Faculty Development Advancements-Lessons Learned in a Time of Change.

Faculty development (FD) activities at colleges of medicine shifted to virtual in March 2020 as the coronavirus pandemic limited in-person engagement. Medical schools delivered quality virtual faculty development (VFD) through accessing national and international experts virtually, improving faculty access to FD through recorded sessions, collaborating across institutions, and building on previous success as comfort with virtual platforms grew. Disruptive innovation and Keller's ARCS model, highlighting motivational concepts of attention, relevance, confidence, and satisfaction, guided nine faculty developers' reflections towards continuous quality improvement of VFD offerings. The convenience and low-cost availability of virtual activities mean this format will likely persist.

Promoting Transfer of Learning to Practice in Online Continuing Professional Development.

ABSTRACT: Leveraging online learning tools and encouraging transfer of learning to practice remains a critical challenge to successful continuing professional development (CPD) offerings. Four sets of factors are essential to the transfer of learning from CPD into practice: learner characteristics, instructional design, content, and environment. Through incorporating elements of educational theories/frameworks into the planning of online CPD activities, educators can maximize opportunities for learning transfer. In this article, we highlight four educational theories/frameworks that provide useful insight to tackle these interrelated factors in online CPD: Self-Determination Theory considers the intrinsic and extrinsic motivation of participants, which can be encouraged through flexibility, customization, and choices available in online formats. Practical Inquiry Model encourages intentionally planning and embedding opportunities for reflection and dialogue in online activities to enhance knowledge application. Virtual Communities of Practice can be used to transcend spatial and temporal boundaries, promoting interactions and relationships where participants learn from peers. Finally, Professional Learning Networks can be fostered through developing interpersonal connections and sharing resources for informal and flexible learning. Online CPD is likely to increase in the future, and educators should consider elements of these educational theories/frameworks in the design and delivery of CPD to support participants' application of newly acquired knowledge.

Examining Bloom's Taxonomy in Multiple Choice Questions: Students' Approach to Questions.

BACKGROUND: Analytic thinking skills are important to the development of physicians. Therefore, educators and licensing boards utilize multiple-choice questions (MCQs) to assess these knowledge and skills. MCQs are written under two assumptions: that they can be written as higher or lower order according to Bloom's taxonomy, and students will perceive questions to be the same taxonomical level as intended. This study seeks to understand the students' approach to questions by analyzing differences in students' perception of the Bloom's level of MCQs in relation to their knowledge and confidence. METHODS: A total of 137 students responded to practice endocrine MCQs. Participants indicated the answer to the question, their interpretation of it as higher or lower order, and the degree of confidence in their response to the question. RESULTS: Although there was no significant association between students' average performance on the content and their question classification (higher or lower), individual students who were less confident in their answer were more than five times as likely (OR = 5.49) to identify a question as higher order than their more confident peers. Students who responded incorrectly to the MCQ were 4 times as likely to identify a question as higher order than their peers who responded correctly. CONCLUSIONS: The results suggest that higher performing, more confident students rely on identifying patterns (even if the question was intended to be higher order). In contrast, less confident students engage in higher-order, analytic thinking even if the question is intended to be lower order. Better understanding of the processes through which students interpret MCQs will help us to better understand the development of clinical reasoning skills.

Relieving Dry Mouth: Varying Levels of pH Found in Bottled Water.

It is estimated that 30% of people older than 60 years suffer from hyposalivation or dry mouth. Drinking water frequently has been recommended as a safe, non-pharmacologic way to combat hyposalivation. The saliva in patients with dry mouth is acidic. Beverages consumed daily may have an erosive potential on teeth. The pH and the mineral content of the beverage determine its erosive potential. An acidic beverage, therefore, may have harmful effects on mineralized tooth structures, causing erosion of enamel, dentin, and cementum. Because bottled water is both convenient and easily available, the authors tested the pH of eight common brands of bottled water. (One brand included two different bottle types, for a total of nine bottled waters tested.) To standardize the pH electrode, pH buffers of 4.7 and 10 were used. The pH was measured using the Denver Instruments basic pH meter. Six recordings were used for each brand and then averaged to report the pH. Two of the bottled water samples tested were below the critical level of 5.2 pH to 5.5 pH, the level at which erosion of enamel occurs. Six of the samples tested were below the critical pH of 6.8, at which erosion of root dentin occurs. The authors conclude that both patients and clinicians incorrectly presume bottled water to be innocuous. Clinicians should be cognizant of the erosive potential of different brands of bottled water to both educate patients and to recommend water with neutral or alkaline pH for patients with symptoms of dry mouth to prevent further deterioration and demineralization of tooth structure.

Twelve tips for developing, implementing, and sustaining medical education fellowship programs: Building on new trends and solid foundations.

Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization's educational mission and participants' career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a team of committed individuals who provide expertise, guidance, and mentoring. Qualified MEFP directors should utilize instructional methods that promote individual and institutional short and long term growth. Directors must balance the use of traditional design, implementation, and evaluation methodologies with advancing trends that may support or threaten the acceptability and sustainability of the program. Drawing on the expertise of 28 MEFP directors, we provide twelve tips as a guide to those implementing, sustaining, and/or growing a successful MEFP whose value is demonstrated by its impacts on participants, learners, patients, teaching faculty, institutions, the greater medical education community, and the population's health.

Combining Expertise: Reflecting on a Team Approach to Curriculum Development and Implementation.

INTRODUCTION: This article discussed curriculum development and implementation using a unique collaboration of basic scientists and clinicians functioning as course co-directors. It explores the pros, cons, and unintended consequences of this integrated approach through reflections of the faculty involved. METHODS: Ten faculty participated in semi-structured phone interviews to reflect on their experiences. RESULTS: Analysis of interview transcripts revealed four key themes: (1) the value of the basic scientist and clinician partnership, (2) strategies for coordination, (3) balancing responsibilities, and (4) hierarchy and power. DISCUSSION: This study identified that both basic scientists and clinicians experienced benefits from using a course co-director collaborative approach to curriculum development and implementation. While challenges are also noted, the benefits of the collaboration were evident in course organization, course evaluation reports, student feedback, and USMLE Step I pass rate.

Voice abnormalities at school age in children born extremely preterm.

BACKGROUND AND OBJECTIVES: Voice abnormality is a frequent finding in school age children born at <25 weeks' gestation in Western Australia. The objective of this study was to determine the frequency of voice abnormality, voice-related quality of life, and demographic and intubation factors in this population. METHODS: Survivors <25 weeks' gestational age in Western Australia born from 1996 to 2004 were included. Voice assessments (auditory perceptual assessment scale and Pediatric Voice Handicap Index) were carried out by speech pathologists. Intubation history was obtained by retrospective chart review. RESULTS: Of 251 NICU admissions, 154 (61%) survived. Exclusions were based on severe disability (11) or distant residence (13). Of 70 assessed, 67 completed assessments, 4 (6%) were in the normal range and 39 (58%) showed moderate-severe hoarseness. Simultaneous modeling of demographic and intubation characteristics showed an increased odds of moderate-severe voice disorder for children who had more than 5 intubations (odds ratio 6.96, 95% confidence interval 2.07-23.40, P = .002) and for girls relative to boys (odds ratio 3.46, 95% confidence interval 1.12-10.62, P = .030). Tube size and duration of intubation were not significant in the multivariable model. Median scores of parent-reported voice quality of life on the Pediatric Voice Handicap Index were markedly different for preterm (22) and term (3) groups, P < .001. CONCLUSIONS: Voice disorders in this population were much more frequent than expected. Further studies are required to assess voice across a broader range of gestational ages, and to investigate voice-protective strategies in infants requiring multiple episodes of intubation.

Objective assessment of pediatric voice disorders with the acoustic voice quality index.

OBJECTIVES/HYPOTHESIS: Instrumental measures of voice allow practitioners to assess the severity of voice disorders and objectively measure treatment outcomes. Instrumental measures should be calculated on both sustained vowel and connected speech samples to ensure ecological validity. However, there is a lack of appropriate, validated acoustic measurements for use in the pediatric population. The Acoustic Voice Quality Index (AVQI) is a multivariate acoustic measure of dysphonia that has been found to be reliable, valid, and have diagnostic accuracy and response to change in an adult population. This study aimed to evaluate the AVQI in a pediatric population. STUDY DESIGN: This study was a prospective observational study of a sample of dysphonic and normophonic children. METHODS: Sixty-seven preterm participants (born at less than 25 weeks gestation) aged between 6 and 15 years were recruited. Participants were excluded because of either inability to comply with task requirements or other speech-related factors that affected acoustic measurement. Forty normophonic term-born participants aged between 5 and 15 years were also recruited. AVQI analysis was conducted on a prolonged vowel sample and a sample of continuous speech. RESULTS: The AVQI was found to have diagnostic accuracy and specificity in this population of children with and without dysphonia. It was moderately correlated with ratings of severity on the GRBAS (overall grade of hoarseness (G), roughness (R), breathiness (B), aesthenicity (A), and strain (S)), a subjective rating scale. The threshold for pathology of this sample of 3.46 showed strong sensitivity, specificity, and accuracy, with good-to-excellent likelihood ratios. CONCLUSIONS: This study found that the AVQI has diagnostic accuracy in a pediatric population, suggesting that it is an appropriate assessment tool to determine the presence and severity of pediatric voice disorders.