Patient, Provider, and Organizational Considerations for Implementing Rehabilitation Telehealth.

Introduction: While telehealth services (THS) have been around for some time, for many in the rehabilitation services, it is a new mode of service delivery. THS can be as effective as face-to-face care and are valued by patients and clinicians. However, THS present considerable challenges and may not be appropriate for everyone. Clinicians and organizations must be prepared to triage and manage patients in this environment. Aims of this study were to capture clinician perceptions of the implementation of THS in rehabilitation and use the insights gained to provide strategies for overcoming implementation challenges. Methods: An electronic survey was emailed to 234 rehabilitation clinicians in a large urban hospital. Completion was voluntary and anonymous. Qualitative analysis of the open-ended responses consisted of an iterative consensus-driven interpretivist approach. Multiple strategies were used to minimize bias and optimize trustworthiness. Results: From the 48 responses received, four themes were identified: (1) THS provide unique benefits for patients, providers, and organizations; (2) challenges arose in multiple domains (clinical, technological, environmental, and regulatory); (3) clinicians require specific personal, clinical, and technological knowledge, skills, and attributes to be effective; and (4) individual characteristics, session type, home environment, and needs must be considered in patient selection. Discussion and Conclusion: From the themes identified, a conceptual framework illustrating the keys to effective implementation of THS was developed. Recommendations addressing challenges across multiple domains (clinical, technological, environmental, and regulatory), and at all levels of care delivery (patient, provider, and organization) are provided. Insights gained from this study can be used by clinicians in advocating for and designing effective THS programs. Educators would also gain from using these recommendations to train students and clinicians to recognize and address the challenges they may encounter in providing THS in rehabilitation.

Transformative Learning Emerging From Challenges First-Year Students Experienced.

INTRODUCTION: Doctor of physical therapy (PT) (DPT) programs are rigorous, and students report facing overwhelming challenges. Faculty may not be cognizant of the extent of these challenges and miss opportunities to support student learning. The purpose of this article is to describe factors affecting student coping abilities and the lessons they learned from managing their self-identified challenges. REVIEW OF LITERATURE: Given the growing body of evidence surrounding mental health issues in DPT students, educators are exploring ways to support student well-being and promote their professional development. SUBJECTS: This study is a component of a larger multisite study of first-year DPT students from 3 private universities. METHODS: Participants submitted written narratives in response to a critical incident questionnaire designed to better understand first-year challenges. Responses were deidentified, researchers were blinded to participation, and confidentiality was maintained throughout. A consensus-driven interpretivist approach to qualitative data analysis was used. Strategies to ensure trustworthiness included triangulation of researchers, peer review, prolonged engagement, and use of thick rich descriptions. RESULTS: Seventy responses were analyzed. Two major themes are presented: (1) students described factors internal and external to the learning environment that inhibited and facilitated their ability to cope with challenges and (2) students shared academic successes and lessons learned from overcoming challenges, including the development of new behaviors, enhanced self-awareness, and personal and professional growth. DISCUSSION AND CONCLUSION: Building on previous work, analysis of the lived experiences of first-year DPT students revealed a process of transformational learning through challenge. This process highlights the importance of recognizing and supporting the significant incidental learning that occurs in our students during their journey through PT school. Faculty focusing solely on content knowledge, skills, and even critical thinking may not recognize and support the incidental learning occurring and may be missing significant transformational learning opportunities.

How Do Standardized Patients Form Their Complex Identities? The Impact of Interactions With Medical Students.

INTRODUCTION: Little is known about the nature of standardized patient (SP) identity and its formation. Understanding identity and formation can have important implications for recruiting, working with, and retaining SPs. Social relational theory explains how identity is formed in a social context in relationship with others. In keeping with social relational theory, this study explored SP identity formation through the SP experience with one of the most important elements of their social context-medical students. METHODS: Using qualitative methods, we conducted four 1-hour semistructured focus group interviews with SPs (N = 18). Interviews were audio recorded and transcribed verbatim. We used a constant comparative approach and consensus development to analyze the data and identify codes, categories, and ultimately themes. We used multiple methods to ensure credibility and trustworthiness of the study, as well as transparency of methods and thick rich descriptions to enable readers to judge transferability of the findings and conclusions. RESULTS: We identified 4 major themes. Through their interactions, SPs experienced: (1) identity transformation toward a new professional identity; (2) self-actualization toward their maximum potential; (3) judgmental reactions to medical student behaviors; and (4) simulation-reality interaction between their simulated and real selves. CONCLUSIONS: Through their interactions with medical students, SPs experienced a transformation into a complex identity composed of multiple roles. Within this identity, they found purpose, fulfillment, and self-actualization through fostering students', as well as their own, personal, and professional growth and through developing a higher sense of social responsibility. Within this identity, they also encountered the challenges of navigating between judging and supporting medical students, and toggling between their real and simulated selves. Guided by the SPs' perspectives, and in conjunction with professional organizational standards, we provide recommendations for training, recruitment, and retention of SPs.

Physical Therapist, Physical Therapist Assistant, and Student Response to Inappropriate Patient Sexual Behavior: Results of a National Survey.

Background: A recent survey found that 84% of physical therapist, physical therapist assistant, and student respondents experienced inappropriate patient sexual behavior (IPSB) over their careers and 47% over the prior 12 months. Prevalence data justify consideration of how to address IPSB. Objective: The objective was to determine how physical therapist clinicians (used here to mean physical therapists, physical therapist assistants, and students) address IPSB and examine strategy impact. Design: The design was observational and cross-sectional. Methods: Several sections of the American Physical Therapy Association and selected education programs fielded the electronic survey. Respondents reported on the frequency and effect of IPSB response strategy. Response-strategy impact was tested for statistical significance. Open-ended comments were analyzed using qualitative methods. Results: Of 1027 respondents, 396 had experienced IPSB over the prior 12 months; 391 provided data on the frequency and effect of response strategies used. Common informal responses included distraction, ignoring IPSB, and altering treatment to avoid physical contact or being alone. Common formal responses included reporting the behavior within the facility and documenting the behavior. Successful strategies included distraction, avoidance, direct confrontation, behavioral contracts, transfer of care, and chaperone use. Experienced clinicians were more likely to be direct, whereas novice clinicians were more likely to engage in unsuccessful actions of ignoring and joking. Limitations: Limitations included self-report, clinician memory, and convenience sampling. Conclusions: The first findings in 20 years on physical therapist, physical therapist assistant, and student response to IPSB provide direction for the profession. Results indicate a need for clear workplace policies coupled with training for managers and supervisors to support clinicians in resolving IPSB. Policies on using behavioral contracts, chaperones, and transfer of care could empower staff to consider these successful options. Professional education and training for all physical therapy professionals on assertive communication and redirection strategies with IPSB appears warranted.

Preparing Interprofessional Faculty to Be Humanistic Mentors for Medical Students: The GW-Gold Mentor Development Program.

INTRODUCTION: The GW-Gold Humanistic Mentor Development Program addresses the challenge faced by medical schools to educate faculty to prepare students for humanistic practice. Grounded in Branch's Teaching Professional and Humanistic Values model, the program prepares interprofessional faculty mentoring teams in humanistic communities of practice. The teams consist of physician-psychosocial professional pairs, each mentoring a small student group in their professional development course. Through GW-Gold workshops, faculty mentors develop interprofessional humanistic communities of practice, preparing them to lead second such communities with their students. This article describes the program and its evaluation. METHODS: To assess outcomes and better understand the mentor experience, we used a mixed-method validating triangulation design consisting of simultaneous collection of quantitative (mentor and student surveys) and qualitative (open-ended survey questions and focus group) data. Data were analyzed in parallel and merged at the point of interpretation, allowing for triangulation and validation of outcomes. RESULTS: Mentors rated the program highly, gained confidence in their humanistic skills, and received high scores from students. Three themes emerged that validated program design, confirmed outcomes, and expanded on the mentor experience: (1) Interprofessional faculty communities developed through observation, collaboration, reflection, and dialogue; (2) Humanistic mentors created safe environments for student engagement; and (3) Engaging in interprofessional humanistic communities of practice expanded mentors' personal and professional identities. DISCUSSION: Outcomes support the value of the GW-Gold program's distinctive features in preparing faculty to sustain humanism in medical education: an interprofessional approach and small communities of practice built on humanistic values.

Systems Thinking and Systems-Based Practice Across the Health Professions: An Inquiry Into Definitions, Teaching Practices, and Assessment.

Phenomenon: Systems thinking is the cornerstone of systems-based practice (SBP) and a core competency in medicine and health sciences. Literature regarding how to teach or apply systems thinking in practice is limited. This study aimed to understand how educators in medicine, physical therapy, physician assistant, nursing, and speech-language pathology education programs teach and assess systems thinking and SBP. APPROACH: Twenty-six educators from seven different degree programs across the five professions were interviewed and program descriptions and relevant course syllabi were reviewed. Qualitative analysis was iterative and incorporated inductive and deductive methods as well as a constant comparison of units of data to identify patterns and themes. FINDINGS: Six themes were identified: 1) participants described systems thinking as ranging across four major levels of healthcare (i.e., patient, care team, organization, and external environment); 2) participants associated systems thinking with a wide range of activities across the curriculum including quality improvement, Inter-professional education (IPE), error mitigation, and advocacy; 3) the need for healthcare professionals to understand systems thinking was primarily externally driven; 4) participants perceived that learning systems thinking occurred mainly informally and experientially rather than through formal didactic instruction; 5) participants characterized systems thinking content as interspersed across the curriculum and described a variety of strategies for teaching and assessing it; 6) participants indicated a structured framework and inter-professional approach may enhance teaching and assessment of systems thinking. Insights: Systems thinking means different things to different health professionals. Teaching and assessing systems thinking across the health professions will require further training and practice. Tools, techniques, taxonomies and expertise outside of healthcare may be used to enhance the teaching, assessment, and application of systems thinking and SBP to clinical practice; however, these would need to be adapted and refined for use in healthcare.

Prevalence and Risk of Inappropriate Sexual Behavior of Patients Toward Physical Therapist Clinicians and Students in the United States.

BACKGROUND: For health care providers in the United States, the risk for nonfatal violence in the workplace is 16 times greater than that for other workers. Inappropriate patient sexual behavior (IPSB) is directed at clinicians, staff, or other patients and may include leering, sexual remarks, deliberate touching, indecent exposure, and sexual assault. Inappropriate patient sexual behavior may adversely affect clinicians, the organization, or patients themselves. Few IPSB risk factors for physical therapists have been confirmed. The US prevalence was last assessed in the 1990s. OBJECTIVE: The objectives of this study were to determine career and 12-month exposure to IPSB among US physical therapists, physical therapist assistants, physical therapist students, and physical therapist assistant students and to identify IPSB risk factors. DESIGN: This was a retrospective and observational study. METHODS: An electronic survey was developed; content validity and test-retest reliability were established. Participants were recruited through physical therapist and physical therapist assistant academic programs and sections of the American Physical Therapy Association. Inappropriate patient sexual behavior risk models were constructed individually for any, mild, moderate, and severe IPSB events reported over the past 12 months. Open-ended comments were analyzed using qualitative methods. RESULTS: Eight hundred ninety-two physical therapist professionals and students completed the survey. The career prevalence among respondents was 84%, and the 12-month prevalence was 47%. Statistical risk modeling for any IPSB over the past 12 months indicated the following risks: having fewer years of direct patient care, routinely working with patients with cognitive impairments, being a female practitioner, and treating male patients. Qualitative analysis of 187 open-ended comments revealed patient-related characteristics, provider-related characteristics, and abusive actions. LIMITATIONS: Self-report, clinician memory, and convenience sampling are limitations of this type of survey research. CONCLUSIONS: The extremely high prevalence of IPSB among physical therapist professionals warrants practitioner and student education as well as clear workplace policy and support.

A Cloud With a Silver Lining: Helping Students Learn About Professionalism.

PROBLEM: Educators face many challenges in teaching professionalism. Despite attempts to define professionalism, it remains abstract for students and often not fully appreciated until they are in clinic. Without a way to make it personally relevant, students will likely be less motivated to learn. INTERVENTION: We used student-generated word clouds to facilitate reflection and discussions, thereby helping students make their perceptions of professionalism more explicit. Group discussion was followed by a 5-minute written reflection. Word clouds created in Semesters 1 and 7 enabled students to compare perceptions at two points in the curriculum. CONTEXT: The George Washington University Doctor of Physical Therapy Program is a 3-year, 8-semester, 109-credit postgraduate program that includes 34 weeks of clinical practice. Reflection is foundational to the curriculum, and students reflect on their learning and professional growth each semester. Historically, students were introduced to professionalism in Semester 1 using explicit instructional strategies. Despite the wealth of resources, readings, and discussions, engagement remained challenging. OUTCOME: Student-generated word clouds created a personally relevant visual from which uniquely designed prompts were created to facilitate discussion. Having students compare word clouds across semesters enabled them to identify what, when, how, and where they learned about professionalism. Word clouds, categorized words, and 5-minute written reflections provided evidence of individual and collective changes in student perceptions. LESSONS LEARNED: Students will engage in rich discussions on professionalism if it is personally relevant. Anonymity can foster discussion on personal characteristics and biases. Visualization of student-generated, narrative data enhanced reflection and discussion. Comparing word clouds from two points in time helped students articulate changes in their perceptions of professionalism. A 5-minute reflection can be a powerful learning tool for students and faculty. Outcomes demonstrated the value of designing interventions grounded in the educational principles.

Do Standardized Patients Have Concerns About Students Not Captured by Traditional Assessment Forms?

Construct: Traditionally, standardized patients (SPs) assess students' clinical skills principally through numerical rating forms-an approach that may not fully capture SPs' concerns. SPs are students' closest approximation to real patients. To maximally benefit students' clinical training and evaluation it is important to find ways to give voice to the totality of SPs' perspectives. BACKGROUND: SPs have been shown to be a reliable and valid means to assess medical students' clinical skills in clinical skills examinations. We noticed, however, that SPs often express "off the record" concerns about students, which they do not include on traditional assessment forms. APPROACH: To explore these "off the record" concerns, we designed a Concerns item and added it to the traditional assessment form for an end-of-3rd-year clinical skills examination shared by three medical schools. We asked SPs to use this Concerns item to identify students about whom they had any "gut-level" concerns and provided them with a narrative opportunity to explain why. SPs were informed that the purpose of the item was to help students with difficulties and was not part of the student's grade. RESULTS: We analyzed the concerns data using quantitative and qualitative methods. Of 551 students at three schools, 223 (∼40%) had concerns recorded. Seventy students received two or more concerns. Qualitative analysis of SPs' comments revealed 3 major categories of concern: communication and interpersonal skills, history taking, and physical exam. Grouped under each were several subcategories. More than half of the written comments from the SPs related to the communication/interpersonal skills category and included subcategories commonly addressed in communications courses: lack of empathy, good listening skills, and lack of connection to the patient. They also included subcategories that in our experience are less commonly addressed: odd or off-putting mannerisms, lack of confidence, unprofessional behavior, domineering behavior, and biased behavior. Another 47% of concerns identified deficiencies in history taking and physical examination. Of the students with concerns noted by two or more SPs, SPs' narrative comments on 84%, 42%, and 48% of the students in the domains of communications, history, and physical exam respectively indicated potential problems not identified by scores on the traditional assessment form. CONCLUSION: The Concerns item is a narrative assessment method that may add value to traditional quantitative scoring by identifying and characterizing problematic student performance not captured by the traditional assessment form. It may thus contribute to giving fuller voice to the totality of SPs' perspective.

Assessing Performance and Learning in Interprofessional Health Care Teams.

PURPOSE: Teamwork has become an integral part of health care delivery. Such emphasis on teamwork has generated the need to systematically measure and improve the learning and performance of health care teams. The purpose of this study was to develop a comprehensive assessment instrument, the Interprofessional Education and Practice Inventory (IPEPI), to evaluate learning and performance in interprofessional health care teams. METHODS: The 12-month study commenced in three 4-month phases: (1) a panel of 25 national and international experts participated in the Delphi process to identify factors influencing team learning and team performance; (2) the research team analyzed the findings from the two Delphi rounds to develop the IPEPI; and (3) a cohort of 27 students at the university engaged in clinical simulations to test and refine the IPEPI. RESULTS: Findings suggest key factors that significantly influence team learning and performance include whether the group is able to foster a climate of mutual respect, adopt effective communication strategies, develop a sense of trust, and invite contributions from others. Additionally, in assessing organizational factors, participants indicated those factors that significantly influence team learning and performance include whether the organization is patient-centered, creates a culture of safety (not blame), and supports individual and team learning. CONCLUSIONS: These findings highlight the critical role assessment plays in enhancing not just interprofessional education or interprofessional practice, but in essence advancing interprofessional education and practice--which requires an integrated examination of how health care professionals learn and perform in teams.

How learning transfers: a study of how graduates of a faculty education fellowship influenced the behaviors and practices of their peers and organizations.

PURPOSE: Faculty development programs have been criticized for their limited assessment methods, focused only on the learners and limited to satisfaction measures or self-reported behavior changes. Assessment of organizational impact is lacking. This study explored the impact of faculty education fellowship graduates on their organization and how that impact occurred. METHOD: The design was a qualitative study of 13 departments across three institutions, partnered with the George Washington University School of Medicine and Health Sciences. In-depth interviews with 13 supervisors and 25 peers of graduates were conducted in fall 2012 to examine graduates' organizational impact related to program purposes: enhancing teaching skills, pursuing scholarship in education, and developing leadership potential. Triangulation, purposive sampling, rich descriptions, and member checks minimized bias and optimized transferability. RESULTS: A model of how graduates of a faculty education fellowship transfer learning to peers and their organizations emerged. Analysis of interview responses showed that in the presence of environmental facilitators, graduates exhibited enhanced confidence and five new behaviors. Graduates raised peer awareness, leading to changes in individual and group practices and development of shared peer understanding. Analysis suggests they facilitated a culture of continuous learning around teaching, scholarship, and leadership. CONCLUSIONS: This study enhances traditional assessment of faculty education fellowship programs by examining the impact that graduates had on peers and work groups. A model is proposed for how graduates interact with and impact work group processes and practices. This model can facilitate more comprehensive program assessments, which can demonstrate program impact beyond the individual participant.

Out-of-school genomics program for young women demystifies genomics and fosters interest in biomedical sciences.

BACKGROUND: Pharmacogenomics (PGx) plays a critical role in personalized medicine; however, most healthcare practitioners lack the training and confidence in PGx required to fully utilize its potential. Although continuing education and inclusion of PGx into the professional curricula will begin to address this deficiency, PGx education at the secondary and postsecondary levels would demystify PGx and pique interest at an academic stage that is key to funneling PGx curious students into the science and healthcare pipeline earlier. METHODS: This article describes the development and evaluation of a genomics outreach program targeted at young women in high school with the ultimate goal of recruiting students into an undergraduate PGx program and school of pharmacy. RESULTS: This program increased participants' genomics knowledge, influenced their careers interests, and imparted positive feelings towards a genomics-based and/or biomedical career. CONCLUSION: Genomics-based educational outreach programs geared towards secondary school students can increase interest in and confidence to pursue a PGx-centric degree/career. Original submitted 3 July 2013; Revision submitted 6 January 2014.

Introducing medical students to careers in medical education: the student track at an annual medical education conference.

Few avenues exist to familiarize medical students with careers as clinician-educators, and the clinician-educator career pathway has not been well defined. In this article, the authors describe how they integrated a career-oriented student track into the 2011 Northeast Group on Educational Affairs (NEGEA) annual retreat to introduce students to careers in medical education. Annual education conferences are principal sources of educational scholarship, networking, collaboration, and information sharing; as such, they represent attractive venues for early exposure to the culture of medical education. The authors' goal in creating the NEGEA conference student track was to excite students about careers in medical education by providing them with an array of opportunities for active involvement in both student-specific and general conference activities.The authors draw from their experience to provide a guide for recruiting student participants to career-building student tracks. They also offer a guide for developing future student tracks, based on their experience and grounded in social cognitive career theory. Although their focus is on medical education, they believe these guides will be useful for educators planning a conference-based student track in any field.

Perceived effectiveness and barriers to physical therapy services for families and children with Friedreich ataxia.

PURPOSE: To describe the frequency, type, and perceived effectiveness of physical therapy interventions for children with Friedreich ataxia (FA); identify barriers to therapy; and solicit advice from parents. METHOD: Parents of 30 children with FA participated in semistructured interviews. Qualitative and quantitative methods were used to analyze the data. RESULTS: Sixty-seven percent of children received direct physical therapy service. Stretching and strengthening exercises were used most frequently, and their perceived usefulness increased as the children aged. Seventy-three percent received home exercise programs; 9% implemented these consistently. External barriers included a lack of expert providers and limited reimbursement. Internal barriers included limited time and energy, lack of awareness of services, and children's preferences not to be treated differently. Parents advised therapists to become experts, advocates, and use approaches based on family and child preferences. CONCLUSIONS: Outcomes provide a starting point for developing further research, education, and effective interventions for children with FA.

Integrating executive coaching and simulation to promote interprofessional education of health care students.

This study used executive coaching and simulation to enhance interprofessional teamwork by promoting collaboration and leadership capacity in health professional students attending undergraduate programs. A mixed methods approach to program evaluation was used. A statistically significant (p<0.05) increase was noted pre- and post-program on the Team Assessment Inventory. Qualitative analysis of reflective essays and focus group interviews revealed that students participated as a career-building opportunity and because they wanted to gain a better appreciation for the roles and contributions of other health care providers. The themes that emerged related to aspects of the process students found helpful, lessons learned about professional roles, and the meaning of leadership in the context of interprofessional teams. Students also provided recommendations for future studies. Findings suggest that integrating executive coaching and simulation in interprofessional education may have the potential to create meaningful experiences for health professional students. While more empirical research is needed to investigate this potential, in terms of how executive coaching and simulation may increase professional collaborative care and improve the quality of health care delivery, the initial insights seem promising.

Using a commercially available web-based evaluation system to enhance residents' teaching.

BACKGROUND: Residents-as-teachers (RATs) programs have been shown to improve trainees' teaching skills, yet these decline over time. INTERVENTION: We adapted a commercial Web-based system to maintain resident teaching skills through reflection and deliberate practice and assessed the system's ability to (1) prevent deterioration of resident teaching skills and (2) provide information to improve residents' teaching skills and teaching program quality. METHODS: Ten first-year obstetrics-gynecology (Ob-Gyn) residents participated in a RATs program. Following the program, they used a commercial evaluation system to complete self-assessments of their teaching encounters with medical students. Students also evaluated the residents. To assess the system's effectiveness, we compared these residents to historical controls with an Objective Structured Teaching Examination (OSTE) and analyzed the ratings and the free text comments of residents and students to explore teaching challenges and improve the RATs program. RESULTS: The intervention group outscored the control group on the OSTE (mean score ± SD  =  81 ± 8 versus 74 ± 7; P  =  .05, using a 2-tailed Student t-test). Rating scale analysis showed resident self-assessments were consistently lower than student evaluations, with the difference reaching statistical significance in 3 of 6 skills (P < .05). Comments revealed that residents most valued using innovative teaching techniques, while students most valued a positive educational climate and interpersonal connections with residents. Recommended targets for RATs program improvement included teaching feedback, time-limited teaching, and modeling professionalism behaviors. CONCLUSIONS: Our novel electronic Web-based reinforcement system shows promise in preventing deterioration of resident teaching skills learned during an Ob-Gyn RATs program. The system also was effective in gaining resident and student insights to improve RATs programs. Because our intervention was built upon a commercially available program, our approach could prove useful to the large population of current subscribers.

Learning clinical versus leadership competencies in the emergency department: strategies, challenges, and supports of emergency medicine residents.

BACKGROUND: Emergency medicine residents are expected to master 6 competencies that include clinical and leadership skills. To date, studies have focused primarily on teaching strategies, for example, what attending physicians should do to help residents learn. Residents' own contributions to the learning process remain largely unexplored. The purpose of this study was to explore what emergency medicine residents believe helps them learn the skills required for practice in the emergency department. METHODS: This qualitative study used semistructured interviews with emergency medicine residents at a major academic medical center. Twelve residents participated, and 11 additional residents formed a validation group. We used phenomenologic techniques to guide the data analysis and techniques such as triangulation and member checks to ensure the validity of the findings. RESULTS: We found major differences in the strategies residents used to learn clinical versus leadership skills. Clinical skill learning was approached with rigor and involved a large number of other physicians, while leadership skill learning was unplanned and largely relied on nursing personnel. In addition, with each type of skills, different aspects of the residents' personalities, motivation, and past nonclinical experiences supported or challenged their learning process. CONCLUSION: The approaches to learning leadership skills are not well developed among emergency medicine residents and result in a narrow perspective on leadership. This may be because of the lack of formal leadership training in medical school and residency, or it may reflect assumptions regarding how leadership skills develop. Substantial opportunity exists for enhancing emergency medicine residents' learning of leadership skills as well as the teaching of these skills by the attending physicians and nurses who facilitate their learning.

Peer-facilitated virtual action learning: reflecting on critical incidents during a pediatric clerkship.

OBJECTIVES: Action learning (AL) facilitates reflection, critical thinking, and learning while solving real-world problems. Virtual AL is an asynchronous collaborative process that encourages students to analyze their critical incidents and learn from these experiences. The researchers sought to: 1) determine whether medical students engaged in peer-facilitated virtual action learning (VAL) demonstrated reflection and critical thinking around complex issues during their pediatric clerkship; and 2) identify challenges students face during their clerkships. METHODS: Seventy clerkship students were introduced to reflection and participated in VAL by using an electronic discussion board. Each posted 1 critical incident and group members responded with thought-provoking questions and comments to facilitate reflection and analysis. Weekly, students who posted incidents revisited their incidents, pondered the questions posed, and wrote essays summarizing their reflections and insights gained. Data were analyzed using qualitative methods. RESULTS: Seventy incidents, 210 responses, and 70 revised incidents/essays were analyzed. Outcomes included broadened perspectives (44/70), questioned assumptions (12/70), and reconfirmed thinking (14/70). Content themes included communication, role identification, medical treatment concerns, and limited voice and power. CONCLUSIONS: Most of the students engaged in VAL demonstrated reflection on complex clinical issues. Themes portrayed struggles encountered and exposed issues in the hidden curriculum, suggesting a lack of voice and power that may lead to missed learning opportunities. Discussion threads offered the clerkship director insights into the overall student experience to improve future clerkship experiences.

Development of an undergraduate pharmacogenomics curriculum.

Pharmacogenomic biomarkers are becoming increasingly common in medicine and drug development. However, there is a genuine concern that the healthcare workforce will be ill-equipped to translate this information to clinical practice. As a result, a major effort is underway to educate future healthcare professionals on pharmacogenomics. This paper describes the development of a year-long course that aims to instill the fundamental concepts of this rapidly growing field into the minds of undergraduate students. This course offers the advantage of exposing students to the concepts of pharmacogenomics prior to their enrollment in PhD, PharmD or MD/DO graduate programs.