A Practical Guide for Building Collaborations Between Clinical Researchers and Engineers: Lessons Learned From a Multidisciplinary Patient Safety Project.

OBJECTIVES: Engineering and operations research have much to contribute to improve patient safety, especially within complex, highly regulated, and constantly evolving hospital environments. Despite new technologies, clinical checklists, and alarm systems, basic challenges persist that impact patient safety, such as how to improve communication between healthcare providers to prevent hospital-acquired complications. Because these collaborations are often new territory for both clinical researchers and engineers, the aim of the study was to prepare research teams that are embarking on similar collaborations regarding common challenges and training needs to anticipate while developing multidisciplinary teams. METHODS: Using a specific patient safety project as a case study, we share lessons learned and research training tools developed in our experience from recent multidisciplinary collaborations between clinical and engineering teams, which included many nonclinical undergraduate and graduate students. RESULTS: We developed a practical guide to describe anticipated challenges and solutions to consider for developing successful partnerships between engineering and clinical researchers. To address the extensive clinical, regulatory, data collection, and laboratory education needed for orienting multidisciplinary team members to join research projects, we also developed and shared a checklist for project managers as well as the training materials as adaptable resources to facilitate other teams' initiation into these types of collaborations. These resources are appropriate and tailorable for orienting both clinical and nonclinical team members, including faculty and staff as well as undergraduate and graduate students. CONCLUSIONS: We shared a practical guide to prepare teams for new multidisciplinary collaborations between clinicians and engineers.

Managing expansions in medical students' clinical placements caused by curricular transformation: perspectives from four medical schools.

Many challenges could occur that result in the need to handle an increase in the number of medical student clinical placements, such as curricular transformations or viral pandemics, such as COVID 19. Here, we describe four different institutions' approaches to addressing the impact of curricular transformation on clerkships using an implementation science lens. Specifically, we explore four different approaches to managing the 'bulge' as classes overlap in clerkships Curriculum leaders at four medical schools report on managing the bulge of core clinical placements resulting from reducing the duration of the foundational sciences curriculum and calendar shifts for the respective clerkship curriculum. These changes, which occurred between 2014 and 2018, led to more students being enrolled in core clinical rotations at the same time than occurred previously. Schools provided respective metrics used to evaluate the effectiveness of their bulge management technique. These data typically included number of students affected in each phase of their curricular transformation, performance on standardized examinations, and student and faculty feedback. Not all data were available from all schools, as some schools are still working through their 'bulge' or are affected by COVID-19. There is much to be learned about managing curricular transformations. Working on such endeavors in a learning collaborative such as the AMA Accelerating Change in Medical Education Initiative provided support and insights about how to survive, thrive and identifying lessons learned during curricular transformation.

Generalizability of Competency Assessment Scores Across and Within Clerkships: How Students, Assessors, and Clerkships Matter.

PURPOSE: Many factors influence the reliable assessment of medical students' competencies in the clerkships. The purpose of this study was to determine how many clerkship competency assessment scores were necessary to achieve an acceptable threshold of reliability. METHOD: Clerkship student assessment data were collected during the 2015-2016 academic year as part of the medical school assessment program at the University of Michigan Medical School. Faculty and residents assigned competency assessment scores for third-year core clerkship students. Generalizability (G) and decision (D) studies were conducted using balanced, stratified, and random samples to examine the extent to which overall assessment scores could reliably differentiate between students' competency levels both within and across clerkships. RESULTS: In the across-clerkship model, the residual error accounted for the largest proportion of variance (75%), whereas the variance attributed to the student and student-clerkship effects was much smaller (7% and 10.1%, respectively). D studies indicated that generalizability estimates for eight assessors within a clerkship varied across clerkships (G coefficients range = 0.000-0.795). Within clerkships, the number of assessors needed for optimal reliability varied from 4 to 17. CONCLUSIONS: Minimal reliability was found in competency assessment scores for half of clerkships. The variability in reliability estimates across clerkships may be attributable to differences in scoring processes and assessor training. Other medical schools face similar variation in assessments of clerkship students; therefore, the authors hope this study will serve as a model for other institutions that wish to examine the reliability of their clerkship assessment scores.

Student Evaluation of Faculty Physicians: Gender Differences in Teaching Evaluations.

PURPOSE: To investigate whether there is a difference in medical student teaching evaluations for male and female clinical physician faculty. METHODS: The authors examined all teaching evaluations completed by clinical students at one North American medical school in the surgery, obstetrics and gynecology, pediatrics, and internal medicine clinical rotations from 2008 to 2012. The authors focused on how students rated physician faculty on their "overall quality of teaching" using a 5-point response scale (1 = Poor to 5 = Excellent). Linear mixed-effects models provided estimated mean differences in evaluation outcomes by faculty gender. RESULTS: There were 14,107 teaching evaluations of 965 physician faculty. Of these evaluations, 7688 (54%) were for male physician faculty and 6419 (46%) were for female physician faculty. Female physicians received significantly lower mean evaluation scores in all four rotations. The discrepancy was largest in the surgery rotation (males = 4.23, females = 4.01, p = 0.003). Pediatrics showed the next greatest difference (males = 4.44, females = 4.29, p = 0.009), followed by obstetrics and gynecology (males = 4.38, females = 4.26, p = 0.026), and internal medicine (males = 4.35, females = 4.27, p = 0.043). CONCLUSIONS: Female physicians received lower teaching evaluations in all four core clinical rotations. This comprehensive examination adds to the medical literature by illuminating subtle differences in evaluations based on physician gender, and provides further evidence of disparities for women in academic medicine.

Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of educational programmes for the self management of asthma in children and adolescents. DATA SOURCES: Databases of the Cochrane Airways Group, PsychINFO, reference lists of review papers, and eligible studies. REVIEW METHODS: Eligible studies were published randomised controlled trials or controlled clinical trials of educational programmes for the self management of asthma in children and adolescents that reported lung function, morbidity, self perception of asthma control, or utilisation of healthcare services. Eligible studies were abstracted, assessed for methodological quality, and pooled with fixed effects and random effects models. RESULTS: 32 of 45 identified trials were eligible, totalling 3706 patients aged 2 to 18 years. Education in asthma was associated with improved lung function (standardised mean difference 0.50, 95% confidence interval 0.25 to 0.75) and self efficacy (0.36, 0.15 to 0.57) and reduced absenteeism from school (-0.14, -0.23 to -0.04), number of days of restricted activity (-0.29, -0.33 to -0.09), and number of visits to an emergency department (-0.21, -0.33 to -0.09). When pooled by the fixed effects model but not by the random effects model, education was also associated with a reduced number of nights disturbed by asthma. The effect on morbidity was greatest among programmes with strategies based on peak flow, interventions targeted at the individual, and participants with severe asthma. CONCLUSIONS: Educational programmes for the self management of asthma in children and adolescents improve lung function and feelings of self control, reduce absenteeism from school, number of days with restricted activity, number of visits to an emergency department, and possibly number of disturbed nights. Educational programmes should be considered a part of the routine care of young people with asthma.