Enhancing Examination Success: the Cumulative Benefits of Self-Assessment Questions and Virtual Patient Cases.

Purpose: Research on the learning benefits of the feedback-rich formative assessment environment of virtual patient cases (VPCs) has largely been limited to single institutions and focused on discrete clinical skills or topical knowledge. To augment current understanding, we designed a multi-institutional study to explore the distinct and cumulative effects of VPC formative assessments and optional self-assessment questions (SAQs) on exam performance. Method: In this correlational study, we examined the records of 1,692 students on their family medicine (FM) clerkship at 20 medical schools during the 2014-2015 academic year. Schools utilized an established online curriculum, which included family medicine VPCs, embedded formative assessments, context-rich SAQs corresponding with each VPC, and an associated comprehensive family medicine exam. We used mixed-effects modeling to relate the student VPC composite formative assessment score, SAQ completion, and SAQ performance to students' scores on the FM final examination. Results: Students scored higher on the final exam when they performed better on the VPC formative assessments, completed associated SAQs, and scored higher on those SAQs. Students' SAQ completion enhanced examination performance above that explained by engagement with the VPC formative assessments alone. Conclusions: This large-scale, multi-institutional study furthers the body of research on the effect of formative assessments associated with VPCs on exam performance and demonstrates the added benefit of optional associated SAQs. Findings highlight opportunities for future work on the broader impact of formative assessments for learning, exploring the benefits of integrating VPCs and SAQs, and documenting effects on clinical performance and summative exam scores.

Contemporary teaching strategies of exemplary community preceptors--is technology helping?

BACKGROUND AND OBJECTIVES: Many schools rely upon community preceptors for office-based education of medical students. These preceptors struggle to balance clinical care with the learning needs of students. We aim to gain a deeper understanding of the teaching rewards and challenges of current community preceptors. METHODS: Five schools' family medicine clerkship directors conducted in-depth interviews of two exemplary preceptors at each of their programs. Following qualitative analysis of the interviews, three directors conducted one focus group at their school. The individual and group interviews were recorded, transcribed, and analyzed using grounded theory. RESULTS: Exemplary community preceptors described strategies to improve the learning environment and specific teaching approaches. Well-known teaching strategies such as role modeling, adjusting instruction to the learner's needs, and selecting patients appropriate for a specific student were used. They also described newer techniques such as co-learning and integrating technology, for example, accessing online, current practice guidelines together with the student. They detailed challenges to teaching, including time constraints and too much content to cover and provided advice about teaching tools. CONCLUSIONS: While challenged by clinical demands, preceptors enjoyed teaching and found it rewarding. They used time-proven teaching strategies as well as technology and online resources to facilitate ambulatory teaching. Community preceptors continue to struggle to integrate learners and the priorities of the medical school curriculum into the clinical environment. Further development of electronic tools and other resources to support the teaching needs of preceptors may contribute to learning and help minimize preceptor burden.

Exercise heart rate monitors for anxiety treatment in a rural primary care setting: a pilot study.

BACKGROUND AND OBJECTIVES: Rural patients with anxiety often lack access to traditional biofeedback modalities. Exercise heart rate monitors (HRMs) are tools used in the fitness industry to provide athletes with feedback on heart rate and regulatory breathing strategies. HRMs are inexpensive, discrete, and publicly accessible. This randomized controlled pilot study explored whether use of HRMs for biofeedback during guided mindfulness, diaphragmatic breathing, and progressive muscle relaxation techniques could facilitate anxiety reduction as compared to these techniques alone. METHODS: Fifty-three rural anxiety patients were randomized to HRM or control groups for four weekly 20-minute, scripted sessions with a non-behaviorist wherein they practiced these techniques; the HRM group received feedback on their heart rate response. RESULTS: The HRM group had significantly greater improvement in state anxiety (State-Trait Anxiety Inventory) and self-efficacy (General Self Efficacy Scale), and a greater percentage of the group indicated that they "felt in control of their anxiety." CONCLUSIONS: This pilot study demonstrates that this novel, inexpensive, and accessible tool may be a useful clinical intervention for anxiety and can be easily incorporated by both behaviorists and non-behaviorist primary care clinicians into individual or group biofeedback treatment for patients with anxiety. This tool has additional potential for patients to use for anxiety self-management. Further study with a larger sample and blinded design is warranted.