A Synchronous Hybrid Team-Based Learning Class: Why and How to Do It?

COVID-19 pandemic has transformed much of the medical curriculum delivery from in person to online. Given that interpersonal interaction facilitates team cohesion and professional identity formation, prolonged online learning with minimal social interaction might impact these competencies in medical education. To mitigate the impact of prolonged social isolation, we conducted synchronous team-based learning (TBL) classes, where half the class is physically present and the other is connected via an online platform, termed hybrid TBL. We present practical tips in implementing hybrid TBL for educators teaching in large-sized classes, should conditions exist where not all students can attend in person.

A Systematic Scoping Review on Portfolios of Medical Educators.

BACKGROUND: Heralded as a teaching, assessment and reflective tool, and increasingly as a longitudinal and holistic perspective of the educator's development, medical educator's portfolios (MEP)s are increasingly employed to evaluate progress, assess for promotions and career switches, used as a reflective tool and as a means of curating educational activities. However, despite its blossoming role, there is significant dissonance in the content and structure of MEPs. As such, a systematic scoping review (SSR) is proposed to identify what is known of MEPs and its contents. METHODS: Krishna's Systematic Evidenced Based Approach (SEBA) was adopted to structure this SSR in SEBA of MEPs. SEBA's constructivist approach and relativist lens allow data from a variety of sources to be considered to paint a holistic picture of available information on MEPs. RESULTS: From the 12 360 abstracts reviewed, 768 full text articles were evaluated, and 79 articles were included. Concurrent thematic and content analysis revealed similar themes and categories including: (1) Definition and Functions of MEPs, (2) Implementing and Assessing MEPs, (3) Strengths and limitations of MEPs and (4) electronic MEPs. DISCUSSION: This SSR in SEBA proffers a novel 5-staged evidence-based approach to constructing MEPs which allows for consistent application and assessment of MEPs. This 5-stage approach pivots on assessing and verifying the achievement of developmental milestones or 'micro-competencies' that facilitate micro-credentialling and effective evaluation of a medical educator's development and entrust-ability. This allows MEPs to be used as a reflective and collaborative tool and a basis for career planning.

Visualizing faculty development impact: A social network analysis.

Faculty development programs have tended to focus on low levels of evaluation such as participant satisfaction rather than assess the actual changes that training has brought about in the workplace. This has prompted scholars to suggest using social network analysis as a means to provide a more rigorous method of evaluating the impact of faculty development. To test the feasibility of such a suggestion, we used the social network analysis concepts of social cohesion to assess the impact of a year-long fellowship program conducted by Duke-NUS Medical School's Academic Medicine Education Institute (AM·EI). Specifically, we used the key metrics of connectedness and betweenness centrality to assess the changes in the AM·EI fellows' information and collaboration networks post-fellowship. We invited three cohorts of AM·EI fellows (2013-2016; n = 74) to participate in a branched survey. The response rate was 64%; n = 47. Results showed that in terms of connectedness, the largest connected set more than doubled in size, and pair level reachability grew threefold. Betweenness centrality among the AM·EI fellows also increased, with more individuals reporting that they sought advice from the fellows as well as trusted the advice the fellows provided. In sum, this study suggests that it is indeed viable to use social network analysis to identify changes in social cohesion. As such, social network analysis serves as another tool for scholars to use to assess the impact of their faculty development efforts.

A nationwide, resident-led teaching programme for medical students in Singapore: SingHealth Student Internship Programme Bootcamp.

INTRODUCTION: This study aimed to describe the planning, development and evaluation of the success of the first nationwide, resident-led, large-group teaching programme for medical students - the Singapore Health Services Student Internship Programme (SIP) Bootcamp. METHODS: This was an initial feasibility study evaluating a half-day teaching boot camp initiated, developed and conducted by the resident educators. A three-month preparation period was required to set up an education subcommittee, liaise with medical student leaders, recruit resident educators, meet all the stakeholders and conduct the boot camp. During the SIP Bootcamp, resident educators conducted clinical case presentations using a question-and-answer format. Audience participation was strongly encouraged. A 15-item questionnaire was distributed to assess the participants' learning experience and the resident educators' teaching performance using a five-point Likert scale. RESULTS: Overall, 94.8% (n = 110) of the 116 respondents agreed that the teaching sessions were of high quality and content was relevant to their training. The resident educators appeared well-informed (96.6%, n = 112) and enthusiastic about their respective topics (98.3%, n = 114). However, a few students (9.5%, n = 11) felt that the audio-visual aids and handouts could be improved to better aid their learning process. CONCLUSION: This teaching boot camp for medical students was the first of its kind in Singapore and feedback from medical students showed that it was well-received. Further research using different teaching methods, including small-group discussions and surgical practical sessions by resident educators from different specialties, would be of great value to students.

Academic Medicine Education Institute (AM·EI): Transforming the Educational Culture of Health Professionals.

INTRODUCTION: The Academic Medicine Education Institute (AM∙EI), jointly established by Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth), is a newly formed health professions education academy designed to cultivate best education practices and create a community of health professions educators. To achieve the aims of AM∙EI, the needs of SingHealth educators have to be understood. Therefore, this study was carried out to assess educators' perceptions towards the current education climate and their academic needs. MATERIALS AND METHODS: A 28-item questionnaire consisting of free-response, Likert-type and ranking questions was developed. The questionnaire was electronically distributed to 200 medical and nursing educators, and made available to attendees of the 2012 Singhealth Duke-NUS Scientific Congress through hardcopies. RESULTS: A total of 150 completed questionnaires were received (94 from electronic survey and 56 from Congress). Five themes emerged from the analysis of responses to free-response questions: 1) faculty development, 2) development of a community of educators, 3) recognition for educational efforts, 4) institutional support, and 5) better communication about SingHealth educational activities. Respondents were in highest agreement with the statements (rating of 3.7 out of 5): "The SingHealth education programmes are high quality", "New learning or teaching methods are welcomed in this institution/hospital", and "An academic appointment is important to me". The competencies that respondents felt to be the most important were facilitating discussions, presentation skills, and providing feedback (respective means = 5.1, 5, 5 of 7). CONCLUSION: This needs assessment provided us with important insights regarding SingHealth medical educators' perceptions of their education environment and established key priorities for the AM∙EI's programming efforts.

Twelve tips for facilitating team-based learning.

BACKGROUND: Team-based learning (TBL) has become a more commonly recognized and implemented pedagogical approach in curricula of numerous disciplines. The desire to place more autonomy on the student and spend less in-class time delivering content has resulted in complete or partial adoption of this style of learning in many educational settings. AIM: Provide faculty with tools that foster a well facilitated and interactive TBL learning environment. METHODS: We examined the published literature in the area of facilitation - specifically in TBL environments, and explored learning theories associated with team learning and our own experiences to create these facilitation tips. RESULTS: We created 12 tips for TBL facilitation designed to assist faculty to achieve an effective and engaging TBL learning environment. CONCLUSIONS: Applying these twelve tips while facilitating a TBL classroom session will help to ensure maximal participation and optimal learning in a safe yet stimulating environment.

Team-based learning: a practical guide: AMEE guide no. 65.

Team-based learning™ (TBL) is an instructional strategy developed in the business school environment in the early 1990s by Dr Michaelsen who wanted the benefits of small group learning within large classes. In 2001, a US federal granting agency awarded funds for educators in the health sciences to learn about and implement the strategy in their educational programs; TBL was put forward as one such strategy and as a result it is used in over 60 US and international health science professional schools. TBL is very different from problem-based learning (PBL) and other small group approaches in that there is no need for multiple faculty or rooms, students must come prepared to sessions, and individual and small groups of students (teams) are highly accountable for their contributions to team productivity. The instructor must be a content-expert, but need not have any experience or expertise in group process to conduct a successful TBL session. Students do not need any specific instruction in teamwork since they learn how to be collaborative and productive in the process. TBL can replace or complement a lecture-based course or curriculum.

The Curriculum for the Hospitalized Aging Medical Patient program: a collaborative faculty development program for hospitalists, general internists, and geriatricians.

BACKGROUND: The University of Chicago Curriculum for the Hospitalized Aging Medical Patient (CHAMP) faculty development program (FDP) is targeted at hospitalists and other internists who teach residents and students in the hospital setting. The aim of CHAMP is to increase the quantity and quality of teaching of geriatric medicine pertinent to the inpatient setting. METHODS: Hospitalist and general internist faculty members who attend on the University of Chicago Medicine teaching service were invited to participate. The CHAMP FDP consisted of twelve 4-hour sessions. Two hours of each session covered inpatient geriatrics content, and 2 hours addressed improving clinical teaching (both general teaching skills and challenges specific to the inpatient wards) and teaching the Accreditation Council for Graduate Medical Education core competencies with geriatrics content. The evaluation included a self-report survey of the impact on the graduates' teaching and clinical practice. RESULTS: The FDP was piloted in early 2004 with a core group of geriatrics and hospitalist faculty. Three subsequent cohorts totaling 29 hospitalist and general internal medicine faculty members completed the FDP by the fall of 2006. Faculty participants evaluated the program positively, and significant improvements in knowledge, attitudes to geriatrics, and perceived behavior in teaching and practicing geriatrics skills were found. CONCLUSIONS: The integration of teaching techniques and geriatrics content was enthusiastically accepted by University of Chicago hospitalists and general internists who teach residents and medical students in the inpatient setting. The program has potential for widespread suitability to all teaching faculty who care for the older hospitalized patient.

Teaching medical students about health literacy: 2 Chicago initiatives.

OBJECTIVE: To develop medical students' skills in interacting with individuals who have limited health literacy. METHODS: Described are 2 novel approaches to health literacy curriculum design. Efforts at both schools have been implemented to improve medical student awareness of health literacy, as well as specific skills in clear communication and strategies that ensure patient understanding. RESULTS: Preliminary data from one school suggest an increase in use of health literacy behaviors. Curriculum development at both schools is ongoing. CONCLUSION: The ultimate goal of these curricula is for students to develop the core skills necessary for effective communication with all patients.

Providers' assessment of barriers to effective management of hypertension and hyperlipidemia in community health centers.

We explored 251 providers' (47% licensed practical nurses, 27% registered nurses, 10% physicians, 10% physician assistants, 6% other) perceptions of barriers to effective management of hypertension and hyperlipidemia from 72 Midwest community health centers (CHCs). Optimal care for these diseases is difficult in any setting; little is known about the specific barriers CHCs face. Community health centers often have a multidisciplinary team that participates in patient care. Current models of quality improvement and chronic care management require virtually all CHC providers to know clinical guidelines. Providers in this study generally chose hypertension and hyperlipidemia target levels that met or were more stringent than national guidelines, but lacked confidence to address behavioral change and reported obstacles to modifying patient lifestyle. Community health centers should strengthen providers' skills in facilitating lifestyle change. Improving quality of care requires supporting providers' efforts to take patients' psychosocial and financial challenges into account, and revised policies to eliminate financial and cultural barriers to care.

Improving diabetes care in midwest community health centers with the health disparities collaborative.

OBJECTIVE: To evaluate the Diabetes Health Disparities Collaborative, an initiative by the Bureau of Primary Health Care to reduce health disparities and improve the quality of diabetes care in community health centers. RESEARCH DESIGN AND METHODS: One year before- after trial. Beginning in 1998, 19 Midwestern health centers undertook a diabetes quality improvement initiative based on a model including rapid Plan-Do-Study-Act cycles from the continuous quality improvement field; a Chronic Care Model emphasizing patient self-management, delivery system redesign, decision support, clinical information systems, leadership, health system organization, and community outreach; and collaborative learning sessions. We reviewed charts of 969 random adults for American Diabetes Association standards, surveyed 79 diabetes quality improvement team members, and performed qualitative interviews. RESULTS: The performance of several key processes of care assessed by chart review increased, including rates of HbA(1c) measurement (80-90%; adjusted odds ratio 2.1, 95% CI 1.6-2.8), eye examination referral (36-47%; 1.6, 1.1-2.3), foot examination (40-64%; 2.7, 1.8-4.1), and lipid assessment (55-66%; 1.6, 1.1-2.3). Mean value of HbA(1c) tended to improve (8.5-8.3%; difference -0.2, 95% CI -0.4 to 0.03). Over 90% of survey respondents stated that the Diabetes Collaborative was worth the effort and was successful. Major challenges included needing more time and resources, initial difficulty developing computerized patient registries, team and staff turnover, and occasional need for more support by senior management. CONCLUSIONS: The Health Disparities Collaborative improved diabetes care in health centers in 1 year.

Improving medical care of persons with Alzheimer disease through clinical teaching: the IMPACT program.

The purpose of this project was to develop, implement, evaluate, and disseminate an educational program on ethics and the primary care of patients with dementia for residents. Pre/post-rotation self-confidence measure, a post-rotation assessment of the importance of and achievement of the program's goals, and a post-rotation evaluation of the program were administered. Significant increases in residents' confidence in performing the programmatic clinical goals and in overall confidence were found. Program goals were met, and components of the program were rated highly. We found that a well-designed ethics curriculum can be successfully implemented within a clinical rotation for medicine residents and have a positive impact on the quality of the educational experience as well as on their confidence in performing relevant clinical management behaviors.

Efficient communication: assessment-oriented oral case presentation.

OBJECTIVE: To introduce and assess the time savings from and effectiveness of assessment-oriented (AO) oral case presentation as a model of interphysician communication. METHODS: This was a prospective, interventional study of all 10 on-site faculty and 36 residents in a postgraduate year 1 to 3 format emergency medicine residency training program. Residents were requested to perform all oral case presentations in either the traditional or AO formats. Presentations were timed, and residents and faculty rated essential measures of oral case presentation effectiveness: data content, expression of decision making, organization, and overall satisfaction. RESULTS: A total of 199 oral case presentations were sampled-112 traditional and 87 AO. Mean length of presentation for traditional presentations was 117 seconds versus 71 seconds for AO presentations (p < 0.001), a clinically significant difference, without significant differences in the essential measures of case presentation effectiveness. CONCLUSIONS: AO oral case presentation may provide a means for emergency medicine residents to "get to the point" and to communicate effectively and efficiently.

Increasing problem solving in adolescents with type 1 diabetes: the choices diabetes program.

UNLABELLED: The purpose of this pilot study was to test the hypothesis that adolescents with type 1 diabetes can learn to become better problem solvers in diabetes self-care and thereby improve their metabolic control. METHODS: Fifty-three adolescents aged 13 to 17 with type 1 diabetes were randomly assigned to either a 6-week problem-solving diabetes education program or to a control group (usual care). A1C levels were obtained as well as assessments of problem solving, frequency of behavior, level of responsibility, and 24-hour behavior recall at baseline and 6 months. RESULTS: The experimental group participants showed significantly improved problem-solving test scores and A1C values from baseline to 6 months, changes not evident in the control group. At 6 months, the experimental group participants were doing blood glucose testing more often than those in the control group. However, there was no significant difference in problem-solving test scores or A1C values. CONCLUSIONS: This 6-week intervention for adolescents with diabetes resulted in better problem-solving skills, more frequent blood glucose testing, and improved A1C values. The results suggest that a diabetes problem-solving program for adolescents can be effective in improving metabolic control.