Meg Keeley

Development and validation of a novel ear simulator to teach pneumatic otoscopy.

Introduction Otoscopy is an important skill in diagnosing conditions of the middle ear. This study evaluated the ability of a novel ear simulator to teach medical students diagnostic and pneumatic otoscopy. We hypothesized that exposure to this simulator improves the ability of medical students to apply an appropriate pneumatic pressure during insufflation and accurately identify the presence of a middle ear effusion in a simulated setting. Methods An ear simulator was created to teach otoscopic skills to medical students. Third-year medical students attended a workshop on pediatric otoscopy, including a demonstration, videos, and verbal instruction on otoscope use. A cohort of these students then practiced pneumatic otoscopy with the simulator. All students, as well as a group of experts who had not been exposed to the trainer, then diagnosed the presence or absence of middle ear fluid in six simulator ears and pneumatic pressures generated were recorded. Results Interaction with the simulator enabled students to insufflate with pressures in the proper range (0.4–20 in H2O) more often, apply an average pressure (12.7 in H2O) in the appropriate range, and diagnose middle ear fluid more accurately (79.2%) than students who were not exposed to the trainer (57.3%). The students exposed to the simulator also performed closer to the level of the experts who diagnosed presence of effusion 100% accurately with an average insufflation pressure of 3.8 in H2O. Discussion Medical students trained with the ear simulator applied appropriate pneumatic pressure more consistently and diagnosed the presence of effusion more accurately and more like experts than students not exposed to the simulator. This ear trainer is a valuable tool for teaching pneumatic otoscopy.

The growth of learning communities in undergraduate medical education.

Purpose To determine the presence and characteristics of learning communities (LCs) in undergraduate medical education. Method The authors updated an earlier Web-based survey to assess LCs in medical education. Using a cross-sectional study design, they sent the survey to an LC leader or dean at each Association of American Medical Colleges member medical school (n = 151) between October 2011 and March 2012. The first survey item asked respondents to indicate if their institution had LCs. Those with LCs were asked to provide details regarding the structure, governance, funding, space, curricular components, extracurricular activities, and areas addressed as part of the LCs. Those without LCs were asked only if they were considering developing them. The full survey instrument contained 35 items including yes/no, multiple-choice, and open-ended questions. The authors analyzed data using descriptive statistics and examined open-ended responses for recurrent themes. Results The response rate was 83.4% (126/151). Sixty-six schools (52.4%) had LCs. Of the 60 remaining schools without LCs, 29 (48.3%) indicated that they were considering creating them. Of the 52 schools that provided the year their LCs were established, 27 (51.9%) indicated they began in 2007 or later. LC characteristics varied widely. Conclusions The number of medical schools with LCs is increasing rapidly. LCs provide an opportunity to transform medical education through longitudinal relationships and mentoring. Further study is needed to document outcomes and best practices for LCs in medical education.

Benefits to faculty involved in medical school learning communities

Abstract Purpose: Job satisfaction plays a large role in enhancing retention and minimizing loss of physicians from careers in academic medicine. The authors explored the effect of learning communities (LCs) on the faculty members’ job satisfaction. Methods: Between October 2011 and May 2012, the authors surveyed 150 academic clinical faculty members serving as LC mentors for students at five US medical schools. Factor analysis was used to explore satisfaction themes and relationships between these themes and other characteristics. Results: Factor analysis revealed two major sources of this satisfaction: a Campus Engagement factor (e.g., feeling happier, improved sense of community, better communication skills, and feeling more productive) and a skills factor (e.g., improved clinical skills, being a better doctor). Higher Campus Engagement factor satisfaction was associated with less desire to leave the learning community (p = 0.01) and more FTE support for role in LC (p = 0.01). Higher skills factor satisfaction was associated with the school that provided more structured faculty development (p = 0.0001). Conclusion: Academic clinical faculty members reported serving as a mentor in an LC was a strong source of job satisfaction. LC may be a tool for retaining clinical faculty members in academic careers.

Standardized Checklist for Otoscopy Performance Evaluation: A Validation Study of a Tool to Assess Pediatric Otoscopy Skills

Introduction Acute otitis media (AOM) is the most frequently diagnosed pediatric illness in the United States and the most common indication for antibiotic prescription. Skill in pediatric otoscopy is essential to correctly identify children with AOM. However, studies have found diagnostic inconsistency and significant overdiagnosis among practitioners. Given the potential public and individual health consequences, there has been a call for improved education regarding the diagnostic certainty of AOM. Yet educational efforts continue to be limited, particularly in regard to competency assessment. The lack of a validated tool to assess otoscopy skill attainment objectively diminishes the instructors ability to provide useful feedback and direction to the learner. Methods We have undertaken an educational intervention with the goal of developing a validated Standardized Checklist for Otoscopy Performance Evaluation (SCOPE), building on key principles of the general pediatric ear exam. The SCOPE was developed with the input of process and content experts with attention to specific domains of validity. Results Our analysis provides important validity evidence for the SCOPE assessment tool. The instrument was piloted and successfully implemented with medical students and varying levels of residents in pediatrics and emergency medicine over a 5-year period in varied settings: urgent care, large and small pediatric clinics, and the emergency departments at two institutions. It has been used for both instruction and assessment purposes. Discussion Because the SCOPE can be used in teaching demonstration purposes, in formative and summative assessment settings, and across the continuum of learners, this instrument offers the potential for more educational efforts in the field of assessment in direct patient care. We anticipate that the SCOPE will foster an environment of efficient yet high-yield review and discussion of otoscopy and diagnostic competency.

Interval vs Massed Training How Best Do We Teach Surgery

Objective To compare 2 different training paradigms, massed vs interval training, when novice students learn a surgical procedure, myringotomy with ventilation tube insertion, on a validated surgical simulator. Study Design Medical students were randomized into 2 training groups: the interval group (n = 19) was trained to perform the procedure in 5 trials/d over 3 days, and the massed group (n = 21) was trained to perform the procedure in 15 trials all in 1 session. One week later, all students were tested in 5 additional final trials. Pre- and posttest surveys were administered. Setting Academic medical center. Subjects and Methods Forty medical students: 19 students in the interval group were compared with 21 students in the massed group. Time to complete the procedure and number and type of error made were recorded and compared between groups. Pre- and poststudy surveys examined confidence levels working under a microscope and with the procedure. Results Students in both groups had a significant decrease in time between practice and final trials. In the final 5 trials, there was no difference in average time to complete the procedure between the massed and interval training groups. No difference was observed in the number of errors committed per trial between initial and final trials (both groups) or between massed and interval training groups. The students’ confidence levels significantly increased across the trials, regardless of group. Conclusion Surgical training improves proficiency, but method of training had little impact on proficiency in performing a simulated surgical procedure in this setting.

The impact of learning communities on interpersonal relationships among medical students

Background Medical students at the University of Virginia (UVA) are mentored and learn within the framework of a four college learning community. Uniquely, these learning communities are used to organize the third-year clerkship rotations. Methods Students were surveyed after their first pre-clinical year and after their clerkship year to determine what the effect of the learning community was on their social and educational interpersonal relationships. Results Students knew a higher percentage of their college mates after completing their third-year clerkships within the framework of the college system. Students chose peers from within the college system for social and educational interpersonal scenarios statistically more often than what would be expected at random. Small group learning environments that were not formed within the framework of the college system at UVA did not have the same effect on interpersonal relationships, indicating that learning communities are uniquely able to provide a context for relationship building. Students felt more positively about the social and educational effects of the college system after the clerkship year, with a corresponding increase in the strength of their interpersonal bonds with their college peers. Conclusion This work is the first to investigate the effects of learning communities on interpersonal relationships among medical students and finds that learning communities positively impact both social and educational medical student bonds.Background Medical students at the University of Virginia (UVA) are mentored and learn within the framework of a four college learning community. Uniquely, these learning communities are used to organize the third-year clerkship rotations. Methods Students were surveyed after their first pre-clinical year and after their clerkship year to determine what the effect of the learning community was on their social and educational interpersonal relationships. Results Students knew a higher percentage of their college mates after completing their third-year clerkships within the framework of the college system. Students chose peers from within the college system for social and educational interpersonal scenarios statistically more often than what would be expected at random. Small group learning environments that were not formed within the framework of the college system at UVA did not have the same effect on interpersonal relationships, indicating that learning communities are uniquely able to provide a context for relationship building. Students felt more positively about the social and educational effects of the college system after the clerkship year, with a corresponding increase in the strength of their interpersonal bonds with their college peers. Conclusion This work is the first to investigate the effects of learning communities on interpersonal relationships among medical students and finds that learning communities positively impact both social and educational medical student bonds.

Motivational Advising Workshop: Utilizing Motivational Interviewing Theory to Facilitate and Engage Intrinsic Motivation to Change Learners’ Behavior

Introduction Motivational interviewing (MI) is a counseling method that utilizes a patients own motivation to effect personal change. MI has been applied routinely and successfully to managing medical conditions (e.g., substance abuse). Employing MI techniques to engage medical learners (termed motivational advising [MA]) may help them overcome professional and/or personal challenges limiting their career development. Methods Medical educators from four academic medical centers developed a module focused on teaching fellow educators MI theory and techniques for MA using didactic and interactive components. Participants participated in facilitated role-plays to practice MA delivery techniques and observed videos of a traditional advisor-advisee interaction as well as an MA-focused engagement. A postworkshop survey was used to evaluate the workshop. Results In a survey of 48 educators attending the workshop at two medical conferences, over 80% of respondents demonstrated an interest in learning more about MA. Additionally, over 60% indicated that they would seek opportunities to practice and/or implement MA with their advisees. Knowledge of the technical components of MA also increased significantly in pre- and posttest analysis. Discussion This module introducing the concept of MA was well received by medical educators and was viewed as a valuable tool in advising medical learners. The provided components enable replication of this workshop in other settings with or without an expert in MI techniques. Although the workshop has been conducted with physicians involved in medical education, it would be applicable to other health professionals who advise trainees such as nursing, dentistry, pharmacy, or veterinary medicine.

Teaching Pediatric Otoscopy Skills to Pediatric and Emergency Medicine Residents: a Cross-Institutional Study

OBJECTIVE To evaluate a pediatric otoscopy curriculum with the use of outcome measures that included assessment of skills with real patients. METHODS Thirty-three residents in an intervention group from 2 institutions received the curriculum. In the previous year, 21 residents in a nonintervention group did not receive the curriculum. Both groups were evaluated at the beginning and end of their internship years with the use of the same outcome assessments: 1) a written test, 2) an objective standardized clinical examination (OSCE), and 3) direct observation of skills in real patients with the use of a checklist with established validity. RESULTS The intervention group had a significant increase in percentage reaching minimum passing levels between the beginning and end of the internship year for the written test (12% vs 97%; P < .001), OSCE (0% vs 78%; P < .001), and direct observation (0% vs 75%; P < .001); significant mean percentage gains for the written test (21%; P < .001), OSCE (28%; P < .001), and direct observation (52%; P = .008); and significantly higher (P < .001) mean percentage gains than the nonintervention group on the written test, OSCE, and direct observation. The nonintervention group did not have a significant increase (P = .99) in percentage reaching minimum passing levels, no significant mean percentage gains in the written test (2.7%; P = .30) and direct observation (6.7%; P = .61), and significant regression in OSCE (-5.2%; P = .03). CONCLUSIONS A pediatric otoscopy curriculum with multimodal outcome assessments was successfully implemented across different specialties at multiple institutions and found to yield gains, including in skills with real patients.

Interval versus Massed Training: How Do We Best Teach Surgery?

Objectives: 1) Compare two training paradigms, massed vs. interval training, when novice students learn to perform myringotomy with ventilation tube insertion (MVTI) on a validated simulator. 2) Determine if training paradigm affected confidence levels performing the procedure and comfort level working under a microscope. Methods: Between September 2011 and April 2012, 40 medical students were randomized to the interval group (n=19), in which they were trained to perform MVTI in five practice trials/day over 3 days, or the massed group (n=21) in which they were trained over 15 practice trials in one sitting. One week later, all students were tested in five final trials. Outcome measures included time to complete the operation and number and type of error made. Pre- and post-test surveys were administered. Results: Students in both groups demonstrated a significant decrease in time between practice and final trials. There was no significant difference between the two groups in time to complete their final trials. No difference was observed in the number of errors committed per trial between practice and final trials (both groups) or between massed and interval groups in their final trials. Students in both groups showed significantly increased confidence in conducting the procedure and in using a microscope. In the final trials, participants in the interval group felt significantly more confident about their ability to perform the procedure than those in the massed group. Conclusions: Training method had little impact on proficiency in performing a simulated surgical procedure in this setting.