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

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

Active Learning & Library Instruction : Team Teaching with Faculty Physicians

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

A Proposed Interdisciplinary Workflow to Identify Valuable Electronic Learning Resources

http://deepblue.lib.umich.edu/bitstream/2027.42/94438/1/A_Proposed_Interdisciplinary_Workflow_to_Identify_Valuable_Electronic_Learning_Resources.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

Progress Testing of Basic Science Application During a Clinical Competency-Based Curriculum Pilot

Background: In a clinical comptentency-based curriculum, assessment of students' basic science knowledge is important. During a feasibility pilot of such a curriculum, six students acquired basic science knowledge about three clinical domains (renal failure, trauma, hyperglycemia) from clinical encounters with real patients as well as traditional learning resources. Summary of Work: Multiple choice items used for progress tests at Peninsula Medical School were assembled into three 50 item tests, administered online at 2-week intervals. Items used clinical scenarios to test knowledge in the 3 domains plus a control domain (infectious disease). Complete item and answers were provided after each test as formative feedback. Summary of Results: Tests were difficult (mean topic scores from 32\% to 80\%). Repeated items were easier (80\%) than novel items (58\%). Scores on items that specifically addressed learning objectives improved, though not statistically significantly. Conclusions: Brief progress tests are feasible assessments of student learning, though the reliability is a concern in this pilot. Take home messages: Short progress tests may not be the most sensitive way to evaluate basic science knowledge in a clinical competence curriculum. Longer or more focused tests given at longer intervals may be more sensitive to knowledge application abilities acquired during training.http://deepblue.lib.umich.edu/bitstream/2027.42/71389/3/article.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/71389/1/slides.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/71389/7/stansfield01.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