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.

BACKGROUND: Obesity affects 37 % of patients at Veterans Health Administration (VHA) medical centers. The VHA offers an intensive weight management program (MOVE!) but less than 10 % of eligible patients ever attend. However, VHA patients see their primary care provider about 3.6 times per year, supporting the development of primary care-based weight management interventions. To address gaps in the literature regarding Veterans' experiences with weight management and determine whether and how to develop a primary care-based weight management intervention to both improve obesity counseling and increase attendance to MOVE!, we conducted a qualitative study to assess: 1) Veterans' personal experiences with healthy weight-related behavior change (including barriers and facilitators to behavior change and experiences with primary care providers, staff, and the MOVE! program), and 2) potential new approaches to improve weight management within primary care at the VHA including goal setting and technology. METHODS: Overweight/obese VHA patients (aged 18-75, BMI greater than 30 or greater than 25 with at least 1 co-morbidity) were recruited for focus group sessions stratified by gender, MOVE! referral, and attendance. Each session was facilitated by a trained moderator, audio-recorded, and professionally transcribed. Using an iterative coding approach, two coders separately reviewed and coded transcripts, and met frequently to negotiate codes and synthesize emerging themes. RESULTS: Of 161 eligible patients, 54 attended one of 6 focus groups (2 female, 4 male, 9-11 participants per session): 63 % were male, 46 % identified as African-American, 32 % White/Caucasian, 74 % were college-educated or higher, and 61 % reported having attended MOVE!. We identified two major themes: Impact of Military Service and Promotion and Sustainability of Healthy Behaviors. After service in a highly structured military environment, Veterans had difficulty maintaining weight on their own. They perceived physical activity as having more impact than diet, but chronic pain was a barrier. We identified individual/interpersonal-, community/environment-, and healthcare system-related factors affecting healthy behaviors. We also received input about Veteran's preferences and experiences with technology and setting health goals. CONCLUSIONS: Unique factors influence weight management in Veterans. Findings will inform development of a technology-assisted weight management intervention with tailored counseling and goal-setting within primary care at the VHA.