Hello COMSEP!
Summer is here. Often this is a wonderful time in pediatrics as the viral epidemics wane and we get some time to breathe fresh air and bask in the sun. And, if you are so motivated, this could be a time to do some projects you have had on the back burner—like writing a COMSEP JC review (?)!
Enjoy this month’s Journal Club. Note that every review is either written or co-written by a learner.
Hope you get a chance to breathe, bask and catch up. Reach out if you (or your learners!) want to write a review.
Jon, Amit and Karen
Hocus POCUS
Ferre, R.M., Kaine, J.C., Lobo, D. et al. A shared point of care ultrasound curriculum for graduate medical education. BMC Med Educ 24, 843 (2024). https://doi.org/10.1186/s12909-024-05797-1
Reviewed by Julie Ehrlich and Molly Rideout
What was the study question?
Would a core POCUS curriculum be effective education for residents across various residency subspecialty programs?
How was the study done?
This was a prospective observational study of PGY-1 resident trainees from EM, FM, IM combined internal medicine - pediatrics and combined EM-pediatrics training programs (n = 85) at Indiana University. A core POCUS curriculum was developed with 11 asynchronous online modules and 9 hands-on training sessions that occurred over a 10-month period and was proctored by faculty with POCUS experience. Key measurement points were attitudes towards POCUS before and after participation, online surveys assessing knowledge before and after each module and an Observed Structured Clinical Examination (OSCE) with a standardized patient at the end of the curriculum.
What were the results?
Residents with the highest level of participation in all curricular elements were EM and Peds EM residents. Those who actively participated (n=61) felt significantly more confident following the curriculum with machine operation, image acquisition, image interpretation, procedural guidance, recognizing anatomy on POCUS images, and incorporating POCUS findings into clinical practice (p<0.001). Knowledge improved significantly across most modalities and specialties following each module.
How can I apply this to my work in education?
Point-of-care ultrasound has become an important focus in preclinical medical school education but continuity of this education into the clinical years and throughout residency is varied. Given that commonly cited barriers to GME POCUS education are lack of resources and lack of expertise, this team leveraged resources to create this shared curriculum for PGY-1 residents. They found that residents had improved attitudes towards POCUS, a higher knowledge of POCUS and more comfort performing POCUS exams. Their study highlights a feasible way to expand POCUS education through shared resources.
Editor’s Note: A great example of collaboration for education. Unfortunately, residents didn’t report using POCUS in clinical practice after the training. The authors hypothesized explanations again included lack of access to the equipment and lack of mentors with POCUS experience. The challenges to dissemination of this technology are multifactorial, and despite more than a decadeof experience, we’re not there yet---at least in pediatrics (JG)
Reflections on Reflections
MacAskill W, Chua WJ, Woodall H & Pinidiyapathirage J. Beyond the Written Reflection: A Systematic Review and Qualitative Synthesis of Creative Approaches to Reflective Learning Amongst Medical Students . Perspectives on Medical Education 2023; 12(1): 361-371. https://dx.doi.org/10.5334/pme.914
Reviewed by Emma Greenberg and Amy Grover
What was the study question?
How do creative reflective learning approaches contribute to a medical student's holistic development?
How was it done?
A literature search identified 15 studies describing creative approaches to RL that addressed the impact of RL practices on medical students through either qualitative or mixed methods design. Included studies specifically needed to assess the impact of RL on students and utilized creative approaches to RL beyond reflective writing or group discussion. The included studies were analyzed using thematic synthesis to identify key areas in which creative RL impacts student development.
What were the results?
The authors sorted creative RL methods into 5 categories: viewing, performing, creating, imagining and mind-body experiences. Key themes describing student development related to creative RL were identified: personal development such as improved ability to process thoughts and emotions, building and maintaining relationships through increased empathy, patient-centeredness and the ability to recognize multiple perspectives, and positive impacts on students’ sense of belonging through trust and community building among a peer group. This study concluded that the use of diverse RL promotes broader student participation and engagement, and has the potential to improve interpersonal skills, contribute to personal development and foster a sense of belonging.
How can this be applied to my work in education?
By synthesizing the types of creative RL methods and their outcomes for student learning, this study provides recommendations for the development of a curriculum that includes additional experiences beyond traditional narrative practices. Educators seeking to design RL experiences that achieve authentic student engagement and the development of skills related to patient-centered care can utilize this analysis as a toolbox to facilitate holistic medical education through creative reflective learning.
Editor’s Comments: While written reflection and group discussion are most oft used methods for reflection, this article nicely highlights other creative strategies for promoting reflection in medical students. Alas, we cannot guarantee that a student who has “completed” a reflective exercise/assignment has actually reflected, but perhaps we might increase the likelihood of that if students were given options for other reflective methods that allowed for individual preferences in methods and engagement. (KFo)
Social Determinants of Health Review
Doobay-Persaud A, Adler MD, Bartell TR, Sheneman NE, Martinez MD, Mangold KA, Smith P, Sheehan KM. Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review. J Gen Intern Med. 2019 May;34(5):720-730. https://dx.doi.org/10.1007/s11606-019-04876-0
Reviewed by Ria Gupta
What was the study question?
What are some key characteristics on how to integrate social drivers of health (SDoH) education in undergraduate medical education (UME)?
How was the study done?
Scientific databases were searched using the key words “social determinants [drivers] of health” and other terms related to this phrase for articles published in English in North America between 2010 and 2016. Articles were screened through 4 rounds of 2 - 4 reviewers examining titles, abstracts, and content for relevance. The data from the articles were then charted in the following categories: content, educational methods, timing, educator, learner characteristics, evaluation, and funding.
What are the results?
The search strategy identified initially with 171 articles selected for the full text review. After full text review, 22 were selected for the final study. All content included some form of definition to SDoH with an emphasis on how it impacts the underserved. Most (20) used didactics as the primary educational method. Other components included case-based instruction (7), small group collaboration (5), and peer to peer teaching (5). Experiential learning (17) was either in the clinic or in the community setting. Curriculum length was < 6 weeks (5), < 1 year (7), and > 1 year (9) Incorporation of this topic could be anywhere in the curriculum including first year orientation to making, part of each clerkship, or a separate course for SDoH. Educators were university faculty alongside members of the community. Assessments ranged from surveys, tests, reflections, project evaluations, graduation outcomes, and feedback. Lastly, funding for this content education was obtained from a variety of sources including government and endowment funds.
How can this be applied to my work in education?
Given my work in crafting SDoH driven curriculums at both the medical student and resident level, this study serves as an excellent reminder that there are multiple successful pathways for this content integration. I am eager to incorporate the strengths of certain studies into my team’s current curriculum to keep growing our educational outreach.
Editor’s Comments: This scoping review serves as a great inventory for SDoH curriculum. An interesting addition to this review would be including each curriculum’s impact on student performance in this area. (AKP)