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Introduction: Engaging learners in continuing medical education (CME) is challenging. Recently, CME courses have transitioned to livestreamed CME, with learners viewing live, in‐person courses online. The authors aimed to (1) compare learner engagement and teaching effectiveness in livestreamed with in‐person CME and (2) determine how livestream engagement and teaching effectiveness is associated with (A) interactivity metrics, (B) presentation characteristics and (C) medical knowledge. Methods: A 3‐year, non‐randomised study of in‐person and livestream CME was performed. The course was in‐person for 2018 but transitioned to livestream for 2020 and 2021. Learners completed the Learner Engagement Inventory and Teaching Effectiveness Instrument after each presentation. Both instruments were supported by content, internal structure and relations to other variables' validity evidence. Interactivity metrics included learner use of audience response, questions asked by learners and presentation views. Presentation characteristics included presentations using audience response, using pre/post‐test format, time of day and words per slide. Medical knowledge was assessed by audience response. A repeated measures analysis of variance (anova) was used for comparisons and a mixed model approach for correlations. Results: A total of 159 learners (response rate 27%) completed questionnaires. Engagement did not significantly differ between in‐person or livestream CME. (4.56 versus 4.53, p = 0.64, maximum 5 = highly engaged). However, teacher effectiveness scores were higher for in‐person compared with livestream (4.77 versus 4.71 p = 0.01, maximum 5 = highly effective). For livestreamed courses, learner engagement was associated with presentation characteristics, including presentation using of audience response (yes = 4.57, no = 4.45, p <.0001), use of a pre/post‐test (yes = 4.62, no = 4.54, p <.0001) and time of presentation (morning = 4.58, afternoon = 4.53, p =.0002). Significant associations were not seen for interactivity metrics or medical knowledge. Discussion: Livestreaming may be as engaging as in‐person CME. Although teaching effectiveness in livestreaming was lower, this difference was small. CME course planners should consider offering livestream CME while exploring strategies to enhance teaching effectiveness in livestreamed settings. Stephenson et al. report that even if livestreaming education effectiveness is rated as somewhat lower than in‐person teaching, livestreaming may be as engaging as in‐person CME. [ABSTRACT FROM AUTHOR]

Background: Industry funding in continuing medical education has been extensively studied in the USA. Although continuing medical education is also a requirement for Chinese physicians, little is known about Chinese physician perceptions of industry support in continuing medical education. Objective: We aim to determine perceptions regarding industry support for CME among Chinese physicians at a large CME course, examine potential associations between Chinese physicians' perceptions and their demographic characteristics, and compare Chinese and US physicians' perceptions of industry support for CME. Design: We performed a cross-sectional survey of physicians at a nephrology continuing medical education conference in China. All participants received a previously published, anonymous survey consisting of 4 items, with questions asked in English and Mandarin Chinese. Responses were compared with those of a previous cohort in the USA. Results: The response rate was 24% (128/541). Most respondents were nephrologists (112/126, 89%), women (91/128, 71%), and aged 20 to 40 years (79/127, 62%). Most respondents preferred industry-supported continuing medical education (84/123, 68%) or had no preference (33/123, 27%). More clinicians than clinical researchers supported industry offsetting costs (76.9% vs 58.3%; P =.03). Almost half of participants (58/125, 46%) stated that industry-supported continuing medical education was biased in support of industry. Compared with US physicians, Chinese physicians were more likely to believe, or had no opinion, that industry-supported courses were biased (67.2% vs 47.0%; P <.001). Conclusions: Chinese continuing medical education participants preferred industry-sponsored continuing medical education and were strongly in favor of industry offsetting costs, but almost half believed that such education was biased in favor of supporting companies. Concern for bias was higher among Chinese than US physicians. Given participants' concerns, further study examining industry bias in Chinese continuing medical education is recommended. Abbreviations: CME: Continuing medical education; US: USA [ABSTRACT FROM AUTHOR]

Problem: Conferences are the most common form of continuing medical education (CME), but their effect on clinician practice is inconsistent. Reflection is a critical step in the process of practice change among clinicians and may lead to improved outcomes following conference-based CME. However, reflection requires time to process newly-learned material. Adequate time for reflection may be noticeably absent during many conference presentations. Intervention: The pause procedure is a 90-second 'pause' during a 30-minute presentation so learners can review and discuss content. The goal of the pause procedure is to stimulate learners' active engagement with newly learned material which will, in turn, promote learner reflection. Context: Fifty-six presentations at two hospital medicine CME conferences were assigned to the pause procedure or control. Study outcomes provided by conference participants were validated reflection scores and commitment-to-change (CTC) statements for each presentation. A post-hoc survey of the intervention group was conducted to assess presenters' experiences with the pause procedure. Impact: A total of 527 conference participants completed presentation evaluations (response rate 72.7%). Presentations incorporating the pause procedure failed to lead higher participant reflection scores (percentage 'top box' score; intervention: 39.2% vs. control: 41.7%, p = 0.40) or participant CTC rates (median [IQR]; intervention: 4.64 [3.04, 10.57] vs. control: 8.16 [5.28, 17.12], p = 0.13) than control presentations. However, the majority of presenters (16 out of 17 survey respondents) had never before used the intervention and little active engagement among learners was noted during the pause procedure. Lessons Learned: Adding the pause procedure to CME presentations did not lead to greater reflection or CTC among clinician learners. However, presenters had limited experience with the intervention, which may have reduced their fidelity to the educational principles of the pause procedure. Faculty development may be necessary when planning a new educational intervention that is to be implemented by conference presenters. [ABSTRACT FROM AUTHOR]

Purpose: Experiential learning has been suggested as a framework for planning continuing medical education (CME). We aimed to (1) determine participants' learning styles at traditional CME courses and (2) explore associations between learning styles and participant characteristics. Materials and methods: Cross-sectional study of all participants (n = 393) at two Mayo Clinic CME courses who completed the Kolb Learning Style Inventory and provided demographic data. Results: A total of 393 participants returned 241 surveys (response rate, 61.3%). Among the 143 participants (36.4%) who supplied complete demographic and Kolb data, Kolb learning styles included diverging (45; 31.5%), assimilating (56; 39.2%), converging (8; 5.6%), and accommodating (34; 23.8%). Associations existed between learning style and gender (p = 0.02). For most men, learning styles were diverging (23 of 63; 36.5%) and assimilating (30 of 63; 47.6%); for most women, diverging (22 of 80; 27.5%), assimilating (26 of 80; 32.5%), and accommodating (26 of 80; 32.5%). Conclusions: Internal medicine and psychiatry CME participants had diverse learning styles. Female participants had more variation in their learning styles than men. Teaching techniques must vary to appeal to all learners. The experiential learning theory sequentially moves a learner from Why? to What? to How? to If? to accommodate learning styles. [ABSTRACT FROM AUTHOR]

Background: E-learning--the use of Internet technologies to enhance knowledge and performance--has become a widely accepted instructional approach. Little is known about the current use of e-learning in postgraduate medical education. To determine utilization of e-learning by United States internal medicine residency programs, program director (PD) perceptions of e-learning and associations between e-learning use and residency program characteristics. Methods: We conducted a national survey in collaboration with the Association of Program Directors in Internal Medicine of all United States internal medicine residency programs. Results: Of the 368 PDs, 214 (58.2%) completed the e-learning survey. Use of synchronous e-learning at least sometimes, somewhat often, or very often was reported by 85 (39.7%); 153 programs (71.5%) use asynchronous e-learning at least sometimes, somewhat often, or very often. Most programs (168; 79%) do not have a budget to integrate e-learning. Mean (SD) scores for the PD perceptions of e-learning ranged from 3.01 (0.94) to 3.86 (0.72) on a 5-point scale. The odds of synchronous e-learning use were higher in programs with a budget for its implementation (odds ratio, 3.0 [95% CI, 1.04-8.7]; P = .04). Conclusions: Residency programs could be better resourced to integrate e-learning technologies. Asynchronous e-learning was used more than synchronous, which may be to accommodate busy resident schedules and duty-hour restrictions. PD perceptions of e-learning are relatively moderate and future research should determine whether PD reluctance to adopt e-learning is based on unawareness of the evidence, perceptions that e-learning is expensive, or judgments about value versus effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: Reflection exposes performance gaps and is a step in the process of behavior change among adult learners. However, little is known about the relationships between reflection and behavior change in CME. Our objectives were to measure associations between validated reflection scores and behavior change among CME participants and to identify associations between reflection and characteristics of CME presentations. Methods: This was a cohort study of attendees at a national hospital medicine CME course. Participants provided reflection scores for each presentation and planned commitment-to-change (CTC) statements at the conclusion of the course. Reflection scores from 1 (strongly disagree) to 5 (strongly agree) were averaged for each presentation. CTC statements were linked to their accompanying presentations. A 3-month postcourse survey was conducted to assess if planned CTCs were successfully implemented. Results: In all, 223 of 281 participants (79.4%) returned evaluations. Of the 195 planned CTC statements available for postcourse analysis, 128 (65.6%) were implemented. Reflection scores correlated with the number of planned CTC statements across all presentations (Pearson correlation, 0.65; P < .001). In addition, higher reflection scores (mean [SD]) were associated with the presence of audience response opportunities (Yes: 4.13 [0.18] versus No: 3.96 [0.16]; P = .01) and the use of clinical cases (Yes: 4.09 [0.18] versus No: 3.86 [0.12]; P < .01). Discussion: To our knowledge, this is the first study to show a relationship between participant reflection and CTC in conferencebased CME. Presentations that incorporate clinical cases and audience response systems seem to stimulate participant reflection and behavior change. [ABSTRACT FROM AUTHOR]

Introduction: We sought to understand what influences physicians' decisions about participation in continuous professional development (CPD) activities, and how often physicians engage in specific CPD activities. Methods: From September 2015 to April 2016, we administered a survey to 4648 randomly sampled licensed US physicians. Survey items addressed perceived barriers to CPD, factors that might influence participation in four prototypical CPD activities (reading an article, or completing a local activity, online course, or far-away course), and frequency of CPD engagement. Results: Nine hundred eighty-eight (21.6%) physicians responded. The most important barriers were time (mean [SD] 3.5 [1.3], 1 = not important, 5 = extremely important) and cost (2.9 [1.3]). In prioritizing factors influencing participation in four prototypical CPD activities, topical relevance consistently had the highest average rank. Quality of content and time to complete the activity were also frequently selected. Over the past 3 years, most physicians reported having participated in patient-focused learning and selfdirected learning on a weekly basis; quality improvement and local continuing medical education (CME) activities several times per year; online learning, on-site courses, and national board-related activities a few times per year; and interprofessional learning less than once per year. Physicians believed that they ought to engage more often in all of these activities except board-related activities. They would like CME credit for these activities much more often than currently obtained. Discussion: The reasons physicians select a given CPD activity vary by activity, but invariably include topic and quality of content. Physicians want CME credit for the CPD activities they are already doing. [ABSTRACT FROM AUTHOR]

Effective medical educators can engage learners through self-reflection. However, little is known about the relationships between teaching effectiveness and self-reflection in continuing medical education (CME). We aimed to determine associations between presenter teaching effectiveness and participant self-reflection in conference-based CME. This cross-sectional study evaluated presenters and participants at a national CME course. Participants provided CME teaching effectiveness (CMETE) ratings and self-reflection scores for each presentation. Overall CMETE and CME self-reflection scores (five-point Likert scale with one as strongly disagree and five as strongly agree) were averaged for each presentation. Correlations were measured among self-reflection, CMETE, and presentation characteristics. In total, 624 participants returned 430 evaluations (response, 68.9%) for the 38 presentations. Correlation between CMETE and self-reflection was medium (Pearson correlation, 0.3–0.5) or large (0.5–1.0) for most presentations (n = 33, 86.9%). Higher mean (SD) CME reflection scores were associated with clinical cases (3.66 [0.12] vs. 3.48 [0.14];p = 0.003) and audience response (3.66 [0.12] vs. 3.51 [0.14];p = 0.005). To our knowledge, this is the first study to show a relationship between teaching effectiveness and participant self-reflection in conference-based CME. Presenters should consider using clinical cases and audience response systems to increase teaching effectiveness and promote self-reflection among CME learners. [ABSTRACT FROM PUBLISHER]

Background: Gender bias has been identified as one of the drivers of gender disparity in academic medicine. Bias may be reinforced by gender subordinating language or differential use of formality in forms of address. Professional titles may influence the perceived expertise and authority of the referenced individual. The objective of this study is to examine how professional titles were used in the same and mixed-gender speaker introductions at Internal Medicine Grand Rounds (IMGR). Methods: A retrospective observational study of video-archived speaker introductions at consecutive IMGR was conducted at two different locations (Arizona, Minnesota) of an academic medical center. Introducers and speakers at IMGR were physician and scientist peers holding MD, PhD, or MD/PhD degrees. The primary outcome was whether or not a speaker's professional title was used during the first form of address during speaker introductions at IMGR. As secondary outcomes, we evaluated whether or not the speakers professional title was used in any form of address during the introduction. Results: Three hundred twenty-one forms of address were analyzed. Female introducers were more likely to use professional titles when introducing any speaker during the first form of address compared with male introducers (96.2% [102/106] vs. 65.6% [141/215]; p < 0.001). Female dyads utilized formal titles during the first form of address 97.8% (45/46) compared with male dyads who utilized a formal title 72.4% (110/152) of the time ( p = 0.007). In mixed-gender dyads, where the introducer was female and speaker male, formal titles were used 95.0% (57/60) of the time. Male introducers of female speakers utilized professional titles 49.2% (31/63) of the time ( p < 0.001). Conclusion: In this study, women introduced by men at IMGR were less likely to be addressed by professional title than were men introduced by men. Differential formality in speaker introductions may amplify isolation, marginalization, and professional discomfiture expressed by women faculty in academic medicine. [ABSTRACT FROM AUTHOR]

During lectures, a pause procedure (the presenter pauses so students can discuss content) can improve educational outcomes. We aimed to determine whether (1) continuing medical education (CME) presentations with a pause procedure were evaluated more favorably and (2) a pause procedure improved recall. In this randomized controlled intervention study of all participants (N = 214) at the Mayo Clinic Internal Medicine Board Review course, 48 lectures were randomly assigned to an intervention (pause procedure) or control (traditional lecture) group. The pause procedure was a 1-min pause at the middle and end of the presentation. Study outcomes were (1) presentation evaluation instrument scores and (2) number of recalled items per lecture. A total of 214 participants returned 145 surveys (response rate, 68%). Mean presentation evaluation scores were significantly higher for pause procedure than for traditional presentations (70.9% vs 65.8%; 95%CI for the difference, 3.5–6.7;p < .0001). Mean number of rapid recall items was higher for pause procedure presentations (0.68 vs 0.59; 95%CI for the difference, 0.02–0.14;p = .01). In a traditional CME course, presentations with a pause procedure had higher evaluation scores and more content was recalled. The pause procedure could arm CME presenters with an easy technique to improve educational content delivery. [ABSTRACT FROM PUBLISHER]

Introduction: New teaching approaches for CME are needed. In flipped classrooms, coursework is completed beforehand and applied during class time. Studies of flipped classrooms and their potential benefits in CME have not been published. We sought to develop and validate an instrument measuring flipped classroom perceptions, identify whether participation changed perceptions, and determine which flipped classroom components were perceived as most effective. Methods: In this cross-sectional validation study, 167 participants in the Mayo Clinic's 2015 Internal Medicine Board Review course received surveys. Online modules were developed to deliver content before flipped classroom courses on acid-base disorders and electrolyte disorders. A flipped classroom perception instrument (FCPI) was developed and validated. The FCPI, with eight items structured on 5-point Likert scales, was given to participants before and after their flipped classroom experiences. Results: Of the 167 participants, 111 returned surveys. Flipped classroom perceptions improved, with mean (SD) FCPI scores increasing from 3.74 (0.75) to 3.94 (0.76) (P < .001). The percentage of participants who preferred flipped classrooms increased from 38% before the course to 53% after (P = .002). Positive changes in FCPI scores were unrelated to module completion. Most participants thought knowledge was enhanced by in-class sessions and online modules equally. Discussion: The FCPI, the first validated measure of participants' perceptions of a CME flipped classroom, has strong validity evidence. Participants' perceptions of and preference for the flipped classroom improved after experiencing the flipped CME classroom. These findings support the need to further explore flipped classroom models in CME. [ABSTRACT FROM AUTHOR]

Background: Entrustable professional activities (EPAs) have been developed to assess resident physicians with respect to Accreditation Council for Graduate Medical Education (ACGME) competencies and milestones. Although the feasibility of using EPAs has been reported, we are unaware of previous validation studies on EPAs and potential associations between EPA quality scores and characteristics of educational programs.Objectives: Our aim was to validate an instrument for assessing the quality of EPAs for assessment of internal medicine residents, and to examine associations between EPA quality scores and features of rotations.Design: This was a prospective content validation study to design an instrument to measure the quality of EPAs that were written for assessing internal medicine residents.Participants: Residency leadership at Mayo Clinic, Rochester participated in this study. This included the Program Director, Associate program directors and individual rotation directors.Interventions: The authors reviewed salient literature. Items were developed to reflect domains of EPAs useful for assessment. The instrument underwent further testing and refinement. Each participating rotation director created EPAs that they felt would be meaningful to assess learner performance in their area. These 229 EPAs were then assessed with the QUEPA instrument to rate the quality of each EPA.Main Measures: Performance characteristics of the QUEPA are reported. Quality ratings of EPAs were compared to the primary ACGME competency, inpatient versus outpatient setting and specialty type.Key Results: QUEPA tool scores demonstrated excellent reliability (ICC range 0.72 to 0.94). Higher ratings were given to inpatient versus outpatient (3.88, 3.66; p = 0.03) focused EPAs. Medical knowledge EPAs scored significantly lower than EPAs assessing other competencies (3.34, 4.00; p < 0.0001).Conclusions: The QUEPA tool is supported by good validity evidence and may help in rating the quality of EPAs developed by individual programs. Programs should take care when writing EPAs for the outpatient setting or to assess medical knowledge, as these tended to be rated lower. [ABSTRACT FROM AUTHOR]

Introduction: Mobile device applications (apps) may enhance live CME courses. We aimed to (1) validate a measure of participant attitudes toward using a conference app and (2) determine associations between participant characteristics and attitudes toward CME apps with conference app usage. Methods: We conducted a cross-sectional validation study of participants at the Mayo Clinic Selected Topics in Internal Medicine Course. A conference app was developed that included presentation slides, note-taking features, search functions, social networking with other attendees, and access to presenter information. The CME app attitudes survey instrument (CMEAPP-10) was designed to determine participant attitudes toward conference apps. Results: Of the 602 participants, 498 (82.7%) returned surveys. Factor analysis revealed a two-dimensional model for CMEAPP- 10 scores (Cronbach α, 0.97). Mean (SD) CMEAPP-10 scores (maximum possible score of five) were higher for women than for men (4.06 [0.91] versus 3.85 [0.92]; P = .04). CMEAPP-10 scores (mean [SD]) were significantly associated (P = .02) with previous app usage as follows: less than once per month, 3.73 (1.05); monthly, 3.41 (1.16); weekly, 4.03 (0.69); and daily or more, 4.06 (0.89). Scores were unrelated to participant age, specialty, practice characteristics, or previous app use. Discussion: This is the first validated measure of attitudes toward CME apps among course participants. App usage was higher among younger participants who had previously used educational or professional apps. Additionally, attitudes were more favorable among women and those who had previously used apps. These findings have important implications regarding efforts to engage participants with portable and accessible technology. [ABSTRACT FROM AUTHOR]

Background: Kearns--Sayre syndrome (KSS) is a rare mitochondrial cytopathy, first described at Mayo Clinic in 1958. Aims: We aimed to define patient and disease characteristics in a large group of adult and pediatric patients with KSS. Methods: We retrospectively searched the Mayo Clinic medical index patient database for the records of patients with KSS between 1976 and 2009. The 35 patients identified with KSS were analyzed in terms of demographic characteristics, presenting signs and symptoms, diagnostic features, clinical evolution, and associations between disease features and the development of disability. Results: The mean (standard [SD]) age at KSS presentation was 17 (10) years, but the mean age at diagnosis was 26 (15) years. Ophthalmologic symptoms developed in all patients, and neurologic and cardiac involvement was common. Only four patients (11%) in the series died, but all deaths were from sudden cardiac events. The development of physical disability was significantly associated with cognitive decline (P=0.004) but not with other clinical features, such as sex or sudden cardiac death. Conclusion: We report the largest case series to date of patients with KSS from a single institution. In addition to the conduction system abnormalities identified in previous series, our cohort included patients with syncope and sudden cardiac death. This underscores the need to consider formal electrophysiologic studies and prophylactic defibrillators in patients with KSS. [ABSTRACT FROM AUTHOR]

Medical professionalism is a multifaceted paradigm and is an essential component of medical education. Gross anatomy is a laboratory to teach professionalism, and promoting critical reflection in medical students is a prerequisite to furthering professionalism. The aim of this study was to determine if professionalism case discussions during a Gross Anatomy course improve students' reflections using a validated reflection instrument (12 items; five-point Likert scale where 1 = Disagree, 2 = Disagree with reservation, 3 = Neutral, 4 = Agree with reservation, 5 = Agree). Four facilitated reflection sessions were aimed at fostering reflective capacity through reflection on elements of professionalism. Results did not show a significant change between pre-and postintervention reflection scores (3.45 ± 0.61 vs. 3.48 ± 0.51; P = 0.82). Historical control students were found to have significantly higher reflection scores when compared with postintervention students (3.91 ± 0.53 vs. 3.48 ± 0.51; P < 0.001). However, the historical control students were found to have significantly higher professionalism scores ( P = 0.001) as compared with the intervention students. Student satisfaction was high, with 25 of 28 (89.2%) students reporting that the sessions should be included as a component of future anatomy courses. While reflection scores were not significantly increased as a result of the intervention, students expressed appreciation for the opportunity to discuss professionalism issues related to the dissection of cadavers. Additionally, the intervention students had both lower professionalism scores and lower reflection scores, which supports the idea that highly professional students are more capable of reflecting on professionalism. Future studies should determine whether this case discussion intervention improves objective measures of professionalism. Anat Sci Educ 7: 191-198. © 2013 American Association of Anatomists. [ABSTRACT FROM AUTHOR]

Improving professional attitudes and behaviors requires critical self reflection. Research on reflection is necessary to understand professionalism among medical students. The aims of this prospective validation study at the Mayo Medical School and Cleveland Clinic Lerner College of Medicine were: (1) to develop and validate a new instrument for measuring reflection on professionalism, and (2) determine whether learner variables are associated with reflection on the gross anatomy experience. An instrument for assessing reflections on gross anatomy, which was comprised of 12 items structured on five-point scales, was developed. Factor analysis revealed a three-dimensional model including low reflection (four items), moderate reflection (five items), and high reflection (three items). Item mean scores ranged from 3.05 to 4.50. The overall mean for all 12 items was 3.91 (SD = 0.52). Internal consistency reliability (Cronbach's α) was satisfactory for individual factors and overall (Factor 1 α = 0.78; Factor 2 α = 0.69; Factor 3 α = 0.70; Overall α = 0.75). Simple linear regression analysis indicated that reflection scores were negatively associated with teamwork peer scores ( P = 0.018). The authors report the first validated measurement of medical student reflection on professionalism in gross anatomy. Critical reflection is a recognized component of professionalism and may be important for behavior change. This instrument may be used in future research on professionalism among medical students. Anat Sci Educ 6: 232-238. © 2012 American Association of Anatomists. [ABSTRACT FROM AUTHOR]

Background: Evidence-based practice in education requires high-quality evidence, and many in the medical education community have called for an improvement in the methodological quality of education research. Objective: Our aim was to use a valid measure of medical education research quality to highlight the methodological quality of research publications and provide an overview of the recent internal medicine (IM) residency literature. Methods: We searched MEDLINE and PreMEDLINE to identify English-language articles published in the United States and Canada between January 1, 2010, and December 31, 2011, focusing on IM residency education. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI), which has demonstrated reliability and validity. Qualitative articles were excluded. Articles were ranked by quality score, and the top 25% were examined for common themes, and 2 articles within each theme were selected for in-depth presentation. Results: The search identified 731 abstracts of which 223 articles met our inclusion criteria. The mean (±SD) MERSQI score of the 223 studies included in the review was 11.07 (±2.48). Quality scores were highest for data analysis (2.70) and lowest for study design (1.41) and validity (1.29). The themes identified included resident well-being, duty hours and resident workload, career decisions and gender, simulation medicine, and patient-centered outcomes. Conclusions: Our review provides an overview of the IM medical education literature for 2010-2011, highlighting 5 themes of interest to the medical education community. Study design and validity are 2 areas where improvements in methodological quality are needed, and authors should consider these when designing research protocols. [ABSTRACT FROM AUTHOR]

Background: Critical reflection by faculty physicians on adverse patient events is important for changing physician's behaviors. However, there is little research regarding physician reflection on quality improvement (QI).Objective: To develop and validate a computerized case-based learning system (CBLS) to measure faculty physicians' reflections on adverse patient events.Design: Prospective validation study.Participants: Staff physicians in the Department of Medicine at Mayo Clinic Rochester.Main Measures: The CBLS was developed by Mayo Clinic information technology, medical education, and QI specialists. The reflection questionnaire, adapted from a previously validated instrument, contained eight items structured on five-point scales. Three cases, representing actual adverse events, were developed based on the most common error types: systems, medication, and diagnostic. In 2009, all Mayo Clinic hospital medicine, non-interventional cardiology, and pulmonary faculty were invited to participate. Faculty reviewed each case, determined the next management step, rated case generalizability and relevance, and completed the reflection questionnaire. Factor analysis and internal consistency reliability were calculated. Associations between reflection scores and characteristics of faculty and patient cases were determined.Key Results: Forty-four faculty completed 107 case reflections. The CBLS was rated as average to excellent in 95 of 104 (91.3%) completed satisfaction surveys. Factor analysis revealed two levels of reflection: Minimal and High. Internal consistency reliability was very good (overall Cronbach's α=0.77). Item mean scores ranged from 2.89 to 3.73 on a five-point scale. The overall reflection score was 3.41 (standard deviation 0.64). Reflection scores were positively associated with case generalizability (p=0.001), and case relevance (p=0.02).Conclusions: The CBLS is a valid method for stratifying faculty physicians' levels of reflection on adverse patient events. Reflection scores are associated with case generalizability and relevance, indicating that reflection improves with pertinent patient encounters. We anticipate that this instrument will be useful in future research on QI among low versus high-reflecting physicians. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 149-154 Transformative learning theory supports the idea that reflection on quality improvement (QI) opportunities and the ability to develop successful QI projects may be fundamentally linked. We used validated methods to explore associations between resident doctors' reflections on QI opportunities and the quality of their QI project proposals. Eighty-six residents completed written reflections on practice improvement opportunities and developed QI proposals. Two faculty members assessed residents' reflections using the 18-item Mayo Evaluation of Reflection on Improvement Tool (MERIT), and assessed residents' QI proposals using the seven-item Quality Improvement Project Assessment Tool (QIPAT-7). Both instruments have been validated in previous work. Associations between MERIT and QIPAT-7 scores were determined. Internal consistency reliabilities of QIPAT-7 and MERIT scores were calculated. There were no significant associations between MERIT overall and domain scores, and QIPAT-7 overall and item scores. The internal consistency of MERIT and QIPAT-7 item groups were acceptable (Cronbach's α 0.76-0.94). The lack of association between MERIT and QIPAT-7 scores indicates a distinction between resident doctors' skills at reflection on QI opportunities and their abilities to develop QI projects. These findings suggest that practice-based reflection and QI project development are separate constructs, and that skilful reflection may not predict the ability to design meaningful QI initiatives. Future QI curricula should consider teaching and assessing QI reflection and project development as distinct components. [ABSTRACT FROM AUTHOR]

Medical Education 2010: 44 : 248–255 Objectives Resident reflection on the clinical learning environment is prerequisite to identifying quality improvement (QI) opportunities and demonstrating competence in practice-based learning. However, residents’ abilities to reflect on QI opportunities are unknown. Therefore, we developed and determined the validity of the Mayo Evaluation of Reflection on Improvement Tool (MERIT) for assessing resident reflection on QI opportunities. Methods The content of MERIT, which consists of 18 items structured on 4-point scales, was based on existing literature and input from national experts. Using MERIT, six faculty members rated 50 resident reflections. Factor analysis was used to examine the dimensionality of MERIT instrument scores. Inter-rater and internal consistency reliabilities were calculated. Results Factor analysis revealed three factors (eigenvalue; number of items): Reflection on Personal Characteristics of QI (8.5; 7); Reflection on System Characteristics of QI (1.9; 6), and Problem of Merit (1.5; 5). Inter-rater reliability was very good (intraclass correlation coefficient range: 0.73–0.89). Internal consistency reliability was excellent (Cronbach’s α 0.93 overall and 0.83–0.91 for factors). Item mean scores were highest for Problem of Merit (3.29) and lowest for Reflection on System Characteristics of QI (1.99). Conclusions Validity evidence supports MERIT as a meaningful measure of resident reflection on QI opportunities. Our findings suggest that dimensions of resident reflection on QI opportunities may include personal, system and Problem of Merit factors. Additionally, residents may be more effective at reflecting on ‘problems of merit’ than personal and systems factors. [ABSTRACT FROM AUTHOR]

Background: Continuing medical education (CME) often uses passive educational models including lectures. However, numerous studies have questioned the effectiveness of these less engaging educational strategies. Studies outside of CME suggest that engaged learning is associated with improved educational outcomes. However, measuring participants' engagement can be challenging. We developed and determined the validity evidence for a novel instrument to assess learner engagement in CME. Methods: We conducted a cross-sectional validation study at a large, didactic-style CME conference. Content validity evidence was established through review of literature and previously published engagement scales and conceptual frameworks on engagement, along with an iterative process involving experts in the field, to develop an eight-item Learner Engagement Instrument (LEI). Response process validity was established by vetting LEI items on item clarity and perceived meaning prior to implementation, as well as using a well-developed online platform with clear instructions. Internal structure validity evidence was based on factor analysis and calculating internal consistency reliability. Relations to other variables validity evidence was determined by examining associations between LEI and previously validated CME Teaching Effectiveness (CMETE) instrument scores. Following each presentation, all participants were invited to complete the LEI and the CMETE. Results: 51 out of 206 participants completed the LEI and CMETE (response rate 25%) Correlations between the LEI and the CMETE overall scores were strong (r = 0.80). Internal consistency reliability for the LEI was excellent (Cronbach's alpha = 0.96). To support validity to internal structure, a factor analysis was performed and revealed a two dimensional instrument consisting of internal and external engagement domains. The internal consistency reliabilities were 0.96 for the internal engagement domain and 0.95 for the external engagement domain. Conclusion: Engagement, as measured by the LEI, is strongly related to teaching effectiveness. The LEI is supported by robust validity evidence including content, response process, internal structure, and relations to other variables. Given the relationship between learner engagement and teaching effectiveness, identifying more engaging and interactive methods for teaching in CME is recommended. [ABSTRACT FROM AUTHOR]

Continuous quality improvement is a component of professionalism. Maintenance of Certification (MOC) is a mechanism in the USA for physicians to keep current with medical knowledge and contribute to practice improvement. Little is known about primary care physicians' perceptions of the practice improvement (Part IV) components of MOC. We aimed to determine primary care physicians' perceptions of their professional responsibility to participate in Part IV MOC. This was a cross-sectional study of primary care physicians using the American Medical Association Masterfile. We developed a nine-item survey, designed from expert consensus and literature to determine views on Part IV MOC as a professional responsibility. We surveyed 1500 randomly selected primary care physicians via mail from November 2014 to May 2015. The response rate was 42% (627 of 1,500): 47% (273 of 585) were family practitioners and 49% (289 of 585) were internists. Factor analysis revealed a two-factor survey, with five items pertaining to positive views of MOC Part IV and four items pertaining to negative views. Internists were more likely to view MOC Part IV as time consuming (82.0% vs. 70.3%, P = .001), expensive (50.9% vs. 38.8%, P = .004), and not relevant to practice (39.1% vs. 23.8%, P < .001). Family medicine practitioners were more likely to view MOC Part IV as improving patient care (64.5% vs. 48.8%, P < .001) and maintaining professional responsibility (48.7% vs. 32.5%, P < .001). Regardless of specialty, most physicians viewed MOC Part IV as time intensive, not beneficial for career advancement, and not a professional responsibility. Family medicine practitioners demonstrated more positive views of MOC Part IV. The difference between family medicine practitioners and internists could be related to the ABIM MOC controversy. Future changes to practice improvement requirements could focus on limiting time requirements and on clinical relevance. Abbreviations: ABIM: American Board of Internal Medicine; AMA: American Medical Association; CQI: continuous quality improvement; IRB: institutional review board; MOC: Maintenance of Certification; QI: quality improvement [ABSTRACT FROM AUTHOR]

Background: We conducted a prospective validation study to develop a physician assistant (PA) clinical rotation evaluation (PACRE) instrument. The specific aims of this study were to 1) develop a tool to evaluate PA clinical rotations, and 2) explore associations between validated rotation evaluation scores and characteristics of the students and rotations. Methods: The PACRE was administered to rotating PA students at our institution in 2016. Factor analysis, internal consistency reliability, and associations between PACRE scores and student or rotation characteristics were determined. Results: Of 206 PACRE instruments sent, 124 were returned (60.2% response). Factor analysis supported a unidimensional model with a mean (SD) score of 4.31 (0.57) on a 5-point scale. Internal consistency reliability was excellent (Cronbach α=0.95). PACRE scores were associated with students' gender (P =.01) and rotation specialty (P =.006) and correlated with students' perception of being prepared (r = 0.32; P <.001) and value of the rotation (r = 0.57; P <.001). Conclusions: This is the first validated instrument to evaluate PA rotation experiences. Application of the PACRE questionnaire could inform rotation directors about ways to improve clinical experiences. The findings of this study suggest that PA students must be adequately prepared to have a successful experience on their rotations. PA programs should consider offering transition courses like those offered in many medical schools to prepare their students for clinical experiences. Future research should explore whether additional rotation characteristics and educational outcomes are associated with PACRE scores. [ABSTRACT FROM AUTHOR]

The article offers information regarding the case of a 74-year-old man with Metoprolol-Induced Lichenoid Dermatitis. It states that a skin biopsy showed lichenoid interface dermatitis, incontinence of the dermis, and scattered eosinophils that suggests the diagnosis of lichenoid drug eruption (LDE). It says that the patient's topical steroids were initiated and beta-blockade was discontinued. Moreover, four weeks later, his heart palpitations did not recur and his rash were resolved.