A High-Value Care Curriculum Using Individual and Group Structured Reflection.

OBJECTIVE: One-third of all healthcare dollars are wasted, primarily in the form of clinician-ordered unnecessary diagnostic tests and treatments. Medical education has likely played a central role in the creation and perpetuation of this problem. We aimed to create a curriculum for medical students to promote their contribution to high-value care conversations in the clinical environment. METHODS: At a large university medical center between March 2017 and February 2018, we implemented a 3-phase curriculum combining multimodal educational initiatives with individual and group reflection for third-year medical students during their 12-week long Internal Medicine clerkship rotation. Students were asked to identify examples of clinical decision making that lacked attention to high-value care, propose solutions to the identified situation, and pinpoint barriers to the implementation of effective solutions using a structured reflection framework and then participate in a debrief debate with fellow students. To assess the curriculum, reflective narratives were coded by frequency and codes were compared with one another and with relevant high-value care literature to identify patterns and themes. RESULTS: In total, 151 medical students participated in phase 1 and 119 in phase 3. For phase 2, 126 reflective narratives (94.7% participation rate) comprised 226 problems, 280 solutions, and 179 barriers. CONCLUSIONS: When provided appropriate resources, medical students are able to identify relevant examples of low-value care, downstream solutions, and barriers to implementation through a structured reflection curriculum comprising written narratives and in-person debate.

Incorporating a Microlearning Wellness Intervention Into Nursing Student Curricula.

BACKGROUND: Cultivating healthy lifestyle beliefs (HLBs) can result in positive health outcomes for students during their nursing program. PURPOSE: The purpose of the study was to determine the effectiveness of short wellness interventions (microlearning) in nursing courses on reducing stress and anxiety and enhancing HLB. METHODS: Microlearning wellness interventions were offered to graduate and undergraduate nursing students in this cluster randomized intervention study. The Perceived Stress Scale 4, Generalized Anxiety Disorder 7, and Healthy Lifestyle Beliefs Scales were administered. Student perceptions were evaluated using a short answer narrative. RESULTS: The intervention group reported higher HLB (P = .15), lower anxiety (P = .06), and lower stress (P = .06) compared with the control group after adjusting for baseline differences. Student comments were favorable and included enjoying the activities, weight loss success, and mindfulness strategies. CONCLUSIONS: Incorporating wellness interventions into nursing curricula demonstrates a positive trend toward reducing anxiety and stress and improving HLB.

Visual Arts in Nursing Education: An Inventive Interprofessional Initiative to Cultivate Metacognitive Awareness in Beginning Nursing Students.

PURPOSE: To test an interdisciplinary art-based educational program for beginning baccalaureate traditional and accelerated nursing students. DESIGN: Longitudinal study (Pretest-Posttest) of nursing students' metacognitive awareness. METHOD: As part of a first-semester foundations nursing course, all students participated in the Art of Nursing program consisting of three 90-minute sessions led by graduate Art Education students in a local fine arts museum. Before and after the program, subcomponents of critical thinking were assessed using the Metacognitive Awareness Inventory (MAI). FINDINGS: A total of 218 students (56 traditional, 162 accelerated) participated. Statistically significant improvement was observed on seven components of the MAI. Although significant increases were observed for Declarative (p < .0001), Planning (p < .0001), and Comprehension Monitoring (p < .0001), the differences pre to post were of different magnitudes between the student groups, characterizing a large change in the traditional versus accelerated group. CONCLUSIONS: Our results suggest that (1) nursing students' metacognitive awareness benefits from the museum-based experience despite demographic and educational differences and (2) overall the accelerated student group has exhibited higher metacognitive awareness at baseline as compared with the traditional student group; however, both groups demonstrate significant growth in this area after experiencing an art-based program.

Student midwives' knowledge, skills and competency in relation to the active management of the third stage of labour: A correlational study.

BACKGROUND: Lesotho has been experiencing health challenges as indicated by its high maternal mortality ratio of 620 per 100 000 live births for the year 2010, which has been linked to its limited human resources. OBJECTIVES: The knowledge and skills of final-year student nurse-midwives related to the active management of the third stage of labour were determined. METHOD: A quantitative, descriptive survey design was used to conduct this study with 99 final-year midwifery students at four nursing schools in Lesotho using stratified sampling. The structured questionnaire collected data on the knowledge and self-reported competency. Subsequently, the controlled cord traction marks, extracted from the objective structured clinical examination (OSCE), were compared to the self-reported competency of these midwifery students using R software version 3.4.0. RESULTS: The mean score for knowledge and the OSCE was 73.8% (n = 99) and 77.2% (n = 99), respectively. The majority of respondents (95.2%, n = 99) rated themselves highly in terms of the active management of the third stage of labour competency. There was no correlation between the self-reported competency and knowledge (r = 0.08, p = 0.4402), and self-reported competency and OSCE scores (r = -0.004, p = 0.01). CONCLUSION: The high mean scores for the knowledge and the OSCE indicate that the theoretical component of the curriculum on the active management of the third stage of labour was effective in equipping final-year midwifery students with knowledge and skills to carry out this competency.

Mindful medical practice: An innovative core course to prepare medical students for clerkship.

BACKGROUND: Medical students show a decline in empathy and ethical reasoning during medical school that is most marked during clerkship. We believe that part of the problem is that students do not have the skills and ways of being and relating necessary to deal effectively with the overwhelming clinical experience of clerkship. APPROACH: At McGill University in Montreal, starting in January 2015, we have taught a course on mindful medical practice that combines a clinical focus on the combination of mindfulness and congruent relating that is aimed at giving students the skills and ways of being to function effectively in clerkship. The course is taught to all medical students in groups of 20, weekly for 7 weeks, in the 6 months immediately prior to clerkship, a time when students are very open to learning the skills they need to take effective care of patients. EVALUATION: The course has been well accepted by students as evidenced by their engagement, their evaluations, and their comments in the essays that they write at the end of the course. In a follow-up session at the simulation centre one year later students remember clearly and enact what they were taught in the course. REFLECTION: The next steps will be to conduct a formal evaluation of the effect of our teaching that will involve a combination of qualitative methods to clarify the nature of the impact on our students and a quantitative assessment of the difference the course makes to students' experience and performance in clerkship.

Are Councils on Chiropractic Education expectations of chiropractic graduates changing for the better: a comparison of similarities and differences of the graduate competencies of the Chiropractic Council on Education-Australasia from 2009 to 2017.

BACKGROUND: The Council on Chiropractic Education Australasia (CCE-A) is tasked with assessment and accreditation of chiropractic programs (CPs) in the Australasian community. To achieve this process the CCE-A has developed educational standards and graduate competencies which include minimum expectations of graduates prior to entry into the workforce. We sought to explore if these are changing overtime, and if so are these changes for the better. METHOD: The CCE-A 2009 and 2017 Competency Standards were located and downloaded. The competencies were placed into tables for a comparative analyses in a systematic manner to enable the identification of similarities and differences. In addition, word counts were conducted for the most commonly occurring words and this took place in December 2019. RESULTS: The 2017 competency standards were over three times smaller than the previous standards 2009 standards. More similarities than differences between the old and the new standards were found. There were 18 additions to the 2017 graduate competencies with many that were in unison with contemporary aspects of healthcare such as patient centred-care, respect for practitioner-patient boundaries and patient sexual orientation, transitioning patients to self-management, and consideration of improving lifestyle options. Some competencies were not bought forward to the new standards and included, among others, students being competent in screening for mental health conditions, an expectation to discuss cost of care, re-evaluating and monitoring patients at each visit, and knowing when to discharge patients. The competencies continued to be silent on known issues within the chiropractic profession of a lack of a definition for chiropractic that would inform scope of practice and the presence of vitalism within CPs. CONCLUSION: There have been positive changes which reflect contemporary mainstream health care standards between CCE-A graduate competency revisions. The absence of a clear definition of chiropractic and its attendant scope of practice as well as continued silence on vitalism reflect known issues within the chiropractic profession. Recommendations are made for future accreditation standards to inform the required competencies and aid the integration of chiropractic into the broader health care community.

Considerations for the incorporation of mindfulness into pharmacy education.

INTRODUCTION: A range of approaches are needed to bolster the mental health and well-being of pharmacists and student pharmacists. COMMENTARY: In recent years, medical and nursing educators have been training students to use mindfulness-oriented meditation (MOM) techniques such as Mindfulness-Based Stress Reduction (MBSR) for mental health, wellness, and greater attention and presence. MOM training should be considered for incorporation into pharmacy education. Mindfulness can be included in the pharmacy curriculum in a variety of ways. These include introducing students to the topic didactically, encouraging and facilitating students to take an MBSR course, workshop, or online self-study, and integrating mindfulness through mindful moments during critical educational activities like product verification and communication assessments. IMPLICATIONS: Mindfulness may be a valuable skill for student pharmacists, thus we encourage schools to expose students to the concepts of mindfulness and MOM techniques like MBSR. Additionally, more robust and rigorous research is needed to better understand the effects of MOM in different settings and contexts.

Technical Simulation Using Goldfish Bowl Method: A Medical Teaching Method for Increasing Student's Creativity.

BACKGROUND: Promoting students' creative thinking with new techniques is important in order to foster innovation in a pleasant educational atmosphere. This study aimed to determine the effect of technical simulation using Goldfish Bowl (GFB) method on creative thinking of midwifery students in Tehran University of Medical Sciences. METHODS: During 2015-2016, 70 students in two groups (n = 35 midwifery students in each group) were enrolled in this study and educational intervention was conducted on one of the groups. The intervention was the new GFB method. The students' creative thinking was assessed using Dr. Abedi's standardized creative thinking questionnaire in both groups before and after the intervention and in one-month follow-up. The results were gathered and entered into the SPSS software version 16. For data analysis, descriptive and analytical statistical tests were used to compare the scores of three stages of creative thinking, and variance analysis in the intervention and control groups with the significant level of 0.05. RESULTS: There were no significant differences between the results of the two groups before the intervention. The statistical results showed changes at different levels after intervention, indicating an improvement in the students' creative thinking. The mean score of creative thinking was 70.71 ± 15.75 before the intervention, 80.40 ± 14.68 at the end of the eighth week of the intervention, and 72.09 ± 14.98 in the follow-up. The effect size of this technique on creative thinking was 0.91 in week 8. CONCLUSION: The use of Goldfish Bowl technique in teaching medical students is recommended to promote their creative thinking.

Simulation in midwifery education: A descriptive explorative study exploring students' knowledge, confidence and skills in the care of the preterm neonate.

Undergraduate midwifery programs across Australia have embedded simulation into their curriculum although there is limited but emerging evidence to support the use of simulation as an effective teaching strategy. The purpose of this study was to evaluate the impact that a simulated learning activity (insertion and management of a neonatal nasogastric tube), had on midwifery students' knowledge, confidence and skills post-simulation, and on completion of a clinical placement. A descriptive explorative study was undertaken in two phases. Phase 1: Midwifery students (n = 60) completed a purpose-designed questionnaire to assess their knowledge, confidence and skills, pre and post simulation. Phase 2: Students (n = 46) repeated the questionnaire to reassess their knowledge, confidence and skills after the completion of a neonatal nursery placement. The findings demonstrate that simulation is an effective learning strategy in an undergraduate midwifery program. Students' knowledge, confidence and skills increased significantly post-simulation activity (p0.001). A further increase in these areas was noted post-placement. Key aspects that contributed to student learning included; the demonstrators' level of knowledge, expertise and currency of practice, as well as the role the student assumes in the simulation activity.

Assessing the Role of Screencasting and Video Use in Anatomy Education.

The subject of anatomy, commonly taught with applied clinical focus on medical programmes, is frequently brought to life alongside art, imagery and visualization. Yet, despite being continually hailed as the cornerstone of medicine, the cyclic revalidation of its curricula has often found its educators in the unenviable position of maintaining knowledge standards in the face of reduced contact time. However, the gravity of such challenges has created an opportunity for creative and innovative solutions to these problems. The ease by which educational technology can now be used by non-experts is constantly increasing and the use of technology enhanced learning has now become universal within Higher Education. Many anatomical science educators have turned to building bespoke interactive and engaging online supplementary material which can be blended with face to face delivery as a way to circumvent the time pressure issues. Today's students appear to have a growing preference for visualising moving images and audio explanations as opposed to older traditional static resources, underpinned by vast pages of unattractive dense text and pictures. One such technique being used to provide flexible and student-centred learning is screencast videos. These digital recordings of screen captured drawings, with accompanying narration are overwhelmingly popular with students and on the ascendance. However, as new tools emerge, it becomes increasingly important to determine their impact on both the student experience and knowledge gain. It is also valuable for educators to share their classroom experiences or instructional techniques to optimise their use for learning. This chapter explores the rise of this application in anatomy education and discusses the evidence available investigating student engagement and learning outcomes in the context of well-established learning theories.

Culinary Medicine Basics and Applications in Medical Education in the United States.

Culinary medicine is an evidence-based field of medicine that combines nutrition science and culinary arts to create food that is delicious, promotes wellness, prevents and treats disease. Historically, nutrition education has been limited to fewer than 20 hours in the preclinical years of undergraduate medical education, focused on nutrients rather than food, and largely separated from the clinical experience. Programs at all levels of medical training are introducing culinary medicine educational opportunities to bridge this gap in practical nutrition knowledge and skills to better prepare physicians to help their patients make healthy dietary changes. These courses have an added benefit of helping physicians improve their own diets, which may improve personal health and help them to prevent burnout. Culinary medicine courses are diverse in their organization, class duration and number, format, type of instructor(s), location, and dietary strategy employed. This flexibility means that nearly any medical practice or educational setting can provide some amount of culinary medicine content if institutional support exists. Given the increasing prevalence of diet-related diseases, demand for culinary medicine courses will likely continue to grow.

Integrating Medical Humanities into medical school training.

Medical teaching must include new knowledge and technologies and how these affect patient care. The Medical Humanities can contribute to a more holistic and caring view of health and disease.

Active Learning on Center Stage: Theater as a Tool for Medical Education.

Introduction: Knowledge and skill development related to communication must incorporate both affective and behavioral components, which are often difficult to deliver in a learning activity. Using theater techniques and principles can provide medical educators with tools to teach communication concepts. Methods: This 75-minute faculty development workshop presents a variety of techniques from theater and adapts them for use in medical education. Using examples related to diversity and inclusion, this session addresses general educational and theater principles, role-play, sociodrama, applied improvisation, and practical aspects of involving theater partners. The session materials include a PowerPoint presentation with facilitator notes, interactive activities to demonstrate each modality, and an evaluation. The sessions can be extended to longer formats as needed. Results: Forty-five participants at Learn Serve Lead 2016: The AAMC Annual Meeting attended the 75-minute session. We emailed 32 participants 5 months after the conference, and eight responded. Participants reported that their confidence level in using theater techniques as a tool for medical education increased from low-to-medium confidence presession to high confidence postsession. All survey respondents who were actively teaching said they had made changes to their teaching based on the workshop. All commented that they appreciated the active learning in the session. Many indicated they would appreciate video or other follow-up resources. Discussion: Principles and techniques from theater are effective tools to convey difficult-to-teach concepts related to communication. This workshop presents tools to implement activities in teaching these difficult concepts.

From "Coordinated" to "Integrated" Residency Training: Evaluating Changes and the Current State of Plastic Surgery Programs.

BACKGROUND: Since the inception of the integrated model, educational leaders have predicted its ongoing evolution, as the optimal plastic surgery curriculum remains a source of debate. With the now complete elimination of the "coordinated" pathway, the total number of integrated programs has arguably reached a plateau. Accordingly, this study examines the current state of training in integrated residencies and reevaluates the variability in the first 3 years of training observed previously. METHODS: Program information was obtained for all 68 integrated plastic surgery programs, and rotation schedules were available for 59. Plastic, general, and subspecialty surgery exposures were quantified and compared. Inclusion of rotations "strongly suggested" by the Residency Review Committee was also examined. RESULTS: Plastic surgery exposure ranged from 3.5 to 25 months (mean, 13.9 ± 5.4 months). General surgery ranged from 5 to 22.5 months (mean, 12.8 ± 4.7 months). Subspecialty rotations ranged from 0 to 8 months (mean, 3.6 ± 1.8 months). There was no difference in mean plastic surgery exposure between programs based within departments versus divisions (15.4 months versus 13.3 months; p = 0.184). There remained significant variability in the inclusion of 18 non-plastic surgery rotations, including the "strongly suggested" rotations. CONCLUSIONS: Plastic surgery exposure remains highly variable with a greater than 7-fold difference between programs. This suggests that programs are still sorting out the ideal curriculum. However, there is an overall trend toward earlier and increased plastic surgery exposure, which now exceeds the average time spent on general surgery rotations.

Integrating Spiritual Care During Interprofessional Simulation for Baccalaureate Nursing Students.

Interprofessional educational experiences for baccalaureate nursing students are essential to prepare them for interprofessional communication and collaborative interprofessional teamwork. The aim of this descriptive qualitative study was to understand the experience of baccalaureate nursing students utilizing the hospital chaplain while caring for a suicidal patient in the emergency department during simulation. The need for interprofessional education is documented in the literature, but there are very few comprehensive, successful projects integrating spiritual care for nurse educators to use as models. This project can serve as a model of a successful interprofessional education initiative involving preprofessional nursing students and chaplain services. Overall, nursing students found the learning experience to be beneficial in preparation for professional practice on a collaborative interprofessional health care team.

Evaluation of medical marijuana topics in the PharmD curriculum: A national survey of schools and colleges of pharmacy.

INTRODUCTION: To summarize the status of medical marijuana instruction in the PharmD curriculum and capture future plans for the incorporation of medical marijuana content. METHODS: One hundred and forty United States schools and colleges of pharmacy were contacted to complete an anonymous survey regarding inclusion of medical marijuana topics in their curriculum, future plans for inclusion, and evaluation of perceived importance of specific topics. RESULTS: Forty nine percent (68/140) of schools and colleges completed the survey and 62% (44/68) include medical marijuana content in their curriculum. Of the schools and colleges that do not include it, 23% (6/26) plan to incorporate medical marijuana topics within the next 12 months. In regards to perceived importance of specific topics related to medical marijuana, all topics received a median score of three on a scale of one to five, with one being of high importance. CONCLUSION: With more states legalizing medical marijuana, schools and colleges of pharmacy need to evaluate inclusion of medical marijuana topics in their curriculum to prepare student pharmacists to effectively care for patients using this product.

Turning a blind eye and a deaf ear to traditional and complementary medicine practice does not make it go away: a qualitative study exploring perceptions and attitudes of stakeholders towards the integration of traditional and complementary medicine into medical school curriculum in Uganda.

BACKGROUND: A substantial proportion of healthcare professionals have inadequate understanding of traditional and complementary medicine and often consider their use inappropriate. METHODS: We conducted a qualitative study to understand the perceptions and attitudes of medical students, medical school faculty and traditional and complementary medicine practitioners. In-depth interviews and focus group discussions were used to collect data. Thematic approach was used in data analysis to identify emerging themes and sub themes. Data analysis was supported with use of Atlas.ti v6.1.1. RESULTS: The majority of participants commended the inclusion of traditional and complementary medicine principles into medical school curricula. The main reasons advanced were that: patients are already using these medicines and doctors need to understand them; doctors would be more accommodating to use and not rebuke patients, thereby minimizing delays in care due to pursuit of alternative therapies; promote patient safety; foster therapeutic alliance and adherence to therapy; uphold patients' right to self-determination; lead to discovery of new drugs from traditional medicines; and set ground for regulation of practices and quality control. However, participants anticipated operational and ethical challenges that include inadequate number of faculty to teach the subject, congested curricula, increased costs in research and development to produce evidence-base data, obstruction by pharmaceutical companies, inaccessibility to and depletion of medicinal plants, and potential conflicts due to diversity in culture and values. A substantial minority of participants thought traditional medicine need not be taught in medical schools because there is lack of scientific evidence on efficacy, safety, and side effects profiles. These shortfalls could make the determination of benefits (beneficence) and harm (maleficence) difficult, as well as compromise the ability of physicians to adequately disclose benefits and harms to patients and family, thereby undermining the process of informed consent and patient autonomy. CONCLUSIONS: Training medical students in principles of traditional and complementary medicine is considered reasonable, feasible, and acceptable; and could lead to improvement in health outcomes. There are anticipated challenges to implementing a hybrid medical school curricula, but these are surmountable and need not delay introducing traditional and complementary medicine principles into medical school curricula in Uganda.

Design and delivery of a new clinical reasoning course.

BACKGROUND AND PURPOSE: Teaching students therapeutic knowledge is not the same as teaching them how to reason through clinical problems. It was determined a new approach was necessary to close the gap between classroom learning and clinical application. EDUCATIONAL ACTIVITY AND SETTING: A stand-alone clinical reasoning course was developed to enhance students' ability to think about and solve clinical problems. This course involved a variety of active-learning strategies based upon literature regarding clinical reasoning. FINDINGS: The objective of this study was to determine if a clinical reasoning course influenced student perceptions on evolution of their thinking and learning strategies and ways to improve. Thematic analysis of midpoint student reflections (n = 133) revealed eight different themes of how students perceived evolution of their thinking. Top themes were approaching a problem (n = 76), evaluating information (n = 62), and efficiency (n = 44). Thematic analysis of final student reflections (n = 138) included two categories: thinking and improvement. Reflections related to evolvement of thinking revealed five themes, the top three of which were approaching a problem (n = 89), holistic (n = 55), and efficiency (n = 46). Reflections of improvement revealed four themes, the top two of which were continue applying (n = 74) and communication (n = 23). DISCUSSION: The themes indicate that students began to understand clinical reasoning as a set of skills necessary to become an effective practitioner. CONCLUSIONS: A novel course designed to develop clinical reasoning skills can help students evolve their perception of thinking and learning strategies and engage them in a process for the application of knowledge to patient care.

Integrating spiritual care into nursing education and practice: Strategies utilizing Open Journey Theory.

Throughout nursing, spirituality is a recognized domain of patient care, but nurses feel ill prepared by their nursing education to provide care that is spiritual in nature to patients and their families. Incorporating spiritual care into nursing curricula is challenging in light of the amount of topics for healthcare learning. Open Journey Theory is based on the merging of two grounded theories, one teaching and one learning theory, and is the suggested framework for integrating spirituality and spiritual care across all levels of nursing education. Specially chosen readings (books, articles), activities (role-plays, discussion groups), and assignments (journaling, writing papers, giving reports) can be integrated into already existing courses. By utilizing the three stages of preparing, connecting, and reflecting to frame student learning, nurse educators can introduce and build on spiritual concepts from the simple to the complex over the course of the entire nursing program.