Virginia A. Reed

Using mixed methods research in medical education: basic guidelines for researchers

Context  Mixed methods research involves the collection, analysis and integration of both qualitative and quantitative data in a single study. The benefits of a mixed methods approach are particularly evident when studying new questions or complex initiatives and interactions, which is often the case in medical education research. Basic guidelines for when to use mixed methods research and how to design a mixed methods study in medical education research are not readily available.

Fostering Professionalism in Medical Education

Increasing attention has been focused on developing professionalism in medical school graduates. Unfortunately, the culture of academic medical centers and the behaviors that faculty model are often incongruent with our image of professionalism. The need for improved role modeling, better assessment of student behavior, and focused faculty development is reviewed. We propose that the incentive structure be adjusted to reward professional behavior in both students and faculty. The third-year medicine clerkship provides an ideal opportunity for clinician-educators to play a leading role in evaluating, rewarding, and ultimately fostering professionalism in medical school graduates.

Understanding and improving medical student specialty choice: a synthesis of the literature using decision theory as a referent.

Background: As emphasis in medicine has shifted to increasing the number of physicians who choose primary care specialties, many studies of medical specialty choice have been conducted. Although researchers have approached the topic in a number of ways, most approaches have tended to focus on narrow elements of the choice, such as the effect of programs or curricula. A more comprehensive approach is possible by fitting the process to a preexisting broad theoretical framework. Summary: This synthesis of the literature examines specialty choice from the perspective of decision theory--with its aims of understanding how decisions are made, providing information about the quality of decisions, and improving the decision-making process. Conclusion: This approach has the potential to not only help deconstruct the process of decision making regarding specialty choice but also uncover information about the best ways to help medical students learn to make wise decisions.

Enhancing practice improvement by facilitating practitioner interactivity: New roles for providers of continuing medical education†

&NA; Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may explain in part the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects. Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers.

A Longitudinal Study of Determinants of Career Satisfaction in Medical Students

Abstract: Context: There is evidence of significant career dissatisfaction among practicing physicians and those considering medicine as a profession. Most research on career satisfaction has examined practicing physicians. This study was undertaken to look at determinants of satisfaction in those at the earliest stage of their medical careers — medical students. Methods: As part of a larger study, students comprising one class at the University of Washington School of Medicine were surveyed three times over the course of their medical education. For the present study we examined measures specifically related to determinants of career satisfaction. Findings: Over time, students’ sense of the importance of most measured determinants of satisfaction showed significant change, the majority of which were in the direction of decreased importance. However, most of the change was relative. That is, factors that students considered to be most important at the start of medical school continued to be most important throughout the educational experience and those factors students considered to be least important at Year 1 continued to be least important at Years 2 and 4. Discussion: These findings have implications for medical education, a time when students are forming expectations that will impact their career satisfaction. In addition to information on career satisfaction, students should understand the professional values of medicine, their own values and expectations, current practice patterns, economics, and the role of advocacy.

Enhancing Provider Engagement in Practice Improvement: A Conceptual Framework

Engaging individual members of clinical teams in practice improvement initiatives is a challenge. In this commentary, we first summarize evidence supporting enhanced practitioner engagement through the creation of a work environment that builds on mutually respectful relationships and valued interdependencies. We then propose a phased, collaborative process that employs practice talk, a term that describes naturally occurring, collegial conversations among members of clinical teams. Planned interactions among team members, facilitated by individuals trained in dialogic techniques, enable health care providers and support staff to share their experiences and expertise, agree on what improvements they would like to make, and test the success of these changes. Participants would be encouraged to express their own suggestions for better practice and disclose strategies that are already working. Dissent would be regarded as an opportunity rather than a barrier. Iterative, sense-making conversations would generate a shared vision, enabling team members to engage in the entire process. Given that practice improvement ultimately depends on frontline providers, we encourage the exploration of innovative engagement strategies that will enable entire clinical teams to develop the collaborative learning skills needed to accomplish their goals.

Teaching children about health: an example of secondary gain in an academic-community partnership.

CONTEXT The Partners in Health Education (PHE) program is an elective that pairs first and second year medical students with local classroom teachers to promote health messages to students in kindergarten through grade eight. Designed with the primary goal of helping medical students improve their communication skills through the process of teaching children about health, the PHE program has secondary goals of supporting community teachers in their efforts to promote health and of teaching children about health and the prevention of disease and injury. This report contains the results of the assessment of program impact on the school children. METHODS A total of 327 elementary grade students in 14 experimental classrooms and 13 comparison classrooms comprised the participants for the study. Students were individually interviewed twice over an eight-week period using a structured interview form designed to capture self-report information about health and healthy living. Repeated measures analysis of variance was conducted. The effect of interest in each case was the treatment x time interaction. RESULTS There were significant treatment x time interactions for several measures of childrens reported knowledge and attitudes about health. DISCUSSION Although designed primarily to help medical students improve their communication skills, the PHE program produced a secondary gain such that elementary students in participating classrooms reported learning more about health than did students in comparison classrooms. Programs such as PHE can provide ways to meet the goal of helping children become empowered to take charge of their own health and to make healthy choices.

Do Lessons Learned in a Training Intervention on Web-Based Health Care Resources Diffuse to Nonexposed Members in the Primary Care Setting? A Comparative Study

Objective The Internet offers a significant information resource for health professionals. A strategy to improve the use of these resources is for health care providers and staff to receive specific training. The aim of this study was to determine whether those who attended an Internet health care resource training intervention transferred knowledge and skills to others in the practice. Methods Twenty-four primary care practices participated in the study in which 64 providers and staff attended a training intervention and 288 did not. A preintervention questionnaire that assessed knowledge, skill, and Internet usage was compared with a postintervention questionnaire. The main effect of interest in the linear model was the group by time interaction term, to determine whether knowledge and skill improved for both groups. Results There were 41 attendees and 222 nonattendees that completed both pre- and postintervention questionnaires. There were 9 variables that showed a possible diffusion pattern, in which both attendees and nonattendees improved between pre- and postintervention. Overall, the training intervention seemed to have impacted knowledge and skills of the respondents and also reported improvements in the clinical area of patient education, but frequency of use for most Web resources for medical decision making did not improve. Conclusion An improvement strategy that depends on a training intervention for a few members in a practice may not necessarily transfer relative to all aspects of patient care.

Health Behavior Research and Medical Training

Despite rapid advances in the technology of the health sciences and in understanding of the basic biology of diseases at the molecular level, most of the disease processes that in the postantibiotic age cause disability and death have behavioral roots. The statistics concerning behavioral risk factors noted in youth are particularly alarming. For example, among American high school students, 73.9% indicated that they had tried smoking by their senior year, while 24.7% admitted to smoking daily over the past month. Furthermore, 48% indicated that they had had at least one alcoholic drink within the past month. With regard to sex, 70% responded that they had had sexual intercourse by their senior year, with 18.5% reporting having had four or more sexual partners. As for suicide, 24% indicated that they had given serious consideration to the thought of suicide over the past year. Finally, 22% indicated that they had carried a weapon in the past month (Kann et al., 1995).