Economic impact of education: evidence and relevance

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A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

BACKGROUND: A variety of methods exists for teaching and learning evidence-based medicine (EBM). However, there is much debate about the effectiveness of various EBM teaching and learning activities, resulting in a lack of consensus as to what methods constitute the best educational practice. There is a need for a clear hierarchy of educational activities to effectively impart and acquire competence in EBM skills. This paper develops such a hierarchy based on current empirical and theoretical evidence. DISCUSSION: EBM requires that health care decisions be based on the best available valid and relevant evidence. To achieve this, teachers delivering EBM curricula need to inculcate amongst learners the skills to gain, assess, apply, integrate and communicate new knowledge in clinical decision-making. Empirical and theoretical evidence suggests that there is a hierarchy of teaching and learning activities in terms of their educational effectiveness: Level 1, interactive and clinically integrated activities; Level 2(a), interactive but classroom based activities; Level 2(b), didactic but clinically integrated activities; and Level 3, didactic, classroom or standalone teaching. SUMMARY: All health care professionals need to understand and implement the principles of EBM to improve care of their patients. Interactive and clinically integrated teaching and learning activities provide the basis for the best educational practice in this field

Programs of study in student development in higher education : job relevancy of the CACREP accreditation standards

The purpose of this exploratory study was to determine the job relevancy of the core and specialty standards of the Council on Accreditation of Counseling and Related Educational Programs by determining the importance to work of the standards by surveying current student development professionals' opinions. Such a study has not so far been reported in the literature. A survey questionnaire was developed to solicit opinions on importance of the standards, pilot tested, and mailed to student development practitioners in the southeastern United states. A response rate of 45.3% was achieved. The independent variables were years of service in the field of student development; level of degree received; level of position or title; future career plans to remain in the field; membership in professional organizations and type of degree program, CACREP or non-CACREP. The dependent variables were the eleven core areas or subscales drawn from the CACREP entry-level standards and environmental and specialty standards for student affairs practice in higher education

A Longitudinal Analysis of Academic Self-Concept Among Preclinical Medical Students

Medical school plays a pivotal role in the training of future physicians. Academic Self-Concept (ASC) represents a person’s beliefs about their academic ability, and it has been documented across educational contexts as an important factor in relation to academic performance. Despite decades of research into the relationship between ASC and academic performance, this relationship remains underexplored in medical education. The purpose of this study was to examine the ASC of preclinical medical students using longitudinal data to explore both the relationship between ASC and performance and ASC throughout the preclinical phase of medical school. Survey data from three cohorts of preclinical medical students, for a total sample of 495 students, was analyzed. Bivariate correlation and simple linear regression analysis was used to explore the relationship between preadmissions performance and ASC during matriculation to medical school. There was a statistically significant positive relationship between preadmissions performance and ASC, but a low correlation coefficient suggested the relationship was not a practically significant one. Ordinal regression was used to explore the relationship between ASC and academic performance, as measured by rank quartile. In an analysis of factors influencing rank quartile at the end of the first year, ASC was a statistically significant predictor of subsequent performance, though prior academic performance was the strongest predictor of subsequent performance. Ordinal regression was also used to determine the impact of ASC at the end of the first year on academic performance at the end of the second year. The results of this analysis also suggested that ASC plays a statistically significant role in performance, but prior performance was again the strongest predictor of subsequent performance. Repeated measures ANOVA was conducted to explore changes in ASC over time. There was a significant decline in ASC between matriculation and the end of the first and second years, but there was not a significant difference in ASC between the end of the first and the end of the second year of medical school. The results of these analyses provide support for the relationship between ASC and academic performance among preclinical medical students. Evidence of this relationship, as well as the decline in ASC over time, provide insight into the experiences of medical students that may be used to help improve those experiences, as well as academic processes and outcomes

Protocol - realist and meta-narrative evidence synthesis: Evolving Standards (RAMESES)

<p>Abstract</p> <p>Background</p> <p>There is growing interest in theory-driven, qualitative and mixed-method approaches to systematic review as an alternative to (or to extend and supplement) conventional Cochrane-style reviews. These approaches offer the potential to expand the knowledge base in policy-relevant areas - for example by explaining the success, failure or mixed fortunes of complex interventions. However, the quality of such reviews can be difficult to assess. This study aims to produce methodological guidance, publication standards and training resources for those seeking to use the realist and/or meta-narrative approach to systematic review.</p> <p>Methods/design</p> <p>We will: [a] collate and summarise existing literature on the principles of good practice in realist and meta-narrative systematic review; [b] consider the extent to which these principles have been followed by published and in-progress reviews, thereby identifying how rigour may be lost and how existing methods could be improved; [c] using an online Delphi method with an interdisciplinary panel of experts from academia and policy, produce a draft set of methodological steps and publication standards; [d] produce training materials with learning outcomes linked to these steps; [e] pilot these standards and training materials prospectively on real reviews-in-progress, capturing methodological and other challenges as they arise; [f] synthesise expert input, evidence review and real-time problem analysis into more definitive guidance and standards; [g] disseminate outputs to audiences in academia and policy. The outputs of the study will be threefold:</p> <p>1. Quality standards and methodological guidance for realist and meta-narrative reviews for use by researchers, research sponsors, students and supervisors</p> <p>2. A 'RAMESES' (Realist and Meta-review Evidence Synthesis: Evolving Standards) statement (comparable to CONSORT or PRISMA) of publication standards for such reviews, published in an open-access academic journal.</p> <p>3. A training module for researchers, including learning outcomes, outline course materials and assessment criteria.</p> <p>Discussion</p> <p>Realist and meta-narrative review are relatively new approaches to systematic review whose overall place in the secondary research toolkit is not yet fully established. As with all secondary research methods, guidance on quality assurance and uniform reporting is an important step towards improving quality and consistency of studies.</p

Modelling Sociotechnical Change in IS with a Quantitative Longitudinal Approach: The PPR Method.

The following article suggests a critical realistic framework, which aims at modeling sociotechnical change linked to end-users' IT appropriation: the "archetypal approach". The basic situations it includes (the "sociotechnical archetypes"), and the possible appropriative trajectories that combine them, together with three propositions linked to the model, are developed. They are illustrated by means of a case study describing the implementation of an e-learning system within a French university. The paper then presents an instrumentation of the theoretical framework, based on a quantitative longitudinal approach: the Process Patterns Recognition (PPR) method. This one draws mainly on Doty, Glick and Huber (1993, 1994) who propose to evaluate the distance between organizational archetypes and empirical configurations by means of Euclidean distance calculus. The adaptation consists in evaluating the distance between appropriative trajectories (embodied by series of theoretically specified vectors) and empirical processes linked to the implementation of computerized tools in organizations. The PPR method is then applied to the same organizational setting as the one related to the case study. It validates the relevance of this type of a research strategy, which makes it possible to model sociotechnical dynamics related to end-users' IT appropriations.Technology-organization interaction; sociotechnical process modelling; Process Patterns Recognition; critical realism; Structuration; methodology of research; longitudinal methods; e-learning;

Professional decision-making in medicine: Development of a new measure and preliminary evidence of validity

INTRODUCTION: This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment. METHODS: Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs. RESULTS: Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions. CONCLUSIONS: These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies

Information Systems and Healthcare XXII: Characterizing and Visualizing the Quality of Health Information

We all need ways to assess the quality of the information we look for, but this task is critically important when we are seeking health information. Healthcare consumers increasingly seek and use health information to address their health concerns. However, many health consumers lack the time and expertise required to make solid judgments about the quality of health information they encounter. A full range of quality appraisal methods for health information offer help, yet health consumers use those methods infrequently. Health consumers need better support to overcome barriers to efficiency, scalability, and transparency often associated with this breadth of valuable methods. Furthermore, they need ways to assess the quality of health information they find in the context of their own, individually situated needs. Our goals were to investigate the concept of health information quality and to explore how we can provide health consumers with better support by highlighting, rather than hiding, important aspects of health information quality. First, by reviewing and synthesizing criteria used by a broad range of quality appraisal methods for health information, we identified four focal characteristics of health information quality: content, reference, authorship, and publisher. Together, these four characteristics of intrinsic quality provide an organizing framework for health consumers to assess the quality of health information along multiple dimensions according to their own needs. Next, we used a user-center approach to design a prototype tool that concretely illustrates our framework by allowing the user to highlight multiple dimensions of health information quality. We present a usage case example of this illustrative tool, which visualizes the quality of MEDLINE search results. Our work provides a new perspective on health information quality by acknowledging and supporting consumers\u27 needs for transparency and flexibility as they take a prominent role in health information quality assessment

A continuing medical education program based in high quality evidence to transfer knowledge and to improve practice for health care professionals

This Doctoral of Philosophy program aimed to evaluate an initiative to foster knowledge translation through a national, interactive, and distant continuing education program based on an evidence based medicine point-of-care information service. It further explored the quality of the contents used in ECCE as compared to its market competitors (i.e. other evidence-based practice point-ofcare services). Our randomised controlled trial of nearly 200 physicians revealed little evidence for a difference in the health care knowledge of physicians who were exposed to versus those who were not exposed to contents derived from a point-of-care service. These results suggest that changes in behaviours, a direct consequence of changes in knowledge, may be difficult to obtain or might not be attainable at all, at least when a single continuing medical education program is implemented for short time period. In terms of determining the best available online resources among the 18 authoritative point-of-care services for guidance in clinical decision making that were assessed, only a minority satisfied the quality criteria (coverage of medical conditions, editorial quality, evidence-based methodology, and speed of updating), with none excelling in all. Publishers should continue to invest in the development of such products and improve their efficient use in continuing educational programs. These results might influence how international research and editorial groups that advocate evidence-based decision-making and evidence syntheses think about dissemination