Digital chalk-talk videos improve knowledge and satisfaction in renal physiology.

The authors began a curriculum reform project to improve the experience in a Renal Physiology course for first-year medical students. Taking into account both the variety of learning preferences among students and the benefits of student autonomy, the authors hypothesized that adding digital chalk-talk videos to lecture notes and live lectures would improve student knowledge, course satisfaction, and engagement. The authors measured performance on the renal physiology exam before (the traditional curriculum) and for 2 yr after implementation of the new curriculum. During the traditional and subsequent years, students took a Q-sort survey before and after the Renal Physiology course. Satisfaction was assessed based on ranked statements in the Q sort, as well as through qualitative analysis of student commentary. Compared with the traditional curriculum, mean scores on the renal physiology final exam were higher after implementation of the new curriculum: 65.3 vs. 74.4 ( P < 0.001) with year 1 and 65.3 vs. 79.4 ( P < 0.001) in the second year. After the new curriculum, students were more likely to agree with the statement, "I wish other courses were taught like this one." Qualitative analysis revealed how the video-based curriculum improved student engagement and satisfaction. Adding digital chalk-talk videos to a traditional Renal Physiology course that included active learning led to improved exam performance and high levels of student satisfaction. Other preclinical courses in medical school may benefit from such an intervention.

Community-Based Approaches to Reducing Health Inequities and Fostering Environmental Justice through Global Youth-Engaged Citizen Science.

Growing socioeconomic and structural disparities within and between nations have created unprecedented health inequities that have been felt most keenly among the world's youth. While policy approaches can help to mitigate such inequities, they are often challenging to enact in under-resourced and marginalized communities. Community-engaged participatory action research provides an alternative or complementary means for addressing the physical and social environmental contexts that can impact health inequities. The purpose of this article is to describe the application of a particular form of technology-enabled participatory action research, called the Our Voice citizen science research model, with youth. An overview of 20 Our Voice studies occurring across five continents indicates that youth and young adults from varied backgrounds and with interests in diverse issues affecting their communities can participate successfully in multiple contributory research processes, including those representing the full scientific endeavor. These activities can, in turn, lead to changes in physical and social environments of relevance to health, wellbeing, and, at times, climate stabilization. The article ends with future directions for the advancement of this type of community-engaged citizen science among young people across the socioeconomic spectrum.

Entrustable Professional Activities for Entering Residency: Establishing Common Osteopathic Performance Standards in the Transition From Medical School to Residency.

Entrustable professional activities (EPAs) are measurable units of observable professional practice that can be entrusted to an unsupervised trainee. They were first introduced as a method of operationalizing competency-based medical education in graduate medical education. The American Association of Medical Colleges subsequently used EPAs to establish the core skills that medical students must be able to perform before they enter residency training. A recently published guide provides descriptions, guidelines, and rationale for implementing and assessing the core EPAs from an osteopathic approach. These osteopathically informed EPAs can allow schools to more appropriately assess a learner's whole-person approach to a patient, in alignment with the philosophy of the profession. As the single accreditation system for graduate medical education moves forward, it will be critical to integrate EPAs into osteopathic medical education to demonstrate entrustment of medical school graduates. The authors describe the collaborative process used to establish the osteopathic considerations added to EPAs and explores the challenges and opportunities for undergraduate osteopathic medical education.

Educational Outcomes of Small-Group Discussion Versus Traditional Lecture Format in Dental Students' Learning and Skills Acquisition.

The aim of this prospective quantitative study was to compare the effect of different instructional formats on dental students' skills and knowledge acquisition for access cavity preparation. All first-year dental students were invited to participate in this study conducted during the four consecutive two-week endodontic rotation courses at the University of the Pacific Arthur A. Dugoni School of Dentistry in spring semester 2015. Four alphabetically distributed intact groups of students were randomly allocated to two groups (n=70 each) that participated in either small-group discussion or a traditional lecture on access preparation. The first outcome measure was skill acquisition, measured by the quality of access cavities prepared in extracted teeth at the conclusion of the session. Two blinded raters scored direct observations on a continuous scale. Knowledge, the second outcome measure, was scored with a multiple-choice and open-ended question test at the end of each two-week session. Data were obtained for 134 of the 140 students, for a 96% response rate. The results showed that students in the small-group discussion groups scored significantly higher than those in the lecture groups when skill performance was tested (p=8.9 × 10(-7)). However, no significant differences were found in the acquisition of knowledge between the two groups on the written test. Active student participation was significantly related to improved manual skill acquisition, but the format of the session does not seem to have had a direct influence on acquired knowledge.

Managing attention-deficit/hyperactivity disorder in children and adolescents.

Attention-deficit/hyperactivity disorder (ADHD) is the most frequently diagnosed neurodevelopmental disorder; 6.4 million children and adolescents have been diagnosed with ADHD as of 2011. However, only 3.5 million children and adolescents are taking medication for ADHD. Adolescents with ADHD are much less willing to pursue or adhere to medication or psychosocial therapy, often because of their perceptions of side effects or perceived value of treatment, which places them at greater risk for difficulties at school, work, and home environments. Providing adolescents with increased autonomy through patient-centered approaches can increase their involvement and ability to manage their ADHD symptoms and treatment.

Playground Safety is Associated With Playground, Park, and Neighborhood Characteristics.

BACKGROUND: More than 200,000 children each year are treated at emergency departments for injuries occurring on playgrounds. Empirically derived data are needed to elucidate factors associated with playground safety and reduce injury rates. OBJECTIVE: Determine if neighborhood, park and playground characteristics are significantly associated with playground safety. METHODS: A 24-item report card developed by the National Program for Playground Safety was used to assess playground safety at 41 public parks in a small to midsized, Midwestern city. Trained assessors evaluated the parks and playgrounds in June/July and used a standardized method to count the numbers of users. Data from the 2010 U.S. Census were used to describe the neighborhoods surrounding the parks. RESULTS: The average safety score for all playgrounds was 77.4% which denotes acceptable safety levels. However, 17.1% of the playgrounds were potentially hazardous and in need of corrective measures. Playgrounds were safer in neighborhoods with more youth (< 18 years of age) and educated adults and in parks with better quality features. Playgrounds with fewer amenities were relatively less safe. CONCLUSIONS: Park safety levels need to be improved to reduce the risk of physical injuries. Future studies examining cause-effect associations between environmental features and playground safety are warranted.

Use of a structured template to facilitate practice-based learning and improvement projects.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging. PURPOSE: We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning. METHODS: We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008-2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure. RESULTS: An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template. DISCUSSION: The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.

Spirituality and medicine: prevalence of spirituality-in-medicine instruction at osteopathic medical schools.

CONTEXT: Since the 1990s, there has been a heightened awareness of the value of teaching medical students about how aspects of spirituality and religion may affect patient care. OBJECTIVE: To determine the prevalence of spirituality-in-medicine instruction at colleges of osteopathic medicine (COMs) in the United States. METHODS: Prescreened subjects at 20 COMs were contacted by electronic mail and asked to complete a 25-item Web-based survey. The survey instrument consisted of questions about spirituality-in-medicine instruction at their institutions. If an institution was not represented in our survey results through subject response, we reviewed that institution's Web site to locate material suggestive of an extant spirituality-in-medicine curricula (eg, prospective student information). RESULTS: Surveys were submitted to investigators by representatives of 12 COMs for a response rate of 60%. Subjects from 8 COMs reported a structured spirituality-in-medicine curriculum currently in place at their institutions. Osteopathic medical students generally receive a total of 2 to 20 hours of instruction on spirituality and religion. Of the 10 unrepresented institutions, 4 COMs had material available on their Web sites that suggested spirituality-in-medicine topics were embedded in their curricula. Therefore, approximately 55% of all COMs have some form of spirituality-in-medicine program in place. CONCLUSION: Some form of spirituality-in-medicine instruction is available at slightly more than half the COMs in the United States. As the need for spirituality-in-medicine curricula is increasingly recognized, improved methods of documenting ongoing curricular development and student competency will be required.