Connecting Classrooms, Clinicians, and Community Clinics Through Technology (C4Tech) for Active and Collaborative Learning.

PURPOSE: This pilot study investigated the level of cognition that physician assistant (PA) students achieved through adoption of an innovative blended learning model that connects the classroom, clinicians, and community clinics through electronic-learning (e-learning) technologies (C4Tech) used in a PA course. This education intervention aimed to facilitate authentic learning collaborations between PA students and practicing clinicians that would result in higher-order cognition related to the manifestations of social determinants of health and health disparities. METHODS: A case study approach was adopted to assess levels of cognition and changes in those levels resulting from application of an innovative blended learning model. Content analysis using Bloom's taxonomy of cognitive domains facilitated determination levels of cognition and changes in those levels. The sample of 8 groups comprised 70 PA students and 8 clinical instructors from community clinics with underrepresented patient populations. RESULTS: Analysis of 2 course assignments revealed that application of the C4Tech model yields high levels of cognition. By the course's end, all 8 groups achieved at least the "evaluate" level of cognition and half of the groups achieved the highest level of cognition, the "create" level. A wide variation in the level of cognition was demonstrated between the first and second assignments in each group and among groups. CONCLUSION: Our findings suggest that e-learning technologies can be effective in blending classrooms and work environments for authentic and collaborative learning. Adoption of the C4Tech model yielded higher-order cognition related to course content.

The benefits and challenges of a rural community-based work-ready placement program for allied health students.

INTRODUCTION: Rural and remote Australia has a shortage of allied health clinicians. The provision of quality rural placement experiences for allied health students has been a significant strategy to address these health workforce shortages. Service learning rural placements are providing allied health services in small rural towns where previously allied health services were limited or did not exist. Published literature has little detailed description of the origin or nature of particular placement programs. METHODS: An increase in Commonwealth funding for rural allied health clinical placements led to the development of an innovative service learning placement model in northern New South Wales, the Rural Community-Based Work-Ready Placement Program. During this placement, students were paired for 4-10 full-time weeks in a preschool, school or aged care facility. The program's fundamental properties included cultural and social equity education, providing continuous service throughout the year, and quality improvement initiatives in placement sites. The program was underpinned by an interdisciplinary approach that included interdisciplinary placements, interdisciplinary supervision and a structured interdisciplinary education program. RESULTS: The program required investment in stakeholder engagement and in the alignment of universities' requirements for student learning outcomes and the sites' specific needs. Clinical supervisors had to adapt to supervising students from various disciplines and universities across several sites, towns and services. The program provided students with opportunities to work autonomously, problem-solve and to initiate and implement quality improvement projects at each site. CONCLUSION: Careful selection of students, adequate preparation and management of students' expectations were important contributors to the success of the program. Providing a continuous service is an ongoing logistical challenge.

Development of a System to Measure and Improve Outcomes in Congenital Heart Disease: Heart Institute Safety, Quality, and Value Program.

Achieving excellent outcomes for patients with congenital heart disease requires coordinated effort and resources, and a need has developed for a structure that facilitates improvement and measures cardiac centers' progress toward optimal patient care. METHODS: The Heart Institute (HI) at Cincinnati Children's Hospital developed a Safety, Quality and Value (SQV) program to formalize the use of quality improvement (QI) methods with the goal of optimizing patient outcomes, experience, and value. The SQV program adopted a conceptual framework that considers aspects of structure, process, outcome, and value in defining quality metrics, and the program used the Model for Improvement to guide design and implementation of QI interventions. RESULTS: In the first four years since its inception, the SQV program facilitated important improvements in clinical outcomes, cost reductions, and safety. In addition to achieving measurable improvements, the creation of a formal SQV program fostered a culture of transparency and accountability, providing a new structure for how the HI shares clinical data among clinicians, hospital leadership, and the public. CONCLUSION: The creation of an infrastructure to strategically design, implement, and support QI efforts in a clinically busy pediatric acquired and congenital heart institute was successful in meeting its initial aims and is a promising approach and model for other programs.

Applied Epidemiology Training Needs for the Modern Epidemiologist.

Applied epidemiology training occurs throughout an epidemiologist's career, beginning with academic instruction before workforce entry, continuing as professional development while working, and culminating with mentoring the next generation. Epidemiologists need ongoing training on advancements in the field and relevant topics (e.g., informatics, laboratory science, emerging topics) to maintain and improve their skills. Even epidemiologists with advanced skills often want training on methodologic innovations or to practice a skill. Effective applied epidemiology training includes blended learning components of instruction that incorporate hands-on experiences such as simulations and experiential learning, allowing for real-time workflows and incorporation of feedback. To prepare epidemiologists for the future, public health training courses in applied epidemiology must consider the evolution in public health toward a focus on including informatics, technologic innovation, molecular epidemiology, multidisciplinary teams, delivery of population health services, and global health security. Supporting efforts by epidemiologists to increase their skills as part of their career paths ensures a strong workforce that able to tackle public health issues. We explore how to meet current training challenges for the epidemiology workforce, especially given limited resources, based on research and our experience in workforce development across federal agencies and state/local health departments, as well as with international governments and organizations.

Assessment of medical students' leadership traits in a problem/case-based learning program.

BACKGROUND: Healthcare delivery is shifting to team-based care and physicians are increasingly relied upon to lead and participate in healthcare teams. Educational programs to foster the development of leadership qualities in medical students are needed to prepare future physicians for these roles. OBJECTIVE: Evaluate the development of leadership attributes in medical students during their first 2 years of medical school while participating in leadership training integrated into a problem/case-based learning program utilizing the Leadership Traits Questionnaire assessment tool. DESIGN: Ninety-eight students enrolled at Zucker School of Medicine participated in Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), a hybrid problem/case-based learning program, during the first and second years of medical school. The Leadership Traits Questionnaire, designed to measure 14 distinct leadership traits, was utilized. It was administered to students, peers in students' PEARLS groups and their faculty facilitators. Participants completed questionnaires at three-time points during the study. Likert scale data obtained from the questionnaire was analyzed using a two-level Hierarchal Linear Model. RESULTS: Complete data sets were available for 84 students. Four traits, including self-assured, persistent, determined, and outgoing, significantly increased over time by measurements of both peer and facilitator-rated assessments. Six additional traits significantly increased over time by measurement of facilitator-rated assessment. By contrast, a majority of student self-rated assessments trended downward during the study. CONCLUSIONS: Medical students demonstrated development of several important leadership traits during the first 2 years of medical school. This was accomplished while participating in the PEARLS program and without the addition of curricular time. Future work will examine the impact of third year clerkships on leadership traits.

Progress and assessment of a contextualized teaching session of pharmacology.

BACKGROUND: Learning transfer, in medical teaching, remains an essential question and optimizing it is the main preoccupation of every trainer in medical sciences. Some learning methods showed their efficacy as the contextualized learning in the framework of a professional activity or in a situation recalling it in a realistic manner. AIM: To describe steps of planning and progress of a session of clarification, illustration, application et participation (CIAP) of pharmacology teaching students from second cycle of medical studies (DCEM) and to assess the session. METHODS: We performed a descriptive transversal study in April 2017 in the Faculty of Medicine of Tunis. Our work was composed of two parts. The first part consisted in a description of the preparation and the progress of the CIAP session entitled antiepileptic drugs, which is comprised in the pharmacology teaching of the certificate of Neurology to the students of DCEM. The second part consisted in an assessment of knowledge acquisition and the progress of the session by the students. RESULTS: We proceeded to a planning of the session which resulted in a contextualized teaching and induced an active participation and an interactivity of the students. Comparison of the results of the pretest and the posttest showed a statistically significant difference in terms of good responses. The assessment of the session progress was good. CONCLUSION: Our study demonstrated the feasibility of a session of contextualized teaching session or CIAP of pharmacology and its input in terms of knowledge to the students.

Mi viaje por el Curso de Especialización en Gestión de Políticas de Salud Informadas por Evidencias (ESPIE): como las metodologías activas añadiran para una aprendizaje significativa en la gestión de políticas de salud / My Specialization Course on Health Policy Management Informed by Evidence (ESPIE) travel: how active methodologies stimulate significant learning in health policy management / Minha viagem pelo Curso de Especialização em Gestão de Políticas de Saúde Informadas por Evidências (ESPIE): como as metodologias ativas estimularam uma aprendizagem significativa na gestão de políticas de saúde

Me embarqué en esta experiencia en una etapa de la vida en la cual, según las costumbres hegemónicas, dejase el trabajo para dedicarse a descansar y disfrutar de la vida. Estas reflexiones tratan de la experiencia en el Curso de Especialización en Gestión de Políticas de Salud Informadas por Evidencias-ESPIE. En la partida llevaba un equipaje para permitirme emprender un camino desconocido. En el viaje visité muchos lugares nuevos que, aunque los había escuchado mencionar, pude conocerlos más cabalmente con ayuda de mis compañeros de viaje, entre ellos: el planeamiento estratégico, la gestión de políticas públicas en salud, la búsqueda de la mejor evidencia científica disponible y la metodología constructivista. La integración dialéctica entre teoría y práctica a partir de la problematización de la realidad es lo que me ha permitido encontrar el sentido a mi trabajo.(AU)

I embarked on this experience in a stage of life in which, according to the hegemonic customs, we must leave the labor life to dedicate itself to rest and enjoy the life. These reflections deal with the experience in the Specialization Course on Health Policy Management Informed by Evidence - ESPIE. At the departure I carried a baggage that allowed me to undertake an unknown road. On the trip I visited many new places that, although I had listened about them, I was able to get to know them more thoroughly with the help of my fellow travelers, among them: Strategic planning, health policy management, the search for the best available scientific evidence, and the constructivist methodology. The dialectical integration between theory and practice from the problematization of reality is what has allowed me to find meaning in my work.(AU)

Embarquei nesta experiência em uma etapa da vida na qual, segundo os costumes hegemônicos, devemos sair da vida laboral para dedicar-se a descansar e disfrutar da vida. Estas reflexões tratam da experiência no Curso de Especialização em Gestão de Políticas de Saúde Informadas por Evidências - ESPIE. Na partida levada uma bagagem que me permitiu empreender um caminho desconhecido. Na viagem visitei muitos lugares novos que, embora já houvesse escutado, pude conhecê-los mais cabalmente con a ajuda dos meus companheiros de viagem, entre eles: o planejamento estratégico, a gestão de políticas de saúde, a busca da melhor evidêwncia científica disponível e a metodologia construtivista. A integração dialética entre teoria e prática a partir da problematização da realidade é o que tem me permitido encontrar sentido ao meu trabalho.(AU)

Qualitative Analysis of a Cultural Dexterity Program for Surgeons: Feasible, Impactful, and Necessary.

OBJECTIVES: Ineffective cross-cultural communication contributes to adverse outcomes for minority patients. To address this, the authors developed a novel curriculum for surgical residents built on the principle of cultural dexterity, emphasizing adaptability to clinical and sociocultural circumstances to tailor care to the needs of the individual patient. This study's objective was to evaluate the feasibility, acceptability, and perception of this program upon conclusion of its first year. DESIGN, SETTING, AND PARTICIPANTS: The curriculum was implemented at 3 general surgery programs. The flipped classroom model combined independent study via e-learning modules with interactive role-playing sessions. Sessions took place over 1 academic year. Four focus groups were held, each with 6 to 9 participants, to gain feedback on the curriculum. Focus groups were recorded and transcribed, and the data were analyzed using a grounded theory approach. RESULTS: Five major themes emerged: (1) Role modeling from senior colleagues is integral in developing communication/interpersonal skills and attitudes toward cultural dexterity. (2) Cultural dexterity is relevant to the provision of high-quality surgical care. (3) Barriers to providing culturally dexterous care exist at the system level. (4) "Buy-in" at all levels of the institution is necessary to implement the principles of cultural dexterity. (5) The shared experience of discussing the challenges and triumphs of caring for a diverse population was engaging and impactful. CONCLUSION: Early implementation of the curriculum revealed that the tension between surgical residents' desire to improve their cultural dexterity and systemic/practical obstacles can be resolved. Combining surgically relevant didactic materials with experiential learning activities can change the paradigm of cross-cultural training.

[Reform efforts in dentistry - national and international approaches]. / Reformbemühungen in der Zahnmedizin ­ nationale und internationale Ansätze.

The Study of dentistry in Germany is in need of reform. The actual regulation on licensing dentists in Germany is from 1955, with the last changes made in 1993. Recently there have been different initiatives related to reform: a national catalogue of competency-based learning objectives in dental education (NKLZ), changes and stipulations in the respective rules relating to undergraduate curriculum in dental medicine, and an initiative of the Germany Ministry of Health to tackle and reorganize dental education in Germany.This article presents and reflects on these reform efforts in the context of actual teaching in Germany, Europe, and the United States.The reform process is an opportunity for dental education in German faculties of medicine. New dentistry programs are allowed at all faculties with model educational programs in medicine. Therefore, an example of actual reform efforts are presented based on the experiences of Hamburg. Research on dental educational programs revealed interesting approaches in dental education in other European faculties of medicine. Selected faculties were visited. These experiences led to the formulation of five main goals of reform: interdisciplinary study, problem- and symptom-based learning, early patient contact, science-based education, and communication training. The main goal is a dental education program designed along science-based, prevention-oriented, multidisciplinary, and individualized dental care that contributes to the life-long oral health of patients.

Student Hotspotting: Teaching the Interprofessional Care of Complex Patients.

PROBLEM: Individuals with complex health and social needs drive much of the total cost of care. Addressing these individuals' needs and decreasing costs requires interprofessional teams, called "hotspotters," who engage with communities with high utilization. Training health professions students to succeed in the hotspotting approach may benefit trainees, academic health centers (AHCs), and communities. APPROACH: The Camden Coalition of Healthcare Providers and the Association of American Medical Colleges launched the Interprofessional Student Hotspotting Learning Collaborative in 2014. The goal was to train health professions students working in interprofessional teams at U.S. AHCs to meet the needs of complex patients, providing home visits and intensive case management for up to five patients over six months. The authors report themes from 20 reflections from the five-student Virginia Commonwealth University (VCU) team. OUTCOMES: Across 10 sites, 57 students participated during June-December 2014. The review of the VCU experience demonstrated that the hotspotting program was successful in teaching students how social determinants affect health and the benefits of interprofessional teamwork for addressing the unmet health and social needs of complex patients. Key elements that students identified for improvement were more program structure; protected time for program activities; and formalized processes for recruiting, retaining, and transitioning patients. NEXT STEPS: Future iterations of the program should strengthen the curriculum on caring for complex patients, provide protected time or academic credit, and formally integrate teams with primary care. A larger study evaluating the program's impact on patients, health systems, and communities should be undertaken.

Socially Accountable Medical Education: An Innovative Approach at Florida International University Herbert Wertheim College of Medicine.

PROBLEM: Despite medical advances, health disparities persist, resulting in medicine's renewed emphasis on the social determinants of health and calls for reform in medical education. APPROACH: The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Herbert Wertheim College of Medicine provides a platform for the school's community-focused mission. NeighborhoodHELP emphasizes social accountability and interprofessional education while providing evidence-based, patient- and household-centered care. NeighborhoodHELP is a required, longitudinal service-learning outreach program in which each medical student is assigned a household in a medically underserved community. Students, teamed with learners from other professional schools, provide social and clinical services to their household for three years. Here the authors describe the program's engagement approach, logistics, and educational goals and structure. OUTCOMES: During the first six years of NeighborhoodHELP (September 2010-August 2016), 1,470 interprofessional students conducted 7,452 visits to 848 households with, collectively, 2,252 members. From August 2012, when mobile health centers were added to the program, through August 2016, students saw a total of 1,021 household members through 7,207 mobile health center visits. Throughout this time, households received a variety of free health and social services (e.g., legal aid, tutoring). Compared with peers from other schools, graduating medical students reported more experience with clinical interprofessional education and health disparities. Surveyed residency program directors rated graduates highly for their cultural sensitivity, teamwork, and accountability. NEXT STEPS: Faculty and administrators are focusing on social accountability curriculum integration, systems for assessing and tracking relevant educational and household outcomes, and policy analysis.

Qualitative evaluation of general university requirements in a new 4-year university curriculum: findings based on experiences of students.

Following the North American model, the length of undergraduate program in Hong Kong has been extended from 3 to 4 years since 2012. To maximize the impact of the additional year, The Hong Kong Polytechnic University (PolyU) has implemented a new general education framework entitled "General University Requirements (GUR)" aiming to cultivate students in a holistic manner. This study explored students' impressions of the GUR subjects using a survey collecting primarily qualitative data. Results from 163 students of eight faculties showed that students perceived the GUR subjects favorably. Having opportunities to make new friends from other departments and the teaching and learning methods, particularly experiential learning stimulated students' interest and enriched their learning experiences which were reportedly are unforgettable. Some of the obstacles encountered by students in several subjects were identified. The beneficial effects of the GUR subjects in different domains were voiced by the students.

An evaluation study on a university general education subject in Hong Kong.

This study evaluated a university general education subject on leadership and intrapersonal development ("Tomorrow's Leaders", TL) offered at The Hong Kong Polytechnic University (PolyU) based on an online survey using the Student Feedback Questionnaire (SFQ). At the end of the first semester of the 2013/2014 academic year, 725 Year-1 students completed the online questionnaire. Results showed that the students generally had positive ratings on both the subject attributes and the qualities of teachers. The majority of the participants perceived the subject as beneficial to their holistic development and leadership competencies. Students from the Faculty of Health and Social Sciences (FHSS) and the Faculty of Applied Science and Textiles (FAST) had more favorable evaluation of the subject than students from the Faculty of Construction and Environment (FCE). Students' perceived benefit of the subject was significantly predicted by the subject attributes and teacher attributes. Implications of the findings are discussed.

Analysis of Student Reflections of Experiential Learning in Nursing Health Policy Courses.

This is a content analysis of the reflections of 187 nursing students after experiential learning opportunities in both master's and doctoral level health policy courses. Results show that experiential activities in a health policy class for nursing students increased their knowledge of the legislative process and motivated them to identify newfound intent to become more involved in the political process.

Coding and Billing in Surgical Education: A Systems-Based Practice Education Program.

OBJECTIVE: Despite increased emphasis on systems-based practice through the Accreditation Council for Graduate Medical Education core competencies, few studies have examined what surgical residents know about coding and billing. We sought to create and measure the effectiveness of a multifaceted approach to improving resident knowledge and performance of documenting and coding outpatient encounters. DESIGN: We identified knowledge gaps and barriers to documentation and coding in the outpatient setting. We implemented a series of educational and workflow interventions with a group of 12 residents in a surgical clinic at a tertiary care center. To measure the effect of this program, we compared billing codes for 1 year before intervention (FY2012) to prospectively collected data from the postintervention period (FY2013). All related documentation and coding were verified by study-blinded auditors. SETTING: Interventions took place at the outpatient surgical clinic at Rhode Island Hospital, a tertiary-care center. PARTICIPANTS: A cohort of 12 plastic surgery residents ranging from postgraduate year 2 through postgraduate year 6 participated in the interventional sequence. RESULTS: A total of 1285 patient encounters in the preintervention group were compared with 1170 encounters in the postintervention group. Using evaluation and management codes (E&M) as a measure of documentation and coding, we demonstrated a significant and durable increase in billing with supporting clinical documentation after the intervention. For established patient visits, the monthly average E&M code level increased from 2.14 to 3.05 (p < 0.01); for new patients the monthly average E&M level increased from 2.61 to 3.19 (p < 0.01). CONCLUSIONS: This study describes a series of educational and workflow interventions, which improved resident coding and billing of outpatient clinic encounters. Using externally audited coding data, we demonstrate significantly increased rates of higher complexity E&M coding in a stable patient population based on improved documentation and billing awareness by the residents.

Structure and Management of an Engineering Senior Design Course.

The design of products and processes is an important area in engineering. Students in engineering schools learn fundamental principles in their courses but often lack an opportunity to apply these methods to real-world problems until their senior year. This article describes important elements that should be incorporated into a senior capstone design course. It includes a description of the general principles used in engineering design and a discussion of why students often have difficulty with application and revert to trial and error methods. The structure of a properly designed capstone course is dissected and its individual components are evaluated. Major components include assessing resources, identifying projects, establishing teams, understanding requirements, developing conceptual designs, creating detailed designs, building prototypes, testing performance, and final presentations. In addition to the course design, team management and effective mentoring are critical to success. This article includes suggested guidelines and tips for effective design team leadership, attention to detail, investment of time, and managing project scope. Furthermore, the importance of understanding business culture, displaying professionalism, and considerations of different types of senior projects is discussed. Through a well-designed course and proper mentoring, students will learn to apply their engineering skills and gain basic business knowledge that will prepare them for entry-level positions in industry.

Problem-Based Learning in Biomechanics: Advantages, Challenges, and Implementation Strategies.

Problem-based learning (PBL) has been shown to be effective in biomedical engineering education, particularly in motivating student learning, increasing knowledge retention, and developing problem solving, communication, and teamwork skills. However, PBL adoption remains limited by real challenges in effective implementation. In this paper, we review the literature on advantages and challenges of PBL and present our own experiences. We also provide practical guidelines for implementing PBL, including two examples of PBL modules from biomechanics courses at two different institutions. Overall, we conclude that the benefits for both professors and students support the use of PBL in biomedical engineering education.

Teaching research: a programme to develop research capacity in undergraduate medical students at the University of KwaZulu-Natal, South Africa.

BACKGROUND: Improved research ability is a core competency to achieve in health professionals. The Selectives is a three-year, longitudinal, community-based programme within the undergraduate curriculum which aims to develop research capacity in all medical students during the prescribed curriculum. In relation to the programme, the authors describe the types of studies conducted by students, conditions that facilitated their learning, how the experience improved students' knowledge of research and public health and their development of reflective learning practices. METHODS: A cohort of 212 students completed the Selectives Programme in 2014, and 69 (32 %) completed an anonymous online evaluation thereafter. Data collected include students' perceptions of the research component of Selectives; its impact on their knowledge of research and a documentary analysis of their research protocols and posters. Ethical approval for the ongoing evaluation of the Selectives was sought and obtained from the institutional Biomedical Research Ethics Committee. RESULTS: During Selectives, 75 groups of 2-4 students conducted research studies of primary health care problems in community settings. Each group is assessed on their presentation of research findings as a scientific poster. The Selectives facilitated learning for the majority of the cohort. Students reported positive learning experiences about the research process, including ethics; protocol writing; data processing; dissemination of findings and results; and their use in informing a health promotion intervention. Students reported having gained a better understanding of their strengths and weaknesses through reflective learning from this academic activity. The Selectives is scheduled adjacent to the students' mid-year vacation. This scheduling together with the placement in the students' home community minimizes travel and accommodation costs associated with working outside the academic teaching platform and therefore makes it a cost-effective model in a low resource context. CONCLUSIONS: The Selectives has proven beneficial to develop a range of generic and practical research competencies for a full cohort of students enrolled in the undergraduate medical curriculum. The Selectives research process is integrated with learning about population health and the social determinants of health in a primary health care setting.