Castillo, Richmond

Objective This survey study assessed trainee attitudes and perceptions of the longitudinal public speaking curriculum at Mayo Clinic Pediatric and Adolescent Residency Program. Methods This 3-part survey of Mayo Clinic pediatric residents was conducted from 2013 to 2017 and utilized yes/no questions, Likert scales, and open-ended questions. Code book content analysis was used to analyze open-ended questions. Results A total of 121 participants (96.8%, n = 121/125) completed the survey. Most respondents (93.3%, n = 111/119) either agreed or strongly agreed that the public speaking requirement enabled them to be more effective in delivering information to large groups. Most respondents (89.2%, n = 107/120) agreed or strongly agreed that they incorporated feedback from previous public speaking feedback sessions into subsequent presentations. The 2 activities that respondents found most useful for preparing later presentations were setting goals for future presentations in a feedback session and discussing performance in a feedback session. Conclusions There was a perceived effectiveness of a longitudinal public speaking curriculum among pediatric residents at our program. Multidimensional feedback seems to be a critical aspect of a public speaking curriculum in graduate medical education.

Abstract Background Mobile applications allow health care providers to capture point-of-care medical photographs and transfer them to the electronic health record (EHR). It is unclear how providers use these photographs or how they affect clinical care. Objectives We aimed to understand the content, purpose, and outcomes of point-of-care medical photography performed in the pediatric emergency department (ED) at large academic medical center. Methods A retrospective chart review was conducted of patients <21 years of age who were seen in the ED and photographed between March 29, 2015 and July 1, 2017 using a secure smartphone application integrated with the EHR. Inter-rater agreement and reliability between the two reviewers was assessed for the first 50 charts, and any discrepancies in interpretation were resolved before proceeding with the remaining data abstraction. The documented rationale for photography, content of photographs, and outcomes were recorded. Results We identified 619 clinical encounters involving photographs of 605 patients who were eligible for inclusion. Skin was photographed in 499 (81%). The most common finding was rash (N = 177; 29%). Photos were of acceptable quality, with 569 (94%) achieving a score between 4 and 5 out of 5. The primary use of photography was documentation (N = 334; 54%), though teleconsultation was noted in 38 (6%). Nearly one-third (N = 187; 30%) of patients were seen in the ED or outpatient clinic for any reason within 2 weeks, and in 25 (13%), clinical notes explicitly referenced the initial photograph(s). In 53 (9%) cases, patients were photographed at a clinical visit in the subsequent 2 weeks, suggesting that photography was used to track changes over time. Conclusion Documentation of findings using mobile point-of-care photography allows for high-fidelity documentation and facilitates continuity of care.

Objective Measurement of motivation and cognitive load has potential value in health professions education. Our objective was to evaluate the validity of scores from Dweck's Implicit Theories of Intelligence Scale ( ITIS ), Elliot's Achievement Goal Questionnaire‐Revised ( AGQ ‐R) and Leppink's cognitive load index ( CLI ). Methods This was a validity study evaluating internal structure using reliability and factor analysis, and relationships with other variables using the multitrait‐multimethod matrix. Two hundred and thirty‐two secondary school students participated in a medical simulation‐based training activity at an academic medical center. Pre‐activity ITIS (implicit theory [mindset] domains: incremental, entity) and AGQ ‐R (achievement goal domains: mastery‐approach, mastery‐avoidance, performance‐approach, performance‐avoidance), post‐activity CLI (cognitive load domains: intrinsic, extrinsic, germane) and task persistence (self‐directed repetitions on a laparoscopic surgery task) were measured. Results Internal consistency reliability (Cronbach's alpha) was > 0.70 for all domain scores except AGQ ‐R performance‐avoidance (alpha 0.68) and CLI extrinsic load (alpha 0.64). Confirmatory factor analysis of ITIS and CLI scores demonstrated acceptable model fit. Confirmatory factor analysis of AGQ ‐R scores demonstrated borderline fit, and exploratory factor analysis suggested a three‐domain model for achievement goals (mastery‐approach, performance and avoidance). Correlations among scores from conceptually‐related domains generally aligned with expectations, as follows: ITIS incremental and entity, r = −0.52; AGQ ‐R mastery‐avoidance and performance‐avoidance, r = 0.71; mastery‐approach and performance‐approach, r = 0.55; performance‐approach and performance‐avoidance, r = 0.43; mastery‐approach and mastery‐avoidance, r = 0.36; CLI germane and extrinsic, r = −0.35; ITIS incremental and AGQ ‐R mastery‐approach, r = 0.34; ITIS incremental and CLI germane, r = 0.44; AGQ ‐R mastery‐approach and CLI germane, r = 0.48 (all p < 0.001). We found no correlation between the number of task repetitions (i.e. persistence) and mastery‐approach scores, r = −0.01. Conclusions ITIS and CLI scores had appropriate internal structures and relationships with other variables. AGQ ‐R scores fit a three‐factor (not four‐factor) model that collapsed avoidance into one domain, although relationships of other variables with the original four domain scores generally aligned with expectations. Mastery goals are positively correlated with germane cognitive load.