Raymond C. Baker

Teaching in the medical setting: balancing teaching styles, learning styles and teaching methods.

Summary Effective teaching in medicine requires flexibility, energy, and commitment amidst a busy background of clinical care. Successful medical teaching also requires that teachers are able to address learner’s needs and understand the variations in learners’ styles and approaches. Teachers can accomplish these requirements while creating an optimal teaching-learning environment by utilizing a variety of teaching methods and teaching styles. If teachers use a variety of teaching methods and styles, learners are exposed to both familiar and unfamiliar ways of learning which provide both comfort and tension during the process ultimately giving learners multiple ways to excel. As Hemesath and colleagues have suggested (1997), new instructional methods are critical as medical school curricula are changing. Others have mentioned the importance of using a variety of creative, non-traditional teaching techniques and strategies in clinical teaching (Handfield-Jones et al., 1993; DaRosa et al., 1997; Wilkerson & Sarkin, 1998). Grasha (1996) suggests using varied teaching styles to address the diversity of learner needs. Using a variety of teaching methods and styles ultimately may encourage adaptability and lifelong learning in the teaching-learning process. This paper, supplemented by a related website, will provide a conceptual framework and an expanded compendium of teaching styles and teaching methodologies which can be used in different clinical settings.

NASPGN guidelines for training in pediatric gastroenterology

G.G.C. has received com M.C. has served on th served on the board o and Enteral Nutrition; her institution has rec collaborative and Prov pensation from Child L.A.G. has received c received compensatio employment, expert t stocks/stock options; LLC, consulted to No received or has grants Institutes of Health, th holds equity interest in has received compens Fibrosis Foundation; M Abbott Laboratories, Foundation, the Natio Diseases/National Ins ticals; E.A.R. has rece sionalism & Ethical institution has receive as the medical editor has received compen Pharmaceuticals, and Nutrition; J.T. has rec Pediatrics, Prometheu conflicts of interest. Copyright # 2012 by E Hepatology, and Nut Gastroenterology, He DOI: 10.1097/MPG.0b01

Psychological size and distance: emphasising the interpersonal relationship as a pathway to optimal teaching and learning conditions

Background  Positive interpersonal relationships between teachers and learners increase the quality of learning. The purpose of this study was to investigate psychological size (perceived status) and psychological distance (perceived emotional connectedness) in medical teaching interactions and their impact on the teaching and learning process.

The Problem Learner.

Background: A problem learner is a learner whose academic performance is significantly below performance potential because of a specific affective, cognitive, structural, or interpersonal difficulty. Problem learners are difficult for the clinical preceptor to manage. Description: We propose a general problem-solving process, the S-T-P model, through which unique solutions for different problem learners can be developed. The S-T-P model is a process that incorporates feedback and problem solving; it consists of three steps: (a) specify the problem (S); (b) desired target state (T); and (c) procedure, plan, or path to get from S to T (P). Evaluation: We offer suggestions for the evaluation of the problem learner, including more emphasis on peer and self-evaluation and insights to teaching and implementing the S-T-P model, including the use of role play. Conclusions: Considerations of the problem learner may suggest evaluation, curricular, and organizational changes in residency programs and medical schools.

Limited heterogeneity of HIV type 1 in infected mothers correlates with lack of vertical transmission.

The human immunodeficiency virus type 1 (HIV-1) envelope V3 region sequences of peripheral blood mononuclear cell DNA were analyzed from three nontransmitting mothers (infected mothers who failed to transmit HIV-1 to their infants in the absence of antiretroviral therapy), including one mother with two deliveries, and compared with the sequences of seven previously analyzed transmitting mothers. The coding potential of the envelope open reading frame, including several patient-specific amino acid motifs and previously described molecular features across the V3 region, were highly conserved. There was a low degree of heterogeneity within the sequences of each nontransmitting mother compared with the sequences of transmitting mothers. In addition, the estimates of genetic diversity of nontransmitting mother sequences were significantly lower compared with transmitting mother sequences. Phylogenetic analysis showed that the sequences of each nontransmitting mother formed distinct clusters that were well discriminated from each other and the sequences of seven transmitting mothers. In conclusion, a low degree of HIV-1 genetic heterogeneity in these infected mothers correlates with lack of vertical transmission; this finding may be useful in developing strategies for further prevention of maternal-fetal transmission.

Development and testing of a CD-ROM program for improving adolescent knowledge of inflammatory bowel disease.

Objective: The aim of this study was to design a theory-based educational program for adolescents with inflammatory bowel disease (IBD) using an interactive multimedia CD-ROM and to test its effectiveness in improving knowledge in IBD. Materials and Methods: Curriculum-based instruction using educational theory and principles was designed for adolescents on an interactive multimedia CD-ROM. Twenty subjects completed summative evaluation of the CD-ROM measuring gain in knowledge about IBD immediately and 9 months after instruction. Results: Subjects found the CD-ROM to be informative, appealing, and easy to use. The mean baseline score of the adolescents on the Crohns and Colitis Knowledge questionnaire was 12.2 (standard deviation 5.14, range 3–24). After an average of 30 minutes of self-directed learning, adolescent subjects increased their posttest score to a mean of 19.8, a gain of 7.6 points over baseline (95% confidence interval 5.2–10.1, P < 0.0001). Knowledge of medications, disease complications, and gastrointestinal structure and function was gained and retained upon retesting at 9 months with a mean Crohns and Colitis Knowledge questionnaire score of 17.5 (standard deviation 3.9, range 12–26), which was still an improvement over the mean pretest knowledge score of 12.2 (P < 0.001). Conclusions: Adolescents with IBD have low baseline knowledge about their disease. A rigorously developed interactive educational tool is now available for instructing adolescent patients about their IBD.

Effectiveness of an online pediatric primary care curriculum.

OBJECTIVE The aim of this study was to evaluate the effectiveness of a supplementary online pediatric primary care (PPC) curriculum in reaching pediatric residents and increasing knowledge in selected primary care topics. METHODS We conducted a nonrandomized, controlled, pre-test/post-test study comparing an online PPC curriculum supplement with the traditional formal, conference-based curriculum alone, both with identical content. We compared 2 groups of first-year categorical pediatric residents from 2 successive years: one group (from 2006-2007) was offered the online curriculum supplement (study group) and one (2005-2006) was not (control group). Comparisons were made using the following: 1) pre-testing and post-testing of knowledge; and 2) monitoring of attendance at the formal conferences and accessing the online curriculum. RESULTS The control group of 33 residents and the study group of 34 residents were similar with respect to gender, age, and first-year in-training exam scores. In the first quarter of the year, 93% (mean) of the study group accessed the online curriculum; 43% accessed it in the last quarter of the year. For the same time periods, 33% and 30% of all of the residents (intervention and control groups combined) attended the noon conferences. The pre-test and post-test scores of the study group showed a significant increase (P < .001), and the post-test score comparison of study versus control group was also significant (P = .035). There were no significant differences in the in-training exam scores between the 2 groups for exams given at the beginning of their second year. CONCLUSION An online PPC curriculum is an effective supplement to traditional resident education and reaches a significantly larger number of residents compared with the traditional conference-based format.

Development and implementation of an online master's degree in education program for health care professionals.

Technological advances, especially the Internet and the World Wide Web, have drastically changed educational practices by reforming the concept of education and knowledge transmission at a distance. Professionals in all disciplines have begun using this advanced technology to expand the number of learning opportunities for intellectual growth and professional development. As a result, many universities and educational institutions now offer online higher degree programs to provide opportunities for nontraditional students who have difficulty attending scheduled, campus-based classes. In medicine, a need has been identified for advanced graduate studies in education to develop the next generation of medical educators and to train them in educational research methods to validate their educational efforts. This need was identified by both informal needs assessment at local, regional, and national faculty development meetings and more formal literature review and government survey. The faculty development team of Cincinnati Childrens Hospital Medical Center (Department of Pediatrics, University of Cincinnati College of Medicine) collaborated with the College of Education to develop an online Masters Degree in Education for health care professionals. The program was designed to apply these advanced technologies in order to make the program flexible and accessible to health care professionals whose busy schedules preclude more traditional, in-class graduate programs. This article presents how this program evolved and the problems, challenges, and solutions associated with the development and implementation of the program.

Variability in the Management of Childhood Constipation

To assist primary care providers, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) published clinical practice guidelines for management of childhood constipation. A cross-sectional survey of pediatricians from across the United States was conducted to assess pediatricians’ constipation management strategies, whether pediatricians are familiar with the NASPGHAN constipation guidelines, and reasons pediatricians refer constipated patients to a pediatric gastroenterologist. Overall, 75% of pediatricians used polyethylene glycol without electrolytes to treat childhood constipation, 8% of pediatricians were aware NASPGHAN had published constipation guidelines, and parental pressure was just one reason pediatricians referred constipated patients to a pediatric gastroenterologist.

Welcome back? Frequent attenders to a pediatric primary care center

This study examines frequent attenders of a pediatric primary care clinic at a large urban children’s hospital — who they are and their reasons for frequent attendance to the clinic. The literature suggests that some visits by frequent attenders may not be medically necessary, and these additional appointments may impair others’ access to medical care within the same system. The key to eliminating excessive primary care visits is to determine if it is a problem in the primary care practice (quantify the problem), explore the reasons for the visits (from the patients’ perspective), and then provide educational interventions that address the various causes for the extra visits and encourage the use of available resources, either ancillary services in the practice itself or resources and agencies available in the community (e.g. social service, legal aid).