Medical school opens up to public

Elyssia Adamo has always been interested in a career in medicine.

"Throughout high school and even before that I've always had a very keen interest for the math and science fields," said Adamo, now a first-year student at the Northern Ontario School of Medicine's Thunder Bay campus.

Born and raised in the same city, Adamo hopes to build a career in the North and to help the medical school continue to make health care more accessible in the North by adding to the number of physicians practising in the region.

Adamo was one of several students, as well as staff, in attendance at NOSM's open house on Thursday.

The event was to feature the work the medical school has done since opening 10 years ago and also to attract potential students.

"I was attracted to NOSM because there are various characteristics that I think make it a very good and attractive medical school to want to go to," said Adamo, noting one of those reasons is the smaller class sizes.

"It allows a lot of small group learning, lets you build off of other students, have discussions on topics," she said. "I find it expands your scope of learning."

The open house featured information kiosks and interactive activities and NOSM's director of communications Kim Daynard said they also specifically invited high school and elementary students.

"We recognize there may be youth that haven't considered health as a career option and we want to make sure people have the information they need to make informed decisions," she said. "What we'd like to really do is spark an interest in health care and related professions in the youth of Northern Ontario."

The medical school has graduated 415 MDs since opening in 2015 and Daynard said 94 per cent of NOSM graduates who complete their residency in Northern Ontario are practicing in the North.

Daynard added that the open house is important to show the community they are living up to their social accountability mandate to continue improving the health of people in Northern Ontario.

"It's important that we report back to the community," she said, adding it's also about giving the community a chance to see what the school is doing and if they're accomplishing their goals.

Medical school access 'dominated by most affluent', says new study

Access to medical school across the UK is still dominated by students from more affluent parts of society, a new study led by the University of Dundee has shown.

The study has revealed considerable variation between the four UK nations and between different medical schools.

Researchers from the Universities of Dundee and Central Lancashire analysed application data for 22 medical schools and around 30,000 applicants across the UK for the three years from 2009-10 to 2011-12, The study was supported by the UK Clinical Aptitude Test consortium (www.ukcat.ac.uk/our-research ) which provided data.

The results are published in the journal BMC Medical Education.

The study looked at socioeconomic status using postcode data for applicants, school type and parental occupation.

Medical students have historically largely come from more affluent parts of society, leading many countries to seek to broaden access to medical careers on the grounds of social justice and the perceived benefits of greater workforce diversity.

However, the new study shows marked differences across the social gradient of applicants. Depending on which UK country they were from, between 19.7% and 34.5% of applicants lived in the most affluent tenth of postcodes, as opposed to only 1.8-5.7% in the least affluent tenth of areas.

The inequality between the most and least affluent appears to be greatest in Scotland, Wales and Northern Ireland, with England appearing to have the most equitable distribution of applicants, although researchers say comparisons between countries are difficult because they measure affluence and deprivation differently.

However, the majority of applicants in all postcodes had parents in higher end occupations. A quarter of people in the UK are in the two lowest occupational groups, but only one in twenty medical applicants had parents in these occupations.

There was also a higher rate of applications from students at independent schools as opposed to state schools.

"Regardless of which measure you look at, those coming from less affluent backgrounds are much less likely to apply to study medicine, and those that do apply are somewhat less likely to be offered a place at medical school," said Professor Bruce Guthrie, of the University of Dundee Medical School.

"One of the major implications arising from our results is that they show that modifying selection processes is unlikely to have a major impact on widening participation because so few people from less affluent backgrounds apply in the first place.

"There is a large variation between medical schools in terms of the applicants they attract, and the proportion of applicants from less affluent backgrounds who get a firm offer of a place. This may indicate that some medical schools have implemented effective strategies to widen participation. However, there needs to be better understanding of why these differences exist and how best practice can be shared.

"Admission to medical school determines the composition of the medical profession in the future and, based on our analysis, medicine in the UK will remain dominated by those from more affluent backgrounds.

"There is no quick fix to widening participation, partly because gaining a place remains, rightly, largely determined by academic ability."

Is the stethoscope dead? Time to check the pulse of a medical icon

Medical students and residents listen to their stethoscopes during a training session at Johns Hopkins School of Medicine in Baltimore. Photo / The Washington Post, Ricky Carioti

The stethoscope is having a crossroads moment. Perhaps more than at any time in its two-century history, this ubiquitous tool of the medical profession is at the centre of debate over how medicine should be practiced.

In recent years, the sounds it transmits from the heart, lungs, blood vessels and bowels have been digitised, amplified, filtered and recorded. Four months ago, the Food and Drug Administration approved a stethoscope that can faithfully reproduce those sounds on a cellphone app thousands of miles away or send them directly to an electronic medical record.

Algorithms already exist that can analyse the clues picked up by a stethoscope and offer a possible diagnosis.

But whether all this represents the rebirth of diagnostic possibility or the death rattle of an obsolete device is a subject of spirited discussion in cardiology. The widespread use of echocardiograms and the development of pocket-sized ultrasound devices are raising questions about why doctors and others continue to sling earphones and rubber tubing around their necks.

"The stethoscope is dead," said Jagat Narula, a cardiologist and associate dean for global health at the Icahn School of Medicine at Mount Sinai Hospital in New York. "The time for the stethoscope is gone."

Not so, counters W. Reid Thompson, an associate professor of pediatrics at Johns Hopkins University School of Medicine. "We are not at the place, and probably won't be for a very long time," where listening to the body's sounds is replaced by imaging. "It is valuable," he said.

One thing on which both sides agree, however, is that doctors aren't very good at using stethoscopes - and haven't been for a long while.

Medical students and residents listen to their stethoscopes during a training session at Johns Hopkins School of Medicine in Baltimore. Photo / The Washington Post, Ricky Carioti

In 1997, researchers examined how well 453 physicians in training and 88 medical students interpreted the information obtained via stethoscope. According to their study, "both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events."

Nineteen years later, another team tried to determine when doctors stopped improving at "auscultation" - the art of listening to the body to detect disease. The answer: After the third year of medical school.

Worse, the researchers wrote in the Archives of Internal Medicine, that skill "may decline after years in practice, which has important implications for medical decision-making, patient safety, cost-effective care and continuing medical education."

That can't be what French physician René Laennec envisioned in 1816 when, reluctant to place his ear against a woman's chest to listen to her heart, he rolled sheets of paper into a tube that amplified the sounds. He went on to invent the stethoscope and is considered the father of auscultation.

In 2016, the device remains one of the last instruments that health care providers use to infer the nature of a problem, rather than viewing it directly.

Doctors "are the most conservative people on earth," said Sanjiv Kaul, head of the division of cardiovascular medicine at the Oregon Health & Science University. "Once they have learned something, they don't want to learn something else."

W. Reid Thompson, a pediatric cardiologist and associate professor of pediatrics, encourages students to hone their listening skills to make better decisions. Photo / Washington Post, Ricky CariotiW. Reid Thompson, a pediatric cardiologist and associate professor of pediatrics, encourages students to hone their listening skills to make better decisions. Photo / Washington Post, Ricky Carioti

The stethoscope is also an icon, of course. Yet it carries more than symbolic value. It narrows the physical distance between doctor and patient. It compels human touch.

Medicine's familiar list of woes is at least partly to blame for auscultation's decline. Doctors, especially the overworked medical residents who staff hospitals, have much less time to spend with patients. That means less time for physical examinations, including listening with stethoscopes. The demands of electronic medical records have further eaten into time with patients, many doctors complain.

"It's all chart rounds and computer readout rounds. It's horrible. I cringe," said John M. Criley, professor emeritus of medicine and radiological sciences at the David Geffen School of Medicine at UCLA.

For decades now, it has been easier to send a heart patient for an echocardiogram, and that increasingly sophisticated imaging test has proven more accurate than scope-to-chest interpretation of the lub-dubs, clicks, gallops and whooshes produced by the human heart.

Some doctors point out glumly that providers and hospitals can charge separately for echocardiograms. A chest exam with a stethoscope nets nothing extra.

Now the cycle is repeating itself: Young physicians have fewer mentors who can pass on the skill of auscultation. Thompson, Criley and a handful of others teach special classes to doctors-in-training, an effort to push back.

During a late-December session at Johns Hopkins Children's Center in Baltimore, two young doctors and a medical student visiting from Syria listened intently to the recorded sounds of a heart coming through special stethoscopes, which receive an infrared signal from a computer. The "patient" was a teenage athlete who was suddenly having trouble keeping up on the soccer field. Was there a problem with her heart?

All three ventured that there was - perhaps a hole in the wall that separates the heart's top two chambers. This condition, known as an atrial septal defect, was indeed the correct answer.

"Think of the power of what you did," Thompson told the trio. "With no further assistance or technology than your stethoscope . . . you said 'I think she has an ASD.' "

Thompson has collected thousands of heart sounds and created MurmurLab.org for anyone who wants listening practice. This month he will unveil MurmurQuiz.org, a site that will allow professionals, students or anyone else to test their prowess interpreting what the sounds mean.

Some medical schools have chosen a different approach. Starting in 2012, Mount Sinai began giving its students hand-held ultrasound devices that are little bigger than a cellphone but can generate real-time images of the heart right at the bedside. Several other schools will join the experiment next fall.

Stethoscopes retain their value for listening to lungs and bowels for clues of disease, experts agree. But for the cardiovascular system, "auscultation is superfluous. We are wasting [students'] time," Narula said. "Why should I not have an echocardiogram in my hand if it's as small as the stethoscope?"

For now, that device is utilised most commonly in emergency rooms, where speed is critical. Its quality, said Thompson, is not yet good enough for routine use in other clinical settings.

But a 2014 study in the Journal of American Cardiological Imaging suggests the hand-held instruments are at least superior to physical examination. Cardiologists using them accurately identified 82 percent of patients with heart abnormalities, while cardiologists using physical examination caught just 47 percent.

"It is time to discard the inaccurate, albeit iconic, stethoscope and join the rest of mankind in the technology revolution," Kaul, one of the researchers, wrote in an editorial for the Knight Cardiovascular Institute at Oregon Health and Science University.

Others wonder what might be lost when doctors stop placing that round, often cold disc against a patient's skin. In an essay last month in the New England Journal of Medicine, Elazer Edelman pointed out that a stethoscope exam is an opportunity to create a bond between doctor and patient.

"The link between patient and physician . . . is unlike any other relationship between two non-related people," Edelman, a doctor who teaches at both Harvard Medical School and the Massachusetts Institute of Technology, stressed in an interview. "When one physically moves oneself farther and farther away, that link is either frayed or is torn.

"You can't trust someone who won't touch you."

- Washington Post

National commendation for the Trust’s Medical Education Team

 

Maggie JohnsonMaggie Johnson The Medical Education Team within Cumbria Partnership NHS Foundation Trust will receive national commendation from the General Medical Council (GMC) for their project called the Medical Education Reviewers (MER) process.

The MER process makes sure the trainers whom oversee doctors in training, continually develop through feedback and that they use reflective practice in their role as trainers. As well as national commendation 15 other Trusts across the north-west have expressed an interest in implementing the process.

Maggie Johnson, Medical Education & Development Manager for Cumbria Partnership NHS Foundation Trust said: “Each year trainers have to submit evidence to meet GMC trainer standards and we wanted to make this effective by encouraging trainers to self-reflect. The MER process is a really innovative approach to underpin the educational development of the trainers’ evidence using reflective practice and developmental feedback.

“This focus underpins lifelong learning and embodies the Trust’s vison and values to ensure a better experience for medical students and PG trainees which ultimately deliver better patient safety, experience and care both now and in the future.”

Medical Education recently delivered a regional masterclass on the trust’s Medical Education Reviewers process and in early 2016 it will be included in the GMC guidance as notable practice.

Dr Sam Dearman, Director of Medical Education for Cumbria Partnership NHS Foundation Trust said: “I am naturally delighted and proud that the GMC will be including our Medical Education Reviewers Process as notable practice. It is another example of our department, and our trust, hitting way above our weight.

“MER puts solid educational principles at its core, rather than being a limited exercise in compliance. Medical education includes not only the team but critically all the doctors whom also work as trainers and teachers, we have a lot of talented and committed people. Although we developed MER as a team, it is the brain child of our Medical Education & Development Manager Mrs Maggie Johnson, I certainly can’t do my job without her and the trust is very lucky to have her.”

Maggie added: “The MER project has given the whole team an opportunity to be creative and generate ground-breaking solutions and is truly a team effort and achievement translating the vision and ideas into a practical sustainable solution.”

6 Ways Continuing Medical Education Must Change

The traditional academic, research-driven, information-sharing model of CME is not enough to address the realities of medicine in 2015 and beyond. The healthcare profession is changing rapidly, but continuing education for healthcare professionals is all too often stuck in the past. Today’s HCPs can’t just receive information about the latest research—they have to learn how to adapt it to their practice needs and patient base, work with the full range of other HCPs on their patient teams to implement it, and be able to show improvements in both their patients’ health and their practices.

In part one of a three-part series based on a recent MeetingsNet webinar, Velvet Chainsaw’s Executive Vice President of Education and Engagement Jeff Hurt outlines six trends that are driving change in healthcare today. In this article, he explains how continuing healthcare professional development must shift as well to meet the needs of today’s HCPs. Part three provides some techniques you can use to align your educational activities with the needs of your HCP learners. Also, check out the Learner’s Bill of Rights Hurt and the audience developed during the webinar.

1. Rein in the research—take a performance-outcome approach.

Much of CPD is still based on disseminating the latest research, not on helping HCPs learn how to better communicate with their patients and teach patients how—and why—to follow their treatment plans, Hurt said.

He asked the audience what role research plays in their education. They responded overwhelmingly that research is vital to what they do, from using it to identify practice gaps and determine best practices, to keeping physicians up to date. “It’s important because it’s used to shape physician behavior, diagnosis, and patient care,” said one person. Several said that the majority of what is presented at their meetings is research. But, added one person, “doctors need to know how to apply these advances to their practice,” not just learn the data.

Hurt agreed, saying, “We have to build a bridge between academic research and practitioner inquiry.” While the data can advance a field, data alone may not be enough to improve an HCP’s practice. “How can HCPs apply the research? What does it mean to their practices, their patients?” Because research often is conducted by academics, not practicing clinicians, it may look at just the broader impact on patients as a whole, not the local patient base of a particular HCP’s practice. “Too much of what happens in medical meetings is a research-based, linear process focused on control and prediction. We need to shift to a cyclical process that is focused on providing practitioner insight into how they can improve.”

2. Go on a session diet.

“It’s no longer about the volume of information you present, it’s about the value” to HCPs and their patients, said Hurt. “The majority of your meetings need to go on a session diet. You need to target your sessions more closely to your HCPs’ needs,” which may have more to do with teaching HCPs how to reach, and teach, their than just sharing the academic research with them.

3. Focus on outcomes, not satisfaction with the meeting.

Healthcare education also has to take more of an outcomes approach, which means your evaluations also will have to change to reflect HCP performance improvement in their practices, not just their satisfaction immediately post-activity, said Hurt. You now need to measure the extent to which HCPs can—and do—demonstrate what they’ve learned back in their practices.

“What if your jobs as medical meeting providers depended on the performance outcomes from your education, just as Medicaid reimbursement depends on outcomes beyond the patient’s hospital stay? Just as ACOs are moving care beyond the hospital setting, we must move our focus beyond the conference session to performance in practice,” Hurt said.

4. Provide a better experience, because a better experience encourages better outcomes.

Most organizations still use learning methods that aren’t effective in helping HCPs—and, ultimately, their patients—learn. “If you asked most HCPs, they would say their best learning experiences come from interactions with colleagues, residency, fellowships, and on-the-job training, not in meetings, said Hurt.

Think about how you could change just 10 percent of your educational offerings to be more focused on outcomes and providing real-world learning examples, Hurt challenged the audience. “It’s time for medical meetings to live and breathe evidence-based education.”

5. Engage the audience in their own learning. Because the word gets thrown around a lot, he asked the audience what “engagement” means to them. Among their responses were: active listening, real-time interaction, participatory activities that get learners’ full attention, getting learners involved in designing the education, having learners draw their own conclusions rather than be asked to parrot back a solution that is handed to them—in short, having an involved audience that is thinking about and interacting with the content.

“We used to think that if you had an audience facing forward with their eyes on the stage and not on their phones, they were actively engaged,” said Hurt. “Wrong. We have no idea if those people are engaged. We’ve become very good at ‘camouflaged listening’—looking forward, putting a smile on our faces, while we’re actually counting ceiling tiles and thinking about lunch or incoming e-mail. Engagement in learning means the speaker needs to shut up every now and then and let people think, and then discuss what they learned.” Also, ask yourself if you are helping learners understand why the information presented is important—“sometimes you need to spoonfeed them the connection,” he said.

6. Incorporate peer-to-peer interaction and group learning. Hurt said that the “working out loud” movement that’s sweeping the education community calls for people to process information together in groups, connecting with past experiences, and predicting how each individual plans to use what they learn. This helps them transfer the new knowledge to their jobs, Hurt said. It’s also vital to provide followup activities, support, and possibly the tools they will need to apply what they learn to their practices.

How do you know if attendees have learned something? “When they can put it in their own words and teach it to someone else,” Hurt said. “We are really bad judges of knowing when we learn something. If all we do is mimic the presenter, we may be misleading ourselves into thinking we learned it.”

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