Michael J. Mintzer

Learning objects in medical education

A learning object (LO) is a grouping of instructional materials structured to meet a specified educational objective. Digital LOs, which can be stored electronically, allow a new approach to instructional activity, making medical education more efficient, and potentially more cost-effective. They are reusable and can incorporate text, graphics, animations, audio, and video to support and enhance learning. A learning object can stand alone or be aggregated with additional objects to create larger forms of educational content meeting multiple educational objectives. Digital learning objects located in online repositories can be accessed by many computers and are easily handled by an array of learning management systems for delivery to learners at any time. Integrating digital learning objects with traditional educational methods in a blended learning approach assists medical educators in meeting the challenges of competing priorities. Multimedia LOs enable learners to tailor their experience to their preferred learning style. Through the use of learning objects, learners’ reactions, their acquisition of knowledge, skills and attitudes, and their behavioral changes become readily measurable. Learning objects provide multiple research opportunities, such as their use in adaptive learning, their added value in preclinical versus clinical education, and their impact as part of a blended learning strategy. Practice points•A learning object is a grouping of instructional materials structured to meet a specified educational objective.•Learning objects are interactive, interoperable, multimedia and easily accessible in online repositories.•Learning objects can stand alone or can be aggregated to create larger forms of educational content to meet multiple educational objectives.•Learning objects allow a blended learning approach to instructional activity, making medical education more efficient and potentially more cost-effective.•Learning objects create new teaching efficiencies for educators and create new learning opportunities.

Is Geriatric Medicine Terminally Ill

Although substantial academic resources are directed to encourage interest in geriatric medicine, fewer internal medicine and family medicine residents are seeking geriatric medicine fellowship tra...

A Fourth‐Year Medical School Clerkship That Addressed Negative Attitudes Toward Geriatric Medicine

Despite extensive educational efforts, many medical students still have negative attitudes toward the field of geriatric medicine and the care of older adult patients. This article describes a fourth‐year geriatric clerkship that addressed this issue by providing opportunities for students to actively discuss many of the negative stereotypes that exist regarding geriatric medicine. Emphasis was also placed on personalizing the course content to show the relevance of geriatric medicine to all medical students. During the 2008/09 academic year, 150 students completed the rotation. Although no students expressed an interest in pursuing a career as a geriatrician, they expressed a highly favorable evaluation of this personalized geriatric clerkship and voted this clerkship “the most outstanding clinical course” at the medical school.

Computer-based animations and static graphics as medical student aids in learning home safety assessment: a randomized controlled trial

Background: Although animations may intuitively seem more effective than static graphics for teaching, there is no clear-cut evidence for the superiority of simple computer-based animations in medical education. Aims: We investigated whether simple animations are better than static graphics as an aid to medical students in learning home safety assessment, an important part of geriatric curriculum. Methods: We used two versions of an interactive online module, one that depicted common home safety issues in static graphics and the other in animations. We randomized first-year medical students who agreed to participate into two groups. After the module, students completed a cognitive burden scale and a standardized competency assessment test in which they had to identify the salient home safety issues and give recommendations based on the hazards. We also captured time spent on task. Results and conclusions: We found no significant differences between the groups in the cognitive burden level, competency assessment scores, and time spent on task. The much cheaper-to-produce static graphics were equally effective as simple animations in this medical education scenario.

A Competency-Based Medical Student Curriculum Targeting Key Geriatric Syndromes

Abstract The University of Miami Miller School of Medicine (UMMSM) has developed and implemented a competency-based undergraduate medical education (UME) curriculum that targets 61 learning objectives for three geriattic syndromes: dementia, falls, and delirium. This curriculum redesign changed the educational focus from what is taught to what is learned. Students complete 13 different competency assessments throughout their four years of training and are required to meet specific performance standards. Documentation of competency is now provided for 600 students annually. This paper describes the design, development, implementation, and evaluation of this curriculum, reviews our data-driven curriculum quality improvement efforts, and discusses the challenges to translating student competency into routine practice.

An Interactive E-Learning Tutorial for Medical Students on How to Conduct the Performance-Oriented Mobility Assessment

Abstract We evaluated the effectiveness of an e-learning tutorial (iPOMA) as a supplement to traditional teaching of the Performance-Oriented Mobility Assessment. Second-year medical students (137) completed the iPOMA, in preparation for a session on fall risk assessment consisting of a lecture, practice with elder volunteers and small group debriefing. Before and after the tutorial, students completed online questionnaires, a quiz on POMA scoring immediately after the tutorial and competency assessments on POMA performance 1 month later. Self-efficacy in using the POMA increased and post-tutorial quiz scores were significantly correlated with self-efficacy. Students who completed the tutorial performed significantly better on the verbal instructions portion of the POMA. The iPOMA is an effective instructional modality.

Simulating geriatric home safety assessments in a three-dimensional virtual world.

Virtual worlds could offer inexpensive and safe three-dimensionalenvironments in which medical trainees can learn to identify home safety hazards. Our aim was to evaluate the feasibility, usability, and acceptability of virtual worlds for geriatric home safety assessments and to correlate performance efficiency in hazard identification with spatial ability, self-efficacy, cognitive load, and presence. In this study, 30 medical trainees found the home safety simulation easy to use, and their self-efficacy was improved. Men performed better than women in hazard identification. Presence and spatial ability were correlated significantly with performance. Educators should consider spatial ability and gender differences when implementing virtual world training for geriatric home safety assessments.

Group-based differences in anti-aging bias among medical students.

Medical students (MS) may develop ageist attitudes early in their training that may predict their future avoidance of caring for the elderly. This study sought to determine MS’ patterns of explicit and implicit anti-aging bias, intent to practice with older people and using the quad model, the role of gender, race, and motivation-based differences. One hundred and three MS completed an online survey that included explicit and implicit measures. Explicit measures revealed a moderately positive perception of older people. Female medical students and those high in internal motivation showed lower anti-aging bias, and both were more likely to intend to practice with older people. Although the implicit measure revealed more negativity toward the elderly than the explicit measures, there were no group differences. However, using the quad model the authors identified gender, race, and motivation-based differences in controlled and automatic processes involved in anti-aging bias.

Fatal falls in an ethnically diverse urban community: the link between demographic factors and the circumstances surrounding fatal falls.

Objectives Fatal falls cause more than 15,000 deaths per year in the United States. Despite this, the circumstances surrounding fatal falls in elderly adults are poorly understood. It is unknown whether these circumstances differ across ethnicities, although Hispanic American individuals are at reduced risk for fatal falls. This study sought to describe fatal falls in an urban, predominantly Hispanic, and white non-Hispanic community and to determine the association of demographics with the circumstances surrounding these falls (proximate factors). Methods The death certificates and medical examiners’ reports for all 328 elderly individuals experiencing a fatal fall in Miami-Dade County, FL, from 2005 to 2007 were reviewed for demographic and proximate factors such as the preceding activity and fall location. Results Fatal falls in elderly adults were experienced mostly by individuals living in the community (80%) and affected all demographic subgroups, although 80% occurred in individuals older than 74 years. Most fatal falls occurred at home (74%), indoors (75%), and during nonvigorous activities such as walking (58%) and these tended to affect the oldest elderly. In addition, a significant number of fatal falls occurred in public locations, outdoors, and during vigorous activity, with these falls tending to affect younger individuals living without family. Hispanic ethnicity was not associated with proximate factors. Conclusions Fatal fall prevention is needed for elderly individuals living in the community and should target the oldest elderly adults living at home while helping to ensure that individuals who are living without family have the appropriate support. These data suggest that Hispanic individuals may benefit from prevention strategies developed in other populations.

Dramatic reduction in 30-day readmissions through high-risk screening and two-phase interdisciplinary care

Objectives Thirty-day readmissions are common, serious, and costly. Most important, often they are preventable. The purpose of this quality improvement study was to evaluate an interdisciplinary, two-phase intervention to reduce 30-day readmissions among high-risk medical patients. One or two high-risk patients were selected each weekday by a hospitalist using literature-based, locally tested criteria that included common medical illnesses, active psychiatric illness, and recent or recurrent hospital admissions. Methods Patients admitted to 1 of 5 medical hospitalist teams were selected to receive the intervention; patients admitted to the 4 remaining teams were used for comparison. The two-phase care coordination intervention consisted of a daily interdisciplinary team meeting for the selected high-risk patients and postdischarge interventions that included outpatient care coordination until the patients’ first follow-up appointment. The care plan addressed medical/geriatric assessment, social stability, medication reconciliation, nutritional needs, care coordination including future appointments/testing, and community services. Eighty-five patients in the intervention group were compared with 84 patients from the comparison group using propensity score matching. Patient characteristics were similar at baseline. Results The intervention group demonstrated a reduction in 30-day readmissions by 52% (11 vs 23, P = 0.019). Length of stay was reduced: 5.5 days compared with 7.2 days (P = 0.258). Conclusions This intervention produced a significant reduction in 30-day readmissions for high-risk patients and a trend for shorter lengths of stay compared with similarly matched patients. Future research trials are needed to verify these results.