Wittich, Christopher M.

Medical error is an important cause of patient morbidity/mortality. Disclosing medical errors to patients is an important component of safe practice. There is a growing need to assess the inherent nature of how physicians in training approach such unanticipated outcomes. With limited exposure for medical students to the idea of medical error disclosure, which is an important area of professionalism in medicine, we believe that a reflective writing exercise can be an efficient tool to objectively assess how students acknowledge and address medical errors early in their medical career. Every year, students in the 1 st year gross anatomy course are asked to respond to a scenario in which a medical student's cellular phone conversation with a friend in a public area (i.e. post office) was overheard by a family member of a cadaver donor to Mayo Medical School. Students were asked to write an apology email to the offended party (Mrs. X) as though they were the student who made the mistake. Students were given 48 hours to complete and submit the assignment. We retrospectively reviewed the medical error disclosure assignment of medical students in the first‐year gross anatomy course at Mayo Medical School between 2005 and 2015. An instrument for assessing medical error disclosure, consisting of fifteen items evaluated on Likert scale (1–5, 1 is the lowest and 5 is the highest), was developed. Using this evaluation tool, we assessed the basic elements of medical error disclosure – acknowledgement of error/system failure, expression of regret, awareness of its impact, description of future behavior, and proper tone as an apology letter. Preliminary data from years 2005, 2008, 2011, and 2014 indicated the mean error disclosure scores of 3.49 ± 0.83, 3.32 ± 0.81, 3.29 ± 0.84, and 3.25 ± 0.75, respectively. The word count in those four class years were 246.9 ± 84.0, 236.3 ± 86.4, 211.2 ± 92.3, and 242.3 ± 79.1 words, respectively. The proportion of students who claimed to have spoken with his/her mother was 2 out of 42 (4.7%), 4 out of 49 (8.2%), 0 out of 48 (0%), and 20 out of 51 (39%) students, respectively. Across the four class years, there was a non‐significant but uniform trend of reduced mean error disclosure score over time, while the mean word count did not show a certain pattern. One notable trend over the class years was an increasing attribution to their mother as the person they spoke with, possibly a way to help alleviate Mrs. X's frustration by eliciting empathy. Overall, this efficient, integrated writing exercise serves as a sensitive tool to objectively gauge skills in the basic areas of medical error disclosure in a preclinical anatomy course. Support or Funding Information My sponsor is Dr. Wojciech Pawlina, the senior author of the abstract. Funding will be considered by the Department of Anatomy, Mayo Clinic College of Medicine, Rochester, MN.

Abstract 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.

Medical professionalism is a multifaceted concept that includes maintenance of knowledge, interpersonal skills, teamwork, privacy and honesty. While non‐technical skills are often under‐emphasized in the medical student learning environment these skills are directly associated with providing professional medical care. There is an increasing trend however, for basic science courses such as Anatomy to introduce medical students early onto the concept of professionalism and highlight the importance of non‐technical skill development to patient care. To reinforce these competencies as well as develop an authentic curriculum for non‐technical skill development, anatomists and internists at Mayo Clinic, College of Medicine aligned objectives within medical school and residency programs. Strategies were designed to evaluate (1) teamwork, (2) communication and (3) self‐reflection. The aim of this presentation is to demonstrate how each of these core competencies can be promoted in both residency and medical student curricula and how trainee and student progress may be measured by educational approaches within their learning environments. Strategies include the use of a team charter, self‐reflection/reflective diaries and communication exercises that target patients and the multidisciplinary health care team. Through educational design (1) trainee and student's ability to acknowledge self‐limitation and develop critical thinking skills appeared to evolve and (2) trainee and student appreciation of the importance of communication skills when interacting with different groups as well as ability to translate medical/anatomical terminology to lay language were evident. In addition, the use of reflection and team charters promoted understanding team dynamics and facilitation of effective teamwork. The current multi‐disciplinary health care environment places strong emphasis on team‐work, confidentiality of protected health information and the role of communication in preventing medical errors and improving patient outcome. Anatomy courses designed on team‐based approaches with use of body donors provide a useful simulated learning environment. Medical students may be assessed through a variety of activities targeting team‐work, communication skills and clinical reasoning at different levels. Use of reflective exercises assessing team interaction, evolution of critical thinking skills and course challenges have found an important place in the evolving anatomy curriculum. Early exposure to these critical skills helps prepare for clinical rotations where milestones for these skills will need to be reached. This presentation will demonstrate the translational approach in synergizing non‐technical skill development between anatomy and residency curricula. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Use of reflection in medical education has been shown to enhance health care practitioner competency and enable a transformation from passive learning of theoretical constructs to a more active acquisition of core competences. Implementation of reflection in medical curriculum is a challenge, and a deficiency of reflective practice has been noted by residency directors. This highlights a need to develop reflective skills within the medical curriculum. In the anatomy course, reflection facilitates deeper learning and gives meaning to a student's dissection experience. During the 7 week gross anatomy course, we implemented four reflection sessions (“Safe Harbor”) aimed at fostering reflective capacity through encouraging student reflection on elements of professionalism including teamwork, ethics, and work‐life balance. Approximately two‐thirds of the class voluntarily participated in sessions lead by near‐peer facilitators. Reflection in professionalism index scores were analyzed at the beginning and end of the course. Preliminary results suggest first year students appreciate the “Safe Harbor” forum to reflect on anatomy course experience, professionalism, and personal challenges. Facilitators report positively on students personally adopting and integrating the reflection framework during Safe Harbor sessions, thereby suggesting an increased capacity to reflect on professionalism. Grant Funding Source : Dept of Anatomy, Mayo Clinic, Rochester, MN

Use of reflection in medical education has been shown to enhance health care practitioner competency and enable a transformation from passive learning of theoretical constructs to a more active acquisition of core competences. Implementation of reflection in medical curriculum is a challenge, and a deficiency of reflective practice has been noted by residency directors. This highlights a need to develop reflective skills within the medical curriculum. In the anatomy course, reflection facilitates deeper learning and gives meaning to a student's dissection experience. During the 7 week gross anatomy course, we implemented four reflection sessions (“Safe Harbor”) aimed at fostering reflective capacity through encouraging student reflection on elements of professionalism including teamwork, ethics, and work‐life balance. Approximately two‐thirds of the class voluntarily participated in sessions lead by near‐peer facilitators. Reflection in professionalism index scores were analyzed at the beginning and end of the course. Preliminary results suggest first year students appreciate the “Safe Harbor” forum to reflect on anatomy course experience, professionalism, and personal challenges. Facilitators report positively on students personally adopting and integrating the reflection framework during Safe Harbor sessions, thereby suggesting an increased capacity to reflect on professionalism. Grant Funding Source : Dept of Anatomy, Mayo Clinic, Rochester, MN

Abstract 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 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. All item responses were double-coded for statistical analysis, using a dedicated survey research center. 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 A total of 2486 LEI and CMETE surveys were submitted during the 5-day course. 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.