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Open Access Publications from the University of California

Scholarly Works (29 results)

  • Article
  • Peer Reviewed
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 23, Issue 1 (2022)

Introduction: Head computed tomography (CT) interpretation is a vital skill for emergency physicians. Existing literature shows poor concordance between emergency physicians and radiologists in head CT interpretation. Prior studies have used passive learning methods to address this knowledge gap. We created an active learning curriculum for teaching head CT interpretation to emergency medicine (EM) residents and compared its effectiveness to a passive learning strategy. 

Methods: We conducted a prospective, randomized controlled study of EM residents at a single institution. Three educational sessions were delivered over a three-month period via video conference. The active learning cohort (ALC) scrolled through head CT teaching cases we designed on Pascbin, a web-based radiology picture archiving and communication system. The passive learning cohort (PLC) watched instructional videos that scrolled through the same cases. Both cohorts were given equal time to review the cases and ask an instructor questions. Residents took pre-intervention and post-intervention tests on head CT interpretation. We analyzed scores using paired and unpaired t-tests.

Results: Forty-two residents took the pre-intervention test.  Mean pre- and post-test scores for the ALC were 43.8% and 59.0% (P <0.001), and for the PLC were 41.7% and 45.3% (P = 0.29). The difference in ALC and PLC post-test scores was statistically significant (P = 0.009) with a large effect size (Cohen’s d = 1.34). 

Conclusion: Our active learning head CT curriculum using Pacsbin showed superior learning outcomes when compared to a passive learning strategy and required no additional time or resources. This intervention offers a more effective and learner-centric method for implementing radiology curricula in EM residency programs.

  • 1 supplemental ZIP
Cover page: Rethinking Radiology: An Active Learning Curriculum for Head Computed Tomography InterpretationCreative Commons 'BY' version 4.0 license
  • Article
  • Peer Reviewed
UC Davis Previously Published Works (2021)
    Cover page: A practical guide for conducting qualitative research in medical education: Part 1—How to interview
    • Article
    • Peer Reviewed
    UC Davis Previously Published Works (2021)
    The process of performing qualitative analysis can be a daunting task. Technology can be employed to ease the burden of the work; however, the researcher may not fully appreciate how and when computer software can assist in conducting qualitative analysis. In this, the third installment of our "how-to" series on qualitative research methods, we describe basic concepts and approaches to using both simple word processing programs and specific qualitative research software programs to assist in coding and analysis. We hope that the concepts put forth in this paper will help qualitative researchers become more familiar with available technological approaches and that they will, in turn, enhance the efficiency of the research process as well as the depth, clarity and richness of research findings.
      Cover page: A practical guide for conducting qualitative research in medical education: Part 3—Using software for qualitative analysis
      • Article
      • Peer Reviewed
      UC Davis Previously Published Works (2014)

      Background

      High-fidelity patient simulation has been praised for its ability to recreate lifelike training conditions. The degree to which high fidelity simulation elicits acute emotional and physiologic stress among participants - and the influence of acute stress on clinical performance in the simulation setting - remain areas of active exploration. We examined the relationship between residents' self-reported anxiety and a proxy of physiologic stress (heart rate) as well as their clinical performance in a simulation exam using a validated assessment of non-technical skills, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS).

      Methods

      This was a prospective observational cohort study of emergency medicine residents at a single academic center. Participants managed a simulated clinical encounter. Anxiety was assessed using a pre- and post-simulation survey, and continuous cardiac monitoring was performed on each participant during the scenario. Performance in the simulation scenario was graded by faculty raters using a critical actions checklist and the Ottawa GRS instrument.

      Results

      Data collection occurred during the 2011 academic year. Of 40 eligible residents, 34 were included in the analysis. The median baseline heart rate for participants was 70 beats per minute (IQR: 62 - 78). During the simulation, the median maximum heart rate was 140 beats per minute (IQR: 137 - 151). The median minimum heart rate during simulation was 81 beats per minute (IQR: 72 - 92), and mean heart rate was 117 beats per minute (95% CI: 111 - 123). Pre- and post-simulation anxiety scores were equal (mean 3.3, IQR: 3 to 4). The minimum and maximum Overall Ottawa GRS scores were 2.33 and 6.67, respectively. The median Overall score was 5.63 (IQR: 5.0 to 6.0). Of the candidate predictors of Overall performance in a multivariate logistic regression model, only PGY status showed statistical significance (P = 0.02).

      Conclusions

      Simulation is associated with physiologic stress, and heart rate elevation alone correlates poorly with both perceived stress and performance. Non-technical performance in the simulation setting may be more closely tied to one's level of clinical experience than to perceived or actual stress.
        Cover page: Heart rate, anxiety and performance of residents during a simulated critical clinical encounter: a pilot studyCreative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        UC Davis Previously Published Works (2024)
        BACKGROUND: Despite the central importance of physical examination (PE) skills to patient evaluation, early trainees struggle with its correct application and interpretation. This struggle may reflect the instructional strategies of PE courses which have largely ignored the clinical reasoning necessary to accurately apply these skills. The core + cluster (C + C) is a recent approach to teaching PE to clerkship-level medical students that combines a basic core exam with cluster based on the students hypothesis about their patients clinical presentation. Our institution developed a novel C + C curriculum to teach PE to preclinical students. We aimed to assess the impact of this new curriculum on students clinical skills and course evaluations in comparison to the traditional head-to-toe approach wed used previously. METHODS: This was a retrospective study comparing two consecutive medical school cohorts exposed to the new (C + C) and prior (HTT) curricula respectively. We studied two complete cohorts of first-year medical students at our institution who matriculated in 2014 and 2015. The 2014 cohort received PE training via an HTT approach. The 2015 cohort received PE training via a C + C approach. Outcomes included performance scores on a statewide clinical performance exam (CPX) and student course evaluations. RESULTS: We found no statistically significant difference in mean CPX scores between the two cohorts. However, student course ratings were significantly higher in the C + C cohort and students rated the C + C format as highly useful in clinical encounters. CONCLUSIONS: The C + C curriculum appears to be as effective a method of teaching PE to preclinical students as the HTT approach and is better received by students. We believe that this approach more appropriately reflects the way PE is used in clinical encounters and may help students with diagnostic hypothesis generation.
          Cover page: Core and cluster or head to toe?: a comparison of two types of curricula for teaching physical examination skills to preclinical medical students.Creative Commons 'BY' version 4.0 license
          • Article
          • Peer Reviewed
          UC Davis Previously Published Works (2016)

          Introduction

          In-hospital cardiac arrest (IHCA) is a particularly vexing entity from the perspective of preparedness, as it is neither common nor truly rare. Survival from IHCA requires the coordinated efforts of multiple providers with different skill sets who may have little prior experience working together. Survival rates have remained low despite advances in therapy, suggesting that human factors may be at play.

          Methods and analysis

          This qualitative study uses a quasiethnographic data collection approach combining focus group interviews with providers involved in IHCA resuscitation as well as analysis of video recordings from in situ-simulated cardiac arrest events. Using grounded theory-based analysis, we intend to understand the organisational, interpersonal, cognitive and behavioural dimensions of IHCA resuscitation, and to build a descriptive model of code team functioning.

          Ethics and dissemination

          This ongoing study has been approved by the IRB at UC Davis Medical Center.

          Results

          The results will be disseminated in a subsequent manuscript.
            Cover page: Code Blue: methodology for a qualitative study of teamwork during simulated cardiac arrestCreative Commons 'BY-NC' version 4.0 license
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2021)
            An organized and rigorous approach to analyzing qualitative data can yield important insights into the intricacies of human behavior and can answer "how" and "why" questions. One process of coding interview responses from study subjects using grounded theory with a constructivist approach is outlined and applied to an example study. The emergent themes can provide insight to medical educators to create interventions that optimize the learning environment. For researchers, they may generate hypotheses to study by quantitative analysis.
              Cover page: A practical guide for conducting qualitative research in medical education: Part 2—Coding and thematic analysisCreative Commons 'BY-NC-ND' version 4.0 license
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2021)

              Background

              Workflow efficiency (WFE) is essential to the practice of emergency medicine (EM), but a standardized approach to measuring and teaching it during residency is lacking. In this study we sought to describe how EM residency programs in the United States currently measure and teach WFE and to assess the relative importance of WFE teaching to EM residency program leaders.

              Methods

              We conducted a cross-sectional survey of all accredited EM residency training programs in the United States in Fall 2019. We invited all allopathic EM residency programs to participate in the study by directly emailing program directors and assistant/associate program directors. We conducted the study and performed descriptive statistics using SurveyMonkey software.

              Results

              We received a total of 133 responses out of 190 total programs (70%) with proportionate representation from 3- and 4-year programs and all regions of the United States. When asked to what extent teaching efficiency should be a priority compared to other educational goals, 65% of program leaders responded with "significant" or "moderate" priority. Most EM programs collect WFE data on their residents, either by tracking patients per hour (78%) or by written evaluations (59%). Common methods for providing WFE data to residents were: "individual data provided along with deidentified rank" (35%), "data provided only during private feedback meetings" (26%), and "no data or rank provided to residents" (16%). Regarding targeted WFE teaching to residents, 88% reported utilizing general on-shift teaching, 48% reported teaching WFE during formal didactics, and 45% during dedicated private feedback sessions.

              Conclusion

              This national study of allopathic U.S. EM programs suggests that most EM program leaders do value WFE teaching. However, we found no consistent approach among programs for tracking or distributing resident WFE data, and many programs lack a formalized way to teach efficiency to their residents.
                Cover page: A nationwide survey of emergency medicine resident workflow efficiency: Are training programs teaching residents to be efficient?
                • Article
                • Peer Reviewed
                Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 18, Issue 1 (2017)

                Introduction: Recent literature calls for initiatives to improve the quality of education studies and support faculty in approaching educational problems in a scholarly manner. Understanding the emergency medicine (EM) educator workforce is a crucial precursor to developing policies to support educators and promote education scholarship in EM.  This study aims to illuminate the current workforce model for the academic emergency medicine educator.

                Methods: Program leadership at EM training programs completed an online survey consisting of multiple choice, completion, and free response type items. Descriptive statistics were calculated and reported.

                Results: 112 programs participated.  Mean number of core faculty/program: 16.02 ± 7.83 [14.53-17.5]. Mean number of faculty full time equivalents (FTEs)/program dedicated to education is 6.92 ± 4.92 [5.87-7.98], including (mean FTE): Vice Chair for education (0.25); Director of Medical Education (0.13); Education Fellowship Director (0.2); Residency Program Director (0.83); Associate Residency Director (0.94); Assistant Residency Director (1.1); Medical Student Clerkship Director (0.8); Assistant/Associate Clerkship Director (0.28); Simulation Fellowship Director (0.11); Simulation Director (0.42); Director of Faculty Development (0.13). Mean number of FTEs/program for education administrative support is 2.34 ± 1.1 [2.13-2.61]. Determination of clinical hours varied. 38.75% of programs had personnel with education research expertise.

                Conclusion: Education faculty represent about 43% of the core faculty workforce. Many programs do not have the full spectrum of education leadership roles and educational faculty divide their time among multiple important academic roles. Clinical requirements vary. Many departments lack personnel with expertise in education research. This information may inform interventions to promote education scholarship.
                • 1 supplemental file
                Cover page: Exploring Scholarship and the Emergency Medicine Educator: A Workforce StudyCreative Commons 'BY' version 4.0 license
                • Article
                • Peer Reviewed
                UC Davis Previously Published Works (2019)

                Background

                Physical Examination (PE) skills are vital for patient care, and many medical students receive their first introduction to them in their pre-clinical years. A substantial amount of curriculum time is devoted to teaching these skills in most schools. Little is known about the best way to introduce PE skills to novice learners.

                Objective

                Our objective was to conduct a systematic review of how medical students are first taught PE skills and the evidence supporting these strategies.

                Design

                We searched ERIC, SCOPUS, MEDLINE, PubMed and EMBASE for descriptions of complete PE curricula for novice learners. Inclusion criteria were: (1) English language; (2) subjects were enrolled in medical school and were in the preclinical portion of their training; (3) description of a method to teach physical examination skills for the first time; (4) description of the study population; (5) Description of a complete PE curriculum. We used the Medical Education Research Study Quality Instrument (MERSQI) score to evaluate the quality of evidence provided.

                Results

                Our search returned 5,418 articles; 32 articles met our inclusion criteria. Two main types of curricula were reported: comprehensive 'head-to-toe' PE curricula (18%) and organ system-based curricula (41%). No studies compared these directly, and only two evaluated trainees' clinical performance. The rest of the articles described interventions used across curricula (41%). Median MERSQI score was 10.1 Interquartile range 8.1-12.4. We found evidence for the use of non-faculty teaching associates, technology-enhanced PE education, and the addition of clinical exposure to formal PE teaching.

                Conclusions

                The current literature on teaching PE is focused on describing innovations to head-to-toe and organ system-based curricula rather than their relative effectiveness, and is further limited by its reliance on short-term outcomes. The optimal strategy for novice PE instruction remains unknown.
                  Cover page: How do novices learn physical examination skills? A systematic review of the literature
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