Use of Simulation-Based Education: A National Survey of Pediatric Clerkship Directors

ObjectiveTo document the prevalence of simulation-based education (SBE) for third- and fourth-year medical students; to determine the perceived importance of SBE; to characterize the barriers associated with establishing SBE.MethodsA 27-item survey regarding simulation was distributed to members of the Council on Medical Student Education in Pediatrics (COMSEP) as part of a larger survey in 2012.ResultsSeventy-one (48%) of 147 clerkship directors (CD) at COMSEP institutions responded to the survey questions regarding the use of SBE. Eighty-nine percent (63 of 71) of CDs reported use of SBE in some form: 27% of those programs (17 of 63) reported only the use of the online-based Computer-Assisted Learning in Pediatrics Program, and 73% (46 of 63) reported usage of other SBE modalities. Fifty-four percent of CDs (38 of 71) agreed that SBE is necessary to meet the requirements of the Liaison Committee on Medical Education (LCME). Multiple barriers were reported in initiating and implementing an SBE program.ConclusionsSBE is commonly used for instruction during pediatric undergraduate medical education in North American medical schools. Barriers to the use of SBE remain despite the perception that it is needed to meet requirements of the LCME.     

Changes to Pediatric Clerkships' Nighttime Structure After Introduction of the 2011 ACGME Resident Duty Hour Standards

ObjectiveTo report changes in pediatric clerkship nighttime clinical structures before and after implementation of the 2011 Accreditation Council for Graduate Medical Education (ACGME) resident duty hour standards.MethodsAs part of the 2011 Council on Medical Student Education in Pediatrics (COMSEP) member annual survey, we surveyed leaders of pediatric undergraduate medical education on their medical school's current nighttime clinical structure, changes in nighttime structure between 2010 and 2011, and their school's student duty hour standards.ResultsFifty-six percent (n = 83) of Liaison Committee for Medical Education (LCME)-accredited medical schools responded to the survey. Of received responses, 98% of pediatric clerkships have some form of nighttime clinical experience; 49% of clerkships have medical students stay late, 24% of clerkships utilize night shifts, and 16% use a traditional call structure. Forty-five percent of clerkships report changing their nighttime clinical experience after implementation of the 2011 ACGME duty hour standards; 46% of clerkships that changed had previously used traditional call. Seventy-six percent of clerkships report having medical student duty hour standards at their medical school.ConclusionsThe majority of pediatric clerkships in our survey include nighttime clinical experiences in their curriculum, although variability exists in the type of structure. Additionally, the new ACGME duty hour standards appear to affect clerkships directors' choice of structure.     

Using Tablet Computers to Teach Evidence-Based Medicine to Pediatrics Residents: A Prospective Study

ObjectiveWe sought to determine if tablet computers—supported by a laboratory experience focused upon skill-development—would improve not only evidence-based medicine (EBM) knowledge but also skills and behavior.MethodsWe conducted a prospective cohort study where we provided tablet computers to our pediatric residents and then held a series of laboratory sessions focused on speed and efficiency in performing EBM at the bedside. We evaluated the intervention with pre- and postintervention tests and surveys based on a validated tool available for use on MedEdPORTAL. The attending pediatric hospitalists also completed surveys regarding their observations of the residents' behavior.ResultsAll 38 pediatric residents completed the preintervention test and the pre- and postintervention surveys. All but one completed the posttest. All 7 attending pediatric hospitalists completed their surveys. The testing, targeted to assess EBM knowledge, revealed a median increase of 16 points out of a possible 60 points (P < .0001). We found substantial increases in individual resident's test scores across all 3 years of residency. Resident responses demonstrated statistically significant improvements in self-reported comfort with 6 out of 6 EBM skills and statistically significant increases in self-reported frequencies for 4 out of 7 EBM behaviors. Attending pediatric hospitalists reported improvements in 5 of 7 resident behaviors.ConclusionsThis novel approach for teaching EBM to pediatric residents improved knowledge, skills, and behavior through the introduction of a tablet computer and laboratory sessions designed to teach the quick and efficient application of EBM at the bedside.     

Cross Talk: Evaluation of a Curriculum to Teach Medical Students How to Use Telephone Interpreter Services

Purpose

Telephone interpretation and recent technology advances assist patients with more timely access to rare languages, but no one has examined the role of this technology in the medical setting and how medical students can be prepared for their use. We sought to determine if structured curriculum on interpretation would promote learners self-reported competency in these encounters and if proficiency would be demonstrated in actual patient encounters.

Milestone Ratings and Supervisory Role Categorizations Swim Together,but Is the Water Muddy?

Objective

This single-specialty, multi-institutional study aimed to determine 1) the association between milestone ratings for individual competencies and average milestone ratings (AMRs) and 2) the association between AMRs and recommended supervisory role categorizations made by individual clinical competency committee (CCC) members.

Teaching paediatric epilepsy to medical students: A randomised crossover trial

Aim: Research has shown computerised tutorial to be as effective as face‐to‐face teaching in promoting knowledge acquisition. Subsequently, the clinician must synthesise and interpret data (clinical reasoning). This study extends previous research and compares the effectiveness of interactive lecture and computerised tutorial in promoting observational skills and clinical reasoning in the evaluation of paroxysmal events. Methods: The modalities were compared through a randomised crossover trial teaching epilepsy to third and fourth year medical students. The content matter (history and video clip) and format were identical for each topic (Topic 1: altered awareness, Topic 2: movement and posturing) in both modalities (interactive lecture and computerised tutorial). Structured worksheets promoted and evaluated skills of observation and clinical reasoning. Responses in both domains were compared with gold standard qualitative scores. Participants rated modality preference and perceptions of teaching. Results: One‐hundred and fifty‐seven medical students participated. Interactive lecture and computerised tutorial were both effective in promoting observational skills and clinical reasoning with no differences between modalities. Participants preferred the interactive lecture and rated it more enjoyable and effective. Twenty‐five participants randomised to the computerised tutorial for Topic 1, elected to withdraw participation. Both modalities promoted interest and willingness to further learn. Conclusion: This is the first randomised crossover trial evaluating the teaching of clinical reasoning in comparative medical education research. Interactive lecturing and computerised tutorial were both effective in teaching observational skills and clinical reasoning. Interactive lecture is the preferred method, and may influence initial engagement in learning.     

A content validity analysis of neoplastic items of the national board of medical examiners part II examination

As part of its evaluation of the Clinical Cancer Education Program (CCEP) at the Albert Einstein College of Medicine, the Office of Educational Research and Evaluation analyzed student performance on neoplastic items of the National Board of Medical Examiners (NBME) Examination Part II. The evaluation provided a successful application of the American Association for Cancer Education (AACE) coding schema for analysis of neoplastic items. Two examinations were analyzed in order to determine the frequency with which specific disease sites, treatment modalities, and question emphasis items appeared. With reference to disease site, the greatest number of questions on both examinations dealt with gynecological issues while the fewest dealt with lung and hematologic-related disease. A breakdown of questions into various treatment modalities indicated that of items that could be categorized, most dealt with surgical treatment, while other therapeutic modalities were given little or no emphasis. Looking at question emphases, the most frequently asked questions referred to diagnostic tests and stratagems, whereas the least amount of emphasis was placed on rehabilitative and psychosocial aspects of the disease. These findings corroborate those reported by Ruckdeschel and his associates and point out several limitations to the content validity of the neoplastic items on NBME Part II.     

Content bias in the neoplastic-related items of the national board of medical examiners part II examination

The Education Evaluation Committee of the American Association for Cancer Education (AACE) attempted to employ the neoplastic-related items from the National Board of Medical Examiners (NBME) Part II examination in a study correlating program characteristics at various medical schools with performance on the neoplastic-related items. All questions on the September, 1977 and April, 1978 NBME Part II examinations were reviewed by board certified medical oncologists who found an approximate 20% discordance between the AACE and NBME classifications. Content analysis of the neoplastic-related items disclosed a preponderance of questions related to gynecologic cancer with few questions concerning the major solid tumors: lung, breast and colorectal cancer. In addition, virtually no questions related to the psychologic impact of cancer or to the therapy of cancer were asked. We conclude that the use of item by item performance scores from the neoplastic-related items is inadequate for program analysis due to disagreements over what constitutes such an item and to content bias in the agreed upon items. We propose a coding system that may allow the results from current NBME examinations to be used in program evaluation.     

Annotation Medical student education in paediatrics and child health: Where are we going?

In most undergraduate medical curricula, learning is becoming less content based and the emphasis is changing to problem based learning, continuing self directed learning, and the use of a wide range of learning resources. Particular needs in paediatrics and child health are an increasing emphasis on learning in ambulatory care and community based health facilities, and on assessment processes which are formative and reflect the learning objectives appropriately. A wide range of resources is needed for learning at a time when teaching hospital and health system facilities face significant financial restraints.     

Implementing Emotional Debriefing in Pediatric Clinical Education

Challenging situations and intense emotions are inherent to clinical practice. Failure to address these emotions has been associated with health care provider burnout. One way to combat this burnout and increase resilience is participation in emotional debriefing. Although there are many models of emotional debriefings, these are not commonly performed in clinical practice. We provide a guide for implementing emotional debriefing training utilizing the American Academy of Pediatrics Resilience Curriculum into clinical training programs, with a focus on preparing senior residents and fellows to act as debriefing facilitators. Senior residents and fellows can provide in-the-moment emotional debriefing which allows for greater health care provider participation, including medical students and other pediatric trainees. Training of senior residents and fellows may allow more frequent emotional debriefing and in turn may help to improve the resilience of pediatricians when they face challenging situations in clinical practice.