- Los Angeles, California, United States
Win May
University of Southern California, School of Medicine, Faculty Member
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Findings are presented from eight focus group discussions. Each group was comprised of seven women under 30 years of age and their husbands who lived in one of four rural villages in Kyaukpadaung township in central Myanmar. In-depth... more
Findings are presented from eight focus group discussions. Each group was comprised of seven women under 30 years of age and their husbands who lived in one of four rural villages in Kyaukpadaung township in central Myanmar. In-depth interviews were conducted among older women. The aim was to ascertain what rural women and their husbands perceived and believed about pregnancy and prenatal care. Most of the women were aware of the symptoms of pregnancy. Most told their husbands or mothers first about the pregnancy. Women waited 3 months after the end of menstruation for confirmation of the pregnancy. Other women stated that pregnancy was confirmed after 5 months when the baby started to move. Birth order had an impact on feelings toward the pregnancy. Women felt happiness and feelings of importance but feared for the dangers of pregnancy. Men felt happy but were concerned about the health of the mother and child. Subsequent unplanned pregnancies were considered to be a drain on resou...
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The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Examination emphasizes the need for other reliable standardized assessments of medical student clinical skills. For 30 years, the California... more
The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Examination emphasizes the need for other reliable standardized assessments of medical student clinical skills. For 30 years, the California Consortium for the Assessment of Clinical Competence (CCACC) has collaborated in the development of clinical skills assessments, and has become a valuable resource for clinicians, standardized patient educators, psychometricians, and medical educators. There are many merits to strong multi-institutional partnerships, including the integration of data across multiple schools to provide feedback to both students and curricula, pooled test performance statistics for analysis and quality assurance, shared best practices and resources, individual professional development, and opportunities for research and scholarship. The infrastructure of the CCACC allows member schools to adapt to a changing medical landscape, from emerging trends in clinical medicine to the limitations imposed by a global pandemic. In the absence of a national examination, there is now a greater need for all medical schools to develop a comprehensive, dynamic, and psychometrically sound assessment that accurately evaluates clinical skills. Medical schools working together in regional consortia have the opportunity to create and implement innovative and robust assessments that evaluate a wide range of clinical skills, ensure that medical students have met an expected level of clinical competency prior to graduation, and provide a framework that contributes to ongoing efforts for the development of new national clinical skills standards.
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Abstract This resource is a standardized patient case used to assess the interpersonal and communication skills of a resident who is asking a patient to consent to a procedure. It has been used wit...
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Research Interests: Program Evaluation, Obstetrics, Evidence Based Medicine, Medicine, Learning, and 15 moreHumans, Independent learning, Statistical Significance, Cluster Analysis, Netherlands, Randomised Controlled Trial, Just in Time, Group Intervention, Great Britain, Gynecology, On the Job Training, Public health systems and services research, Curriculum and Pedagogy, Internet, and Control Group
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To determine the effect of educational interventions on medical... more
To determine the effect of educational interventions on medical students' attitudes toward pharmaceutical industry marketing practices and whether restrictive medical school policies governing medicine-industry interactions are associated with student support for banning such interactions. Prospective cohort study involving the graduating classes of 2009 (intervention, n=474) and 2010 (control, n=459) at four U.S. medical schools. Intervention students experienced a former pharmaceutical representative's presentation, faculty debate, and a Web-based course. Both groups completed baseline and follow-up attitude surveys about pharmaceutical marketing. A total of 482 students (51.6%) completed both surveys. In regression analyses, intervention students were more likely than control students to think that physicians are strongly or moderately influenced by pharmaceutical marketing (OR, 2.29; 95% CI, 1.46-3.59) and believed they would be more likely to prescribe a company's drug if they accepted that company's gifts and food (OR, 1.68; 95% CI, 1.12-2.52). Intervention students were more likely to support banning interactions between pharmaceutical representatives and students (OR, 4.82; 95% CI, 3.02-7.68) and with physicians (OR, 6.88; 95% CI, 4.04-11.70). Students from schools with more restrictive policies were more likely to support banning interactions between pharmaceutical representatives and students (OR, 1.99; 95% CI, 1.26-3.16) and with physicians (OR, 3.44; 95% CI, 2.05-5.79). Education about pharmaceutical marketing practices and more restrictive policies governing medicine-industry interactions seem to increase medical students' skepticism about the appropriateness of such marketing practices and disapproval of pharmaceutical representatives in the learning environment.
Research Interests: Marketing, Medicine, Curriculum, Policy making, Prospective studies, and 15 moreMedical Students, Humans, Gift Giving, Female, Male, Regression Analysis, Academic Medicine, Intervention Studies, Adult, Curriculum and Pedagogy, Drug Industry, Reference Values, Academic, Case Control Studies, and interprofessional relations
Scoring clinical assessments in a reliable and valid manner using criterion-referenced standards remains an important issue and directly affects decisions made regarding examinee proficiency. This generalizability study of... more
Scoring clinical assessments in a reliable and valid manner using criterion-referenced standards remains an important issue and directly affects decisions made regarding examinee proficiency. This generalizability study of students' clinical performance examination (CPX) scores examines the reliability of those scores and of their interpretation, particularly according to a newly introduced, "critical actions" criterion-referenced standard and scoring approach. The authors applied a generalizability framework to the performance scores of 477 third-year students attending three different medical schools in 2008. The norm-referenced standard included all station checklist items. The criterion-referenced standard included only those items deemed critical to patient care by a faculty panel. The authors calculated and compared variance components and generalizability coefficients for each standard across six common stations. Norm-referenced scores had moderate generalizability (ρ = 0.51), whereas criterion-referenced scores showed low dependability (φ = 0.20). The estimated 63% of measurement error associated with the person-by-station interaction suggests case specificity. Increasing the number of stations on the CPX from 6 to 24, an impractical solution both for cost and time, would still yield only moderate dependability (φ = 0.50). Though the performance assessment of complex skills, like clinical competence, seems intrinsically valid, careful consideration of the scoring standard and approach is needed to avoid misinterpretation of proficiency. Further study is needed to determine how best to improve the reliability of criterion-referenced scores, by implementing changes to the examination structure, the process of standard-setting, or both.
Research Interests: Psychology, Educational Measurement, Medicine, California, Humans, and 14 moreUnited States, Undergraduate medical education, Checklist, Differential Diagnosis, Academic Medicine, Educational Models, Curriculum and Pedagogy, Physical examination, Reproducibility of Results, Patient Simulation, Clinical Competence, Reference standards, Medical History Taking, and Physician-Patient Relations
In this paper we describe the development of a doctor-patient dialogue corpus to support a speech-to-speech machine translation effort for English-Persian medical dialogues. The corpus was developed by recording and transcribing... more
In this paper we describe the development of a doctor-patient dialogue corpus to support a speech-to-speech machine translation effort for English-Persian medical dialogues. The corpus was developed by recording and transcribing English-to-English dialogues between medical students and standardized patients (actors who have been trained to portray illness or injury victims), and then translated into Persian. We discuss some of the benefits and drawbacks to creating a corpus in this way. Benefits include the ability to customize the corpus in a way that would be infeasible for actual doctor-patient data and avoidance of privacy and legal issues, while drawbacks include the fact that the Persian does not originate as speech, but as text translation of English speech. We address concerns such as the authenticity of the dialogues and the value of such data for system development.
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1. Physical performance capacity was assessed before and after injection of cyanocobalamin and a placebo for thirty-one Burmese male subjects whose age ranged from 18.7 to 20.8 years.2. The subjects chosen were free from anaemia and were... more
1. Physical performance capacity was assessed before and after injection of cyanocobalamin and a placebo for thirty-one Burmese male subjects whose age ranged from 18.7 to 20.8 years.2. The subjects chosen were free from anaemia and were paired on a ‘weight-age’ basis and divided into two groups.3. One group received an injection of 1 mg cyanocobalamin and the other was given a placebo injection three times weekly for 6 weeks. This was done on a ‘double-blind’ basis.4. There was no significant difference between the two groups in any of the criteria measured, before and after administration of either 1 mg cyanocobalamin or placebo injection. So also there was no significant increase in any of the measurements in the subjects after receiving cyanocobalamin injections compared with those receiving the placebo.
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Abstract This is a standardized patient case that has been used to assess the communication skills of radiology residents when disclosing a medical error to a patient. In the case, a 50-year-old wo...
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The Research in Medical Education (RIME) Program Planning Committee is committed to advancing scholarship in and promoting dialogue about the critical issues of racism and bias in health professions education (HPE). From the call for... more
The Research in Medical Education (RIME) Program Planning Committee is committed to advancing scholarship in and promoting dialogue about the critical issues of racism and bias in health professions education (HPE). From the call for studies focused on underrepresented learners and faculty in medicine to the invited 2016 RIME plenary address by Dr. Camara Jones, the committee strongly believes that dismantling racism is critical to the future of HPE.The evidence is glaring: Dramatic racial and ethnic health disparities persist in the United States, people of color remain deeply underrepresented in medical school and academic health systems as faculty, learner experiences across the medical education continuum are fraught with bias, and current approaches to teaching perpetuate stereotypes and insufficiently challenge structural inequities. To achieve racial justice in HPE, academic medicine must commit to leveraging positions of influence and contributing from these positions. In th...
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Research Interests: Communication, Educational Measurement, Professional Role Socialization, Humans, Observer Variation, and 9 morePatient Care Team, Public health systems and services research, Patient Simulation, Negotiating, Online Continuing Medical Education, Cooperative Behavior, Health Personnel, Professional Role, and interprofessional relations
Implicit attitudes are outside of conscious awareness and are thought to affect automatic responses outside of one's deliberate control, with the potential to impact physician-patient relationships. To measure the nature and extent of... more
Implicit attitudes are outside of conscious awareness and are thought to affect automatic responses outside of one's deliberate control, with the potential to impact physician-patient relationships. To measure the nature and extent of implicit biases towards depression in internal medicine and psychiatry residents. Descriptive and comparative study. Fifty-one residents from three internal medicine programs and 35 residents from three psychiatry programs located in two states. Participants were sent a link to voluntarily participate in four online implicit association tests. Residents' identities were anonymous. Four implicit association tests to measure the association of (1) attitude (good/bad), (2) permanence, (3) controllability, and (4) etiology with depression/physical illness. Internal medicine residents demonstrated a significant association between depression and negative attitudes (t(38) = 6.01, p < .001, Cohen's d = .95), uncontrollability (t(35) = 4.80, p &...
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To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Between May and August... more
To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Between May and August 2016, clinical cases were developed, shared, and administered across seven medical schools (990 students participated). Raters were calibrated using training protocols, and guidelines were developed collaboratively across sites to standardize scoring. Data included scores from standardized patient encounters for history taking, physical examination, and PNs. Descriptive statistics were used to examine scores from the different assessment components. Generalizability studies (G-studies) using variance components were conducted to estimate reliability for composite scores. Validity evidence was collected for response process (rater perception), internal structure (variance components, reliability), relations to other variables (interassessment correlati...
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This supplement includes the eight research papers accepted by the 2016 Research in Medical Education Program Planning Committee. In this Commentary, the authors use &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;conversations in... more
This supplement includes the eight research papers accepted by the 2016 Research in Medical Education Program Planning Committee. In this Commentary, the authors use &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;conversations in medical education&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; as a guiding metaphor to explore what these papers contribute to the current scholarly discourse in medical education. They organize their discussion around two domains: the topic of study and the methodological approach. The authors map the eight research papers to six &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;hot topics&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; in medical education: (1) curriculum reform, (2) duty hours restriction, (3) learner well-being, (4) innovations in teaching and assessment, (5) self-regulated learning, and (6) learning environment, and to three purposes commonly served by medical education research: (1) description, (2) justification, and (3) clarification. They discuss the range of methods employed in the papers. The authors end by encouraging educators to engage in these ongoing scholarly conversations.
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Feedback can have a powerful influence on the performance of learners, and has traditionally been provided by faculty. This study set out to explore whether feedback from a standardized patient (SP) can improve... more
Feedback can have a powerful influence on the performance of learners, and has traditionally been provided by faculty. This study set out to explore whether feedback from a standardized patient (SP) can improve students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; performance of the neurological examination. A randomized controlled design was used with final year medical students. The control group did not receive any feedback. The intervention groups received either written feedback or a combination of written and verbal feedback. A written test was given prior to the intervention to assess comparability of the three groups. Pretest and post-test scores on the neurological examination were compared. Attitudinal questionnaires were administered at the time of the posttest, and 6 months later. Students receiving feedback from the SPs had significantly greater scores on the posttest than the control group. In the intervention groups, students receiving both verbal and written feedback scored significantly higher than those who received only written feedback. More positive perceptions of learning outcomes and the value of SP feedback were noted in the intervention groups. SP feedback was associated with a significant increase in student scores on the neurological examination, as well as more favorable perceptions of the experience.
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ABSTRACT
Research Interests: Communication, Educational Measurement, Professional Role Socialization, Humans, Observer Variation, and 9 morePatient Care Team, Public health systems and services research, Patient Simulation, Negotiating, Online Continuing Medical Education, Cooperative Behavior, Health Personnel, Professional Role, and interprofessional relations
We hypothesized that medical students exposed to a case-based curriculum in years 1 and 2 and clinical cases in the year 3 clerkship would demonstrate a longitudinal increase in the deep approach to learning and a decrease in the surface... more
We hypothesized that medical students exposed to a case-based curriculum in years 1 and 2 and clinical cases in the year 3 clerkship would demonstrate a longitudinal increase in the deep approach to learning and a decrease in the surface apathetic approach. A cohort of first-year medical students completed the Approaches and Study Skills Inventory for Students at the beginning of their first term and again at the beginning of their fourth year. Approaches and Study Skills Inventory for Students scores were aggregated into three main learning approach scales: deep, strategic, and surface apathetic. On average, deep and strategic scores did not significantly change between years 1 and 4, but the surface apathetic mean score decreased as a result of lower syllabus boundness and fear of failure subscale scores. Effect sizes were small (d = 0.30, 0.34, respectively). The deep approach to learning is a complex process and did not change in our students after 3 years of medical school, eve...
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ABSTRACT A double blind study was made on 31 subjects to determine the effect of an anabolic steroid, methandrostenolone &#39;Dianabol&#39; on physical fitness. The physical fitness assessment were done at approximately two weekly... more
ABSTRACT A double blind study was made on 31 subjects to determine the effect of an anabolic steroid, methandrostenolone &#39;Dianabol&#39; on physical fitness. The physical fitness assessment were done at approximately two weekly intervals l.c. one month before drug administration, during three months of drug administration and one month after the drug was stopped. There was a significant increase in the anthropometric measurements and in the static and dynamic strength areas as compared to the placebo group. In the balance, coordination and flexibility areas and the cardio respiratory endurance areas there was no significant difference between the two groups.
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Current questionnaires for assessing satisfaction of university students are not specific for nursing education. The aim of this study was to develop an instrument to measure the quality of baccalaureate nursing education. Guidelines by... more
Current questionnaires for assessing satisfaction of university students are not specific for nursing education. The aim of this study was to develop an instrument to measure the quality of baccalaureate nursing education. Guidelines by DeVellis were adopted to develop the instrument. After expert review the initial 98 items identified were reduced to 63. The questionnaire was administered to 325 nursing students in Latium and Tuscany regions. A Delphi survey was carried out to validate the contents according to the students' opinions, expressed on a 5 point Likert scale. Three-hundred-ten questionnaires were completed and considered for the present study. The mean age of the students was 25.4 years, 69.3% were females. Items which scored less than 2.5 on average at the Delphi survey were removed, as well as those which correlated less than 0.40 with the total score. Thus, 41 items were definitely considered for the Scale for Quality Evaluation of the Bachelor Degree in Nursing ...
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Abstract Background: To understand how third-year medical student interprofessional collaborative practice (IPCP) is affected by self-efficacy and interprofessional experiences (extracurricular experiences and formal curricula). Methods:... more
Abstract Background: To understand how third-year medical student interprofessional collaborative practice (IPCP) is affected by self-efficacy and interprofessional experiences (extracurricular experiences and formal curricula). Methods: The authors measured learner IPCP using an objective structured clinical examination (OSCE) with a standardized nurse (SN) and standardized patient (SP) during a statewide clinical performance examination. At four California medical schools from April to August 2012, SPs and SNs rated learner IPCP (10 items, range 0-100) and patient-centered communication (10 items, range 0-100). Post-OSCE, students reported their interprofessional self-efficacy (16 items, 2 factors, range 1-10) and prior extracurricular interprofessional experiences (3 items). School representatives shared their interprofessional curricula during guided interviews. Results: Four hundred sixty-four of 530 eligible medical students (88%) participated. Mean IPCP performance was 79.6 ± 14.1 and mean self-efficacy scores were 7.9 (interprofessional teamwork) and 7.1 (interprofessional feedback and evaluation). Seventy percent of students reported prior extracurricular interprofessional experiences; all schools offered formal interprofessional curricula. IPCP was associated with self-efficacy for interprofessional teamwork (β = 1.6, 95% CI [0.1, 3.1], p = 0.04) and patient-centered communication (β = 12.5, 95% CI [2.7, 22.3], p = 0.01). Conclusions: Medical student IPCP performance was associated with self-efficacy for interprofessional teamwork and patient-centered communication. Increasing interprofessional opportunities that influence medical students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; self-efficacy may increase engagement in IPCP.
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ABSTRACT Purpose: Numerous studies have documented inequities in delivery of health care to Latinos with limited English proficiency. Advances in technology, using automatic two-way speech translation offer new possibilities for... more
ABSTRACT Purpose: Numerous studies have documented inequities in delivery of health care to Latinos with limited English proficiency. Advances in technology, using automatic two-way speech translation offer new possibilities for cost-effective, targeted interpretation solutions for improved communication with monolingual Spanish speaking/limited English proficiency patients and their families. Methods: The National Science Foundation funded a transdisciplinary team of experts from engineering, communication, preventive medicine and public health, and medical education to develop and evaluate the use, effectiveness and cultural appropriateness of SpeechLinks, a technology-based cross-lingual communication tool. Data was compiled from 50 sessions of clinical encounters among triads of English speaking physicians, Spanish language standardized patients and bilingual Spanish/English interpreters. These data will be used in two ways: First, to develop the core SpeechLinks technologies including capturing the relevant dialectal and Spanish language information for the target interaction scenarios, and developing tools for easy end-user customization and updating; second, to assist and inform SpeechLinks to understand the most useful functionalities and form. Results: Findings reveal the importance of incorporating information on culturally bound syndromes, variations in the meaning of specific Spanish words, and factors impacting the communication of emotion in the medical environment. SpeechLinks has the potential to help bridge the language gap so that health care access and delivery to Latinos is not compromised by sociolinguistic barriers. However, technology is challenged in conveying variations in language and the cultural-emotional content in a caring doctor/patient relationship within a Latino context. Incorporation of these findings is the goal of our next design iteration.
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Feedback can have a powerful influence on the performance of learners, and has traditionally been provided by faculty. This study set out to explore whether feedback from a standardized patient (SP) can improve... more
Feedback can have a powerful influence on the performance of learners, and has traditionally been provided by faculty. This study set out to explore whether feedback from a standardized patient (SP) can improve students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; performance of the neurological examination. A randomized controlled design was used with final year medical students. The control group did not receive any feedback. The intervention groups received either written feedback or a combination of written and verbal feedback. A written test was given prior to the intervention to assess comparability of the three groups. Pretest and post-test scores on the neurological examination were compared. Attitudinal questionnaires were administered at the time of the posttest, and 6 months later. Students receiving feedback from the SPs had significantly greater scores on the posttest than the control group. In the intervention groups, students receiving both verbal and written feedback scored significantly higher than those who received only written feedback. More positive perceptions of learning outcomes and the value of SP feedback were noted in the intervention groups. SP feedback was associated with a significant increase in student scores on the neurological examination, as well as more favorable perceptions of the experience.
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Objective: In response to school shut downs amid the COVID-19 pandemic, nurse educators from the University of Southern California implemented a virtual objective structured clinical examination (OSCE) using standardized patients (SPs) to... more
Objective: In response to school shut downs amid the COVID-19 pandemic, nurse educators from the University of Southern California implemented a virtual objective structured clinical examination (OSCE) using standardized patients (SPs) to assess family nurse practitioner (FNP) students’ clinical and communication skills as an alternative to the traditional in-person OSCE format. The intent of this paper is to share the nurse educators’ experiences with the transitional process and students’ feedback about their virtual OSCE experiences.Methods: Students (N = 36) enrolled in a childbearing/childrearing clinical course participated in the virtual OSCE using Zoom. The experience included briefing and debriefing sessions. Students were evaluated for their communication and clinical decision making skills based on their assessment of two adolescent patients: one acute with behavioral problems presenting for a checkup and one with headache.Results: All students who participated in the vir...
Although there is a growing body of literature on the educational use of standardized patients (SP) in teaching and learning, there have been no reviews on their value. To determine whether the educational use of SPs has an effect on the... more
Although there is a growing body of literature on the educational use of standardized patients (SP) in teaching and learning, there have been no reviews on their value. To determine whether the educational use of SPs has an effect on the knowledge, skills, and behaviour of learners in the health professions. English-language articles covering the period 1996-2005 were reviewed to address the issue of to what extent has the use of SPs affected the knowledge, skills and performance of learners. Out of 797 abstracts, 69 articles, which met the review criteria, were selected. An adaptation of Kirkpatrick&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s model was used to classify and analyse the articles. Most of the learners were students in medicine and nursing. SPs were used mostly to teach communication skills and clinical skills. The study designs were case-control (29%), pre-test/post-test (24.6%), post-test only (26.1%) and qualitative studies (20.3%). METHODOLOGICAL ISSUES: Most of the studies had weak research designs. More rigorous designs with control or comparison groups should be used in future research. Most studies reported that the educational use of SPs was valuable. More rigorous studies would support the evidence-based use of SPs in teaching and learning.
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Background and objectives Evidence-based health care requires clinicians to engage with use of evidence in decision-making at the workplace. A learner-centred, problem-based course that integrates e-learning in the clinical setting has... more
Background and objectives Evidence-based health care requires clinicians to engage with use of evidence in decision-making at the workplace. A learner-centred, problem-based course that integrates e-learning in the clinical setting has been developed for application in obstetrics and gynaecology units. The course content uses the WHO reproductive health library (RHL) as the resource for systematic reviews. This project aims to evaluate a clinically integrated teaching programme for incorporation of evidence provided through the WHO RHL. The hypothesis is that the RHL-EBM (clinically integrated e-learning) course will improve participants' knowledge, skills and attitudes, as well as institutional practice and educational environment, as compared to the use of standard postgraduate educational resources for EBM teaching that are not clinically integrated. Methods The study will be a multicentre, cluster randomized controlled trial, carried out in seven countries (Argentina, Brazil, Democratic Republic of Congo, India, Philippines, South Africa, Thailand), involving 50-60 obstetrics and gynaecology teaching units. The trial will be carried out on postgraduate trainees in the first two years of their training. In the intervention group, trainees will receive the RHL-EBM course. The course consists of five modules, each comprising self-directed e-learning components and clinically related activities, assignments and assessments, coordinated between the facilitator and the postgraduate trainee. The course will take about 12 weeks, with assessments taking place pre-course and 4 weeks post-course. In the control group, trainees will receive electronic, self-directed EBM-teaching materials. All data collection will be online. The primary outcome measures are gain in EBM knowledge, change in attitudes towards EBM and competencies in EBM measured by multiple choice questions (MCQs) and a skills-assessing questionniare administered eletronically. These questions have been developed by using questions from validated questionnaires and adapting them to the current course. Secondary outcome measure will be educational environment towards EBM which will be assessed by a specifically developed questionnaire. Expected outcomes The trial will determine whether the RHL EBM (clinically integrated e-leraning) course will increase knowledge, skills and attitudes towards EBM and improve the educational environment as compared to standard teaching that is not clinically integrated. If effective, the RHL-EBM course can be implemented in teaching institutions worldwide in both, low-and middle income countries as well as industrialized settings. The results will have a broader impact than just EBM training because if the approach is successful then the same educational strategy can be used to target other priority clinical and methodological areas. Trial Registration ACTRN12609000198224
Research Interests: Primary Care, Decision Making, Primary Health Care, Evidence Based Medicine, Health Care, and 26 moreLife Style, Risk, Medication Adherence, Democratic Republic of Congo, Counseling, Canada, South Africa, Humans, Reproductive health, Health Services, Female, Teaching Material, Male, Data Collection, Educational Environment, Group Intervention, Systematic review, IS success, Middle Aged, Patient Care Team, Randomized Controlled Trial, Postgraduate Education, Pharmacists, Coronary Artery Disease, #Hypolipidemic Agents, and Control Group
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BACKGROUND Patient-centered care has been described as one approach to cultural competency education that could reduce racial and ethnic health disparities by preparing providers to deliver care that is respectful and responsive to the... more
BACKGROUND Patient-centered care has been described as one approach to cultural competency education that could reduce racial and ethnic health disparities by preparing providers to deliver care that is respectful and responsive to the preferences of each patient. In order to evaluate the effectiveness of a curriculum in teaching patient-centered care (PCC) behaviors to medical students, we drew on the work of Kleinman, Eisenberg, and Good to develop a scale that could be embedded across cases in an objective structured clinical examination (OSCE). OBJECTIVE To compare the reliability, validity, and feasibility of an embedded patient-centered care scale with the use of a single culturally challenging case in measuring students′ use of PCC behaviors as part of a comprehensive OSCE. METHODS A total of 322 students from two California medical schools participated in the OSCE as beginning seniors. Cronbach’s alpha was used to assess the internal consistency of each approach. Construct validity was addressed by establishing convergent and divergent validity using the cultural challenge case total score and OSCE component scores. Feasibility assessment considered cost and training needs for the standardized patients (SPs). RESULTS Medical students demonstrated a moderate level of patient-centered skill (mean = 63%, SD = 11%). The PCC Scale demonstrated an acceptable level of internal consistency (alpha = 0.68) over the single case scale (alpha = 0.60). Both convergent and divergent validities were established through low to moderate correlation coefficients. DISCUSSION The insertion of PCC items across multiple cases in a comprehensive OSCE can provide a reliable estimate of students′ use of PCC behaviors without incurring extra costs associated with implementing a special cross-cultural OSCE. This approach is particularly feasible when an OSCE is already part of the standard assessment of clinical skills. Reliability may be increased with an additional investment in SP training.