FAIMER Fellows Continue to Work on “Really Good Stuff”

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The November 2010 issue of Medical Education contains the latest collection of “Really Good Stuff,” a peer-reviewed compilation of short, structured reports, published semiannually, on new ideas in medical education, including curriculum design, teaching practice, and assessment. Included in the current issue are six reports on the innovation projects of FAIMER Fellows (bold font):

“A Way to Assess Students’ Clinical Reasoning”
Iêda M. B. Aleluia (BRAZ 2009), Paulo M. Carvalho, Jr. (PHIL 2006), Marta S. Menezes (BRAZ 2007)

“Community-based Cervical Cancer Prevention in the Western Amazon”
José O. Ferrari (BRAZ 2009)

“Using Appreciative Inquiry on Learning Styles to Facilitate Student Learning”
Latha Rajendra Kumar (PSG 2009), Thomas V. Chacko (PHIL 2004, IFME 2006)

“Teaching Community-based Palliative Care to Medical Students”
Sairu Philip (PSG 2009), Ayshabeevi Remlabeevi

“Virtual Microscopy as a Teaching Tool Adjuvant to Traditional Microscopy”
Seema Raja (PSG 2009)

“Identification of Social Determinants of Health Components for Teaching: A Pilot Process”
Yegnanarayanaiyer S. Sivan (PSG 2009), Thomas V. Chacko (PHIL 2004, IFME 2006), Pandian Subramaniyan

Study Finds Non-U.S. Citizen International Medical Graduates Provide Same Quality of Care as Physicians Educated in the United States

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Internationally trained physicians are key members of the U.S. physician workforce. The United States has not produced enough nationally educated physicians to meet the country’s health care demands for some time, and internationally trained physicians have made up for this shortfall, comprising approximately 25% of the total U.S. physician workforce. Despite a rigorous certification process, questions have persisted concerning the quality of care that these physicians provide. A new study, published in the August issue of Health Affairs and authored by a team led by FAIMER President and CEO John Norcini, examines the performance of internationally trained physicians compared to their U.S. counterparts, and addresses those concerns:

“Evaluating the quality of care provided by graduates of international medical schools” (Health Affairs, 29(8):1461-1468)
John J. Norcini, Ph.D., FAIMER President and CEO
John R. Boulet, Ph.D., FAIMER Associate Vice President for Research and Data Resources
W. Dale Dauphinee, M.D., FAIMER Senior Scholar
Amy Opalek, M.S., FAIMER Data Resource Specialist
Ian D. Krantz, M.D., Member, FAIMER Board of Directors and Chair, Educational Commission for Foreign Medical Graduates Board of Trustees
Suzanne T. Anderson, Trustee-at-Large, Educational Commission for Foreign Medical Graduates Board of Trustees

The study analyzed 244,153 hospitalizations of patients with congestive heart failure or acute heart attack in Pennsylvania from 2003 to 2006. Patients were treated by physicians who specialized in family medicine, internal medicine, or cardiology. Each physician fell into one of three groups: U.S. medical graduates, U.S. citizen international medical graduates, and non-U.S. citizen international medical graduates. The composition of physicians in the study closely matched that of the total U.S. physician workforce: Approximately 75% of the 6,113 doctors were U.S. medical graduates, with the remaining 25% educated abroad. Of the physicians educated abroad, approximately 75% were non-U.S. citizens and 25% were U.S. citizens.

The study examined both mortality rates and hospital lengths-of-stay as indicators of the quality of care that physicians provide. Among the three groups, in-hospital death rates differed significantly. Non-U.S. citizen international graduates were associated with a 16% decrease in mortality relative to U.S. citizen international graduates and a 9% decrease relative to U.S. graduates. Patients of U.S. medical graduates had the shortest hospital lengths-of-stay, while patients of U.S. citizen international graduates had the longest. The length-of-stay of patients of non-U.S. citizen international graduates was only slightly higher than that of U.S. graduates, indicating little practical difference.

These results provide a measure of confidence in the care provided by non-U.S. citizen internationally educated physicians and highlight the important contribution that they make to the U.S. health care system. As Dr. Norcini points out, “It is reassuring to know that patients of these doctors receive the same quality of care that they would receive from a physician trained in the United States.” He adds, “These findings bring attention to foreign-trained doctors and the valuable role they have played in responding to the nation’s physician shortage.”

Still, the findings concerning internationally trained U.S. citizens elicit a moment of pause. Why did these physicians fare less well in the study? The authors speculate that some of them may seek their education abroad because they were unable to enter U.S. medical schools due to lower grades and/or test scores. Alternately, the quality of education provided at some of the schools attended by these physicians may be of a lower standard than at schools attended by physicians in the other two groups. There may be other explanations as well, and additional research is warranted. Regardless, as U.S. medical schools expand enrollment to combat the shortage of home-educated physicians, some of the students who might have otherwise gone abroad may apply to medical schools in the United States. If that happens, U.S. schools will need to maintain high admission standards to ensure the quality of the physician pool. Further compounding the issue is a lack of proportionate growth in graduate training programs to complement the expansion of medical schools. As Dr. Norcini points out, “If this continues, the current physician shortages will persist and the numbers of foreign-trained doctors will likely decrease significantly.”

In addition to its findings concerning the three separate groups of medical graduates, the study also provided insights applicable to the general physician population. The authors found that in-hospital mortality rates and hospital lengths-of-stay increase with the number of years following graduation from medical school, whereas specialty board certification was associated with lower mortality and shorter hospital stays. These findings point to the need for ongoing training and periodic assessment throughout a physician’s career to maintain a high level of competence, an important consideration for all doctors, regardless of where they received their education.

New Textbook on Medical Education

Posted on Categories FAIMER faculty, FAIMER staff, health professions education, publicationsTags , , , ,

Presented by the Association for the Study of Medical Education (ASME), Understanding Medical Education: Evidence, Theory and Practice is a new, comprehensive textbook on medical education scheduled to be available from Wiley-Blackwell publishers in August 2010. Edited by Tim Swanwick, Director of Professional Development in the London Deanery, Visiting Fellow at the Institute of Education, and Visiting Professor of Medical Education at the University of Bedfordshire, the book is designed to be an accessible reference for students and practitioners of medical education at all levels: from undergraduates to those pursuing continuing professional development.

Understanding Medical Education includes chapters on teaching and learning, problem-based learning, personal development, e-learning, mentoring, group encounters, simulation, test design, research, assessment, and leadership, among others. Also included are three chapters contributed by FAIMER staff and faculty:

“Principles of Curriculum Design”
Janet Grant (Professor of Education in Medicine at The Open University, FAIMER faculty member)

“Workplace Assessment”
John Norcini (FAIMER President and Chief Executive Officer)

“Structured Assessments of Clinical Competence”
Kathy Boursicot, Trudie Roberts, and Bill Burdick (FAIMER Associate Vice President for Education and Co-Director of the FAIMER Institute)

For more information, including a complete table of contents, please visit http://www.wiley.com/WileyCDA/WileyTitle/productCd-1405196807.html.

Fellows and Faculty Working on Some “Really Good Stuff”

Posted on Categories FAIMER faculty, Fellows, journals, publicationsTags ,

The May 2010 issue of Medical Education contains the latest collection of “Really Good Stuff,” a peer-reviewed compilation of short, structured reports, published semiannually, on new ideas in medical education, including curriculum design, teaching practice, and assessment. Included in the current issue are eight reports on the innovation projects of 2008 FAIMER Institute Fellows. Following are all reports by FAIMER Fellows (bold blue font) and faculty (bold black font):

“Teaching Anatomy with Digital Self-learning Modules”
Ashwini C. Appaji (PSG 2008), Roopa Kulkarni, Anupama Poojar, Kalaivani Vinayagam

“Needs Assessment as a Strategic Planning Tool”
Payal K. Bansal (PHIL 2007), Savita Marathe (GSMC 2008), Prakash M. Shere, Mrudula A. Phadke

“Developing a Web-based Multiple-choice Question Item Bank”
S. Ayhan Çaliskan (PHIL 2008), H. Ibrahim Durak, S Elif Törün, Ö. Sürel Karabilgin

“Epidemiology Training Needs Assessment in Vietnam”
An T. M. Dao (PHIL 2008), Le T. Huong, Huy V. Nguyen, Luu N. Hoat

“Mentored Student Project for Inculcating Research Skills”
Vasudha Devi, Reem R. Abraham (PSG 2007), Sachidananda Adiga, Ramnarayan Komattil

“Optimising Feedback Using the Mini-CEX during the Final Semester Programme”
Sari P. Dewi (PHIL 2008), Tri H. Achmad

“Structuring an Internship Programme for Enhanced Learning”
Harpreet Kapoor (CMCL 2006, PHIL 2008), Ara Tekian, Stewart Mennin

“Student Learning Experiences in a Diversified Academic Environment”
Dianne Manning (PHIL 2008), Danette McKinley, Shalote Chipamaunga

“Utilising Assessment as a Drive for Changing Teaching”
Valéria G. F. Pinheiro, Elcineide S. Castro, Luiz E. A. Troncon

“Academic Counselling for Undergraduate Medical Students of Pharmacology”
Anupama Sukhlecha (CMCL 2008)

“Improving Assessment of Evidence-based Medicine Skills in Medical Students”
John Tumbo (PHIL 2008)

“Using Positive Deviance to Improve Student Performance”
Zareen Zaidi (PHIL 2008), Tara Jaffery (PHIL 2005), Shaheen Moin

Academic Medicine Celebrates Flexner Report Centenary

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The year 2010 marks the 100th anniversary of the publication of the Flexner Report (Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching), Abraham Flexner’s seminal critical assessment of standards and practices in medical education. Flexner’s report led to widespread reform and laid much of the groundwork for health professions education today. To both celebrate the centenary of the Flexner Report and examine its influence on contemporary theory and practice, Academic Medicine has devoted its February 2010 issue to the report’s legacy—the successes it has engendered, its relevance today, and the challenges yet to be overcome. In a broader sense, the issue seeks to look back at health professions education’s past in an effort to see its future. As Dr. Richard B. Gunderman explains in his Foreword to the issue, an “overarching theme in this collection is the creative tension between continuity and change. To be faithful to the spirit of Flexner’s work, we must not only re-examine the questions he presented but also pose new ones that he could not have foreseen. These articles invite us to ponder both types of questions.”

Included in the special issue are two articles authored by FAIMER staff and Fellows (to view the abstract for each article, click on its title):

“Relevance of the Flexner Report to Contemporary Medical Education in South Asia”
Zubair Amin, Yong Loo Lin School of Medicine, National University of Singapore
William P. Burdick, FAIMER Associate Vice President for Education and Co-Director of the FAIMER Institute
Avinash Supe (PHIL 2002), Director of the GSMC-FAIMER Regional Institute
Tejinder Singh (PHIL 2003), Director of the CMCL-FAIMER Regional Institute

“Flexner’s Global Influence: Medical Education Accreditation in Countries that Train Physicians Who Pursue Residency in the United States”
Marta van Zanten, FAIMER Research Associate
John R. Boulet, FAIMER Associate Vice President for Research and Data Resources
Frank Simon, FAIMER Senior Scholar

A Practical Guide for Medical Teachers, Third Edition

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ECFMG President Emeritus and FAIMER Senior Scholar James A. Hallock, M.D., recently contributed the Foreword to A Practical Guide for Medical Teachers, now in its third edition. Since its initial publication in 2001, the book has strived to “provide a bridge between the theoretical aspects of medical education and the practical delivery of enthusiastic teaching.” Dr. Hallock has described the work as “an outstanding contribution to the medical education literature which should have significant global appeal.” Also contributing to the present volume are FAIMER President and CEO John Norcini, Ph.D., FAIMER Research Scientist Danette W. McKinley, Ph.D., and FAIMER Faculty member, Stewart P. Mennin, Ph.D. Drs. Norcini and McKinley coauthored the chapter on “Standard Setting.” Dr. Mennin contributed the chapter on “Academic Standards and Scholarship.” Edited by John A. Dent and Ronald M. Harden, A Practical Guide for Medical Teachers was published in June 2009 by Elsevier. For more information, click here.

Ara Tekian Contributes to Assessment Textbook for Health Professions Educators

Posted on Categories FAIMER faculty, publicationsTags ,

Long-standing FAIMER Institute and FAIMER Regional Institute faculty member Ara Tekian, Ph.D., has co-authored three chapters in Assessment in Health Professions Education, a new comprehensive textbook on assessment written specifically for members of the health professions education community. Dr. Tekian, who is Associate Professor of Medical Education and Director of International Affairs in the Department of Medical Education, University of Illinois at Chicago, contributed to chapters on standard setting, oral examinations, and assessment portfolios. Published by Routledge in April 2009, and edited by Steven Downing and Rachel Yudkowsky, Assessment in Health Professions Education is available in both hard cover and paperback editions. For more information, please click here.

FAIMER Articles in Education for Health

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Education for Health (EfH), the peer-reviewed, MEDLINE-indexed journal of The Network: Towards Unity for Health, recently publicized the top five most frequently visited articles published in the journal in 2007. Two of the articles were authored by FAIMER staff and FAIMER Institute Fellows. The top five articles, listed in descending order by number of “hits,” were:

Application of the Health Belief Model for Osteoporosis Prevention among Middle School Girl Students, Garmsar, Iran
S.M. Hazavehei, M.H. Taghdisi, M. Saidi

Capacity Building in Medical Education and Health Outcomes in Developing Countries: the Missing Link
W.P. Burdick, P.S. Morahan, J.J. Norcini

Research on Medical Migration from Sub-Saharan Medical Schools: Usefulness of a Feasibility Process to Define Barriers to Data Collection and Develop a Practical Study
A. Longombe (PHIL 2003), V. Burch (PHIL 2001), S. Luboga (PHIL 2003), C. Mkony (PHIL 2003), E. Olapade-Olaopa (PHIL 2002), B. Otieno-Nyunya (PHIL 2001), B. Afolabi (PHIL 2002), E. Nwobodo (PHIL 2004), S. Kiguli (PHIL 2004), W.P. Burdick, J.R. Boulet, P.S. Morahan

Gender Sensitization among Health Providers and Communities through Transformative Learning Tools: Experiences from Karachi, Pakistan
B.T. Shaikh, S. Reza, M. Afzal, F. Rabbani

DREEM and beyond; studies of the educational environment as a means for its enhancement
S.R. Whittle, B. Whelan, D.G. Murdoch-Eaton

The Network: Towards Unity for Health is a global consortium of health professions schools committed to improving the education of health professionals with a focus on strategies that improve responsiveness to the needs of communities. EfH is dedicated to the dissemination of scholarship that reflects the Network’s mission and goals, goals that FAIMER shares. FAIMER has provided financial support to EfH and two FAIMER staff members, Jack Boulet and Bill Burdick, are members of the EfH Editorial Board. EfH publishes “original contributions of interest to health and clinical practitioners, educators, policy makers, administrators, and learners in the health professions. Specifically this focus is on global models of health system integration and health professions education that lead to improved health and health care delivery.”

April 2008 Issue of Education for Health

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The April 2008 issue of Education for Health (Volume 21, Issue 1) is now available on the journal’s website. In this issue, a brief communication entitled, “An Example of Program Evaluation Project in Undergraduate Medical Education” was co-authored by several faculty members from the Medical Education Department at Dokuz Eylul University School of Medicine in Turkey, including 2002 IFME Fellow Berna Musal and 2003 FAIMER Institute Fellow Huseyin Cahit Taskiran.

New AMEE Guide Series

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Ronald M. Harden, M.D., General Secretary of the Association for Medical Education in Europe (AMEE), recently announced the launch of a new AMEE Guide Series. Dr. Harden is also Editor of Medical Teacher and Director of Education for the International Virtual Medical School.

This new series currently has two publications: one on peer-assisted learning by Michael Ross and Helen Cameron (Medical Teacher, 2007, 29: 527-545) and the other on work-based assessment by John Norcini, Ph.D., President and CEO of FAIMER; and Vanessa Burch, M.B.Ch.B., M.Med., Ph.D., core faculty member of the FAIMER Institute and 2001 FAIMER Institute Fellow (Medical Teacher, 2007: 855-871). To access the new guide series, click here.