Pedagogical Strategies for the Enhancement of Medical Education

More than a bag of tricks - Curriculum schema for chronic lower extremity wound healing

Chronic wound treatment is a huge burden on our healthcare system, yet wound healing is not broadly taught in U.S. medical schools. Chronic lower extremity wounds (CLEW) often have delays in diagnosis of the underlying aetiology and inappropriate evaluation before referral. We devised a CLEW healing curriculum in 2019 for medical students in their clinical years. The curriculum includes a session of brief online learning modules, a multi-disciplinary face-to-face workshop, and an online vignette. Pre-session surveys found that students felt most comfortable describing aetiologies and least comfortable choosing a wound product. Self-reported confidence was significantly higher across all wound types following the online modules (p < 0.001). Performance on the peripheral arterial occlusive disease online modules remained low throughout. Future work aims to determine the success of long-term memory encoding of this curriculum as well as address potential biases that students may have when caring for patients with chronic wounds.

Handoff Mnemonics Used in Perioperative Handoff Intervention Studies: A Systematic Review

BACKGROUND

Perioperative handoffs are known to present unique challenges to safe and effective patient care. Numerous national accrediting bodies have called for standardized, structured handoff processes. Handoff mnemonics provide a memory aid and standardized structure, as well as promote a shared mental model. We set out to identify perioperative handoff intervention studies that included a handoff mnemonic; critically assess process and patient outcome improvements that support specific mnemonics; and propose future recommendations.

METHODS

We conducted a systematic review of the English language perioperative handoff intervention literature designed to identify handoff mnemonic interventions. A comprehensive protocol was developed and registered (CRD42022363615). Searches were conducted using PubMed, Scopus, ERIC (EBSCO), Education Full Text (EBSCO), EMBASE (Elsevier), and Cochrane (January 1, 2010 to May 31, 2022). Pairs of trained reviewers were involved in all phases of the search and extraction process.

RESULTS

Thirty-seven articles with 23 unique mnemonics met the inclusion criteria. Most articles were published after 2015 (29/37; 78%). Situation, Background, Assessment, Recommendation (SBAR), and SBAR variants were used in over half of all studies (22/37; 59%), with 45% (10/22) reporting at least 1 statistically significant process improvement. Seventy percent of handoff mnemonics (26/37) were expanded into lists or checklists. Fifty-seven percent of studies (21/37) reported using an interdisciplinary/interprofessional team to develop the intervention. In 49% of all studies (18/37) at least 1 measurement tool was either previously published or the authors conducting some form of measurement tool validation. Forty-one percent of process measurement tools (11/27) had some form of validation. Although most studies used training/education as an implementation strategy (36/37; 97%), descriptions tended to be brief with few details and no study used interprofessional education. Twenty-seven percent of the identified studies (10/37) measured perception alone and 11% (4/37) measured patient outcomes.

CONCLUSIONS

While the evidence supporting one handoff mnemonic over others is weak, SBAR/SBAR variants have been studied more often in the perioperative environment demonstrating some process improvements. A key finding is that 70% of included studies converted their handoff mnemonic to a list or checklist. Finally, given the essential nature of effective handoffs to perioperative patient safety, it is crucial that handoff interventions are well developed, implemented, and evaluated. We propose 8 recommendations for future perioperative handoff mnemonic clinical interventions and research.

A Game-Based Tool for Reducing Jargon Use by Medical Trainees

Introduction

Physicians can be unaware that many US adults have intermediate or lower health literacy. Avoiding medical jargon in patient communication can improve poor outcomes associated with lower health literacy, but physicians may struggle to do so as health literacy education is neither standardized nor universal at US allopathic medical schools. As with other skills-based proficiencies in medical education, repeat exposure and active learning help build competency. Medical students developed the Patient Communication Challenge (PCC), an adaptation of the Hasbro game Taboo, to facilitate practice of patient-centered communication skills among medical trainees.

Methods

Hour-long workshops were held for groups of preclinical medical students. Students watched a communication exemplar video, played the PCC game, and completed a postworkshop survey. To play, two teams competed to earn points by identifying medical concepts as explained by a teammate who described the term without using medical jargon.

Results

Evaluations indicated that the game was enjoyable and reinforced didactic concepts through active learning, with self-reported participant satisfaction and competency gain. Overall, 59% of participants (53 of 90) completed postworkshop surveys; 91% (48 of 53) agreed they felt more proficient in avoiding jargon, 94% (50 of 53) would recommend the workshop to a classmate, and 100% (53 of 53) would play again.

Discussion

The PCC can help early medical trainees develop health communication skills through gamification with utilization of adult learning principles and adequate frequency for skill retention. Future applications include longitudinal assessment and expanding to later stages of medical training and other health professions.

Strategies to Effectively Utilize Images in Anatomical Teaching and Assessment

Anatomical images are commonly used in the teaching process to help students understand the spatial orientation of anatomical structures. Previous research has shown that images effectively visualize the relationship between anatomical structures that are difficult to comprehend through verbal or written explanations alone. However, there is a lack of guidelines that specifically address the various methods of utilizing anatomical images and delivering them through multimedia and cognitive load principles. This article aims to provide a concise overview of the proper utilization and delivery of anatomical images and how these images can facilitate student interaction.

Tomographic Plane Visualization (ToPlaV): a Tool to Enhance Echocardiographic Training

Visual learning is an important part of echocardiographic training. Our aim is to describe and evaluate a visual teaching tool, tomographic plane visualization (ToPlaV) as an adjunct to skills training in pediatric echocardiography image acquisition. This tool incorporates learning theory by applying psychomotor skills that closely emulate the skills used in echocardiography. ToPlaV was used as part of a transthoracic bootcamp for first year cardiology fellows. A qualitative survey was given to trainees to evaluate their perceptions of its usefulness. There was universal agreement among fellow trainees that ToPlaV is a useful training tool. ToPlaV is a simple, low cost, education tool which can complement a simulator and live models. We propose that ToPlaV should be incorporated into early training in echocardiography skills for pediatric cardiology fellows.

Neurology Education in 2035: The Neurology Future Forecasting Series

In the past decade, there have been dramatic changes in all aspects of neurologic care, and along with this, neurology education has transformed. These changes have affected all aspects of education across the educational continuum, including learners, teachers, educators, content, delivery methods, assessments, and outcomes. Health systems science, health humanities, diversity, equity, and inclusion and health disparities are becoming core components of neurology curricula, and, in the future, will be integrated into every aspect of our educational mission. The ways in which material is taught and learned have been influenced by technologic innovations and a growing understanding of the science of learning. We forecast that this trend will continue, with learners choosing from an array of electronic resources to engage with fundamental topics, allowing front-line clinical teachers to spend more time supporting critical reasoning and teaching students how to learn. There has been a growing differentiation of educational roles (i.e., teachers, educators, and scholars). We forecast that these roles will become more distinct, each with an individualized pattern of support and expectations. Assessment has become more aligned with the work of the learners, and there are growing calls to focus more on the impact of educational programs on patient care. We forecast that there will be an increased emphasis on educational outcomes and public accountability for training programs. In this article, we reflect on the history of medical education in neurology and explore the current state to forecast the future of neurology education and discuss ways in which we can prepare.

Metamemory functioning and memory strategies used among medical students

BACKGROUND

Metamemory can be described as an intentional endeavor to guide or control one's memory processes. In other words, awareness and knowledge of one's own memory process and strategies for using the memories effectively. Planning, allocating cognitive resources, selecting strategies, assessing understanding, and evaluating performance all rely heavily on metamemorial information. For efficient learning, good memory abilities are necessary. This study aimed to understand metamemory functioning and to see if there were any gender differences in metamemory functioning among medical students.

MATERIALS AND METHODS

This cross-sectional study was conducted by collecting data from 350 medical students using the Memory Functioning Questionnaire in 2021. The sample group was selected from medical colleges in South India such as Kerala, Karnataka, Tamil Nadu, Telangana, and Andhra Pradesh using a purposive sampling technique. This questionnaire focused on the seriousness of forgetting, the rate at which people recalled things over time, and frequency of use of mnemonics and techniques that assist memory. Descriptive statistics, independent sample t-test, correlation, and regression were used for analysis.

RESULTS

There was a significant difference based on gender among medical students in general memory functioning and frequency of forgetting (P < 0.001). Similarly, it was also found that gender was a major predictor of general memory functioning and frequency of forgetting among medical students (P < 0.001).

CONCLUSION

Most medical students believe they have a minor memory issue. Even if the majority of medical students forget information, the vast majority of them believe they have an exceptional memory. Gender acts as a significant predictor of general memory performance and forgetfulness.

Advances in the understanding and enhancement of the human cognitive functions of learning and memory

Learning and memory are among the key cognitive functions that drive the human experience. As such, any defective condition associated with these cognitive domains could affect our navigation through everyday life. For years, researchers have been working toward having a clear understanding of how learning and memory work, as well as ways to improve them. Many advances have been made, as well as some challenges that have also been faced in the process. That notwithstanding, there are prospects with regards to the frontier of the enhancement of learning and memory in humans. This review article selectively highlights four broad areas of focus in research into the understanding and enhancement of learning and memory. Brain stimulation, effects of sleep, effects of stress and emotion, and synaptic plasticity are the main focal areas of this review, in terms of some pivotal research works, findings and theories.