Focal Spot, Summer/Fall 2009

https://digitalcommons.wustl.edu/focal_spot_archives/1112/thumbnail.jp

JointZone: users' view of an adaptive online learning resource for rheumatology

This paper describes an online learning resource for rheumatology that was designed for a wide constituency of users including primarily undergraduate medical students and health professionals. Although the online resources afford an informal learning environment, the site was pedagogically designed to comply with the general recommendations of the Standing Committee on Training and Education of EULAR (European League Against Rheumatism) for a rheumatology core curriculum. Any Internet user may freely browse the site content with optional registration providing access to adaptive features that personalize the user’s view, for example, providing a reading history and targeted support based on scores from completed case studies. The site has now been available since early 2003, and an online survey of site registrants indicates that well structured pedagogical materials that reflect a learners’ dominant ‘community of practice’ appear to be a successful aid to informal learning

Self-monitoring accuracy does not increase throughout undergraduate medical education

Context: Accurate self-assessment of one's performace on a moment-by-moment basis (ie, accurate self-monitoring) is vital for the self-regulation of practising physicians and indeed for the effective regulation of self-directed learning during medical education. However, little is currently known about the functioning of self-monitoring and its co-development with medical knowledge across medical education. This study is the first to simultaneously investigate a number of relevant aspects and measures that have so far been studied separately: different measures of self-monitoring for a broad area of medical knowledge across 10 different performance levels. Methods: This study assessed the self-monitoring accuracy of medical students (n = 3145) across 10 semesters. Data collected during the administration of the formative Berlin Progress Test Medicine (PTM) were analysed. The PTM comprises 200 multiple-choice questions covering all major medical disciplines and organ systems. A self-report indicator (ie, confidence) and two behavioural indicators of self-monitoring accuracy (ie, response time and the likelihood of changing an initial answer to a correct rather than an incorrect item) were examined for their development over semesters. Results: Analyses of more than 390 000 observations (of approximately 250 students per semester) showed that confidence was higher for correctly than for incorrectly answered items and that 86% of items answered with high confidence were indeed correct. Response time and the likelihood of the initial answer being changed were higher when the initial answer was incorrect than when it was correct. Contrary to expectations, no differences in self-monitoring accuracy were observed across semesters. Conclusions: Convergent evidence from different measures of self-monitoring suggests that medical students self-monitor their knowledge on a question-by-question basis well, although not perfectly, and to the same degree as has been found in studies outside medicine. Despite large differences in performance, no variations in self-monitoring across semesters (with the exception of the first semester) were observed

Virtual patients design and its effect on clinical reasoning and student experience : a protocol for a randomised factorial multi-centre study

Background Virtual Patients (VPs) are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent) and structured clinical reasoning feedback (present or absent). Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent), and structured clinical reasoning feedback (present or absent).The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for both primary outcomes

Focal Spot, Summer/Fall 2006

https://digitalcommons.wustl.edu/focal_spot_archives/1103/thumbnail.jp

Speech Recognition Technology: Improving Speed and Accuracy of Emergency Medical Services Documentation to Protect Patients

Because hospital errors, such as mistakes in documentation, cause one in six deaths each year in the United States, the accuracy of health records in the emergency medical services (EMS) must be improved. One possible solution is to incorporate speech recognition (SR) software into current tools used by EMS first responders. The purpose of this research was to determine if SR software could increase the efficiency and accuracy of EMS documentation to improve the safety of patients of EMS. An initial review of the literature on the performance of current SR software demonstrated that this software was not 99% accurate, and therefore, errors in the medical documentation produced by the software could harm patients. The literature review also identified weaknesses of SR software that could be overcome so that the software would be accurate enough for use in EMS settings. These weaknesses included the inability to differentiate between similar phrases and the inability to filter out background noise. To find a solution, an analysis of natural language processing algorithms showed that the bag-of-words post processing algorithm has the ability to differentiate between similar phrases. This algorithm is best suited for SR applications because it is simple yet effective compared to machine learning algorithms that required a large amount of training data. The findings suggested that if these weaknesses of current SR software are solved, then the software would potentially increase the efficiency and accuracy of EMS documentation. Further studies should integrate the bag-of-words post processing method into SR software and field test its accuracy in EMS settings

Focal Spot, Summer 1999

https://digitalcommons.wustl.edu/focal_spot_archives/1082/thumbnail.jp

Virginia Commonwealth University Professional Bulletin

Professional programs bulletin for Virginia Commonwealth University for the academic year 2018-2019. It includes information on academic regulations, degree requirements, course offerings, faculty, academic calendar, and tuition and expenses for graduate programs

Improving case study research in medical education: A systematised review

Context:Case study research (CSR) is a research approach that guides holistic investigation of a real phenomenon. This approach may be useful in medical education to provide critical analyses of teaching and learning, and to reveal the underlying elements of leadership and innovation. There are variations in the definition, design and choice of methods, which may diminish the value of CSR as a form of inquiry.Objectives:This paper reports an analysis of CSR papers in the medical education literature. The review aims to describe how CSR has been used and how more consistency might be achieved to promote understanding and value.Methods:A systematised review was undertaken to quantify the number of CSR articles published in scholarly medical education journals over the last 10 years. A typology of CSR proposed by Thomas and Myers to integrate the various ways in which CSR is constructed was applied.Results:Of the 362 full‐text articles assessed, 290 were excluded as they did not meet the eligibility criteria; 76 of these were titled ‘case study’. Of the 72 included articles, 50 used single‐case and 22 multi‐case design; 46 connected with theory and 26 were atheoretical. In some articles it was unclear what the subject was or how the subject was being analysed.Conclusions:In this study, more articles titled ‘case study’ failed than succeeded in meeting the eligibility criteria. Well‐structured, clearly written CSR in medical education has the potential to increase understanding of more complex situations, but this review shows there is considerable variation in how it is conducted, which potentially limits its utility and translation into education practice. Case study research might be of more value in medical education if researchers were to follow more consistently principles of design, and harness rich observation with connection of ideas and knowledge to engage the reader in what is most interesting

Focal Spot, Summer/Fall 2008

https://digitalcommons.wustl.edu/focal_spot_archives/1109/thumbnail.jp