February Faculty Development: How to Get the Most Out of a Survey

How to Get the Most Out of a Survey
By: Kimberly Dao, Maine Track, M’18
‘‘Let’s just do a quick survey.’’
— Someone in everyone’s program

Surveys are an easily accessible and commonly used tool in many disciplines. However, the
quality of responses and response rate can vary dramatically. Below are some basic tips to
maximize your survey.

Tip 1 : Picking the Right Survey Tool – There are countless survey tools available online. When
selecting the application, recognize the services offered, pricing, and complexity of each tool.
Qualtrics, SurveyMonkey, and Google Forms are among the most popular tools with specific
advantages to each.
a. Qualtrics: Recommended for large (>10,000 participants) sophisticated surveys that
require special types of input, allows survey takers to save their work and return later, or
if survey questions need to be integrated with other data sets. This product must be
purchased, but many institutions have this tool available for employees.
b. SurveyMonkey: Recommended for most simple research projects. Service is free with
the option for purchase of advanced services.
c. Google Forms: Recommended for simple research projects. Although it does not include
any tools to automate data analysis, you can track and monitor responses.
See below for sites that review/compare survey tools.

Tip 2 : Other Things to Consider – Do you need/require HIPAA compliance? Does your survey
support accessibility (like screen readers, text-to-speech tools, or screen magnifiers)? Does
your survey support mobile devices?
Tip 3 : Survey Design – “The Five Tenets of Survey Design” recommends avoiding: agreement
response items, multi-barreled items, unlabeled response options, unevenly spaced response
options, and non-substantive response options formatted together with substantive response
items. 1 For further explanation and examples, please see the attached table.
Tip 4 : Incentives – Studies have shown that surveys providing incentives have significantly
improved response rates. 4 The mean response rates for surveys providing incentives was
above 70%.
Tip 5 : Time Commitment – Be upfront with how long the survey will take. This enables
participants to plan appropriately.
Sites that review/compare survey tools:
a. TopTenReviews – http://survey-software-review.toptenreviews.com/(link is external)
b. Relevant Insights – http://www.relevantinsights.com/free-online-survey-tools(link is
external)
c. SocialBrite –
http://www.socialbrite.org/2010/09/16/5-top-online-survey-tools-for-nonprofits/(link is
external)

References:
1. Artino, A. R., Phillips, A. W., Utrankar, A., Ta, A. Q., & Durning, S. J. (2017). “The
Questions Shape the Answers”. Academic Medicine, 1.
doi:10.1097/acm.0000000000002002
2. Church AH. Estimating the effect of incentives on mail survey response rates: A
meta-analysis. Public Opin Q. 1993; 57: 62-79
3. Phillips, A. W., Friedman, B. T., Utrankar, A., Ta, A. Q., Reddy, S. T., & Durning, S. J.
(2017). Surveys of Health Professions Trainees. Academic Medicine, 92(2), 222-228.
doi:10.1097/acm.0000000000001334
4. Retrieved January 26, 2018, from
https://education.temple.edu/help/survey-tools-dissertations-and-research

January Faculty Development: Power Posing to Increase Presentation Quality

Power Posing to Increase Presentation Quality     

Andy Biedlingmaier, Tufts M18 Student on Medical Education Elective

Humans and nonhuman primates use open and expansive postures to convey power.  However, new research shows that these “high-power poses” not only communicate power, they also create it.  Therefore, high-power posing can be used to boost presenter confidence, and consequently improve audience evaluation, during high-stakes presentations.

Tip #1:  Spend at least 2 minutes in a high-power pose prior to a high-stakes evaluation or presentation.

Cuddy, Wilmuth, and Carney (2012) performed an experiment in which 61 Columbia University students were randomly assigned to hold either a high-power (expansive, open) pose or a low-power (contractive, closed) pose prior to performing a mock job interview.  Poses were held initially for 2 minutes, and then for an additional 5 minutes immediately before the interview.  Students assigned to the high-power poses reported feeling significantly more powerful after the interview, and scored significantly higher in terms of overall performance and hireability.  This response is believed to result from hormonal changes, as shown by Carney, Cuddy, and Yap (2010).  In their study, participants randomly assigned to high-power poses for two minutes showed a significant increase in testosterone and decrease in cortisol as compared to the low-power posers.  In fact, the low-power posers showed decreased testosterone and increased cortisol after posing for two minutes.  Additionally, high-power posers rated themselves as feeling more powerful on average, and were more comfortable with risk-taking.

Tip #2:  Use a high-power pose to re-gain control of an audience.

 Hale, Freed, and Ricotta, et al. (2017) suggest that the work by Cuddy and others as described above can be applied strategically to re-assert control over a room, or in handling a “difficult” audience member.  They recommend standing up straight with hands on hips as a method of self-assurance and to signal one’s authority to the crowd as needed.  However, one downfall to this method is that it might not be appropriate when addressing more “senior” audience members.

Overall, the work by Cuddy and others suggests a new understanding of body language.  Our posture can stimulate hormonal pathways that mediate our sense of power.  Harnessing this power through selective use of expansive “high-power” poses can improve performance during high-stakes presentations and may have applications in asserting control over an audience as necessary.

For more information on this topic, please see Amy Cuddy’s Ted Talk  

Sources:

Carney, DR, Cudy, AJC, and Yap, AJ.  2010.  Power posing:  brief nonverbal displays affect neuroendocrine levels and risk tolerance.  Pscychol Sci.  21(10):1363-1368.

Cuddy, AJC, Wilmuth, CA, and Carney, DR.  2012.  The benefit of power posing before a high-stakes social evaluation.  Harvard Business School Working Paper, No. 13-027.

Hale, AJ, Freed, J, Ricotta, D, et al.  2017.  Twelve tips for effective body language for medical educators. Med Teach.  39(9):914-919.

December Faculty Development: How do you learn best? Effective Teaching and Learning Style Preference

How do you learn best? Effective Teaching and Learning Style Preference

By: Sarah Couser, Maine Track MS4

Do you prefer to have a map or written directions when you travel somewhere new? When you pick up a

new book, do you buy a hard copy or the audiobook? As a student, did you write notes meticulously or

prefer to have a more hands-on learning experience?

As described by Neil Fleming, there are four different modes of communicating information. Visual

learners, are those that learn best when using graphs, flowcharts, or maps. Aural learners are those that

prefer to learn by listening or discussing. Read/Write learners prefer learning by reading or writing new

material. Kinesthetic learners are those that prefer multi-sensory experiences, including touch, smell, and

taste.

In 2006, Lugan and Dicarlo asked first year medical students to participate in a survey to discover their

learning style preferences. Of the 166 participants, ~5% preferred auditory information, ~5% preferred

visual information, ~8% preferred information in the form of printed words, and 18% preferred

kinesthetic learning, or learning from touch, smell, hearing, taste, and sight. The remaining 64% of

students preferred to learn with multiple modes of information. The study concluded that by knowing

students’ learning style preferences, teachers could help to provide individualized learning experiences for

their learners.

Although many of us are familiar with how we personally learn best, we often forget that others may have

different learning styles than our own. Just as you may doze off looking at diagrams or tables, others may

begin daydreaming if they are not provided with a visual during a lecture. Below, I’ve included some

helpful tips for teaching students with varying learning style preferences. Whether we are teaching in a

classroom or on clinical rounds, it is important to incorporate multiple modes of information. This will

improve our teaching, and ultimately, our students’ learning.

Visual:

• Utilize a powerpoint or videos to display important information

• Show pictures to learners or ask a patient to participate (impetigo or finger clubbing)

• Use a white board to draw diagrams, tables, or flowcharts

Aural:

• Verbally discuss important points with a group of learners

• Ask patients to participate in learning by sharing their own experiences

• Implement teach-back to provide learners additional opportunities to speak and listen

Read/Write:

• Offer lists or handouts for reading material

• Encourage learners to take notes

• Prompt learners to read outside of the hospital (UpToDate, research papers, etc.)

Kinesthetic:

• Provide learners with real-life examples or relevant cases

• Use metaphors that learners are familiar with to facilitate learning

• Ask patients to participate in teaching with physical exam findings (ascites or crackles)

Don’t know your learning style — whether you’re a Visual, Aural, Read/Write, or Kinesthetic learner?

Take the quiz here:

References:

Lujan HL, and DiCarlo SE. “First-Year Medical Students Prefer

 

November Faculty Development: Exercises in Virtue

Exercises in Virtue by Michael Stanley, MS4

Please open the PDF and see text icon in upper left hand corner for the lecture. For access to the original Power point document please email Medical Education at mededuc@mmc.org

October Faculty Development: Tips for Teaching High Value Care on Rounds

Tips for Teaching High Value Care on Rounds     Emily Zarookian, MD

Teaching high value care in medical education is an essential, although recent addition to many graduate and undergraduate medical education curriculums. High value care has become an essential part of medical education as healthcare expenditures continue to rise with up to 30% ($765 billion) of those costs identified as potentially avoidable costs. 1

As teaching high value care can be a new skill for many seasoned attendings physicians it is not surprising that multiple studies have found a lack of teaching high value care on rounds. One study found that only in 20% of observed rounding episodes was there any discussion of high value test ordering principles.2

The following two exercises are examples of easy to use exercises on rounds to emphasize the principles of high value care.

Exercises to use on rounds:

Ask the “five questions” before ordering tests.

The American College of Physicians published five questions physicians should ask before ordering tests.3 Choose one patient on daily rounds and ask the team these five questions before ordering a test.

  1. Whether a diagnostic test other than a CBC, BMP, CMP, or INR was previously performed
  2. Whether diagnostic test results would affect care
  3. Whether a test result represented- or a study under consideration might produce a false positive result
  4. Whether the patient would experience short-term harm if a test were not ordered
  5. Whether the team considered patient preferences towards a diagnostic study

Focus on “Choosing Wisely”

 Select one of the Hospital Medicine “Choosing Wisely” initiatives for the week. Focus on this initiative by asking one team member to track progress throughout the week on decreasing utilization of unnecessary foley catheters, low utility telemetry, or repetitive daily labs. Report progress daily.

Society of Hospital Medicine “Choosing Wisely” 

  1. Don’t place, or leave in place urinary catheters for incontinence, convenience, or monitoring of output for non-critically ill patients.  Suggest team members track foley catheters using EHR to remind team members which patients have foley catheters in place
  2.  Don’t prescribe medications for stress ulcer prophylaxis to medical inpatients unless at high risk for GI complications
  3.  Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms of  active coronary disease, heart failure or stroke.
  4. Don’t order continuous telemetry monitoring without using a protocol that governs continuation
  5. Don’t perform repetitive CBC, CMP in the face of clinical and lab stability.  Suggestion: use comparemaine.org to quickly review the costs of tests and procedures at different facilities in Maine. This        will give learners insight into how expensive unnecessary daily labs can be.

 Additional Resources

  1. JAMA Internal Medicine Teachable Moments Series : Short, easy to read articles that each begin with a clinical vignette in which unnecessary care resulted in patient harm followed by a quick evidence based review of the subject. This series is first authored by learners. Consider encouraging a learner to submit a “teachable moment” if occurs.

References:

  1. Smith, Cynthia MD et al. “Teaching High-Value, Cost-Conscious Care to Residents: The Alliance for Academic Internal Medicine- American College of Physicians Curriculum.” Annals of Internal Medicine. 2012; 157:284-286.
  2. Pierce Cason MD et al. “ Frequency of Attending Physician-Led Discussion of Test-Ordering Principles during Teaching Rounds” JAMA Internal Medicine. 2016; 176:2:261-262
  3. Qaseem  A, Alguire  P, Dallas  P,  et al.  Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Ann Intern Med. 2012;156(2):147-149.

August Faculty Development: Education Video Production: A How-To-Guide

Educational Video Production: A How-To Guide by:           Alex Fiorentino, MD, Maine Track ’17

Learners of many types are increasingly utilizing online educational videos, and medical learning is no exception to this trend.  As an example, the massive open online course platform Khan Academy has generated a video series geared toward helping nursing students prepare for the NCLEX-RN licensing exam.  At the time of this writing, the platform’s overview of nephron function has been viewed more than 1.6 million times1.

Unfortunately, clinician educators wishing to use video as a tool for teaching students, residents, or patients may feel ill equipped for the task.  Hiring a professional video production team is expensive, while producing one’s own videos presents unfamiliar technical challenges.

The video below highlights key steps to planning, filming, and editing your own educational videos.  It emphasizes low-cost solutions and attempts to demonstrate that with a thoughtful approach, any clinical educator can create polished and effective video lessons.


For additional resources and literature on educational video production, please see the attached PDF.

References:

  1. Khan, S. (2010, March 3). The kidney and nephron.  Retrieved from https://www.youtube.com/watch?v=cc8sUv2SuaY.

 

July Faculty Development: Teaching Clinical Reasoning with the Think Aloud Technique

Teaching Clinical Reasoning with the Think Aloud Technique                      by Kelly M. Brooks, MD, Maine Track ‘16

“Expert clinicians frequently use automatic unconscious thinking processes as they gather and analyze clinical information to generate diagnoses. When experts use think aloud techniques, they articulate their thinking as they are reasoning and by doing so make their thinking processes clear to students.” 1 Think aloud is most commonly utilized as a research method for studying cognition, and is considered a reliable method for capturing peoples’ thought processes.

Researchers at the Dunedin School of Medicine at the University of Otago in New Zealand, piloted a program in their clinical reasoning curriculum that incorporated online modules and training in the think aloud technique. Their pilot study found that the think aloud technique is an example of teaching clinical reasoning in an explicit, transparent way that allows students to better understand a clinicians thinking along the trajectory of a clinical problem and arriving at a diagnosis. Not only did researchers find that this model can be used to teach medical students, but can also serve as a means for attending physicians to assess a learner’s clinical reasoning skills and provide immediate feedback on their student’s thought process.

Tips for incorporating the think aloud  technique (examples incorporated from the pilot study by Pinnock, et al. 2016):

1) Have the student present a patient on the inpatient wards outside of the patient’s room. As the student presents the patient, have the student pause intermittently; during these pauses, the supervising physician will say out loud how she/he is thinking at each stage of the presentation. This will allow the student(s) to understand how the supervisor analyzes the information during the presentation to come to a diagnosis.

2) Have the student present a patient she/he has seen in clinic outside the exam room. Have the student pause during her/his presentation to explain how/what she is thinking. This allows the supervising physician to assess each stage of the student’s reasoning.

3) Consider the learner’s level of experience—for example, pausing after the HPI may help to gather the learner’s initial instincts and broad differential, compared to talking through their thinking after the subjective/objective portion of the presentation for a more fully developed and specific assessment and plan.

4) Clinicians in this study appreciated the minimal training required to use this technique and that this style of teaching incorporated all stages of clinical reasoning, and could continue to educate students on core clinical reasoning skills such as utilizing pattern recognition and hypothetic–deductive thinking.

5) Potential barriers: Clinician supervisors voiced their concern about time limitations in the clinical setting that may prevent them from utilizing this technique. Researchers are following up with a study to help better understand this and other barriers to teaching clinical reasoning with the think aloud technique.

1 Pinnock R, Fisher TL, Astley J. Think aloud to learn and assess clinical reasoning. Med Educ 2016 May;50(5):585-586. PMID: 27072473

June Faculty Development: Use of Social Media as a Supplement to Medical Education Curricula

Use of Social Media as a Supplement to Medical Education Curricula by Nate Rogers, MD, Maine track ‘16

Though the majority of medical education literature has studied social media and issues of professionalism in relation to its use, medical professionals are beginning to recognize its potential as a powerful educational tool. Twitter and Facebook represent two of the largest and most widely studied social media platforms in medical education, with healthcare professionals finding creative uses of the apps to enhance learning.

Bahner et al. supplemented a novel ultrasound curriculum with Twitter’s “push technology” (i.e., “pushing” information/messages to followers from publishers, rather than requested, or “pulled,” by followers from publishers) and supplemented this delivery with online discussions in Facebook “Pages” and/or “Groups.” The writers offered the following easy-to-follow guide on how to implement its use. Learners will be required to have memberships to Twitter and Facebook, while teachers will benefit from the use of third-party apps in addition to these two platforms.

Step 1: Register for Facebook and Twitter accounts (once registered with these social media outlets, third-party apps will allow you to “sign in” using account name and password from Facebook or Twitter). Instruct learners that they must register for these accounts to participate in discussion and must “follow” the account you create (be sure to share username with potential audience members).

Step 2: Create a “Page” in Facebook to facilitate tweet-related discussions (e.g., “ED Ultrasound page”). Learners can find this page by using the “search” function (be sure to inform them of the Page name). Pages are open for anyone to view and may be linked to Twitter for simultaneous displays of tweets on Facebook. If a private group discussion is required, a “closed” group will need to be created. Learners can join this Group one of two ways:

  • By invitation (using Facebook names and/or email address), or
  • Pressing the “Join Group” button on the Group’s page and awaiting approval from the Group Creator/Administrator.

Step 3: Sign into third-party app (Twuffer or HootSuite) to upload educational pearls as scheduled tweets (≤140 characters +/- image), which will be simultaneously posted to your Facebook Page. Posting once per day at a consistent time is ideal, as this allows time to discuss the pearl before progressing to the following day’s lesson. Use the bit.ly app to include links to articles that would otherwise exceed  Twitter’s 140-character limit.

Step 4: Ensure learner engagement through topical conversation in an “open” (viewable by all) Facebook “Page” or a “closed” (viewable only by invitation) Facebook “Group.”

In-depth descriptions of the above-mentioned apps are included in the attached table.

The use of social media as an educational tool in medicine is an emerging area of research in a rapidly progressing technological field.  A trial of the above plan is an excellent starting point to gain familiarity with the use of social media, while also acting as a good starting point from which to exercise creativity in its use as an educational resource.

Social Media What? Pros Cons Notes
Facebook

www.facebook.com

 

Users make account profiles with personal demographic and post messages on Users’ / Groups’ / Pages’ “walls” ●       Open or closed groups for discussion of common interests

●       Tweets can be simultaneously linked to Facebook (allows audience expansion & further discussion)

Personal account required (privacy concerns) ~1.59 billion active monthly users
Twitter

www.twitter.com

 

Users post “tweets” (≤140 characters each) that are received by “followers” (audience) but visible to the public. ●       140 character limit allows for high yield info in short statement

●       Easy image posting (e.g., radiology, derm, etc.)

●       Large reach allows for sharing of educational info outside of institution’s boundaries.

●       Useful for real-time discussion in conference/lecture environments w/ live twitter feed on large screens

●       Discussion uncommon – unilateral receiving of information more common (see Facebook “Pros” for remedy)

●       Still relies on users to sign up for content

~305  million active monthly users
Twuffer (“Twitter Buffer”)

www.twuffer.com

3rd-party app allows scheduling of posts for later date & time ●       Allows consistent delivery time of tweets.

●       Relieves daily posting burden (schedule multiple tweets at once)

HootSuite

www.hootsuite.com

 

3rd-party social media managing app allows easy use of multiple social media platforms (e.g., Facebook, Twitter, etc.) ●       Allows posting to multiple platforms simultaneously.

●       Allows scheduling of future posts.

●       Allows scheduling and batch-uploading of many tweets from a single text file (greater ease/speed of uploading)

$6/month fee required for most features
bit.ly

www.bitly.com

 

 

3rd-party app that compresses web addresses ●       Allows posting of links that would otherwise have exceeded Twitter’s 140 character-limit

●       Allows archiving of links

●       Produces basic statistics for assessing usage by Twitter followers

Other useful/interesting social media apps:

  1. Figure 1: Medical image sharing for healthcare professionals. Find/share de-identified info of new and interesting cases, page specialists for quick feedback, take part in discussions of cases, and customize app to your experience/specialty. Includes an in-app consent form, the ability to remove details by swiping, and automatic face blocking for HIPAA-compliant de-identification.
  2. YouTube: Useful for visual walk-throughs of some clinical procedures.

Other well-known social media platforms with potential use as educational tools include Google+, Blogs, Podcasts, Picasa, and Flickr.

  1. Bahner DP, et al. How we use social media to supplement a novel curriculum in medical education. Medical Teacher. 2012: 1-6.
    1. Twitter account used for the above study:
      1. “@EDUltrasound,” http://twitter.com/#!/EDUltrasound
    2. Paton C, et al. Experience in the use of social media in medical and health education. Nursing and Health Professions Faculty Research. Paper 6.

 

May Faculty Development: ARCH, A Guidance Model for Providing Effective Feedback to Medical Learners

ARCH Model for Guiding Effective Feedback for Medical Learners by:   Conor Walsh, M17

Although feedback is a vital component of medical education and is important to ensure that standards are met, providing effective and appropriate feedback can be difficult for medical students, residents, and practicing physicians. Oftentimes, feedback can be too general (thereby making it difficult to set specific goals), untimely (i.e. given several weeks to months after a rotation), or be given without an explicit plan for improvement.

Characteristics of effective feedback include:

Considering emotions of both learner and teacher be:

  • Partially based on learner’s self-assessment and be well timed and expected
  • Based on direct observation and reliable information
  • Be specific, not general
  • Given in descriptive non-evaluative language
  • Given in a collaborative spirit

The ARCH concept helps provide a model for structured feedback for medical students and residents.

Allow/ask for self-assessment

Reinforce what is being done well (attitudes, skills, and knowledge)

Confirm what needs Correction or improvement

Help the learner with a plan for improvement and coach as needed

Allow/ask for self-assessment-

  • -Ask the learner to self-assess what they did well and what they could work on.

Example: “How do you feel about your interview with Mr. Smith? What do you think went well? What do you think you could continue to improve on?”

Reinforce what is being done well (attitudes, skills, and knowledge)

Example: “I agree that you were able to take a thorough history and that it was well organized.”

Confirm what needs Correction or improvement

Example: “Although you were thorough in your review of systems, it appeared to me that Mr. Smith really wanted to talk more about his joint pain. Did you notice that as well?

Help the learner with a plan for improvement and coach as needed

Example: “Why don’t you write up our discussion today with the goals to work towards this week and email it to me. I’ll make time this week to make sure we discuss your progress towards achieving those goals.

References:

  1. MacLeod L. Making SMART goals smarter. Physician Exec 2012; Mar/Apr:38(2):68-72.
  2. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004;79(10 Suppl):S70–81.
  3. Bienstock JL, Katz NT, Cox SM, et al. To the point: medical education reviews—providing feedback. Am J Obstet Gynecol 2007 Jun;196(6):508-13.

April Faculty Development: Tips for Educators Early in their Careers

Growing as a new teacher: Tips for educators early in their careers

By Benjamin Levin, MD

For new medical educators developing their career is important, here are 12 tips to help young early career medical educators get their careers started.

  1. Articulate your areas of interests

Ask yourself “what kind of career do I want?” use this as a starting point to set up your career and see how you can fit the needs of your institution

  1. Define what success means to you

Think about the goals of your career, both personal and professional

  1. Create a 5-year strategic plan

Take your career trajectory and goals and set out milestones and steps to achieve your goals

  1. Develop strong communication skills

The ability to craft a message to effectively reach an audience is a vital skill; set aside dedicated time for working on communication.

  1. Cultivate relationships with mentors

Mentors help with ideas, career development and can help you navigate academic medicine

  1. Be a good mentee

Respect your mentor’s commitment to you and use it effectively

  1. Build a network of peers

Colleagues can help with personal or professional challenges; expand beyond your department and training background

  1. Craft multiple elevator pitches

You have multiple audiences and need multiple pitches, retain the interest of the listener

  1. Be a team player

This starts before you become a faculty member

  1. Build resilience as your armor

Life isn’t fair or easy, be adaptive, be persistent and overcome the challenges

  1. Understand that medical education is a field not a discipline

A field brings people together; this can provide opportunities and challenges

  1. Embrace your identity as part of the medical education field

You are a contributor to the community of scholars; strive for the best quality in your work

These steps can help an early career medical educator develop their career but as time progresses go back and review these to help your continued development as an academic physician.

Sources: Cristancho S, Varpio L. Twelve tips for early career medical educators. Med Teach. 2016 Apr;38(4):358-63. doi: 10.3109/0142159X.2015.1062084. Epub 2015 Oct 22. PubMed PMID: 26492100