An online evidence based medicine exercise prompts reflection in third year medical students.

BACKGROUND: Reflective practice is a desirable trait in physicians, yet there is little information about how it is taught to or learned by medical students. The purpose of this study was to determine whether an online Evidence Based Medicine (EBM) exercise with a face-to-face debriefing session would prompt third year medical students to reflect on their current skills and lead them to further reflection on clinical decision making in the future. METHODS: All third year medical students at the University Of Maryland School Of Medicine who completed their pediatrics clerkship between 7/1/09 and 2/11/11 were required to complete the EBM exercise. Following completion each student received a personal report (Learning Profile) of their responses and attended a one hour large group debriefing session. Student responses to a survey following the debriefing sessions were analyzed using a post-test survey design with a single experimental cohort. RESULTS: Ninety-five percent of students completing the debriefing survey indicated that the debriefing session helped them better understand their learning profiles; 68% stated that their profiles allowed them to evaluate themselves and their decisions. Sixty-three percent noted that participating in the exercise and the debrief would lead them to either learn more about EBM and use EBM more in the future or reflect more on their own decision making. CONCLUSIONS: The EBM exercise was a successful way to introduce the concept of reflective practice to third year medical students, and the graphic Learning Profiles were effective instigators of discussion and reflection.

Interrater reliability of an oral case presentation rating tool in a pediatric clerkship.

BACKGROUND: Composing and delivering effective oral case presentations is an important skill for medical students to learn, but the large variety of patients and presenting problems makes teaching and evaluating this skill complex. Few published tools are available for educators to use, and those that are described are not well studied. PURPOSE: The authors describe the development of the Patient Presentation Rating tool and the study to establish its interrater reliability. METHODS: Three raters reviewed 15 recorded new patient presentations delivered by 3rd-year medical students on their pediatrics clerkship. Intraclass correlation coefficients were used to determine the interrater reliability of the tool as a whole, its subsections, and each individual item. RESULTS: The tool was found to reliably rate the technical aspects of presenting patients as well as several aspects of clinical reasoning embedded in that process. CONCLUSIONS: The Patient Presentation Rating tool is a reliable instrument for evaluating medical students' oral patient presentations.

Synchronous virtual interprofessional education focused on discharge planning.

COVID-19 required innovative approaches to educating health professions students who could no longer attend in-person classes or clinical rotations. Interprofessional education (IPE) activities were similarly impacted. To replace an in-person IPE activity slated for this spring, nursing and medical students with similar levels of clinical experience came together to attend a synchronous virtual session focused on discharge planning. The class objectives focused on the IPEC competencies of Role/Responsibility and Interprofessional Communication. Discussion revolved around the discharge planning process for an elderly patient with multiple medical problems, as this is a time when interprofessional collaboration has a clear benefit to patients. Twenty-eight nursing students and eleven medical students attended a 90 min session via Zoom. Students received pre-readings, the day's agenda, learning objectives, and discussion questions in advance. The session had three sections: introduction/welcome, breakout sessions, and debrief and evaluation. Four faculty leaders and four students who participated in a similar in-person session in the past served as facilitators. They received a supplemental facilitator guide for use if students were not able to sustain their discussions for the allotted time. Materials can be accessed by contacting the corresponding author (BR). Students completed a post-session survey, and qualitative analysis demonstrated that they had addressed the two relevant IPEC competencies in their groups and showed evidence of touching on the additional two IPEC competencies as well. Overall, they enjoyed the experience. This virtual experience made scheduling simpler than planning an in-person session and allowed this activity to occur despite restrictions secondary to the pandemic. This might remain a useful format for similar sessions in the future.

Improving education in primary care: development of an online curriculum using the blended learning model.

BACKGROUND: Standardizing the experiences of medical students in a community preceptorship where clinical sites vary by geography and discipline can be challenging. Computer-assisted learning is prevalent in medical education and can help standardize experiences, but often is not used to its fullest advantage. A blended learning curriculum combining web-based modules with face-to-face learning can ensure students obtain core curricular principles. METHODS: This course was developed and used at The Case Western Reserve University School of Medicine and its associated preceptorship sites in the greater Cleveland area. Leaders of a two-year elective continuity experience at the Case Western Reserve School of Medicine used adult learning principles to develop four interactive online modules presenting basics of office practice, difficult patient interviews, common primary care diagnoses, and disease prevention. They can be viewed at (http://casemed.case.edu/cpcp/curriculum). Students completed surveys rating the content and technical performance of each module and completed a Generalist OSCE exam at the end of the course. RESULTS: Participating students rated all aspects of the course highly; particularly those related to charting and direct patient care. Additionally, they scored very well on the Generalist OSCE exam. CONCLUSION: Students found the web-based modules to be valuable and to enhance their clinical learning. The blended learning model is a useful tool in designing web-based curriculum for enhancing the clinical curriculum of medical students.

Minding the Form That Transforms: Using Kegan's Model of Adult Development to Understand Personal and Professional Identity Formation in Medicine.

The formation of a physician's professional identity is a dynamic process shaped by and intertwined with the development of that person's larger adult identity. Constructive-developmentalist Robert Kegan's model of adult development describes four mental lenses used for meaning-making and the trajectory through which they transform over time. These lenses determine the way people take in and integrate complex influences into forming their adult identities.When people use a particular lens to construct meaning, Kegan describes them as being "subject" to that lens: The lens "has them," and they are unaware of the ways it shapes their world. Transformations occur when individuals are able to take a lens to which they were subject and regard it objectively. Kegan's lenses that are relevant to medical educators are called instrumental-focused on rules and rewards; socialized-attending to social norms and expectations; self-authoring-seeking to build internal values; and self-transforming-seeing gaps in one's closely held value systems and being open to those of others.When individuals have difficulty facing current challenges, they begin to grow a more complex lens. Subsequent lenses bring the ability to deal with more complexity but also bring their own challenges. Familiarity with Kegan's model can help educators provide more effective support to groups of learners as well as individuals, support learners' transformational growth through the challenging situations inherent in medical education, and supply a common language for many important areas of medical education, including competencies and entrustable professional activities, remediation, leadership development, and curriculum planning.

UME-21 and teaching ethics: a step in the right direction.

BACKGROUND AND OBJECTIVES: Ethics education for medical students has included a number of relatively vague descriptions of appropriate curricular objectives, but medical schools struggle with the general teaching of ethics, as well as with presenting the ethical dilemmas posed by managed care. This paper proposes some standards and uses them to analyze the general and managed care ethics content of the Undergraduate Medical Education for the 21st Century (UME-21) curricula. METHODS: We analyzed progress and final reports from each school to define their learning objectives, content, teaching methods, and evaluation strategies in ethics. Each was evaluated using principles of adult learning and Rest's Four Component Model of Moral Development. Good examples of curricular elements from participating schools are described. RESULTS: Ethics curricula varied widely among the schools. Goals and objectives were often stated in generalities. Teaching methods were diverse and innovative, and several new combinations of learning activities were created to highlight ethics topics. Content represented managed care and non-managed care topics in varying proportions. Student surveys of attitudes toward managed care and opinions of the ethics programs were the most commonly used as evaluation tools. Some schools were able to develop more direct means of evaluating student learning. The Four Component Model was not fully addressed in the programs developed by the participating schools. CONCLUSIONS: We make recommendations about the objectives, teaching methods, content, and evaluation methods of an ideal medical school curriculum in ethics.

"BreastfeedingBasics": web-based education that meets current knowledge competencies.

BACKGROUND: The United States has not met the majority of the Centers for Disease Control and Prevention goals for breastfeeding duration. Studies have shown a lack of knowledge about breastfeeding by health care professionals and students (HCP/S). Web-based education can be a cost-effective manner of education for HCP/S. "BreastfeedingBasics" is an online free educational program available for use. AIMS: This study compares information in "BreastfeedingBasics" to the breastfeeding knowledge competencies recommended by the US Breastfeeding Committee (USBC). It also evaluates usage of "BreastfeedingBasics" by users and health care professional faculty. METHODS: Using anonymous information from Web site users, the authors compared mean pre-test and post-test scores of the modules as a measure of the knowledge gained by HCP/S users. They evaluated usage by demographic information and used a Web-based survey to assess benefits of usage of "BreastfeedingBasics" to faculty. RESULTS: Overall, 15 020 HCP/S used the Web site between April 1999 and December 2009. "BreastfeedingBasics" meets 8 of the 11 USBC knowledge competencies. Mean post-test scores increased (P < .001) for all modules. Faculty reported its benefits to be free, broad scope, and the ability to be completed on the students' own time; 84% of the faculty combined the use of "BreastfeedingBasics" with clinical work. CONCLUSIONS: Use of "BreastfeedingBasics" can help HCP/S meet the USBC core breastfeeding knowledge competencies and gain knowledge. Faculty are satisfied with its use. Wider use of "BreastfeedingBasics" to help improve the knowledge of HCP/S may help in improving breastfeeding outcomes.

An Internet-based education program improves breastfeeding knowledge of maternal-child healthcare providers.

BACKGROUND AND OBJECTIVES: Breastfeeding rates in the United States remain below the Surgeon General's Healthy People 2010 goals. Encouragement of breastfeeding and education by maternal-child healthcare (MCH) providers (physicians, residents, and midlevel providers) improves breastfeeding initiation and duration. Surveys of MCH providers show lack of knowledge about breastfeeding. This study evaluated the effect of usage of "BreastfeedingBasics," a free Internet-based educational course, on the knowledge of MCH providers and evaluation of the baseline knowledge of course users. METHODS: A before and after intervention study was done of MCH providers using the "BreastfeedingBasics" website between 1999 and 2008. Baseline knowledge and change in knowledge were assessed by computer-scored pretests and posttests. RESULTS: Of 3,456 MCH providers enrolled, 2,237 (65%) completed one or more pretest. Total mean pretest/posttest scores were as follows: midlevel providers, 81%/89%; residents, 84%/93%; and physicians, 85%/92% (p < 0.001 among groups and between pretests and posttests). Mean pretest/posttest scores of the modules were as follows: Anatomy/Physiology, 79%/93%; Growth/Development, 72%/91%; Mother-Infant Couple (normal newborn), 82%/92%; and Breastfed Infant with Problems, 77%/91% (p < 0.001 for all). Specific topics with the lowest pretest scores and subsequent posttest scores were as follows (pretest/posttest): supplementation with vitamin D, 61%/93%; breastfeeding physiology, 38%/65%; growth of breastfed infants at 10 days, 80%/95%, 14 days, 72%/91%, and 3-4 months, 39%/84%; and stopping breastfeeding for maternal problems when not indicated, 69%/93% (p < 0.001 for all). CONCLUSIONS: Use of an Internet-based educational program improved knowledge of MCH providers as measured by pretest and posttest scores. Knowledge of the growth of breastfed infants is particularly poor. Increasing knowledge is the first step in improving clinical practice that is necessary for increasing breastfeeding rates and duration.