Faculty Bibliography

Abstract Using educational technology does not necessarily make medical education more effective. There are many different kinds of technology available to the contemporary medical teacher and what constitutes effective use may depend on the technology, the learning situation and many other factors. Web-based multimedia instruction (WBMI) provides learners with self-directed independent learning opportunities based on didactic material enhanced with multimedia features such as video and animations. WBMI may be used to replace other didactic events (e.g. lectures) or it may be provided in addition to other learning opportunities. Clinical educators looking to use WBMI need to make sure that it will meet both their learners' needs and the program's needs, and it has to align to the contexts in which it is used. The following 12 tips have been developed to help guide faculty through some of the key features of the effective use of WBMI in clinical teaching programs. These tips are based on more than a decade developing, using and appraising WBMI in support of surgical clerkship education across the USA and beyond and they are intended both to inform individual uses of WBMI in clinical training and to guide the strategic use of WBMI in clinical clerkship curricula.

INTRODUCTION: Special concerns often arise when medical students are themselves the subjects of education research. A recently completed large, multi-center randomized controlled trial of computer-assisted learning modules for surgical clerks provided the opportunity to explore the perceived level of risk of studies where medical students serve as human subjects by reporting on: 1) the response of Institutional Review Boards (IRBs) at seven institutions to the same study protocol; and 2) the thoughts and feelings of students across study sites about being research subjects. METHODS: From July 2009 to August 2010, all third-year medical students at seven collaborating institutions were eligible to participate. Patterns of IRB review of the same protocol were compared. Participation burden was calculated in terms of the time spent interacting with the modules. Focus groups were conducted with medical students at each site. Transcripts were coded by three independent reviewers and analyzed using Atlas.ti. RESULTS: The IRBs at the seven participating institutions granted full (n=1), expedited (n=4), or exempt (n=2) review of the WISE Trial protocol. 995 (73% of those eligible) consented to participate, and 207 (20%) of these students completed all outcome measures. The average time to complete the computer modules and associated measures was 175 min. Common themes in focus groups with participant students included the desire to contribute to medical education research, the absence of coercion to consent, and the low-risk nature of the research. DISCUSSION: Our findings demonstrate that risk assessment and the extent of review utilized for medical education research vary among IRBs. Despite variability in the perception of risk implied by differing IRB requirements, students themselves felt education research was low risk and did not consider themselves to be vulnerable. The vast majority of eligible medical students were willing to participate as research subjects. Participants acknowledged the time demands of their participation and were readily able to withdraw when those burdens became unsustainable.

Global health (GH) spans every scientific, clinical and social science discipline. Cultural competency/ cross-cultural sensitivity has been identified as a GH priority for U.S. medical schools (Peluso 2013). As part of Curriculum for the 21st Century (C21), the Global Health Selective is prerequisite to the new Global Health Concentration at NYU School of Medicine (SoM). With special emphasis on cultural competency/ crosscultural sensitivity, its primary aim is to teach future physicians fund of knowledge and clinical skills that strengthen GH care. As a 4-week clinical clerkship, the GH Selective was first completed by 9 medical students in 2012, and again by 12 medical students in 2013. Activities included 18 ninety-minute patient case discussions in tropical medicine; related clinical assignments at NYU; literature review and journal clubs; and 9 half-day clinical skills simulation workshops covering 1) diarrhea in Haiti and Egypt, 2) tuberculosis in Peru 3) malaria in sub-Saharan Africa 4) hypertension screening by community health workers in Ghana 5) survivors of torture from central Africa 6) humanitarian response to tsunami in Indonesia 7) obstetrical emergencies in rural Liberia 8) interpreter exercise in Tibetan, and 9) smoking cessation via interpreters. Leadership is from NYU SoM Departments of Medicine and Population Health, and Center for Healthful Behavior Change. Over two years of the GH Selective, student feedback was overwhelmingly positive. Each year, at least 37 faculty volunteered from 11 departments at SoM to log at least 225 hours of direct contact teaching hours each offering. In its first two years, the GH Selective exceeded expectations. Its interdisciplinary curriculum is a particular strength, and its special emphasis on working with standardized patients in cross-cultural settings, focused on communication skills, health literacy, and health navigation, provided students with knowledge and clinical skills applicable for any clinical care provided locally, nationally,!

Participant attrition may be a significant threat to the generalizability of the results of educational research studies if participants who do not persist in a study differ from those who do in ways that can affect the experimental outcomes. A multi-center trial of the efficacy of different computer-based instructional strategies gave us the opportunity to observe institutional and student factors linked to attrition from a study and the ways in which they altered the participation profile. The data is from a randomized controlled trial conducted at seven US medical schools investigating the educational impact of different instructional designs for computer-based learning modules for surgical clerks. All students undertaking their surgical clerkships at the participating schools were invited participate and those that consented were asked to complete five study measures during their surgery clerkship. Variations in study attrition rates were explored by institution and by participants' self-regulation, self-efficacy, perception of task value, and mastery goal orientation measured on entry to the study. Of the 1,363 invited participants 995 (73 %) consented to participate and provided baseline data. There was a significant drop in the rate of participation at each of the five study milestones with 902 (94 %) completing at least one of two module post-test, 799 (61 %) both module post-tests, 539 (36 %) the mid-rotation evaluation and 252 (25 %) the final evaluation. Attrition varied between institutions on survival analysis (p < 0.001). Small but statistically significant differences in self-regulation (p = 0.01), self-efficacy (p = 0.02) and task value (p = 0.04) were observed but not in mastery or performance goal orientation measures (p = NS). Study attrition was correlated with lower achievement on the National Board of Medical Examiners subject exam. The results of education trials should be interpreted with the understanding that students who persist may be somewhat more self-regulated, self-efficacious and higher achievers than their peers who drop out and as such do not represent the class as a whole.