A Curriculum for Enhancing Physician Teaching Skills: The Value of Physician-Educator Partnerships

Developing as a physician requires an enormous amount of complex training, and quality of instruction greatly affects training outcomes. But while physicians are expected to teach trainees within the clinic, they often do not receive formal training in effective instructional practices. Providing faculty development programs is one way that institutions can help physicians develop teaching skills, but these programs often are developed without the input of educational specialists and not based in educational theory. In this methodology paper, we describe a 5-module curriculum that was developed in a cross-disciplinary collaboration between instructional designers and physician faculty. By merging educational and medical expertise and using adult learning theory with the Charlotte-Danielson educational framework, an essentials for clinical teaching educational endorsement program (ECTEEP) was created as a feature of the institutional curriculum within a large, urban teaching hospital. Here we describe how the program was developed through a physician-educator partnership, outline the program\u27s key content, and highlight essential aspects of successful implementation. The ECTEEP incorporates active learning approaches within an abbreviated format, distilling 5 critical aspects of effective teaching that are relevant to the clinical environment: cultural humility and safe learning environments, instruction practices for engaging learners, instruction and assessment strategies, receiving and giving feedback, and mentorship and coaching. A central feature of the program is that facilitators actively model the teaching behaviors they are conveying, which underscores the critical importance of facilitator preparation and skill. Our curriculum is offered here as a basic template for institutions that may want to establish a program for enhancing physician teaching skill

Visual Analytics Dashboard Promises to Improve Hypertension Guideline Implementation

BACKGROUND: Primary care management of hypertension under new guidelines incorporates assessment of cardiovascular disease risk and commonly requires review of electronic health record (EHR) data. Visual analytics can streamline the review of complex data and may lessen the burden clinicians face using the EHR. This study sought to assess the utility of a visual analytics dashboard in addition to EHR in managing hypertension in a primary care setting. METHODS: Primary care physicians within an urban, academic internal medicine clinic were tasked with performing two simulated patient encounters for HTN management: the first using standard EHR, and the second using EHR paired with a visual dashboard. The dashboard included graphical blood pressure trends with guideline-directed targets, calculated ASCVD risk score, and relevant medications. Guideline-appropriate antihypertensive prescribing, correct target blood pressure goal, and total encounter time were assessed. RESULTS: We evaluated 70 case simulations. Use of the dashboard with the EHR compared to use of the EHR alone was associated with greater adherence to prescribing guidelines (95% vs. 62%, p\u3c0.001) and more correct identification of BP target (95% vs. 57%, p\u3c0.01). Total encounter time fell an average of 121 seconds (95% CI 69 - 157 seconds, p\u3c0.001) in encounters that used the dashboard combined with the EHR. CONCLUSIONS: The integration of a hypertension-specific visual analytics dashboard with EHR demonstrates the potential to reduce time and improve hypertension guideline implementation. Further widespread testing in clinical practice is warranted

Does physician gender effect ordering practice.

BACKGROUND: Breast cancer cases represent 14.6% of all new cancer diagnosis in the United States. However, medical societies disagree when, and how often, we should be screening. The United States Preventative Service Task Force recommends starting at 50 years of age and screening biennially, while others recommend starting at 40 years of age, or screening annually. This has created an environment where physicians must decide which guideline is best for their patients. We sought to find out what factors influence this decision, specifically if the gender of the ordering physician was associated with different screening practices in women aged 40-49. METHODS: We examined every office visit for female patients age 40-49 with an internal medicine (IM), family medicine (FM) or gynecology (Gyn) provider in our health system between July 1, 2015 to May 30, 2016. Patients with a history of breast cancer or other malignant neoplasm were excluded. The association between physician gender and mammogram ordering rates was assessed via chi-squared testing. Other factors, such as comparison between specialties, were assessed via multivariable binary logistic regression. RESULTS: In female patients aged 40-49, female physicians are more likely to order mammograms than male physicians overall. This disparity between genders was largest in internal medicine. Gynecology physicians order mammograms at a higher rate than internal medicine or family medicine physicians. Women aged 45-49 were more likely to receive a mammogram order than women aged 40-44. Also, black patients were less likely to receive a mammogram order compared to white patients. CONCLUSIONS: Physician ordering practices do appear to vary by gender, however, this pattern is also influenced by specialty. The decision also seems to be effected by the age and/or race of the patient. The results of this study support the need for more research in factors contributing to preventive healthcare disparities