Transitioning from a noon conference to an academic half-day curriculum model: effect on medical knowledge acquisition and learning satisfaction.
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ABSTRACT: BACKGROUND: The academic half-day (AHD) curriculum is an alternative to the traditional noon conference in graduate medical education, yet little is known regarding its effect on knowledge acquisition and resident satisfaction. OBJECTIVE: We investigated the association between the 2 approaches for delivering the curriculum and knowledge acquisition, as reflected by the Internal Medicine In-Training Examination (IM-ITE) scores and assessed resident learning satisfaction under both curricula. METHODS: The Cleveland Clinic Internal Medicine Residency Program transitioned from the noon conference to the AHD curriculum in 2011. Covariates for residents enrolled from 2004 to 2011 were age; sex; type of medical degree; United States Medical Licensing Examination Step 1, 2 Clinical Knowledge; and IM-ITE-1 scores. We performed univariable and multivariable linear regressions to investigate the association between covariates and IM-ITE-2 and IM-ITE-3 scores. Residents also were surveyed about their learning satisfaction in both curricula. RESULTS: Of 364 residents, 112 (31%) and 252 (69%) were exposed to the AHD and the noon conference curriculum, respectively. In multivariable analyses, the AHD curriculum was associated with higher IM-ITE-3 (regression coefficient, 4.8; 95% confidence interval 2.9-6.6) scores, and residents in the AHD curriculum had greater learning satisfaction compared with the noon conference cohort (Likert, 3.4 versus 3.0; P = .003). CONCLUSIONS: The AHD curriculum was associated with improvement in resident medical knowledge acquisition and increased learner satisfaction.
Project description:Postgraduate residencies utilize academic half-days to supplement clinical learning. Spaced repetition reinforces taught content to improve retention. We leveraged spaced repetition in a curriculum companion for a paediatric residency program's half-day. One half-day lecture was chosen weekly for reinforcement (day 0). Participants received 3 key points on day 1 and a multiple-choice question (MCQ) on day 8. On day 29, they received two MCQs to test reinforced and unreinforced content from the same day 0. Thirty-one (79%) residents participated over 17 weeks, but only 14 (36%) completed more than half of the weekly quizzes. Of all quizzes, 37.4% were completed, with an average weekly engagement of 5.5 minutes. Helpfulness to learning was rated as 7.89/10 on a Likert-like scale. Reported barriers were missing related half-days and emails, or limited time. There was no significant difference in performance between reinforced (63.4%, [53.6-73.3]) and unreinforced (65.6%, [53.7-73.2]) questions. Spaced repetition is a proven strategy in learning science, but was not shown to improve performance. Operational barriers likely limited participation and underpowered our analysis, therefore future implementation must consider practical and individual barriers to facilitate success. Our results also illustrate that satisfaction alone is an inadequate marker of success.
Project description:Contemporary society expects learners to synthesize large amounts of available information and take advantage of interdisciplinary knowledge to tackle complex, real-world issues. STEAM education aims to cultivate students' ability to solve such problems through interdisciplinary thinking but is often represented by courses that are merely disjointed arrays of school subjects. On the other hand, Maker education harnesses society's enthusiasm for technological innovation and creativity but overlooks the scientific principles that underpin these processes. This research presents a novel elementary school course informed by the interdisciplinary principles of STEAM, integrated with Maker's focus on technology and creativity. The course design also utilized engineering design as a meta-thematic framework. A total of 164 third-grade pupils participated in the research, with responses analyzed using descriptive statistical methods. The findings indicated that the integrated design of the course promoted pupils' learning motivation, self-efficacy, and acquisition of interdisciplinary knowledge. These effects were not gender-specific and demonstrate the potential applicability of a STEAM/Maker integrated approach to curriculum design in other settings.
Project description:BackgroundThe adoption of integrated curricula in medical schools has grown globally, emphasizing the need to understand academic medical staff satisfaction as a crucial factor influencing successful implementation.AimThis study aimed to assess satisfaction levels among academic medical staff with integrated medical curricula, identifying socio-demographic and work-related predictors of dissatisfaction.MethodsA cross-sectional, online multinational survey was conducted from December 2023 to April 2024 among 525 academic medical staff. A structured, self-reported questionnaire was used to assess satisfaction levels, demographic characteristics, and work-related factors. The data were analyzed using descriptive and inferential statistics, including logistic regression analysis, to identify predictors of dissatisfaction.ResultsThe study revealed a low satisfaction rate (44.2%) among medical staff, with significant dissatisfaction influenced by nationality (Jordanian: OR = 7.74, and Egyptian: OR = 4.68), male gender (OR = 3.27), over ten years of teaching experience in integrated curricula (OR = 4.25), and employment in governmental universities (OR = 4.23). Dissatisfaction was particularly high with aspects such as the integration of basic and clinical sciences, assessment methods, and implementation schedules. Faculty from private universities demonstrated significantly higher satisfaction (65.1%) compared to those in governmental institutions (41.3%). Younger staff < 45 years reported higher satisfaction rates (50.9%) compared to their older counterparts ≥ 45 years (39.1%), reflecting greater adaptability to curriculum changes.ConclusionsThe findings highlight substantial dissatisfaction among academic medical staff with the design and implementation of integrated curricula, particularly in governmental institutions and among senior faculty. Institutions must address challenges in curriculum design, resource allocation, and faculty support to enhance satisfaction. Revisiting conventional curriculum components or adopting a hybrid approach may help balance innovation with faculty preferences, fostering a more conducive educational environment.
Project description:BackgroundMorbidity and Mortality (M&M) conferences are widely utilized clinical teaching forums across the USA. Recent literature demonstrates heterogeneity in the educational objectives of M&M, with prior authors suggesting a variety of overarching purposes of the conference, including teaching quality improvement methods; promotion of patient safety; enhancement of clinical knowledge and skills; and reflection on humanistic aspects of medical practice. There is less information in the published literature regarding learning outcomes of M&M participants.ObjectiveThe goal of this study was to describe learning outcomes from the Internal Medicine Morbidity, Mortality, and Improvement conference at Dartmouth-Hitchcock Medical Center.DesignDirected content analysis of learning outcomes statements.ParticipantsInternal medicine physicians who requested Maintenance of Certification credit for one or more conference sessions during the 2017-2018 academic year.ApproachTwo independent reviewers analyzed 347 learning outcomes statements submitted by 49 conference participants. The reviewers used an iterative process to code content themes (the category of medical or healthcare delivery knowledge learned) and learning implementation domains (the context or manner in which learning would be applied), and to identify comments regarding the shared experience of practicing medicine.Key resultsSeventy-eight percent of comments described learning related to clinical knowledge and skills, and 28%, 34%, and 9% of comments described learning related to clinical reasoning skills, systems knowledge, and the need for systems change, respectively. Most conferences generated learning within a variety of themes and across multiple domains. Sixty-four percent of conferences included at least one reflection on the shared experience of practicing medicine.ConclusionsParticipants derived several types of learning from this Internal Medicine M&M conference. Although clinical knowledge and skills represent the most common type of learning, the conference also produces rich learning in other domains as well as reflections on the humility, challenges, and meaning of being a physician.
Project description:BackgroundThe academic half-day (AHD) has grown in popularity for medical education because it intends to provide learners with uninterrupted, immersive learning time that may promote participant attendance, engagement, and knowledge. Little is known about the extent of use, forms, or effectiveness of AHD in Post-graduate medical education. This scoping review summarizes existing literature and describes the learning outcomes, according to the Kirkpatrick model of learning evaluation, of AHD experiences on Post-graduate medical trainees.MethodsAuthors used Arksey and O'Malley's methodological framework, searching electronic scientific literature databases from the years of 1977-2019 with relevant key terms and identifying 735 papers. Two independent raters completed title/abstract screening and then extracted pertinent data from papers meeting specified criteria.ResultsAuthors identified 38 relevant papers published in English, originating from programs in US (n = 19) and Canada (n = 19), spanning 4 disciplines: Medicine (n = 17, 45%), Pediatrics (n = 10, 26%), Critical Care/Surgery (n = 9, 24%), Radiology (n = 2, 5%). A majority (n = 33, 87%) described specific educational experiences; most focused on residents only (n = 27). The educational experiences included various teaching strategies; few were didactics only (n = 4) and most were multi-modal including simulation, case-based learning, problem-based learning, and/or self-directed online study. AHD size ranged from 5 to 364 participants (median 39). AHD length was 1.5-6 h (median 3). Required resources were inconsistently described. When evaluations of the specific educational experience were reported (n = 35 studies), the majority of studies used weak research designs (e.g., one group, pre/post-test, n = 19); few studies used strong research designs (e.g., randomized controlled trial, n = 2). Positive effects of AHD ranged across Kirkpatrick levels 1-3 learner outcomes.ConclusionsThe composition and content of AHD in Post-graduate medical education vary. Few studies of AHD use stringent research designs, and none include learner outcome measures at the highest Kirkpatrick level (i.e., level 4 results/patient outcomes). A consensus definition and further high-quality research on AHD in Post-graduate medical education is needed.
Project description:BackgroundTenofovir alafenamide (TAF) is associated with less renal and bone toxicity compared with tenofovir disoproxil (TDF). TAF's recent FDA approval has spurred HIV providers to consider switching antiretroviral therapy (ART) regimens containing TDF to TAF to minimize long term risks. Patient views on the process of such medication switches have not been explored.MethodsPatients taking elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (E/C/F/TDF) following the Food and Drug Administration's (FDA) approval of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) received medication education from an HIV pharmacist prior to switching to the tenofovir alafenamide (TAF) formulation. Patients were asked to complete a cross-sectional survey assessing satisfaction with the switch process and knowledge about the new medication 4 to 8 weeks post-switch.ResultsSixty five patients completed the switch and 57 (88%) completed a follow-up survey. Most (86%) reported understanding why the switch was made, while 91% correctly identified that TAF is associated with reduced renal toxicity, and 73% correctly identified that TAF is associated with reduced bone toxicity. No statistically significant difference was found in satisfaction with or understanding of why the medication switch was made when assessed by sex, age, race, or education, but there was a trend toward significance in the distribution of answers based on education level with those with a high school diploma, General Educational Development (GED) or less being more likely to be satisfied with the medication switch (p = 0.074).ConclusionsEducation from an ambulatory clinic-based HIV pharmacist resulted in high rates of patient satisfaction and understanding of the switch from TDF to TAF-containing ART.
Project description:Performance on cognitive tasks during learning is used to measure knowledge, yet it remains controversial since such testing is susceptible to contextual factors. To what extent does performance during learning depend on the testing context, rather than underlying knowledge? We trained mice, rats and ferrets on a range of tasks to examine how testing context impacts the acquisition of knowledge versus its expression. We interleaved reinforced trials with probe trials in which we omitted reinforcement. Across tasks, each animal species performed remarkably better in probe trials during learning and inter-animal variability was strikingly reduced. Reinforcement feedback is thus critical for learning-related behavioral improvements but, paradoxically masks the expression of underlying knowledge. We capture these results with a network model in which learning occurs during reinforced trials while context modulates only the read-out parameters. Probing learning by omitting reinforcement thus uncovers latent knowledge and identifies context- not "smartness"- as the major source of individual variability.
Project description:Background: Based on the control-value theory (CVT), learning strategies and academic emotions are closely related to learning achievement, and have been considered as important factors influencing student's learning satisfaction and learning performance in the online learning context. However, only a few studies have focused on the influence of learning strategies on academic emotions and the interaction of learning strategies with behavioral engagement and social interaction on learning satisfaction. Methods: The participants were 363 pre-service teachers in China, and we used structural equation modeling (SEM) to analyze the mediating and moderating effects of the data. Results: The main findings of the current study showed that learning strategies influence students' online learning satisfaction through academic emotions. The interaction between learning strategies and behavioral engagement was also an important factor influencing online learning satisfaction. Conclusions: We explored the internal mechanism and boundary conditions of how learning strategies influenced learning satisfaction to provide intellectual guarantee and theoretical support for the online teaching design and online learning platform. This study provides theoretical contributions to the CVT and practical value for massive open online courses (MOOCs), flipped classrooms and blended learning in the future.
Project description:IntroductionMorbidity and mortality conferences are Accreditation Council for Graduate Medical Education-required educational series that are part of all residency training programs. This conference offers trainees an opportunity to discuss patient cases where errors or complications may have occurred. Conventionally, most of the allotted time is spent on case presentation and therapeutic debates, which is a lost opportunity to teach fundamental principles of patient safety, error analysis, and strategies for system-wide improvement. The goal of this resource is to refocus the content of morbidity and mortality and transform it into a platform for teaching patient safety principles and emphasizing error reduction strategies.MethodsIt was delivered as a 1-hour workshop session once a month during usual conference times. The workshop includes a mortality case review followed by a small-group activity in which trainees are assigned specific safety tasks, including systematic analysis of an error, conducting root cause analysis, and resident peer review.ResultsPostsurveys demonstrated that 90% of the trainees either agreed or strongly agreed that the safety concepts they learned would likely improve the quality of care they provide to future patients.DiscussionWe learned that morbidity and mortality could be used to effectively teach principles of patient safety and could create system-wide improvements.
Project description:ObjectivesPediatric residency trainees interface with electrocardiograms (EKG) as part of routine clinical care. Depending on workflow and availability of support staff, trainees may be required to obtain EKGs on patients, though training on this skill varies. Our intervention seeks to train incoming pediatric residents on obtaining EKGs from pediatric patients and identifying common problems that may result in acquisition of low-fidelity EKGs.MethodsA team of physicians, EKG technicians, and simulation educators designed a 30-min didactic and experiential learning opportunity for incoming pediatric trainees held prior to their start of clinical responsibilities. During the session, trainees were introduced to the basics of EKG acquisition and common quality issues that arise. Afterwards, they practiced placing EKG leads on a mannequin and a live model. A pre- and post-session survey was utilized to assess the session's utility and participant's learning.ResultsThe intervention was perceived as a valuable experience by participants over the course of 2 years. We found increased participant comfort with performing and troubleshooting EKGs (P<.001). There was a 33% improvement in quality assessment of EKG rhythm strips after the session (P<.001).ConclusionGiven the importance of EKGs to the care of pediatric patients, it is essential that pediatricians receive adequate training in acquiring and assessing EKG quality. This intervention was deemed to be highly useful with a demonstrated improvement in EKG troubleshooting skills among first year pediatric residents. This session improves learner comfort with essential clinical responsibilities and identification of low-quality EKGs that often warrant repeat testing.