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Abstract Background Medical educators struggle to incorporate socio-cultural topics into crowded curricula. The “continuum of learning” includes undergraduate and graduate medical education. Utilizing an exemplar socio-cultural topic, we studied the feasibility of achieving expert consensus among two groups of faculty (experts in medical education and experts in social determinants of health) on which aspects of the topic could be taught during undergraduate versus graduate medical education. Methods A modified Delphi method was used to generate expert consensus on which learning objectives of social determinants of health are best taught at each stage of medical education. Delphi respondents included experts in medical education or social determinants of health. A survey was created using nationally published criteria for social determinants of health learning objectives. Respondents were asked 1) which learning objectives were necessary for every physician (irrespective of specialty) to develop competence upon completion of medical training and 2) when the learning objective should be taught. Respondents were also asked an open-ended question on how they made the determination of when in the medical education continuum the learning objective should be taught. Results 26 out of 55 experts (13 social determinants of health and 13 education experts) responded to all 3 Delphi rounds. Experts evaluated a total of 49 learning objectives and were able to achieve consensus for at least one of the two research questions for 45 of 49 (92%) learning objectives. 50% more learning objectives reached consensus for inclusion in undergraduate (n = 21) versus graduate medical education (n = 14). Conclusions A modified Delphi technique demonstrated that experts could identify key learning objectives of social determinants of health needed by all physicians and allocate content along the undergraduate and graduate medical education continuum. This approach could serve as a model for similar socio-cultural content. Future work should employ a qualitative approach to capture principles utilized by experts when making these decisions.

OBJECTIVES:. To determine the prevalence and extent of impairments impacting health-related quality of life among survivors of COVID-19 who required mechanical ventilation, 6 months after hospital discharge. DESIGN:. Multicenter, prospective cohort study, enrolling adults 18 years old or older with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received mechanical ventilation for 48 hours or more and survived to hospital discharge. Eligible patients were contacted 6 months after discharge for telephone-based interviews from March 2020 to December 2020. Assessments included: Montreal Cognitive Assessment-Blind, Hospital Anxiety and Depression Scale, Impact of Event Scale-6, EuroQOL 5 domain quality-of-life questionnaire, and components of the Multidimensional Dyspnea Profile. SETTING:. Two tertiary academic health systems. PATIENTS:. Of 173 eligible survivors, a random sample of 63 were contacted and 60 consented and completed interviews. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Mean age was 57 + 13 years and mean duration of invasive mechanical ventilation was 14 + 8.2 days. Six months post-discharge, 48 patients (80%; 95% CI, 68–88%) met criteria for post-intensive care syndrome (PICS), with one or more domains impaired. Among patients with PICS, 28 (47%; 95% CI, 35–59%) were impaired in at least 2 domains, and 12 (20%; 95% CI, 12–32%) impaired in all three domains. Significant symptoms of post-traumatic stress were present in 20 patients (33%; 95% CI, 23–46%), anxiety in 23 (38%; 95% CI, 27–51%), and depression in 25 (42%; 95% CI, 30–54%). Thirty-three patients (55%; 95% CI, 42–67%) had impairments in physical activity; 25 patients (42%; 95% CI, 30–54%) demonstrated cognitive impairment. CONCLUSIONS:. Eighty percent of COVID-19 survivors who required mechanical ventilation demonstrated PICS 6 months after hospital discharge. Patients were commonly impaired in multiple PICS domains as well as coexisting mental health domains.

Introduction: Vertically integrating physiology into patient care has the potential to improve clinical reasoning. Clinical Physiology Grand Rounds (CPGR) is a case-based teaching method that brings together students from all years of medical school to focus on linking clinical presentations to core basic science concepts including anatomy, physiology, and pathophysiology. In this study, we describe the implementation of CPGR at two different institutions in the United States and assess student-reported outcomes. Methods: We survey students who participated in CPGR at Columbia University College of Physicians & Surgeons (P&S) and Medical University of South Carolina (MUSC). Subjects were queried across three domains: the benefits of attending, the impact of concept maps, and the impact of the mixed-learner environment. Results: Despite differences in session leadership and the underlying medical school curricula, conference attendees reported similar benefits at the two schools included in this study. Students overwhelmingly (92.9%) reported that remembering clinical presentations was easier when they understood the underlying physiology. They also reported gaining a true understanding of concepts that were previously memorized (87.5%). Both clinical (92.5%) and preclinical students (93.1%) valued the mixed-learner environment as a component of the conference. Discussion: By assuring a mixed-learner environment with near-peer interactions, using concept maps as a teaching tool, and rigorously linking clinical presentation and management to physiological concepts, we found that the key benefits of CPGR were replicable across different institutions, despite several local differences in how CPGR was implemented, led, and conducted.

Abstract Peer observation of teaching has become an important element in the assessment of faculty members' instructional skills and competence. Assessing teaching accurately involves the use of reliable and validated instruments, standardized observation procedures, and peer observer training. Without training, observers may provide biased feedback that lacks either sufficient detail or specific suggestions needed for teaching improvement. This resource contains an instrument for peer assessment of medical lecturing along with an accompanying rater training guide. The assessment instrument consists of 11 criteria for effective lecturing and an overall lecture quality measure. Together, the guide and instrument may be used for peer rater training as they provide faculty with detailed behavioral descriptors and guidance on conducting peer assessment of medical lecturing or large-group discussions. After the training, we asked participants to rate a posttest lecture using the instrument and the guide. To determine the effectiveness of the training, these posttest ratings were compared to ratings previously determined by a panel of expert medical educators who had watched the same videotaped lectures. Preliminary results comparing the experts' and participants' ratings indicated closer agreement on the posttest lecture. Moreover, the participants found the rater training facilitator's guide to be valuable in detailing exact behaviors associated with each criterion's performance levels, and they asked to keep the guide for future reference.

Abstract This resource is a handbook designed to help individuals prepare for and conduct an effective teaching observation and feedback session. The handbook presents 10 steps that observers can follow to ensure they identify critical instructional moments during the teaching encounter and then engage in a mutual exchange of ideas with their colleagues at the conclusion of the session. It also suggests ways to avoid common peer observation pitfalls and describes the benefits of partaking in an observation pairing or buddy system. A number of references and sample peer observation of teaching forms are included at the end of the handbook. Creation of this resource originated from the need to translate the theory of peer observation into actual practice. While there have been recent calls from the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education for regularly scheduled feedback to medical education program faculty members about their clinical teaching abilities, there is little guidance on how that feedback should be collected and delivered. To provide individualized instructional development and feedback to the faculty members at our institution, we created the Peer Observation of Teaching Handbook for faculty members to follow in order to conduct effective teaching observations that would inform meaningful feedback to their peers. After each peer teaching observation, we send a brief feedback form to both the observer and the faculty member to collect comments and suggestions about the peer observation of teaching experience. Quantitative and qualitative feedback collected from the forms has been positive.