Article review: Carnegie’s vision for medical education

StethoscopeBookIn 2010, the Carnegie Foundation for the Advancement of Teaching published recommendations for the future reform of medical education. This same Carnegie Foundation had also commissioned and published the landmark 1910 Flexner report 1  on medical education, exactly 100 hears prior.

Here is a summary of the four major recommendations:

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2019-01-28T22:43:03-07:00

Article review: Professionalism in the ED through the eyes of medical students


Professionalism
Teaching professionalism in a formal curriculum is so much different than demonstrating professionalism in the Emergency Department. So much of what students and residents learn about professionalism are from observed behaviors of the attending physicians — that is, the hidden curriculum.

In a qualitative study assessing medical student reflection essays during an EM clerkship, the authors (my friends Dr. Sally Santen and Dr. Robin Hemphill) found some startling results. The instructions to the medical students were to “think about an aspect of professionalism that has troubled you this month. Write a minimum of one half-page reflection describing what was concerning and how you might handle it.”

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2016-11-11T18:52:55-07:00

Article review: Improving case presentations with theater training

“To be or not to be?”

What could be more strange on a medical school curriculum than a theater training course? The authors of this study in Medical Humanities innovatively designed a 1-week elective course to help medical students at Mayo Medical School to improve their case presentation skills in partnership with the Guthrie Theater.

In this pilot course, seven medical students (six 1st year students, one 4th year student) participated. The learning objectives were:

  • Hear stories: those told by patients, colleagues and in written narratives
  • Identify the elements of a narrative, and examine stories for narrative structure 
  • Share stories: through case presentations, body movement, storytelling and acting 
  • Present a patient’s story with elements of traditional medical presentation and narrative

Students were evaluated for the following competencies:

  • The cognitive capacity and flexibility needed to evaluate and acquire reliable clinical information. 
  • The ability to actively and generously observe and listen to another. 
  • An understanding of the components of narrative leading to effective story construction. 
  • A performance sensibility that ensures the delivery of a good story, otherwise known as stage presence. 
  • The finesse to communicate empathically with a patient to create an environment in which she or he feels safe, satisfied and heard.

Eleven sessions, over 25 hours, comprised of the following topics:

  • Improvisation activities
  • Introduction to case presentations
  • Body language – contact improvisation
  • Performance of story
  • Neutral dialogue and elements of a narrative
  • Narrative in context – what’s lost, what’s gained?
  • Listening with a neutral mask
  • Storytelling
  • Writing and presenting case histories
  • The art of personal monologue
  • Final presentations with professional critique

Survey responses uniformly found that students valued this creative, non-traditional approach to learning about interpersonal communications and oral presentations. The art of focused storytelling to an audience  is exactly what physicians do every day when presenting clinical cases.


Reference
Hammer RR, et al. Telling the Patient’s Story: using theatre training to improve case presentation skills. Medical humanities. 2011, 37(1), 18-22. PMID: 21593246
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2016-11-11T18:53:06-07:00

Article review: Clinician attitudes about commercial support of CME

 

CoffeeDid you know that a cup of coffee can cost over $9… when planning a CME conference?

In an interesting survey-based publication by Dr. Tabas (one of my colleagues) that just came out in Archives of Internal Medicine, we learn more about the ins and outs of CME activities. The authors set out to determine the audience members’ opinions about:

  • Commercial/ pharmaceutical support and its impact on bias
  • Their willingness to pay extra conference registration fees to eliminate outside support
 

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2016-11-11T18:53:09-07:00

Article review: Teaching learners about ‘difficult’ patients

DifficultPatient

Your capable resident comes to you, looking frustrated. He says, ‘What a difficult patient. I think you need to get involved.’

This article provides a framework for teachers to allow learners to appreciate these encounters in the Family Medicine. Their points are highly relevant to Emergency Medicine. Strategies include:

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2016-11-11T18:54:24-07:00

Article review: What’s wrong with self-guided learning?

TugOfWar

There is a constant tug-of-war between self-guided learning and supervised learning. With the advances in technology for medical education such as asynchronous learning modules, simulation, there has been a movement away from traditional, instructor-led teaching and towards more independent, self-guided learning. There is less supervision of learning.
But left unsupervised, are learners learning the right things and doing so optimally? The authors, in this review, say yes and no.

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2016-11-11T18:58:01-07:00