Mary Horgan

Association between learning style preferences and anatomy assessment outcomes in graduate-entry and undergraduate medical students.

An improved understanding of the relationship between anatomy learning performance and approaches to learning can lead to the development of a more tailored approach to delivering anatomy teaching to medical students. This study investigated the relationship between learning style preferences, as measured by Visual, Aural, Read/write, and Kinesthetic (VARK) inventory style questionnaire and Honey and Mumfords learning style questionnaire (LSQ), and anatomy and clinical skills assessment performance at an Irish medical school. Additionally, mode of entry to medical school [undergraduate/direct‐entry (DEM) vs. graduate‐entry (GEM)], was examined in relation to individual learning style, and assessment results. The VARK and LSQ were distributed to first and second year DEM, and first year GEM students. DEM students achieved higher clinical skills marks than GEM students, but anatomy marks did not differ between each group. Several LSQ style preferences were shown to be weakly correlated with anatomy assessment performance in a program‐ and year‐specific manner. Specifically, the “Activist” style was negatively correlated with anatomy scores in DEM Year 2 students (rs = −0.45, P = 0.002). The “Theorist” style demonstrated a weak correlation with anatomy performance in DEM Year 2 (rs = 0.18, P = 0.003). Regression analysis revealed that, among the LSQ styles, the “Activist” was associated with poorer anatomy assessment performance (P < 0.05), while improved scores were associated with students who scored highly on the VARK “Aural” modality (P < 0.05). These data support the contention that individual student learning styles contribute little to variation in academic performance in medical students. Anat Sci Educ 9: 391–399.

Determinants of HIV outpatient service utilization: a systematic review.

Demands on HIV services are increasing as a consequence of the increased life-expectancy of HIV patients in the highly active antiretroviral therapy era. Understanding the factors that influence utilization of ambulatory HIV services is useful for planning service provision. This study reviewed factors associated with utilization of hospital based HIV out-patient services. Studies reporting person-based utilization rates of HIV-specific outpatient services broken down by patient or healthcare characteristics were eligible for inclusion. The Andersen Behavioral Model was used to organize the information extracted into pre-disposing, enabling and need components. Ten studies were included in the final review. Older age, private insurance, urban residence, lower CD4 counts, a diagnosis of AIDS, or anti-retroviral treatment were associated with higher utilization rates. The results of this review are consistent with existing knowledge regarding HIV patients’ use of health services. Little information was identified on the influence of health service characteristics on utilization of out-patient services.

A BEME (Best Evidence in Medical Education) review of the use of workplace-based assessment in identifying and remediating underperformance among postgraduate medical trainees: BEME Guide No. 43

Abstract Introduction: The extent to which workplace-based assessment (WBA) can be used as a facilitator of change among trainee doctors has not been established; this is particularly important in the case of underperforming trainees. The aim of this review is to examine the use of WBA in identifying and remediating performance among this cohort. Methods: Following publication of a review protocol a comprehensive search of eight databases took place to identify relevant articles published prior to November 2015. All screening, data extraction and analysis procedures were performed in duplicate or with quality checks and necessary consensus methods throughout. Given the study-level heterogeneity, a descriptive synthesis approach informed the study analysis. Results: Twenty studies met the inclusion criteria. The use of WBA within the context of remediation is not supported within the existing literature. The identification of underperformance is not supported by the use of stand-alone, single-assessor WBA events although specific areas of underperformance may be identified. Multisource feedback (MSF) tools may facilitate identification of underperformance. Conclusion: The extent to which WBA can be used to detect and manage underperformance in postgraduate trainees is unclear although evidence to date suggests that multirater assessments (i.e. MSF) may be of more use than single-rater judgments (e.g. mini-clinical evaluation exercise).

A BEME (Best Evidence in Medical Education) systematic review of the use of workplace-based assessment in identifying and remediating poor performance among postgraduate medical trainees

BackgroundWorkplace-based assessments were designed to facilitate observation and structure feedback on the performance of trainees in real-time clinical settings and scenarios. Research in workplace-based assessments has primarily centred on understanding psychometric qualities and performance improvement impacts of trainees generally.An area that is far less understood is the use of workplace-based assessments for trainees who may not be performing at expected or desired standards, referred to within the literature as trainees ‘in difficulty’ or ‘underperforming’. In healthcare systems that increasingly depend on service provided by junior doctors, early detection (and remediation) of poor performance is essential. However, barriers to successful implementation of workplace-based assessments (WBAs) in this context include a misunderstanding of the use and purpose of these formative assessment tools.This review aims to explore the impact - or effectiveness - of workplace-based assessment on the identification of poor performance and to determine those conditions that support and enable detection, i.e. whether by routine or targeted use where poor performance is suspected. The review also aims to explore what effect (if any) the use of WBA may have on remediation or on changing clinical practice. The personal impact of the detection of poor performance on trainees and/or trainers may also be explored.Methods/designUsing BEME (Best Evidence in Medical Education) Collaboration review guidelines, nine databases will be searched for English-language records. Studies examining interventions for workplace-based assessment either routinely or in relation to poor performance will be included. Independent agreement (kappa .80) will be achieved using a randomly selected set of records prior to commencement of screening and data extraction using a BEME coding sheet modified as applicable (Buckley et al., Med Teach 31:282-98, 2009) as this has been used in previous WBA systematic reviews (Miller and Archer, BMJ doi:10.1136/bmj.c5064, 2010) allowing for more rigorous comparisons with the published literature. Educational outcomes will be evaluated using Kirkpatrick’s framework of educational outcomes using Barr’s adaptations (Barr et al., Evaluations of interprofessional education; a United Kingdom review of health and social care, 2000) for medical education research.DiscussionOur study will contribute to an ongoing international debate regarding the applicability of workplace-based assessments as a meaningful formative assessment approach within the context of postgraduate medical education.Systematic review registrationThe review has been registered by the BEME Collaboration www.bemecollaboration.org.

Is the learning value of workplace-based assessment being realised? A qualitative study of trainer and trainee perceptions and experiences

Purpose Workplace-based assessments (WBAs) were originally intended to inform learning and development by structuring effective observation-based feedback. The success of this innovation has not yet been established due in part to the widely varied tools, implementation strategies and research approaches. Using a conceptual framework of experience, trajectories and reifications in workplace learning, we aimed to explore trainer and trainee experiences and perceptions of the learning value of WBAs. Study design Trainers and trainees who had used at least one WBA in the previous year were invited to participate in semistructured interviews for this phenomenological study. We used a template analysis method to explore and compare the experiences of the two groups, using the emergent themes to develop an understanding of the impact of these experiences on perceptions of learning value. Results Nine trainers and eight trainees participated in the study. Common themes emerged among the two groups around issues of responsibility and engagement along with (mis)understandings of the purpose of the individual tools. Trainer-specific themes emerged related to the concurrent implementation of a new e-portfolio and perceptions of increased workload. Trainees associated WBA with a training structure support value but could not translate experiences into learning values. Conclusions WBAs provide trainees with a justified reason to approach trainers for feedback. WBAs, however, are not being reified as the formative assessments originally intended. A culture change may be required to change the focus of WBA research and reconceptualise this set of tools and methods as a workplace learning practice.

Possibility and agency in Figured Worlds: Becoming a ‘good doctor’

Figured Worlds is a socio‐cultural theory drawing on Vygotskian and Bakhtinian traditions, which has been applied in research into the development of identities of both learners and teachers in the wider education literature. It is now being adopted in medical education.

Peritoneal tuberculosis in the setting of ustekinumab treatment for psoriasis

IL: interleukin MDR: multidrug resistant PsA: psoriatic arthritis TB: tuberculosis TNF: tumor necrosis factor INTRODUCTION Biologics have revolutionized the treatment of moderate-to-severe psoriasis, but serious infection is a risk with these immunosuppressive agents. An increased risk of tuberculosis (TB) reactivation in patients with latent TB infection is well recognized with antietumor necrosis factor (TNF)-a agents, as TNF has a central role in TB immunity, and antieTNF-a agents interfere with innate and cellmediated immune responses. Testing for and treating latent TB before starting therapy reduces the risk of reactivation of TB on biologic agents. Ustekinumab is a fully human monoclonal antibody that targets the p40 subunit of the cytokines interleukin (IL)-12 and IL-23 and is licensed in the treatment of psoriasis and psoriatic arthritis (PsA). Studies found that IL-12 and IL-23 are important in the defense against bacterial, parasitic, and intracellular pathogens. Patients with inborn errors of the IL-12/23 interferon-c circuit are at risk, particularly for mycobacterial infections, especially atypical mycobacterial infections and Mycobacterium tuberculosis.

Protocol for a realist review of workplace learning in postgraduate medical education and training

BackgroundPostgraduate medical education and training (PGMET) is a complex social process which happens predominantly during the delivery of patient care. The clinical learning environment (CLE), the context for PGMET, shapes the development of the doctors who learn and work within it, ultimately impacting the quality and safety of patient care. Clinical workplaces are complex, dynamic systems in which learning emerges from non-linear interactions within a network of related factors and activities. Those tasked with the design and delivery of postgraduate medical education and training need to understand the relationship between the processes of medical workplace learning and these contextual elements in order to optimise conditions for learning. We propose to conduct a realist synthesis of the literature to address the overarching questions; how, why and in what circumstances do doctors learn in clinical environments? This review is part of a funded projected with the overall aim of producing guidelines and recommendations for the design of high quality clinical learning environments for postgraduate medical education and training.MethodsWe have chosen realist synthesis as a methodology because of its suitability for researching complexity and producing answers useful to policymakers and practitioners. This realist synthesis will follow the steps and procedures outlined by Wong et al. in the RAMESES Publication Standards for Realist Synthesis and the Realist Synthesis RAMESES Training Materials. The core research team is a multi-disciplinary group of researchers, clinicians and health professions educators. The wider research group includes experts in organisational behaviour and human resources management as well as the key stakeholders; doctors in training, patient representatives and providers of PGMET.DiscussionThis study will draw from the published literature and programme, and substantive, theories of workplace learning, to describe context, mechanism and outcome configurations for PGMET. This information will be useful to policymakers and practitioners in PGMET, who will be able to apply our findings within their own contexts. Improving the quality of clinical learning environments can improve the performance, humanism and wellbeing of learners and improve the quality and safety of patient care.Systematic review registrationThe review is not registered with the PROSPERO International Prospective Register of Systematic Reviews as the review objectives relate solely to education outcomes.

Early Years Education in Germany and Ireland--a Study of Provision and Curricular Implementation in Two Unique Environments.

This paper highlights the differences and similarities between a Kindergarten outside Bremen in Lower Saxony, Germany and a Primary School Junior Infant Class in County Cork, Republic of Ireland. Both are concerned with the education of the young child but whereas the Kindergarten is attended by three to six year olds, the Junior Infant Class caters almost exclusively for four to five year old children. A case study account of both groups is given and an analysis of the activities which took place in each using the ‘Target Child Observational Schedule’ [Sylva et al., (1980)] is presented in bar‐graph form. The paper concludes that Erzieherinnen, Kinderpflegerinnen and Junior Infant Class teachers need to engage in more interaction with the children in order, in particular, to raise the frequency and quality of linguistic interaction. An increase in the structure of the childrens play would help to enhance cognitive development.

Survey of Irish general practitioners’ preferences for continuing professional development

Abstract Background: Doctors’ continuing professional development (CPD) training needs are known to be strongly influenced by national and local contextual characteristics. Given the changing national demographic profile and government-mandated changes to primary care health care provision, this study aimed to investigate Irish General Practitioners’ (GPs) perceptions of, and preferences for, current and future CPD programmes. Methods: A cross-sectional questionnaire, using closed- and open-ended questions, was administered to Irish GPs, focusing on training needs analysis; CPD course content; preferred format and the learning environment. Results: The response rate was 719/1000 (71.9%). GPs identified doctor-patient communication as the most important and best-performed GP skill. Discrepancies between perceived importance (high) and current performance (low) emerged for time/workload management, practice finance and business skills. GPs identified clinically-relevant primary care topics and non-clinical topics (stress management, business skills, practice management) as preferences for future CPD. Flexible methods for CPD delivery were important. Gender and practice location (urban or rural) significantly influenced CPD participation and future course preference. Conclusion: The increasing diversity of services offered in the Irish primary care setting, in both clinical and non-clinical areas, should be tailored based to include GP practice location and structure.