Learning by Doing,Scale Effects,or Neither? Cardiac Surgeons after Residency

Objective. To examine impacts of operating surgeon scale and cumulative experience on postoperative outcomes for patients treated with coronary artery bypass grafts (CABG) by “new” surgeons. Pooled linear, fixed effects panel, and instrumented regressions were estimated. Data Sources. The administrative data included comorbidities, procedures, and outcomes for 19,978 adult CABG patients in Florida in 1998–2006, and public data on 57 cardiac surgeons who completed residencies after 1997. Study Design. Analysis was at the patient level. Controls for risk, hospital scale and scope, and operating surgeon characteristics were made. Patient choice model instruments were constructed. Experience was estimated allowing for “forgetting” effects. Principal Findings. Panel regressions with surgeon fixed effects showed neither surgeon scale nor cumulative volumes significantly impacted mortality nor consistently impacted morbidity. Estimation of “forgetting” suggests that almost all prior experience is depreciated from one quarter to the next. Instruments were strong, but exogeneity of volume was not rejected. Conclusions. In postresidency surgeons, no persuasive evidence is found for learning by doing, scale, or selection effects. More research is needed to support the cautious view that, for these “new” cardiac surgeons, patient volume could be redistributed based on realized outcomes without disruption.     

Problem-Based Learning and Learning Approach: Is There a Relationship?

Aim: To assess the influence of a graduate-entry PBL curriculum on individual learning style; and to investigate the relationship between learning style, academic achievement and clinical reasoning skill. Method: Subjects were first-year medical students completed the Study Process Questionnaire at the commencement, and again, at the end of the academic year when they also completed the Diagnostic Thinking Inventory, a measure of clinical reasoning skill. Subjects were classified on the basis of their predominant learning approach, and this was correlated with examination results and DTI score. Results: There was a net shift in predominant learning approach away from deep learning towards a more surface approach over the period of the study, as well as a significant decrease in deep-learning scores. There was a statistically significant association between deep learning score and clinical reasoning skill as shown by total DTI score as well as on the structure of knowledge subscale. No correlation was found between learning approach and examination results. Conclusion: Although these results suggest that a deep learning approach may be beneficial in the development of clinical reasoning skill through its potential to enhance the development of knowledge representations, the substantial shift towards a surface learning approach brings into question previous conclusions that PBL curricula foster a deep approach to learning, and suggests that other factors, such as work load may be more determinants of learning approach than curriculum type. Taken together, these findings emphasise the context-dependent nature of learning approach as well as the importance of assessment as a driver of student learning and strongly suggest that further work to determine precisely the factors which influence learning approach in medical students is urgently needed.     

Learning from their mistakes?

Embracing competition American style could turn out to be an expensive mistake, says Donald Light. In the first of a series of five articles he explains how bad advice and underfunding could turn the American dream into a British nightmare.     

Learning to value ethnic diversity – what,why and how?

INTRODUCTION: Learning to value ethnic diversity is the appreciation of how variations in culture and background may affect health care. It involves acknowledging and responding to an individual's culture in its broadest sense. This requires learning the skills to negotiate effective communication, a heightened awareness of one's own attitudes, and sensitivity, to issues of stereotyping, prejudice and racism. This paper aims to contribute to debate about some of the key issues that learning to value ethnic diversity creates. CONTEXT: Although some medical training is beginning to prepare doctors to work in an ethnically diverse society, there is a long way to go. Promoting 'valuing ethnic diversity' in curricula raises challenges and the need to manage change, but there are increasing opportunities within the changing context of medical education. Appropriate training can inform attitudes and yield refinement of learners' core skills that are generic and transferable to most health encounters. CURRICULUM DEVELOPMENT: Care must be taken to avoid a narrow focus upon cultural differences alone. Learning should also promote examination of learners' own attitudes and their appreciation of structural influences upon health and health care, such as racism and socio-economic disadvantage. Appropriate training and support for teachers are required and learning must be explicitly linked to assessment and professional accreditation. CONCLUSION: Greater debate about theoretical approaches, and much further experience of developing, implementing and evaluating effective training in this area are needed. Medical educators may need to overcome discomfort in developing such approaches and learn from experience.     

Tutor Training,Evaluation Criteria and Teaching Environment Influence Students’ Ratings of Tutor Feedback in Problem-Based Learning

Aim In a problem-based learning (PBL) curriculum, tutor’s feedback skills are important. However, evaluation studies often show that students rate many tutors as ineffective in providing feedback. We explored whether this is related: (a) to tutors’ skills, and hence a teaching intervention might improve their performance; (b) to the formulation of the evaluation item, hence a more specific wording might help students better recognize a feedback when received; (c) to PBL teaching environment, and hence the tutors’ teaching unit might influence students’ ratings. Methods Students rated 126 tutors of 13 one-month teaching units over three consecutive years on their ability of providing feedback. We assessed how (a) a teaching intervention given between years 1 and 2, (b) a rewording of the evaluation item which took place in year 3, and (c) the tutors’ teaching unit, influenced students’ ratings. Results The ratings of tutors considered as effective by students at year 1 improved after the teaching intervention, while those of unsatisfactory tutors did not progress. However the ratings of the latter increased after reformulation of the evaluation item. This increase varied across teaching units. Discussion Students’ ratings of tutors’ ability to give feedback seem to vary in function of the tutors’␣training, of the formulation of the evaluation item, and of the tutors’ teaching environment. These variables should be considered for setting up effective strategies in faculty development.     

Impact of a Problem-Based Learning (PBL) Health Literacy Program on Immigrant Women’s Health Literacy,Health Empowerment,Navigation Efficacy,and Health Care Utilization

We evaluated the effectiveness of a problem-based learning (PBL) health literacy program aimed to improve health literacy, health empowerment, navigation efficacy, and health care utilization among immigrant women in Taiwan.

We employed a quasi-experimental design that included surveys at the baseline, immediately after the intervention, and 6 months after the intervention. The intervention group participated in a 10-session PBL health literacy program and the comparison group did not.

Results showed that 6 months after the intervention, the intervention group had significantly fewer ER visits and hospitalizations than the comparison group. The intervention group reported a greater decrease in delaying/avoiding health care due to communication barriers. Although the intervention group showed improvement in health literacy, health empowerment and navigation self-efficacy, the differences were not statistically significant.

The PBL health literacy program resulted in fewer ER visits and hospitalizations, and better health care access among immigrant women. Cognitive and psychological outcomes examined in the study appeared more difficult to change.

The PBL health literacy program effectively improved health care utilization and reduced barriers to health care access among immigrant women in Taiwan. It would be useful to examine the effectiveness of the program in other populations.     

Learning from Nepal’s Progress to Inform the Path to the Sustainable Development Goals for Health,Leaving No-One Behind

Maternal and Child Health Journal -     

Students’ Assessment of Problems in a Problem-Based Learning Pharmacology Course

Problem-based learning has been widely employed in Medical Education. One of its main components is that students construct their knowledge working with problems. Therefore, in literature special attention has been given to the design of problems, while assessment has not received the same emphasis. To assess problems implies determining to which extent the resulting work fulfills the purposes that the designers of problems had planned, based on theoretical rationale. This study was developed to determine: if working with the problems allowed the students to carry out the expected learning activities; if the conditions in which they worked were suitable and if the problems were correctly structured. Participants were second-year medical students, enrolled in a problem-based learning pharmacology course. They were asked to assess each problem they used, by means of a questionnaire. The results suggest that when students worked with the problems they carried out activities related to elaboration of knowledge and activation of prior knowledge. They reported to have doubts after working with problems; this can probably be attributed to deficiencies in the students' prior knowledge. Furthermore, the type of problem in which students had low preference were those where they have to analyze tables and charts taken from pharmacological experiment reports; neither the time available to gather the information and to prepare the study issues was sufficient, nor was to study for other subjects. The information produced by assessment is useful for the designers of problems and as feedback to the educational process. The students' participation in the evaluation phase is a way to keep the congruence with a student-centered approach.     

Can Machine Learning Improve Screening for Targeted Delinquency Prevention Programs?

Prevention Science - The cost-effectiveness of targeted delinquency prevention programs for children depends on the accuracy of the screening process. Screening accuracy is often poor, resulting in...