Managing common ambulatory conditions: Exploring clinical decision making performance between pharmacists and family physicians.

Background: Prescribing is part of the expanded scope of practice for pharmacists in Alberta, Canada. Given these responsibilities, clinical decision making (the outcome from the diagnostic and therapeutic decision making process) is an essential skill for pharmacists. The current study compared diagnostic and therapeutic decision-making between Additional Prescribing Authority (APA) pharmacists and family physicians using a set of common ambulatory clinical cases that both practitioners could encounter in the community as part of their daily practice. Objectives: To explore clinical decision making performance and behaviors between APA pharmacists and family physicians during the assessment and prescribing of common ambulatory conditions. Methods: Eight written ambulatory clinical cases were developed by a panel of experts in both family medicine and pharmacy that were commonly encountered in both professions' daily practice. Participating APA pharmacists and family physicians reviewed the cases and responded with likely diagnoses, recommended treatments, and reported confidence in therapeutic choices. The responses of 18 APA pharmacists and 9 family physicians in community practices were analyzed. Results: There were no significant differences in diagnostic accuracy, therapeutic accuracy, confidence in diagnostic choices, and confidence in therapeutic choices between APA pharmacists and family physicians to these common ambulatory presentations. Conclusions: This study provides preliminary insights regarding the capabilities of pharmacists in the assessment of common ambulatory community conditions and suggests that APA pharmacists are making similar diagnostic and therapeutic decisions to family physicians. Future research could focus on examining the performance of pharmacists trained in different pharmacy education models, as well as their ability to provide clinical assessment in other specialties, or in more uncommon clinical scenarios.

Experience of introducing an electronic health records station in an objective structured clinical examination to evaluate medical students' communication skills in Canada: a descriptive study.

PURPOSE: There is limited literature related to the assessment of electronic medical record (EMR)-related competencies. To address this gap, this study explored the feasibility of an EMR objective structured clinical examination (OSCE) station to evaluate medical students' communication skills by psychometric analyses and standardized patients' (SPs) perspectives on EMR use in an OSCE. METHODS: An OSCE station that incorporated the use of an EMR was developed and pilot-tested in March 2020. Students' communication skills were assessed by SPs and physician examiners. Students' scores were compared between the EMR station and 9 other stations. A psychometric analysis, including item total correlation, was done. SPs participated in a post-OSCE focus group to discuss their perception of EMRs' effect on communication. RESULTS: Ninety-nine 3rd-year medical students participated in a 10-station OSCE that included the use of the EMR station. The EMR station had an acceptable item total correlation (0.217). Students who leveraged graphical displays in counseling received higher OSCE station scores from the SPs (P=0.041). The thematic analysis of SPs' perceptions of students' EMR use from the focus group revealed the following domains of themes: technology, communication, case design, ownership of health information, and timing of EMR usage. CONCLUSION: This study demonstrated the feasibility of incorporating EMR in assessing learner communication skills in an OSCE. The EMR station had acceptable psychometric characteristics. Some medical students were able to efficiently use the EMRs as an aid in patient counseling. Teaching students how to be patient-centered even in the presence of technology may promote engagement.

Data, Big and Small: Emerging Challenges to Medical Education Scholarship.

The collection and analysis of data are central to medical education and medical education scholarship. Although the technical ability to collect more data, and medical education's dependence on data, have never been greater, it is getting harder for medical schools and educational scholars to collect and use data, particularly in terms of the regulations, security issues, and growing reluctance of learners and others to participate in data collection activities. These two countervailing trends present a growing threat to the viability of medical education scholarship. In response, there must either be a more conducive data environment for medical education scholarship or medical education must move to become less dependent on data.There is, therefore, a growing need for a system-wide correction: a shift in practice that makes data use more viable and productive while maintaining high professional standards. There are five core areas that can contribute to a system-wide correction: greater clarity over what can be used as data; greater clarity on what constitutes "good" data; changes to the ways in which data are collected; better strategic stewardship of existing data; and deliberate and strategic attention to "data readiness" in support of medical education and medical education scholarship. These solutions are primarily practical and conceptual changes in the face of what are mainly regulatory challenges. However, medical educators also need to engage with emerging areas of practice such as learning analytics, and they need to consider the shifting social contract for using data in medical education.

Using the METRICS model for defining routes to scholarship in healthcare simulation.

INTRODUCTION: In this paper, we explored the utility and value of the METRICS model for modeling scholarship in healthcare simulation by: (1) describing the distribution of articles in four healthcare simulation journals across the seven areas of METRICS scholarship; and (2) appraising patterns of scholarship expressed in three programs of simulation scholarship and reflecting on how these patterns potentially influence the pursuit of future scholarly activities. METHODS: Two raters reviewed abstracts of papers published between January 2015 and August 2017 in four healthcare simulation journals and coded them using METRICS. Descriptive statistics were calculated for scholarship type and distribution across journals. Twenty-eight articles from three scholars were reviewed, with patterns of scholarship within articles mapped to METRICS. Descriptive synthesis was constructed through discussion between two reviewers. RESULTS: A total of 432 articles from four journals were reviewed. The three most commonly published areas of scholarship were: 32.2% (139/432) evaluation, 18.8% (81/432) innovation, and 15.3% (66/432) conceptual. The METRICS model was able to represent different kinds of scholarship expressed in all of the papers reviewed and across programs of research. Reflecting on patterns of scholarship within their scholarly programs was helpful for research in planning future directions. CONCLUSIONS: The METRICS model for scholarship can describe a wide range of patterns of simulation scholarship within individual articles, programs of research, or across journals.

Turk Talk: human-machine hybrid virtual scenarios for professional education.

This article was migrated. The article was marked as recommended. Virtual scenarios provide a means for creating rich and complex online cases for health professional students to explore. However, the response options available to the learner are usually predefined, which limits the utility of virtual patients. Using artificial intelligence or natural language processing to accommodate such flexibility is expensive and hard to design. This project description lays out an alternative approach to making virtual scenarios more adaptable and interactive. Using OpenLabyrinth, an open-source educational research platform, we modified the interface and functionality to provide a human-computer hybrid interface, where a human facilitator can interact with learners from within the online case scenario. Using a design-based research approach, we have iteratively improved our cases, workflows and scripts and interface designs. The next step is testing this new functionality in a variety of situations. This report describes the pilot implementation of this pilot project. It includes the background, rationale, objectives, learning and educational designs, and implications for software development. The costs and time required to modify the software were much lower than anticipated. Facilitators managed text input from multiple concurrent learners. Learners noted a delay while waiting for the facilitator's response, but denied becoming frustrated. The implementation and use of this new technique seems promising for training and assessment purposes related to developing effective communication skills. This report also explores the provisional implications arising from the study so far.

METRICS: a pattern language of scholarship in medical education.

This article was migrated. The article was marked as recommended. Scholarly activity in health professions education has been growing steadily but despite the broad interest, quite what is considered to be scholarly activity in medical education has remained vague. Boyer's classes of scholarly activity ( Boyer 1990) and Glassick et al.'s criteria required of an artefact to render it scholarly ( Glassick et al. 1997) have been widely discussed. While the Glassick model has helped to define to what scholarly activity should be, we have found the Boyer model of what kinds of activity count as scholarship is lacking. We have developed the METRICS model of scholarly activity in medical education that maps more directly to scholarly activities. Metascholarship - activities that reflect on the nature of scholarshipEvaluation - activities that measure value or axiologyTranslation - activities that move findings or practices from one domain to anotherResearch - activities that focus on theory generation or testing (experimental, descriptive or explanatory)Innovation - activities that focus on creating new ideas, objects and practicesConceptual - activities that explore or develop new models, concepts, and paradigmsSynthesis - activities that focus on the integration of existing knowledge and practice Having built the METRICS model and tested it extensively in our own practice, we now seek to engage others in its use and appraisal.

Raising the BarCamp: international reflections.

This article was migrated. The article was marked as recommended. There is increasing interest in Barcamps and Unconferences as an educational approach during traditional medical education conferences. Our group has now accumulated extensive experience in these formats over a number of years in different educational venues. We present a summary of observations and lessons learned about what works and what doesn't.

Where do physicians start and end?

Medical education is primarily about training physicians and maintaining their capabilities over time. Given that physicians are the primary focus of the field, there is a need for a clear idea of what physicians are or could be. This paper seeks to explore this issue by posing the simple question: ?Where do physicians start and end?' In doing so, the authors explore a series of different conceptual frames, including those of a physician's physical dimensions, their cellular boundaries, personal intentions and beliefs, professional identity, regulation, entrustability, professional performance, extended cognition, and disability. This existential look at the concept of a physician demonstrates the plurality of medical education scholarship and the implications of the many intersecting points of view in the field.

Mobile technologies in medical education: AMEE Guide No. 105.

Mobile technologies (including handheld and wearable devices) have the potential to enhance learning activities from basic medical undergraduate education through residency and beyond. In order to use these technologies successfully, medical educators need to be aware of the underpinning socio-theoretical concepts that influence their usage, the pre-clinical and clinical educational environment in which the educational activities occur, and the practical possibilities and limitations of their usage. This Guide builds upon the previous AMEE Guide to e-Learning in medical education by providing medical teachers with conceptual frameworks and practical examples of using mobile technologies in medical education. The goal is to help medical teachers to use these concepts and technologies at all levels of medical education to improve the education of medical and healthcare personnel, and ultimately contribute to improved patient healthcare. This Guide begins by reviewing some of the technological changes that have occurred in recent years, and then examines the theoretical basis (both social and educational) for understanding mobile technology usage. From there, the Guide progresses through a hierarchy of institutional, teacher and learner needs, identifying issues, problems and solutions for the effective use of mobile technology in medical education. This Guide ends with a brief look to the future.

Exploring digital professionalism.

The widespread use of digital media (both computing devices and the services they access) has blurred the boundaries between our personal and professional lives. Contemporary students are the last to remember a time before the widespread use of the Internet and they will be the first to practice in a largely e-health environment. This article explores concepts of digital professionalism and their place in contemporary medical education, and proposes a series of principles of digital professionalism to guide teaching, learning and practice in the healthcare professions. Despite the many risks and fears surrounding their use, digital media are not an intrinsic threat to medical professionalism. Professionals should maintain the capacity for deliberate, ethical, and accountable practice when using digital media. The authors describe a digital professionalism framework structured around concepts of proficiency, reputation, and responsibility. Digital professionalism can be integrated into medical education using strategies based on awareness, alignment, assessment, and accountability. These principles of digital professionalism provide a way for medical students and medical practitioners to embrace the positive aspects of digital media use while being mindful and deliberate in its use to avoid or minimize any negative consequences.

Virtual patient activity patterns for clinical learning.

BACKGROUND: Virtual patients are software tools that present learners with patient case situations and tasks. Some virtual patients take the learner through a guided case scenario, whereas others require learners to make diagnostic and therapeutic decisions. Much attention has been paid to the design of virtual patients and their use as standalone activities, but rather less attention has been paid to their use in broader educational activities. This article describes a series of activity patterns that make use of virtual patients. CONTEXT: The article describes five patterns of clinical teaching activities that make use of virtual patients: independent study activities; collaborative group activities; blended activities; bridging activities; and reference activities. These patterns were developed inductively from the authors' teaching practices over a number of years. These are not the only activity patterns and designs that can make use of virtual patients but they are ones that have been found to be particularly useful over time and in many different contexts. INNOVATION: Although the design of educational artifacts such as virtual patients is important, clinical teachers also need to consider the ways in which they are used. Different kinds of activity can employ different kinds of virtual patients of varying levels of complexity. An activity focus can allow clinical teachers to make more effective and broader use of virtual patients. IMPLICATIONS: Virtual patients can be used for more than independent study. Clinical teachers are encouraged to explore the multitude of uses that virtual patients can be put to, and the ways in which activities can be constructed around them. Different kinds of activity can employ different kinds of virtual patients, of varying levels of complexity.

Hockey lines for simulation-based learning.

BACKGROUND: Simulation-based health professional education is often limited in accommodating large numbers of students. Most organisations do not have enough simulation suites or staff to support growing demands. CONTEXT: We needed to find ways to make simulation sessions more accommodating for larger groups of learners, so that more than a few individuals could be active in a simulation scenario at any one time. Moreover, we needed to make the experience meaningful for all participating learners. INNOVATION: We used the metaphor of (ice) hockey lines and substitution 'on the fly' to effectively double the numbers of learners that can be actively engaged at once. Team players must communicate clearly, and observe keenly, so that currently playing members understand what is happening from moment to moment and incoming substitutes can take over their roles seamlessly. Most organisations do not have enough simulation suites or staff to support growing demands IMPLICATIONS: We found that this hockey lines approach to simulation-based team scenarios will raise learners' levels of engagement, reinforce good crew resource management (CRM) practices, enhance closed-loop communication, and help learners to understand their cognitive biases and limitations when working in high-pressure situations. During our continuing refinement of the hockey-lines approach, we developed a number of variations on the basic activity model, with various benefits and applications. Both students and teachers have been enthusiastically positive about this approach when it was introduced at our various courses and participating institutions.

Virtual patients on the semantic Web: a proof-of-application study.

BACKGROUND: Virtual patients are interactive computer simulations that are increasingly used as learning activities in modern health care education, especially in teaching clinical decision making. A key challenge is how to retrieve and repurpose virtual patients as unique types of educational resources between different platforms because of the lack of standardized content-retrieving and repurposing mechanisms. Semantic Web technologies provide the capability, through structured information, for easy retrieval, reuse, repurposing, and exchange of virtual patients between different systems. OBJECTIVE: An attempt to address this challenge has been made through the mEducator Best Practice Network, which provisioned frameworks for the discovery, retrieval, sharing, and reuse of medical educational resources. We have extended the OpenLabyrinth virtual patient authoring and deployment platform to facilitate the repurposing and retrieval of existing virtual patient material. METHODS: A standalone Web distribution and Web interface, which contains an extension for the OpenLabyrinth virtual patient authoring system, was implemented. This extension was designed to semantically annotate virtual patients to facilitate intelligent searches, complex queries, and easy exchange between institutions. The OpenLabyrinth extension enables OpenLabyrinth authors to integrate and share virtual patient case metadata within the mEducator3.0 network. Evaluation included 3 successive steps: (1) expert reviews; (2) evaluation of the ability of health care professionals and medical students to create, share, and exchange virtual patients through specific scenarios in extended OpenLabyrinth (OLabX); and (3) evaluation of the repurposed learning objects that emerged from the procedure. RESULTS: We evaluated 30 repurposed virtual patient cases. The evaluation, with a total of 98 participants, demonstrated the system's main strength: the core repurposing capacity. The extensive metadata schema presentation facilitated user exploration and filtering of resources. Usability weaknesses were primarily related to standard computer applications' ease of use provisions. Most evaluators provided positive feedback regarding educational experiences on both content and system usability. Evaluation results replicated across several independent evaluation events. CONCLUSIONS: The OpenLabyrinth extension, as part of the semantic mEducator3.0 approach, is a virtual patient sharing approach that builds on a collection of Semantic Web services and federates existing sources of clinical and educational data. It is an effective sharing tool for virtual patients and has been merged into the next version of the app (OpenLabyrinth 3.3). Such tool extensions may enhance the medical education arsenal with capacities of creating simulation/game-based learning episodes, massive open online courses, curricular transformations, and a future robust infrastructure for enabling mobile learning.

Mining rich health data from Canadian physician claims: features and face validity.

BACKGROUND: Physician claims data are one of the largest sources of coded health information unique to Canada. There is skepticism from data users about the quality of this data. This study investigated features of diagnostic codes used in the Alberta physician claims database. METHODS: Alberta physician claims from January 1 to March 31, 2011 are analyzed. Claims contain coded diagnoses using the International Classification of Diseases, 9th revision (ICD-9), procedures, physician specialty and service-fee type. Descriptive statistics examined the diversity and frequency of unique ICD-9 diagnostic codes used and the level of code extension (e.g. 3- or 4-digit coding). RESULTS: A total of 7,441,005 claims by 6,601 physicians were analyzed. The average number of claims per physician was 1,079, with ranges between 1,330 for family medicine, 690 for internal medicine, 722 for surgery, 516 for pediatrics and 409 for neurology. Family physicians used an average of 121 diagnostic codes, internal medicine physicians 32, surgery 36, pediatrics 46 and neurology 27. Overall, 43.5% of claims had a more detailed diagnosis (ICD code with >3 digits). Physicians on a fee-for-service plan submitted 1,184 claims and used 88 unique diagnosis codes on average compared to 438 claims and 44 unique diagnosis codes from physicians on an alternative payment plan (APP). CONCLUSIONS: Face validity of diagnosis coded in physician claims is substantially high and the features of diagnosis codes seem to reasonably reflect the clinical specialty. Physicians submit a diverse array of ICD 9 diagnostic codes and nearly half of the ICD-9 diagnostic codes examined were more detailed than required (i.e. ICD code with >3 digits). Finally, guidelines and policies should be explored to assess the submission of shadow billings for physicians on APPs.

YouTube as a platform for publishing clinical skills training videos.

The means to share educational materials have grown considerably over the years, especially with the multitude of Internet channels available to educators. This article describes an innovative use of YouTube as a publishing platform for clinical educational materials.The authors posted online a series of short videos for teaching clinical procedures anticipating that they would be widely used. The project Web site attracted little traffic, alternatives were considered, and YouTube was selected for exploration as a publication channel. YouTube's analytics tools were used to assess uptake, and viewer comments were reviewed for specific feedback in support of evaluating and improving the materials posted.The uptake was much increased with 1.75 million views logged in the first 33 months. Viewer feedback, although limited, proved useful. In addition to improving uptake, this approach also relinquishes control over how materials are presented and how the analytics are generated. Open and anonymous access also limits relationships with end users.In summary, YouTube was found to provide many advantages over self-publication, particularly in terms of technical simplification, increased audience, discoverability, and analytics. In contrast to the transitory interest seen in most YouTube content, the channel has seen sustained popularity. YouTube's broadcast model diffused aspects of the relationship between educators and their learners, thereby limiting its use for more focused activities, such as continuing medical education.

The one minute mentor: a pilot study assessing medical students' and residents' professional behaviours through recordings of clinical preceptors' immediate feedback.

INTRODUCTION: The assessment of professional development and behaviour is an important issue in the training of medical students and physicians. Several methods have been developed for doing so. What is still needed is a method that combines assessment of actual behaviour in the workplace with timely feedback to learners. GOAL: We describe the development, piloting and evaluation of a method for assessing professional behaviour using digital audio recordings of clinical supervisors' brief feedback. We evaluate the inter-rater reliability, acceptability and feasibility of this approach. METHODS: Six medical students in Year 5 and three GP registrars (residents) took part in this pilot project. Each had a personal digital assistant (PDA) and approached their clinical supervisors to give approximately one minute of verbal feedback on professionalism-related behaviours they had observed in the registrar's clinical encounters. The comments, both in transcribed text format and audio, were scored by five evaluators for competence (the learner's performance) and confidence (how confident the evaluator was that the comment clearly described an observed behaviour or attribute that was relevant). Students and evaluators were surveyed for feedback on the process. RESULTS: Study evaluators rated 29 comments from supervisors in text and audio format. There was good inter-rater reliability (Cronbach alpha around 0.8) on competence scores. There was good agreement (paired t-test) between scores across supervisors for assessments of comments in both written and audio formats. Students found the method helpful in providing feedback on professionalism. Evaluators liked having a relatively objective approach for judging behaviours and attributes but found scoring audio comments to be time-consuming. DISCUSSION: This method of assessing learners' professional behaviour shows potential for providing both formative and summative assessment in a way that is feasible and acceptable to students and evaluators. Initial data shows good reliability but to be valid, training of clinical supervisors is necessary to help them provide useful comments based on defined behaviours and attributes of students. In addition, the validity of the scoring method remains to be confirmed.

Practica continua: Connecting and combining simulation modalities for integrated teaching, learning and assessment.

Simulation modalities are generally used independently of one another, largely due to physical and operational limitations to integration. Recent developments are enabling simulators and simulation environments to progress beyond single intervention models towards integrated continua of simulation. Moving to greater integration can improve contextualisation, better management of the transition from individual simulation to clinical practice, and provide wider opportunities to synthesise skills and approaches to practice. Simulation integration may involve experiential, modelling, technical, narrative, and evaluation dimensions; it includes both direct actions and activities, and technical and systems designs. The work in developing these integration continua is ongoing and takes many forms in many places. The framework of 'practica continua' proposed in this article links theoretical approaches and practical examples of integrated uses of simulation in education.