Cognitive learning theory for clinical teaching

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148367/1/tct12781_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148367/2/tct12781.pd

Spaced education in medical residents: An electronic intervention to improve competency and retention of medical knowledge

Background: Spaced education is a novel method that improves medical education through online repetition of core principles often paired with multiple-choice questions. This model is a proven teaching tool for medical students, but its effect on resident learning is less established. We hypothesized that repetition of key clinical concepts in a “Clinical Pearls” format would improve knowledge retention in medical residents. Methods: This study investigated spaced education with particular emphasis on using a novel, email-based reinforcement program, and a randomized, self-matched design, in which residents were quizzed on medical knowledge that was either reinforced or not with electronically-administered spaced education. Both reinforced and non-reinforced knowledge was later tested with four quizzes. Results: Overall, respondents incorrectly answered 395 of 1008 questions (0.39; 95% CI, 0.36–0.42). Incorrect response rates varied by quiz (range 0.34–0.49; p = 0.02), but not significantly by post-graduate year (PGY1 0.44, PGY2 0.33, PGY3 0.38; p = 0.08). Although there was no evidence of benefit among residents (RR = 1.01; 95% CI, 0.83–1.22; p = 0.95), we observed a significantly lower risk of incorrect responses to reinforced material among interns (RR = 0.83, 95% CI, 0.70–0.99, p = 0.04). Conclusions: Overall, repetition of Clinical Pearls did not statistically improve test scores amongst junior and senior residents. However, among interns, repetition of the Clinical Pearls was associated with significantly higher test scores, perhaps reflecting their greater attendance at didactic sessions and engagement with Clinical Pearls. Although the study was limited by a low response rate, we employed test and control questions within the same quiz, limiting the potential for selection bias. Further work is needed to determine the optimal spacing and content load of Clinical Pearls to maximize retention amongst medical residents. This particular protocol of spaced education, however, was unique and readily reproducible suggesting its potential efficacy for intern education within a large residency program

Quiz results on material reinforced and not reinforced.

<p>Quiz questions were more often correct on material that was reinforced, compared to on material not reinforced. Interns = PGY-1 Residents; Residents = PGY-2 and PGY-3 Residents.</p

Composition of each quiz for housestaff.

<p>Composition of each quiz for housestaff.</p

Questions written each week.

<p>Questions written each week.</p

Preventability of early vs. late readmissions in an academic medical center

Background: It is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric. Objective: Compare preventability of hospital readmissions, between an early period [0–7 days post-discharge] and a late period [8–30 days post-discharge]. Compare causes of readmission, and frequency of markers of clinical instability 24h prior to discharge between early and late readmissions. Design, setting, patients 120 patient readmissions in an academic medical center between 1/1/2009-12/31/2010 Measures Sum-score based on a standard algorithm that assesses preventability of each readmission based on blinded hospitalist review; average causation score for seven types of adverse events; rates of markers of clinical instability within 24h prior to discharge. Results: Readmissions were significantly more preventable in the early compared to the late period [median preventability sum score 8.5 vs. 8.0, p = 0.03]. There were significantly more management errors as causative events for the readmission in the early compared to the late period [mean causation score [scale 1–6, 6 most causal] 2.0 vs. 1.5, p = 0.04], and these errors were significantly more preventable in the early compared to the late period [mean preventability score 1.9 vs 1.5, p = 0.03]. Patients readmitted in the early period were significantly more likely to have mental status changes documented 24h prior to hospital discharge than patients readmitted in the late period [12% vs. 0%, p = 0.01]. Conclusions: Readmissions occurring in the early period were significantly more preventable. Early readmissions were associated with more management errors, and mental status changes 24h prior to discharge. Seven-day readmissions may be a better accountability measure

Blinded physician-adjudicated readmission preventability score by readmission status.

<p>Blinded physician-adjudicated readmission preventability score by readmission status.</p

Initial hospitalization and patient characteristics by readmission status.

<p>Initial hospitalization and patient characteristics by readmission status.</p

Frequency of markers of clinical instability 24 hours prior to hospital discharge by readmission status.

<p>Frequency of markers of clinical instability 24 hours prior to hospital discharge by readmission status.</p