Targeting and structuring information resource use: A path toward informed clinical decisions

A core skill for all physicians to master is that of information manager. Despite a rapidly expanding set of electronic and print-based information resorces, clinicians continue to answer their clinical queries predominantly through informal or formal consultation. Even as new tools are brought to market, the majority of them present information in a rigid fashion, presenting cumbersome user interfaces and inflexible data presentation. The need to rethink the structure of electronic information is paramount to improving the use of evidence at the bedside. As new tools are developed and educators teach clinians to use them, the context for use of information resources must be considered, with special attention to physician work flow, following the three paths outlined in this article. The process will be facilitated greatly by promoting evidence-based practice for the care of patients in the hospital and clinic setting.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35026/1/1340240504_ftp.pd

The promise of competency-based education in the health professions for improving global health

Abstract Competency-based education (CBE) provides a useful alternative to time-based models for preparing health professionals and constructing educational programs. We describe the concept of ‘competence’ and ‘competencies’ as well as the critical curricular implications that derive from a focus on ‘competence’ rather than ‘time’. These implications include: defining educational outcomes, developing individualized learning pathways, setting standards, and the centrality of valid assessment so as to reflect stakeholder priorities. We also highlight four challenges to implementing CBE: identifying the health needs of the community, defining competencies, developing self-regulated and flexible learning options, and assessing learners for competence. While CBE has been a prominent focus of educational reform in resource-rich countries, we believe it has even more potential to align educational programs with health system priorities in more resource-limited settings. Because CBE begins with a careful consideration of the competencies desired in the health professional workforce to address health care priorities, it provides a vehicle for integrating the health needs of the country with the values of the profession.http://deepblue.lib.umich.edu/bitstream/2027.42/112402/1/12960_2012_Article_314.pd

Active Learning & Library Instruction : Team Teaching with Faculty Physicians

http://deepblue.lib.umich.edu/bitstream/2027.42/101131/1/ActiveLearningPosterMLA2013.pd

How do doctors use information in real-time? A qualitative study of internal medicine resident precepting

Background  Despite the importance of evidence-based medicine in medical education, little observational research exists on how doctors-in-training seek and use evidence from information resources in ambulatory care. Objective  To describe information exchange behaviour by internal medicine residents and attendings in ambulatory resident clinic precepting rooms. Design  We observed resident behaviour and audiotaped resident–attending doctor interactions during precepting sessions. Participants  Participating residents included 70 of an eligible 89 residents and 28 of 34 eligible attendings from one large academic internal medicine residency programme in the Midwestern USA. Residents were observed during 95 separate precepting interactions at four ambulatory sites. Approach  Using a qualitative approach, we analysed transcripts and field notes of observed behaviours and interactions looking for themes of information exchange. Coders discussed themes which were refined using feedback from an interdisciplinary panel. Results  Four themes of information exchange behaviour emerged: (i) questioning behaviours that were used as part of the communication process in which the resident and attending doctor could reason together; (ii) searching behaviour of non-human knowledge sources occurred in a minority of precepting interations; (iii) unsolicited knowledge offering and (iv) answering behaviours were important means of exchanging information. Conclusions  Most clinic interactions between resident and attending doctors relied heavily on spoken deliberation without resorting to the scientific literature or other published information resources. These observations suggest a range of factors that may moderate information exchange behaviour in the precepting context including relationships, space and efficiency. Future research should aim to more readily adapt information resources to the relationships and practice context of precepting.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72879/1/j.1365-2753.2006.00752.x.pd

Competency-based education in the health professions: Implications for improving global health

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85362/1/CompBasedEd.pdf11

Do we practice what we preach? A qualitative assessment of resident–preceptor interactions for adherence to evidence‐based practice

Background  Evidence‐based medicine (EBM) is important in training doctors for high‐quality care. Yet little is known about whether ambulatory precepting incorporates the concepts and principles of EBM. Methods  The authors observed and audiotaped 95 internal medicine residency precepting interactions and rated interactions using a qualitative analytic template consisting of three criteria: (1) presence of clinical questions; (2) presence of an evidence‐based process; and (3) resident ability to articulate a clinical question. Results  Sixty‐seven of 95 audio tapes (71%) were of acceptable quality to allow template analysis. Thirty (45%) contained explicit clinical questions; 11 (16%) included an evidence‐based process. Resident ability to articulate a clinical question when prompted was rated as at least ‘fair’ in 59 of 67 interactions (88%). Conclusions  EBM was not optimally implemented in these clinics. Future research could explore more systematically what factors facilitate or impair the use of EBM in the real‐time ambulatory training context.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99027/1/j.1365-2753.2008.00966.x.pd

Variability in student perceptions of mistreatment

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148349/1/tct12790_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148349/2/tct12790.pd

Estimating probability of germline mismatch repair mutations in colorectal cancer patients with microsatellite stable tumors

http://deepblue.lib.umich.edu/bitstream/2027.42/112938/1/13053_2011_Article_206.pd

Faculty Evaluation of Student Portfolio Presentations of a Seven-Week Clinical Competency-Based Curriculum Pilot

Background: Student portfolios intend to capture qualitative aspects of students' learning experiences, and foster personal responsibility for learning. However, obtaining standardized assessments of portfolios is challenging. This challenge must be met for a true competency-based curriculum in which students have individualized learning paths and educational goals. Summary of Work: During a six-week pilot of a flexible, competency-based curriculum, 5 students summarized their learning experiences for 7 faculty raters who rated each using a novel 5-item instrument. Presentations were 20 minutes long followed by a 10 minute question period. Follow up ratings of videotaped presentations were used to resolve rater disagreements and improve the rating form. Summary of Results: There was low inter-rater reliability of the rating instrument (item intra-class correlations (ICC) ranged from .00 to .91). Follow-up ratings found agreement easier to reach with better-defined item anchors. Conclusions: The difficulties underlying summative assessment of an inherently qualitative experience are likely surmountable. Allowing students to defend their academic progress to a faculty panel in person is enjoyable and worthwhile. Further refinement of a rating instrument will likely overcome interrater reliability issues. Take home messages: Standardized global performance assessment of individualized learning paths is feasible using faculty ratings of semi-structured student presentations.http://deepblue.lib.umich.edu/bitstream/2027.42/76026/1/stansfield02.dochttp://deepblue.lib.umich.edu/bitstream/2027.42/76026/4/stansfield02.pd

The Role of Medical Student Government in Responding to COVID-19.

The COVID-19 outbreak has sown clinical and administrative chaos at academic health centers throughout the country. As COVID-19-related burdens on the health care system and medical schools piled up, questions from medical students far outweighed the capacity of medical school administrators to respond in an adequate or timely manner, leaving students feeling confused and without clear guidance. In this article, incoming and outgoing executive leaders of the University of Michigan Medical School Student Council and medical school deans outline the specific ways they were able to bridge the gap between medical students and administrators in a time of crisis. To illustrate the value of student government during uncertain times, the authors identify the most pressing problems faced by students at each phase of the curriculum-preclerkship, clerkship, and postclerkship-and explain how Student Council leadership partnered with administrators to find creative solutions to these problems and provide guidance to learners. They end by reflecting on the role of student government more broadly, identifying 3 guiding principles of student leadership and how these principles enable effective student representation