A geriatric game to strengthen older adult healthcare delivery and outcomes.

BACKGROUND: Serious games enhance learner engagement and knowledge, yet few medical education games target older adults' healthcare. Addressing this gap, we developed Geri-POP (Geriatrics Population Health), focusing on the Age-Friendly Health System (AFHS) framework and Geriatric 4Ms. METHODS: Geri-POP, a healthcare game is aimed at educating health profession learners about the AFHS framework. Geri-POP employs plan-do-study-act cycles of rapid improvement to apply AFHS principles and explore evidence-based geriatric practices within the game environment while garnering points for insight, trust and outcomes. Faculty and medical students were surveyed for feedback on an alpha version of Geri-POP. RESULTS: Players manage patient panels across three age groups (65-74, 75-84, and 85 years and older) while engaging in plan-do-study-act (PDSA) cycles, applying Geriatric 4Ms (What Matters, Medications, Mentation, and Mobility), and refining strategies based on resource utilization, health outcomes, and real-time feedback. Alpha testing of the game received mixed perceptions on graphics, with faculty endorsing the game for training and integration into the curriculum, while students prioritize academic commitments. Suggestions include enhancing graphics and refining dialogue for a more professional tone. CONCLUSIONS: Geri-POP demonstrates the potential of gamifying older adult population health and quality improvement around AFHS. Feedback on a prototype game revealed different attitudes between faculty and students, thus emphasizing the importance of game development as an iterative process that accounts for educator and learner-centric needs. A future consideration is whether the game informs user's clinical practices and changes healthcare outcomes for older adults.

Lessons learned in evaluating system interdependencies using qualitative methods.

This article shares lessons learned while evaluating the system interdependencies for a clinical and translational research centre (CTR). It explores the methodological challenge of discussing system concepts (e.g., cascading failures, feedback loops, and reflex arcs) with layperson participants during evaluation interviews. The article discusses the iterative process of moving from structured interview approaches in favor of an open narrative approach for data collection and lessons learned.

Evaluation Utility Metrics (EUMs) in Reflective Practice.

The article proposes three evaluation utility metrics to assist evaluators in evaluating the quality of their evaluation. After an overview of reflective practice in evaluation, the different ways in which evaluators can hold themselves accountable are discussed. It is argued that reflective practice requires evaluators to go beyond evaluation quality (i.e., technical quality and methodological rigor) when assessing evaluation practice to include an evaluation of evaluation utility (i.e., specific actions taken in response to evaluation recommendations). Three Evaluation Utility Metrics (EUMs) are proposed to evaluate utility: whether recommendations are considered (EUMc), adopted (EUMa), and (if adopted) level of influence of recommendations (EUMli). The authors then reflect on their experience in using the EUMs, noting the importance of managing expectations through negotiation to ensure EUM data is collected and the need to consider contextual nuances (e.g., adoption and influence of recommendations are influenced by multiple factors beyond the control of the evaluators). Recommendations for increasing EUM rates by paying attention to the frequency and timing of recommendations are also shared. Results of implementing these EUMs in a real-world evaluation provide evidence of their potential value: practice tips led to an EUMc = 100% and EUMa > 80%. Methods for considering and applying all three EUMs together to facilitate practice improvement are also discussed.

Using the Homeland Security Exercise and Evaluation Program (HSEEP) Building Block Approach to Implement System Evaluation Theory (SET).

This article shares lessons learned in applying system evaluation theory (SET) to evaluate a Clinical and Translational Research Center (CTR) funded by the National Institutes of Health. After describing how CTR support cores are intended to work interdependently as a system, the case is made for SET as the best fit for evaluating this evaluand. The article then details how the evaluation was also challenged to facilitate a CTR culture shift, helping support cores to move from working autonomously to working together and understanding how the cores' individual operating processes impact each other. This was achieved by incorporating the Homeland Security Exercise and Evaluation Program (HSEEP) building block approach to implement SET. Each of the seven HSEEP building blocks is examined for alignment with each of SET's three steps and the ability to systematically support the goal of moving CTR cores toward working interdependently. The implications of using HSEEP to support SET implementation for future evaluations are discussed.

The power of interdependence: Linking health systems, communities, and health professions educational programs to better meet the needs of patients and populations.

Promoting optimal health outcomes for diverse patients and populations requires the acknowledgement and strengthening of interdependent relationships between health professions education programs, health systems, and the communities they serve. Educational programs must recognize their role as integral components of a larger system. Educators must strive to break down silos and synergize efforts to foster a health care workforce positioned for collaborative, equitable, community-oriented practice. Sharing interprofessional and interinstitutional strategies can foster wide propagation of educational innovation while accommodating local contexts. This paper outlines how member schools of the American Medical Association Accelerating Change in Medical Education Consortium leveraged interdependence to accomplish transformative innovations catalyzed by systems thinking and a community of innovation.

Medical Student Attitudes toward USMLE Step 1 and Health Systems Science - A Multi-Institutional Survey.

Phenomenon: Because of its importance in residency selection, the United States Medical Licensing Examination Step 1 occupies a critical position in medical education, stimulating national debate about appropriate score use, equitable selection criteria, and the goals of undergraduate medical education. Yet, student perspectives on these issues and their implications for engagement with health systems science-related curricular content are relatively underexplored. Approach: We conducted an online survey of medical students at 19 American allopathic medical schools from March-July, 2019. Survey items were designed to elicit student opinions on the Step 1 examination and the impact of the examination on their engagement with new, non-test curricular content related to health systems science. Findings: A total of 2856 students participated in the survey, representing 23.5% of those invited. While 87% of students agreed that doing well on the Step 1 exam was their top priority, 56% disagreed that studying for Step 1 had a positive impact on engagement in the medical school curriculum. Eighty-two percent of students disagreed that Step 1 scores should be the top item residency programs use to offer interviews. When asked whether Step 1 results should be reported pass/fail with no numeric score, 55% of students agreed, while 33% disagreed. The majority of medical students agreed that health systems science topics were important but disagreed that studying for Step 1 helped learn this content. Students reported being more motivated to study a topic if it was on the exam, part of a course grade, prioritized by residency program directors, or if it would make them a better physician in the future. Insights: These results confirm the primacy of the United States Medical Licensing Examination Step 1 exam in preclinical medical education and demonstrate the need to balance the objectives of medical licensure and residency selection with the goals of the broader medical profession. The survey responses suggest several potential solutions to increase student engagement in health systems science curricula which may be especially important after Step 1 examination results are reported as pass/fail.

Development and validation of the Value-Expectancy STEM Assessment Scale for students in higher education.

BACKGROUND: Science, technology, engineering, and math (STEM) jobs are expected to make up a significant portion of the U.S. workforce. Unfortunately, the trend in retaining students in STEM majors has been going down. If higher education institutions are going to retain more students in STEM majors, it will be important to understand who leaves STEM fields and why. More than 32% of women college students who declare a STEM major are likely to switch to non-STEM majors before they graduate, whereas only 25% of their male counterparts do so, and women may be as much as 1.5 times more likely than men to leave STEM fields. Thus, women represent a significant potential source for increasing STEM majors. Research suggests that values and expectations are powerful predictors of motivation and persistence in a wide variety of activities, tasks, and careers. This paper describes the development and validation of an instrument to measure student motivation, particularly that of women, leading to decisions to persist in or switch out of collegiate STEM programs. RESULTS: The Value-Expectancy STEM Assessment Scale (VESAS), adapted from the Values, Interest, and Expectations Scale, or VIES, was validated with 356 women students from a Midwestern research university as part of a larger study on the reasons that women persist or leave STEM majors. A confirmatory factor analysis suggested a two-factor model, which reflected the components of Eccles et al.'s expectancy-value model. Cronbach's alphas suggested that the VESAS subscales had high internal consistency. Statistically significant differences were found between STEM switchers and persisters on all of the VESAS subscales, thus lending additional support for the validity of the instrument. CONCLUSIONS: The VESAS appears to be a valid scale for measuring female college students' value for and expectations regarding STEM majors. Suggestions are made for use of the VESAS in future studies to examine how motivations of women students enrolled in STEM programs change over time and to better understand when retention interventions might be needed and with whom.