and the Josiah Macy Jr. Foundation jointly sponsored the Millennium Conference 2011 on Critical Thinking. Summary: Teams of physician and nurse educators were selected through an application process. Attendees proposed strategies for integrating principles of critical thinking more explicitly into health professions curricula. Working in interprofessional, multi-institutional groups, participants tackled questions about teaching, assessment, and faculty development. Deliberations were summarized into consensus statements. Conclusions: Educational leaders participated in a structured dialogue about the enhancement of critical thinking in health professions education and recommend strategies to teach critical thinking.

Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches

Importance Optimal approaches to teaching bedside procedures are unknown. Objective To identify effective instructional approaches in procedural training. Data sources We searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014. Study selection We included research articles that addressed procedural training among physicians or physician trainees for 12 bedside procedures. Two independent reviewers screened 9312 citations and identified 344 articles for full-text review. Data extraction and synthesis Two independent reviewers extracted data from full-text articles. Main outcomes and measures We included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as ‘negative’ or ‘positive’ based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes. Results We found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p<0.001) were effective forms of training. Conclusions and relevance This systematic review of bedside procedural skills demonstrates that the current literature is heterogeneous and of varying quality and rigour. Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures, and these approaches should be the mainstay of programmes that train physicians to perform procedures. Further research should clarify differences among instructional methods (eg, forms of hands-on training) rather than among educational modes (eg, lecture vs simulation).

Musculoskeletal preclinical medical school education: meeting an underserved need.

Musculoskeletal problems including both rheumatologic and orthopaedic pathologies are the primary reason for physician office visits across the United States, with approximately 92.1 million encounters reported annually, according to the 2004 National Ambulatory Medical Care Survey1. Despite the impact that musculoskeletal diseases have on society and the wide range of medical practitioners who treat these conditions, there is compelling evidence that undergraduate medical curricula do not adequately prepare physicians in musculoskeletal medicine2-5. In 2005, the Association of American Medical Colleges (AAMC) issued a Medical School Objectives Project Report on musculoskeletal medicine highlighting the need for medical schools to improve the education of future physicians in this area6. The report outlined educational guidelines to establish a more coherent undergraduate musculoskeletal curriculum. We conducted a study at our medical school during the 2005-2006 academic year that substantiated the need for improving the musculoskeletal curriculum. Students lacked cognitive mastery, demonstrated low clinical confidence, and were dissatisfied with the amount of time spent learning musculoskeletal medicine. Findings of the study suggested the need to improve the integration of musculoskeletal medicine into the curriculum3. Data from the 2005 Step-1 United States Medical Licensing Examination at our institution also revealed that performance on the musculoskeletal section was the lowest of all the subsections. Thus, both national as well as institutional concerns prompted us to lobby for, develop, and begin implementation of a four-year integrated musculoskeletal curriculum. We focused our initial reform endeavors on the preclinical (first and second-year) curriculum. The process of curriculum reform and development differs among various medical schools. As such, the purpose of this study was to provide a framework that may assist educators in achieving the adoption of an integrated musculoskeletal curriculum into the preclinical curriculum at their own school. We offer …

A comprehensive new curriculum to teach and assess resident knowledge and diagnostic evaluation of musculoskeletal complaints

Musculoskeletal complaints are a common reason for primary care visits; however, many essential physical examination, diagnostic and treatment skills are not adequately taught. The objectives of the study were to create and implement a comprehensive clinical skills teaching model, and to evaluate its effects on residents’ knowledge and diagnostic skills. A comparison of cohorts who participated and did not participate in a musculoskeletal curriculum was undertaken. Second and third year medical residents participated in comprehensive curricula to teach and evaluate musculoskeletal skills. Sixty-seven attended the first of three lectures on the painful shoulder; 61 attended all three lectures and completed pre- and post-self assessment forms and tests. Three months later 26 of these residents and 10 controls participated in an OSCE examination. Thirty-nine medical residents attended the first of three lectures on the painful knee; 32 attended all three lectures and completed pre- and post-self assessment forms and tests. Seven of these residents and eight controls participated in an OSCE examination three months later. Both the shoulder and knee curricula were associated with a significant improvement in test scores (p < 0.0001), in self-assessment of physical examination, diagnostic and procedural skills (p < 0.0001), and in OSCE results (p < 0.005). It was concluded that the skills required for the diagnosis and treatment of common musculoskeletal complaints can be effectively taught and assessed using inexpensive and simple methods.