Effect of Live Attendance and Video Capture Viewing on Student Examination Performance.

Objective. To compare pharmacy students' performance in a therapeutics course after attending live lectures and/or viewing video-recorded lectures. Methods. Attendance was taken during seven lectures spaced equally throughout the therapeutics course. Data on students' viewing of the video-recorded lectures was extracted. Students were grouped based on class attendance and video-viewing behavior; these data were correlated to student performance on examination lecture specific material. The data were also evaluated based on students' final course grade. Results. From each lecture for which data were collected, between 346 and 349 students were included in the analysis, resulting in 2,430 data points. Students who were attended lecture and did not access the video-recorded lecture were associated with better performance on the respective examination than students who were absent and accessed the video-recorded lecture only once (grade=71.0 vs 62.3). Students who attended lecture, regardless of whether they subsequently viewed the video online, were associated with better performance on the examination than students who were absent (70.4 vs 64.0). Among all students who attended lecture, those that also used the video-recorded lecture were associated with similar performance on the examination as those who did not access the video (grade=69.1 vs 71.0). Conclusion. Results from this pilot study demonstrated that live class attendance was associated with higher examination performance than viewing recorded lectures for a therapeutics class. The results of this pilot study can be used to guide future research in understanding how teaching methods affect student performance.

A Quality Improvement Program to Reduce Potential Overtreatment of Diabetes Among Veterans at High Risk of Hypoglycemia.

Background.. Intensive glycemic control confers increased risk of hypoglycemia and little benefit among older individuals with diabetes. The aim of this quality improvement project was to reduce the number of patients treated to A1C levels that might confer greater risk than benefit (i.e., potential overtreatment) in the VA New England Healthcare System. Methods.. A provider report and clinical reminder were created to identify potentially overtreated patients and prompt clinicians to consider treatment de-intensification. Potentially overtreated patients were defined as those on insulin or a sulfonylurea whose most recent A1C was <7.0% and who were >74 years of age or diagnosed with dementia or cognitive impairment. The numbers of patients screened and whose treatment was de-intensified using the clinical reminder were counted from January to December 2014. The number of high-risk veterans at baseline was compared with that 6 and 18 months after implementation using t tests. Results.. A total of 2,830 patients were screened using the clinical reminder; 9.6% had their glycemic treatment de-intensified. Among the 261 patients reporting hypoglycemia, 37% had their treatment de-intensified. Higher percentages of patients had treatment de-intensified when reported symptoms were more severe. The monthly average in the high-risk cohort declined from baseline by 18% at 6 months and by 22% at 18 months (both P <0.005). Conclusions.. A clinical reminder helps clinicians identify and reduce the number of potentially overtreated patients. The large number of screened patients whose treatment was not de-intensified suggests that a clinical reminder should be combined with provider education, national guidelines, and performance measures aligned in the interest of reducing potential overtreatment.