Steven Rougas

What are the implications of implementation science for medical education

Background Derived from multiple disciplines and established in industries outside of medicine, Implementation Science (IS) seeks to move evidence-based approaches into widespread use to enable improved outcomes to be realized as quickly as possible by as many as possible. Methods This review highlights selected IS theories and models, chosen based on the experience of the authors, that could be used to plan and deliver medical education activities to help learners better implement and sustain new knowledge and skills in their work settings. Results IS models, theories and approaches can help medical educators promote and determine their success in achieving desired learner outcomes. We discuss the importance of incorporating IS into the training of individuals, teams, and organizations, and employing IS across the medical education continuum. Challenges and specific strategies for the application of IS in educational settings are also discussed. Conclusions Utilizing IS in medical education can help us better achieve changes in competence, performance, and patient outcomes. IS should be incorporated into curricula across disciplines and across the continuum of medical education to facilitate implementation of learning. Educators should start by selecting, applying, and evaluating the teaching and patient care impact one or two IS strategies in their work.Background Derived from multiple disciplines and established in industries outside of medicine, Implementation Science (IS) seeks to move evidence-based approaches into widespread use to enable improved outcomes to be realized as quickly as possible by as many as possible. Methods This review highlights selected IS theories and models, chosen based on the experience of the authors, that could be used to plan and deliver medical education activities to help learners better implement and sustain new knowledge and skills in their work settings. Results IS models, theories and approaches can help medical educators promote and determine their success in achieving desired learner outcomes. We discuss the importance of incorporating IS into the training of individuals, teams, and organizations, and employing IS across the medical education continuum. Challenges and specific strategies for the application of IS in educational settings are also discussed. Conclusions Utilizing IS in medical education can help us better achieve changes in competence, performance, and patient outcomes. IS should be incorporated into curricula across disciplines and across the continuum of medical education to facilitate implementation of learning. Educators should start by selecting, applying, and evaluating the teaching and patient care impact one or two IS strategies in their work.

Creating a Cadre of Fellowship-Trained Medical Educators: A Qualitative Study of Faculty Development Program Leaders' Perspectives and Advice.

Purpose Well-trained educators fill essential roles across the medical education continuum. Some medical schools offer programs for existing faculty to enhance teaching and scholarship. No standard postgraduate training model exists for residency graduates to attain competency as faculty members before their first academic appointment. The objective of this study is to inform the development of postgraduate medical education fellowships by exploring perceptions of educational leaders who direct well-established faculty development programs. Method The authors undertook a qualitative study, using purposeful sampling to recruit participants and a constant comparative approach to identify themes. They conducted semistructured telephone interviews with directors of faculty development fellowships using an interpretivist/constructivist paradigm (November 2013). Questions addressed curricular and fiscal structure, perceived benefits and challenges, and advice for starting a postgraduate fellowship. Results Directors reported institutional and participant benefits, notably the creation of a community of educators and pool of potential leaders. Curricular offerings focused on learning theory, teaching, assessment, leadership, and scholarship. Funding and protected time were challenges. Advice for new program directors included evaluating best practices, defining locally relevant goals; garnering sufficient, stable financial support; and rallying leaders’ endorsement. Conclusions Medical education fellowships cultivate leaders and communities of trained educators but require participants to balance faculty responsibilities with professional development. Advice of current directors can inform the development of postgraduate programs modeled after accredited clinical specialty fellowships. Programs with the support of strategic partners, financial stability, and well-defined goals may allow new faculty to begin their careers with existing competency in medical education skills.

When Race Matters on the Wards: Talking About Racial Health Disparities and Racism in the Clinical Setting

Introduction There is a growing body of literature illustrating the negative impact of racial bias on clinical care. Despite the growing evidence, medical schools have been slow to make necessary curricular changes. Most attempts to educate on racial health disparities focus on transferring knowledge and do not foster the development of skills to understand ones own bias or address bias and racism in the clinical setting. To address this, we developed a small-group, case-based curriculum for rising third-year medical students. Methods This session was designed to be delivered in concurrently run, 1-hour small-group sessions, with each small group ideally comprising no more than 10 students and one facilitator. The curriculum was integrated into an existing 3-week clerkship preparation course for 122 students during the 2015–2016 academic year. The session materials include a facilitators guide and three cases for discussion. Results The session was evaluated using a 6-point Likert scale (1 = poor, 6 = exceptional). Students rated this session overall a 4.28 out of 6 (N = 79). Qualitative feedback varied, with the most common theme focusing on the need for more time to discuss this topic. Discussion Though one session before starting clinical clerkships is not enough to maintain the practice of sustained critical thinking regarding bias and racism in clinical medicine, this session is a starting point for curriculum developers looking to use an evidence-based approach to racial bias in clinical care.

Creating a Cadre of Fellowship-Trained Medical Educators, Part II: A Formal Needs Assessment to Structure Postgraduate Fellowships in Medical Education Scholarship and Leadership

Purpose Education leaders at the 2012 Academic Emergency Medicine Consensus Conference on education research proposed that dedicated postgraduate education scholarship fellowships (ESFs) might provide an effective model for developing future faculty as scholars. A formal needs assessment was performed to understand the training gap and inform the development of ESFs. Method A mixed-methods needs assessment was conducted of four emergency medicine national stakeholder groups in 2013: department chairs; faculty education/research leaders; existing education fellowship directors; and current education fellows/graduates. Descriptive statistics were reported for quantitative data. Qualitative data from semistructured interviews and free-text responses were analyzed using a thematic approach. Results Participants were 11/15 (73%) education fellowship directors, 13/20 (65%) fellows/graduates, 106/239 (44%) faculty education/research leaders, and a convenience sample of 26 department chairs. Department chairs expected new education faculty to design didactics (85%) and teach clinically (96%). Faculty education/research leaders thought new faculty were inadequately prepared for job tasks (83.7%) and that ESFs would improve the overall quality of education research (91.1%). Fellowship directors noted that ESFs provide skills, mentorship, and protected time for graduates to become productive academicians. Current fellows/graduates reported pursing an ESF to develop skills in teaching and research methodology. Conclusions Stakeholder groups uniformly perceived a need for training in education theory, clinical teaching, and education research. These findings support dedicated, deliberate training in these areas. Establishment of a structure for scholarly pursuits prior to assuming a full-time position will effectively prepare new faculty. These findings may inform the development, implementation, and curricula of ESFs.

Twelve tips for developing, implementing, and sustaining medical education fellowship programs: Building on new trends and solid foundations

Abstract Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization’s educational mission and participants’ career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a team of committed individuals who provide expertise, guidance, and mentoring. Qualified MEFP directors should utilize instructional methods that promote individual and institutional short and long term growth. Directors must balance the use of traditional design, implementation, and evaluation methodologies with advancing trends that may support or threaten the acceptability and sustainability of the program. Drawing on the expertise of 28 MEFP directors, we provide twelve tips as a guide to those implementing, sustaining, and/or growing a successful MEFP whose value is demonstrated by its impacts on participants, learners, patients, teaching faculty, institutions, the greater medical education community, and the population’s health.

Twelve tips for addressing medical student and resident physician lapses in professionalism

Abstract Medical educators have gained significant ground in the practical and scholarly approach to professionalism. When a lapse occurs, thoughtful remediation to address the underlying issue can have a positive impact on medical students and resident physicians, while failure to address lapses, or to do so ineffectively, can have long-term consequences for learners and potentially patients. Despite these high stakes, educators are often hesitant to address lapses in professionalism, possibly due to a lack of time and familiarity with the process. Attention must be paid to generalizable, hands-on recommendations for daily use so that clinicians and administrators feel well equipped to tackle this often difficult yet valuable task. This article reviews the literature related to addressing unprofessional behavior among trainees in medicine and connects it to the shared experience of medical educators at one institution. The framework presented aims to provide practical guidance and empowerment for educators responsible for addressing medical student and resident physician lapses in professionalism.

Teaching oral presentations in pre-clinical skills courses

research the answers and create an academic poster displaying the content material for their sub-topic. Faculty staff content experts served as resources but did not actively teach. On the final day of the SRB, all students reconvened in their original learning groups and a poster session was organised in which each student was able to sequentially present his or her work to learning group members. The students’ work was peer-evaluated using a 5-point Likert-type survey that assessed the quality of the students’ 20-minute oral poster presentations and the students’ overall effort during the research and poster preparation process. Faculty teachers used the same evaluation tool to assess the students’ performances. What lessons were learned? The poster session was tightly choreographed to allow the simultaneous delivery of multiple student presentations over an entire day. By working collaboratively, the students were actively engaged in the learning process rather than experiencing the passivity of learning through lecture. They were obliged to take an active role in researching answers and applying content material to the videotaped patient case. Every student participated in creating a poster and each student individually presented academically to peers and faculty teachers. Student evaluations of the SRB were extremely positive. Student examination scores following this review module were in line with historical comparisons. The SRB was successful in achieving its four stated goals. This educational innovation, totally devoid of lecture, promoted active learning by allowing students to individually research particular topics, work collaboratively within teams, and develop useful academic communication skills.

Multidisciplinary approach to structural competency teaching

What problems were addressed? Few medical schools have incorporated structural racism – the intersectionality between health outcomes, race, politics and socio-economic status – into their curricula. Challenges include few published examples of robust successful interventions and limited curricular time. Recently, structural competency experts have proposed specific steps medical schools can take to meet this call: teaching students to address episodes of structural racism they encounter, looking to the humanities ‘to be more aware of the ways racism is embedded in institutions’, and increase scepticism of race-based differences in diagnosis. What was tried? As part of a broader initiative to include structural racism in medicine in the curriculum, a 3-hour session on structural competence and racism was integrated into an existing clinical skills course. Using a flippedclassroom model, 144 second-year students were assigned foundational articles explaining structural racism and an approach to countering racial bias in the clinical setting. In class, students participated in a 1-hour interactive panel-based discussion involving a medical student, a physician and medical historian from the social sciences. The panel explored three common clinical scenarios and panelists discussed the intersection of the key learning points from their individual perspectives, followed by questions from students. Students were then divided into groups of eight for a 2-hour debrief with a social-behavioural scientist, where they brainstormed strategies for responding to structural racism. What lessons were learned? First, exploring issues of structural competence and racism cannot be done in the confines of our medical education buildings. Relationships with colleagues in the social sciences who have structural competency expertise need to be explored and developed. Second, developing a shared consciousness regarding issues of structural racism in medicine requires an understanding of shared terminology, especially given the wide range of backgrounds our students come to medical school with. Providing students with supplementary pre-reading that is accessible and digestible, while also engaging experts to provide the relevant context, was a necessary starting point that was previously missing from our curriculum. Third, panel-based discussions that are driven by real-life clinical scenarios allowed for a more focused discussion that centred on a shared commitment and acknowledgement of the issues. Having a non-physician historian from the social sciences provided needed context for the historical and societal implications of the cases. In conjunction with appropriate physician participation that focused the conversation on lived experiences within the medical environment, the panel was a successful vehicle for delivering the content to a large class. Finally, dividing into small groups was important so students could ask appropriate questions in a smaller learning environment. However, students felt strongly that the small-group conversations should involve not only the socialbehavioural scientists but also physician faculty members so that the practical application could be better connected with the theory, as it was on the panel. The small groups were a necessary opportunity to consolidate knowledge, review areas and terminology that were confusing, and brainstorm practical skills to help navigate issues of structural racism in the clinical environment.

Intimate Partner Violence Screening and Counseling: An Introductory Session for Health Care Professionals

Introduction Intimate partner violence is a serious public health concern in the United States. Despite recommendations that physicians should routinely screen their patients, research has shown that lack of specific training has resulted in many health care professionals feeling unable to adequately perform this difficult but vital task. Though many educational resources exist to teach intimate partner violence screening, they often lack specific guidance on how to navigate this difficult conversation. In addition, they often lack formal teaching on how to counsel and refer patients who are victims of intimate partner violence. Methods This unique module, intended for a small-group setting of four to eight students, contains an intimate partner violence checklist with sample language that covers both screening and counseling using a motivational interviewing framework. Additional materials include a checklist companion for tips on how to navigate the conversation, two cases for role-play, a facilitator guide, and an objective structured clinical encounter case and assessment rubric. Results This module was given to 260 second-year medical students at the Warren Alpert Medical School between 2015 and 2017 and was rated highly by almost 90% of students. Discussion After completing this module, learners will be able to appropriately screen for intimate partner violence as well as counsel and refer patients who have screened positive. By implementing this module, educators can increase the number of health care professionals able to broach this difficult conversation with patients who may be in need of help and may otherwise go unaided.