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Director's Message: What Are the Top Cited Papers in Medical Education?
January marks the start of a new year. It is often a time of reflection. It marks the start of many earnest hopes to change and very often, the bitter realization that change is very hard. January starts with the Rose Bowl and ends as the onramp to Super Bowl in February. January is a milestone for entertainment awards: People's Choice, Screen Actor's Guild, Golden Globes as well as Oscar nominations. In academia, perhaps the best we can do is to look at the papers that have made a difference. January is a good time to curl up with your laptop or tablet or printed pages and become acquainted with some of the most important papers in medical education.
 
What is an important paper? Historically, importance has been measured by citations; the premise is that important papers are often cited papers. While there are many limitations to using citations as an index of a paper's importance, it remains a currency of the realm. A recent study by Azer presents the results of a bibliographic analysis to identify the top-cited medical education papers. He compared the results of two approaches to bibliographic analyses: citations of articles published in medical education journals and citations of articles published across all Web of Science journals searched by medical education key words. He identified the top 50 ranked papers using each approach; 26 papers were common to both lists. Almost half of these 26 top ranked publications were review papers (N=12; 46%), and articles (essays, perspectives, etc.) made up most of the rest (N=10; 38%). Only four (15%) research papers made this list. Together, these 26 top papers sample medical education scholarship from 1983 to 2005. The most cited paper in this list was Problem-based learning: A review of literature on its outcomes and implementation issues, published in 1993. In case you were wondering, the top cited paper published in 2015 is Recording medical students' encounters with standardized patients using Google Glass: providing end-of-life clinical education.
 
Information technology now provides another point of view for a paper's importance. Web of Science now offers a measure of "usage" representing user's interest in a specific reference and operationalized as the number of times the full text is viewed at the publisher's website or the reference is saved to reference management software. Usage data have only been available since 2013 although they are available for older articles accessed since 2013. Examining the usage statistics, the most accessed paper since 2013 is 3D printing based on imaging data: review of medical applications, which was published in 2010. The most accessed paper in the past 180 days is An evaluation of medical residents utilization of tablet computers, published in December 2015. Lest you think that only technology-based papers show up in the usage statistics, the top ten also include the 1993 problem-based learning review mentioned above as well as Spirituality and health education: A national survey of academic leaders UK, published last month. A complete list of top accessed references is available here.
 
It is reassuring to know that there are classics in medical education literature that have contributed to our practice and scholarship. January is a time of reflection; our own performance is the seed of our reflection. As educators, citation and usage statistics are the things that awards in academia are made of and while it is likely an exaggeration to say that we obsess about them, we do frequently wonder about them. The ease of accessing your own citation statistics through Google Scholar or other sites feeds that wonder. We are caught: like the People's Choice Awards, we hope each paper we publish finds a readership contributing to what is known and creating something that others can build upon. Our fear, seldom articulated, is that our paper will fail, no one will read it and more like the Darwin Awards, it does not contribute to the academic gene pool of scholarship. 

Brian Mavis, PhD 
Professor
Director, Office of Medical Education Research and Development
Director, CHM Learning Academy  
announcement
Announcements
- Debriefing with Good Judgement
 Quality debriefing and feedback is a critical component of teaching and learning experiences and requires a significant amount of learning and practice on the part of those providing it. Please join Matt Emery, MD (Medical Director, MSU Secchia Center) and Mary Kay Smith, PhDc, MSN, RN, CHSE (Director, MSU Learning and Assessment Center) for this FREE dynamic workshop...everyone will benefit!  Dr. Emery and Ms. Smith will share techniques based on expertise gained from the Center for Medical Simulation at Harvard, advanced debriefing training in addition to their respective roles at MSU. 
 
Participants will:
  • Compare feedback and debriefing
  • Identify multiple methods of debriefing
  • Discuss factors influencing choice of method(s)
  • Apply debriefing techniques in small groups and simulation
  • Learn how to evaluate self and peer debriefing
WHEN: Friday, February 19
TIME: 1:00-5:00 p.m.
WHERE: The Henry Center for Executive Development

- New MSU's Hub for Innovation in Learning and Technology
The Hub is designed to help reinvent what it means to learn at MSU. Its purpose is to facilitate dramatic leaps in teaching and learning. The Hub will build on the innovation that is already occurring in colleges by connecting the best ideas and projects with creative people and appropriate technologies. 

The Hub will facilitate work that will change the student experience on campus, and MSU's outreach around the world. The Hub will both help scale and diffuse innovation, but also support research around teaching and learning processes. The Hub is a partner for the entire campus community, working with all colleges and programs.  

The Hub is part of the integrated student success initiative overseen by the Office of the Provost, which includes MSU Neighborhoods, the Student Success Transformation Program, and MSU's collaboration with 10 other university partners in the University Innovation Alliance.
 
 To learn more and find out how to get involved, read the full release here. 
 
- MATLAB and Qualtrics Licensing at MSU 
MSU IT recently completed agreements for MSU departments, faculty, staff, and students to use MATLAB and Qualtrics.

MATLAB Software
MATLAB software, from MathWorks, is available for teaching and research purposes to departments, faculty, staff, and students. MATLAB may be used in all aspects of the research process including data gathering, data organization, data analysis, model simulation, and visualization of results.

Qualtrics
Through a campus-wide license, departments, faculty, staff, and students may use Qualtrics software for teaching and research purposes. Qualtrics is web-based software that allows an individual to create and share surveys, feedback, and polls, as well as generate reports without needing programming knowledge. In addition, Qualtrics can aid research with a variety of data collection options and reports.

Visit https://tech.msu.edu/technology/hardware-software/ for additional information.
 
BCLR
Spotlight: Pilot Testing at The College of Human Medicine
The Shared Discovery Curriculum, scheduled to start in approximately seven months, promises dramatic changes in the way medical students are educated here at the College of Human Medicine. In preparation for these changes, students and faculty have been participating in pilot tests of various aspects of the curriculum, continuing a tradition that began in 2013.

A pilot test or pilot program is a small-scale, short-term effort designed to provide data about the feasibility of the program before it is implemented on a large scale--in a sense, an educational simulation. Pilot tests of this kind are surprisingly uncommon in medical school curricula. The College of Human Medicine did its first pilot test of the Shared Discovery Curriculum in the summer of 2013, putting 21 intrepid students (volunteers!) through a variety of teaching methods, assessments and educational experiences over seven weeks (click here). The data obtained from this pilot test was crucial in informing the development of the curriculum as it is now conceived.

As we prepare for the fall launch of the Shared Discovery Curriculum with a full cohort of 190 students, we have already organized three pilot tests this month. Once again we have a group of volunteer students who are actively participating and providing data to refine our planning. The first two of these two-hour sessions focused on the modified problem-based learning format that will be used in the learning society sessions. The first pilot test was organized around joint pain and the second around abdominal pain. The content for both sessions was outlined in the Chief Complaints and Concerns (C3) documents (click here), which are the core curriculum documents for the Shared Discovery Curriculum. The most recent pilot test explored early clinical skills instruction.

Clinical faculty and students participating in the modified
PBL session for joint pain
The pilot tests give faculty a chance to consider how to best achieve the learning objectives, the pre-session learning resources needed by students and how to structure the session to engage first year students--who have a limited background in necessary science--in inquiry-based educational approaches. The pilot test also provides us with time to reflect on the faculty needs related to preparation time for these sessions and resources for faculty preparation as well as the group process skills needed by faculty to achieve the learning goals.

Clinical and Basic Science faculty participating with pilot students in the modified abdominal pain PBL session
We continue to plan additional pilot tests of various components of the curriculum including small group teaching and flipped classroom methods, team-based learning, simulations, coaching, debriefing of early clinical experiences and assessments. Not only are these pilot experiences helping to ensure the success of the curriculum going forward, they are providing opportunities for faculty development in an ongoing fashion as faculty are able to practice teaching methods that are new for many in the College.
ProgramEval
CHM Program Evaluation: What Do We Know About Students Who Come Before The Student Performance Committee?
When students encounter academic difficulty through accumulation of failing (N) and conditional pass (CP) grades, the College of Human Medicine places the student on suspension pending dismissal for failure to meet promotion and retention standards. Such an action triggers a hearing by the Student Performance Committee (SPC) to determine if the student's case supports reinstatement to the academic program with supportive measures or dismissal from the College. The SPC is a standing committee of CHM charged with setting standards and policy regarding acceptable student progress in medical school. SPC is composed of twelve faculty members, four medical students, and ex officio representatives as designated by the dean. Students are active members who participate in all discussions and vote on policy matters. Students' votes do not enter into matters affecting any individual student.
 
To our knowledge, CHM has not conducted a comprehensive review of SPC's actions nor the subsequent performance or path of students who have a hearing before the SPC. In 2015, OMERAD reviewed SPC decisions and students affected by those decisions.

Suspensions Pending Dismissal: A Ten-Year Summary 2003-2013

During this period there were 149 suspension actions by SPC affecting 111 students. While the matriculating class doubled since 2003, suspensions as a percent of class size decreased during the 10 years.
 
Suspensions by Admission Year
 

Who are the students who come before SPC?
 
Compared to their matriculating class cohort, suspended students:
  • Had lower undergrad science GPA
  • Had lower MCAT Scores
  • Were older
When do students encounter academic difficulty?
 
Most students have only one appearance before SPC; the timing of the suspension for those students increases from Block I through Block III. For students having multiple suspensions, the timing is roughly equal across Blocks.

Distribution of Suspensions
   
When a student is dismissed for the first time, the SPC is likely to uphold the decision 36% of the time in Block I, 25% in Block II and 17% in Block III. Dismissals are more likely to be upheld as the number of suspensions for a student increases.
 
Dismissals Upheld by Block 
 
 
Professionalism Ratings by Faculty in Clerkships
 
Overall 88% of all students in clerkships do not receive any marks for incidents of unprofessional behavior compared to 74% of students who have been suspended. Block III students who are suspended receive somewhat lower professionalism ratings and are less likely to receive ratings of "exceeded expectations" than students who have never been suspended.
 
Professionalism Ratings

What ultimately happens to suspended students who are reviewed by SPC?
 
Monitoring this important group of students is critical for CHM as we evaluate our policies and understand how SPC decisions ultimately play out. During 2003-2013, we followed 111 students who were suspended pending dismissal. The current status of that group is described below.
 
Status of 111 Students Reviewed by SPC 2003-2013
 
In the Still Enrolled Group (n=14) four students are currently under review for academic performance since reinstatement.

What do these findings mean?
 
As an institution, it is extremely important for faculty and administrators to systematically review the functions, decisions, and outcomes of our college committees. A review of the Student Performance Committee's deliberations followed by open discussion will guide CHM as it develops and refines criteria for student promotion, retention, suspension and dismissal. Further, we can evaluate the effectiveness of a student's program and establish the terms for student progress and retention for any student reinstated in the college.
 
It is inevitable from the roughly 200 students matriculating yearly to CHM that some will encounter academic difficulty. The challenge for SPC is to know what the risk factors for academic failure are and what decisions will identify students who can engage and ultimately succeed in the CHM curriculum and those who cannot. Clearly many students who come before SPC are reinstated, graduate and begin residency training (58%). Yet even for those reinstated, subsequent academic suspensions are not rare and take a significant emotional and financial toll. These data help us appreciate the nature of academic performance problems and the eventual outcome of SPC's decisions.
publications
Hot Off the Press
- Wendling A, Phillips J, Short W, Fahey & Mavis B.  Forty Years Training Rural Physicians, Michigan State University's College of Human Medicine Rural Physician Program.  Academic Medicine. 2016; 91(1): 113-119.
 
- Hoyle JD, Sleight D, Henry R, Chassee T, Fales B & Mavis B.  Pediatric prehospital medication dosing errors: A qualitative study. Prehospital Emergency Care. 2016. 20(1): 117-124. http://dx.doi.org/10.3109/10903127.2015.1061625

- Hanna-Attisha M, LaChance J, Sadler RC, Champney Schnepp A. Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response. Am J Public Health. 2016 Feb;106(2):283-90. doi: 10.2105/AJPH.2015.303003. Epub 2015 Dec 21. 
resources
OMERAD Resources
An interactive gallery featuring examples of CHM blended and online learning projects by B-CLR.
 
Resources are arranged by topic, addressing issues common to educational scholarship, including definitions of scholarship, formulating resource questions, methodology and research design as well as dissemination via poster or publication. 
   
A medical education listserv maintained by OMERAD.
 
Peer-reviewed international open access journal for disseminating information on the education and training of physicians and other health care professionals.
 
Click on the link to view past issues of our newsletter.
 
Medical Education Scholarship Group
Meets first Wednesday of each month in room A116 East Fee Hall (East Lansing) and 451 Secchia Center (Grand Rapids) from 1:30 pm to 3:00 pm. The purpose is to develop and support scholarship related to our educational program. Got an idea?  Need an inspiration?  Looking for collaborators? Join us! For questions about this group contact Dr. Brian Mavis:  mavis@msu.edu. 
 

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965 Fee Road 
East Lansing, Michigan 48824
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