Meridith Marks

Communication skills, cultural challenges and individual support: challenges of international medical graduates in a Canadian healthcare environment

Physicians require good communication skills to develop effective patient–physician relationships. Externally funded international medical graduates (IMGs) move directly from their home countries to complete residency training at the University of Ottawa, Canada. They must learn quickly how to work with patients, families and colleagues. A detailed needs assessment was designed to assess IMGs’ communication skill needs through focus groups, interviews and surveys with IMGs, program directors, allied healthcare professionals and experts in communication skills. There was a high degree of consensus amongst all participants concerning specific educational needs for communication skills and training issues related to the healthcare system for externally funded IMGs. Specific recommendations include (1) English-language skills; (2) how to get things done in the hospital/healthcare system; (3) opportunities to practise specific skills, e.g. negotiating treatment, (4) adequate support system for IMGs; (5) faculty and staff education on the cultural challenges faced by IMGs.

Assessing the quality of supervisors’ completed clinical evaluation reports

Context  Although concern has been raised about the value of clinical evaluation reports for discriminating among trainees, there have been few efforts to formalise the dimensions and qualities that distinguish effective versus less useful styles of form completion.

Ambulation monitoring of transtibial amputation subjects with patient activity monitor versus pedometer

Our study aimed to compare the accuracy of step count and ambulation distance determined with the Yamax Digi-Walker SW-700 pedometer (DW) and the Ossur patient activity monitor (PAM) in 20 transtibial amputation subjects who were functioning at the K3 Medicare Functional Classification Level. Subjects completed four simulated household tasks in an apartment setup and a gymnasium walking course designed to simulate outdoor walking without the presence of environmental barriers or varied terrain. The mean step count accuracy of the DW and the PAM was equivalent for both the household activity (75.3% vs 70.6%) and the walking course (93.8% vs 94.0%). The mean distance measurement accuracy was better with the DW than with the PAM (household activity: 72.8% vs 0%, walking course: 92.5% vs 86.3%; p < 0.05). With acceptable step count accuracy, both devices are appropriate for assessing relatively continuous ambulation. The DW may be preferred for its more accurate distance measurements. Neither device is ideal for monitoring in-home ambulation.

The development of a participant questionnaire to assess continuing medical education presentations

Objective  Feedback on presentation skills is important for developing skilled educators, but often this feedback is based on evaluation tools that have been developed with little concern for psychometric issues or for how the information will be used for feedback. The purpose of this study was to develop a reliable participant questionnaire to assess the quality of continuing medical education (CME) presentations and to provide presenters with feedback.

Formal ventilation patient education for ALS predicts real-life choices

Abstract Our objective was to evaluate a single-session, hands-on education programme on mechanical ventilation for ALS patients and caregivers in terms of knowledge, change in affect and to determine whether ventilator decisions made after the education sessions predict those made later in life. Questionnaires were administered to 26 patients and 26 caregivers on four separate occasions. The questionnaires assessed knowledge of ventilatory support, feedback on the nature of the education programme, as well as self-reported emotional well-being. All patients were followed until their death or until initiation of invasive ventilation. Both groups demonstrated significant improvements in knowledge as a result of the education session which was retained after one month. There was no change in patient or caregiver reports’ self-reported emotional well-being. The choices of ventilatory support expressed at one month (T4) accurately predicted the real-life clinical choices made by 76% of patients. Any difference resulted from choosing palliative care. Hands-on patient and caregiver education results in improved knowledge, assists in decision-making with respect to ventilatory support, and is not associated with a worsening of affect. It also provides for an accurate prediction of real-life choices and avoids undesired life support interventions and critical care admissions.

Quality evaluation reports: Can a faculty development program make a difference?

Background: The quality of medical student and resident clinical evaluation reports submitted by rotation supervisors is a concern. The effectiveness of faculty development (FD) interventions in changing report quality is uncertain. Aims: This study assessed whether faculty could be trained to complete higher quality reports. Method: A 3-h interactive program designed to improve evaluation report quality, previously developed and tested locally, was offered at three different Canadian medical schools. To assess for a change in report quality, three reports completed by each supervisor prior to the workshop and all reports completed for 6 months following the workshop were evaluated by three blinded, independent raters using the Completed Clinical Evaluation Report Rating (CCERR): a validated scale that assesses report quality. Results: A total of 22 supervisors from multiple specialties participated. The mean CCERR score for reports completed after the workshop was significantly higher (21.74 ± 4.91 versus 18.90 ± 5.00, p = 0.02). Conclusions: This study demonstrates that this FD workshop had a positive impact upon the quality of the participants’ evaluation reports suggesting that faculty have the potential to be trained with regards to trainee assessment. This adds to the literature which suggests that FD is an important component in improving assessment quality.

A teaching encounter card to evaluate clinical supervisors across clerkship rotations.

Background: Evaluation of faculty teaching is critical to improving the educational experience for both students and faculty. Aim: Our objectives were to implement an evaluation system, using the teaching encounter card, across multiple rotations in the clerkship and determine the feasibility, reliability and validity of this evaluation tool in this expanded setting. Methods: Students were asked to rate clinical supervisors on nine teaching behaviours using a 6-point rating scale and asked whether they would like to nominate the teacher for a clinical teaching award. Results: A total of 3971 cards for 587 clinical supervisors across seven clerkship rotations were analyzed. There was an average of 7.3 cards per supervisor (median = 5, range 2–66). There was high internal consistency between items on the card (Cronbachs alpha 0.965). The reliability was fair at 0.63. Seventeen cards per supervisor would be required to achieve a reliability >0.8 (G study). Ratings were higher for encounters that occurred in the operating room and within the anaesthesia rotation. The teachers who had a positive recommendation for teaching award nomination received higher scores than their colleagues. Conclusion: We successfully implemented a faculty evaluation card across clerkship rotations that was flexible enough to use in multiple learning environments and allowed the identification of outstanding clinical teachers.

An encounter card to evaluate teachers in clerkship.

by the LIVE consortium to determine if this teaching method in the pre-clinical setting would increase student confidence for learning clinical skills in paediatrics. What was done We implemented an innovative videoenhanced case of a hypotonic infant with an underlying genetic disorder to 12 groups of 5–6 2nd-year medical students. Groups viewed video clips of infants with normal and abnormal physical examination findings as part of the multimedia case during their PBL tutorial. Other elements of the case included video clips of doctor–patient interactions and an interactive laboratory ordering section. Students completed a confidence survey immediately before and after completing the case. Responses were scored using a 4-point Likert scale and analysed using paired t-tests. Tutors participated in a focus group discussion following the intervention. Evaluation of the results and impact Student (n 1⁄4 60, response rate 1⁄4 97%) confidence increased significantly for recognising hypotonia in a newborn, and recognising when a newborn physical examination is not normal (P < 0Æ05 for both). Most students and faculty teaching staff felt that the use of video was a highly effective way of teaching the abnormal finding in the case studied. Anxiety about beginning the newborn nursery portion of the 3rd-year clerkship, confidence in recognising developmental delay and comfort level in assessing a newborn did not increase significantly (P > 0Æ05). A minority of students and faculty teaching staff felt that multimedia altered PBL group dynamics by decreasing student interactions. These findings support the use of video-enhanced PBL to increase student confidence for learning a specific clinical skill. We plan to develop more cases exposing students to a broader spectrum of physical examination findings. Long-term studies are warranted to determine if this enhanced pre-clinical preparation will result in increased student clinical skills performance.

Rewarding development of teaching skills and educational scholarship

Context and setting At our Faculty of Medicine, approximately 60% of faculty identify as clinicianteachers (with roles more centred on clinical care) and 15% represent clinician-educators (with roles more centred on education). Why the idea was necessary Teaching awards reward excellence in teaching and promotion criteria reward achievements in educational scholarship, but our Faculty had few mechanisms in place with which to recognise and encourage faculty members who take steps along those paths. What was done A Teaching Skills Attainment Award (TSAA) was developed to reward participation in programmes designed to enhance teaching skills and recognise increasing levels of involvement in scholarly activities related to teaching and education. The award is given to teachers who document 30 hours of faculty development training; awards ‘with merit’ and ‘with distinction’ require an additional 80 and 130 hours of training, respectively, as well as evidence of dissemination, such as the delivery of a workshop, or a poster or podium presentation at an education meeting http:// www.med.uottawa.ca/facdev/eng/teaching_skills_ attainment_award.html. Annual local calls for peer-reviewed workshops and papers encourage scholarship and allow faculty members to gain experience before disseminating externally; time spent presenting teaching skills workshops is doubled when it is put towards fulfilling the hours requirement. Applicants must provide evidence of having met TSAA requirements. The Faculty Development Advisory Group makes final decisions regarding all awards. The TSAA is conferred with a framed certificate at our annual faculty development day and recipients are acknowledged at the annual faculty excellence awards ceremony. In its first year, the TSAA was heavily advertised to all faculty members (electronically and in the faculty newsletter), as well as to targeted individuals who were identified as potentially meeting award criteria via direct e-mails and through heads of departments. In subsequent years, advertising has been limited to a call for applications. Evaluation of results and impact The TSAA was introduced in 2006; 34 awards have been granted to 32 individuals, 26 at the award level, six with merit and two with distinction. Three awards were granted in 2007, seven in 2008, 13 in 2009 and 11 in 2010. Awardees represent nine of 12 clinical departments and one of three basic science departments. Most recipients submit hours in excess of the requirements; the mean time submitted is 42.3 hours (range: 30.0–68.5 hours), 112.6 hours (range: 95.5–122.5 hours) and 142.5 hours (range: 141.5– 143.5 hours) by recipients of ordinary, merit and distinction awards, respectively. A total of 38% of approved hours were amassed through participation in sessions offered by our Office of Faculty Development (range: 0–49 hours), 10% through participation in other University of Ottawa activities (range: 0–19 hours) and 52% through participation in activities external to our university. Fifteen applicants had presented workshops (locally or externally), accounting for 24% of their total hours (range: 2–63 hours). Eight applicants met one or more of the other scholarship criteria. The TSAA has been well accepted by our faculty members, who show consistent interest and applications. In addition to providing recognition for time spent improving teaching skills, it identifies faculty members who might contribute to local faculty development sessions and provides an additional incentive for the dissemination of innovations and expertise, and thus promotes scholarship in medical education.

Faculty preparation for academic evaluation.

an external mentor to support a research group that would in turn promote the development of a cadre of medical education researchers. What was done In the fall of 2005, we arranged that a mid-career education scientist from a nearby medical school, with expertise in qualitative research, would serve as a research mentor. The opportunity to participate in a group mentored by the expert was advertised via e-mail. The project had six phases: (i) initial group formation and introduction to qualitative methods (three monthly meetings with readings); (ii) identification of a research question and determination of appropriate methodology for its exploration (four bi-monthly meetings); (iii) delegation of a principal investigator and preparation of an ethics application and grant proposal (four to six meetings over 2 months); (iv) data collection and analysis (1 year); (v) dissemination of results (1 year), and (vi) development of follow-up projects (ongoing – into its second year post-project). During each phase, an attempt was made to include all members of the group and to allow different members to participate to greater and lesser extents depending on the tasks and their availability. As the group progressed into phases 4–6, the mentor personally attended meetings at key time-points, but was continually available for advice by phone and e-mail. Evaluation of results and impact Ten individuals indicated an initial interest in participating and nine committed to joining after the first meeting. One dropped out by phase 2. Two others subsequently dropped out because of time constraints by phase 3. The remaining six individuals have collaboratively published two papers and have another currently under review. Six peer-reviewed presentations have been given at international meetings and five at local education conferences. All members co-authored the papers and all but one have presented. The group has remained together and has received two additional grants for follow-up projects. In a post-project anonymous survey, all members who continued their participation rated their experiences very highly. One group member said: ‘It was one of the highlights of my working career.’ Lastly, our mentor also rated the experience highly and has agreed to continue mentoring the group during its ongoing projects.