Education
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/31255
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Browsing Education by Subject "Medical Education"
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Item AN INTEGRATED STRATEGY TO PROMOTE HIGHER ORDER THINKING AND REDUCE COGNITIVE DIAGNOSTIC ERRORS THROUGH PHYSICIAN ASSISTANT EDUCATION(2013-04-12) Tshuma, LisaPurpose: Diagnostic errors are more likely to result in patient harm than other types of medical errors and are frequently preventable. The primary causes of diagnostic error are breakdowns in our health care systems, clinical reasoning or both. Although significant effort has been placed in developing health care system solutions, relatively little has been done to mitigate the common causes of breakdown in clinical reasoning such as failed perception, implicit bias and failed heuristics. Our project employed a set of active and reflective learning activities in the MPAS 5242 course designed to provide physician assistant (PA) students with tools to reduce cognitive diagnostic errors in clinical practice. Methods: An integrated teaching approach centered on five strategies to decrease diagnostic cognitive error was employed. These strategies include Cognitive Dispositions to Respond (CDR) awareness, consideration of alternatives, metacognition, simulation and decreased reliance on memory. Students were introduced to CDRs through lectures and assigned readings including the book How Doctors Think. Students completed pre-class online quizzes to prepare them for interactive lectures and small group activities, including small group skits. Students completed weekly online Implicit Associations Tests to help them identify subconscious biases that may contribute to cognitive diagnostic errors. Finally, students wrote a reflection paper to synthesize their learning experience. Fifteen reflection papers were randomly selected and evaluated by 2 raters using a rubric measuring students' ability identify potential cognitive errors, analyze the reason(s) they were likely to commit the errors, and apply strategies to avoid future similar errors. To achieve inter-rater reliability, the two raters independently rated the 15 samples, and then met to resolve any discrepancies. Results: Overall, the results showed that students achieved a satisfactory outcome, which was shown by their mean scores in the three parts of the rubric: 2.8 out of 3.0 in the ability to identify cognitive errors, 3.5 out of 5.0 in the ability to analyze potential errors, and 3.0 out of 5.0 in their ability to formulate strategies to prevent the errors. Conclusions: The integrated teaching strategy was effective promoting higher order thinking by providing PA students with tools to reduce cognitive diagnostic errors in their clinical practicums and future clinical practice.Item THE ASSOCIATION BETWEEN RURAL TRACK PARTICIPATION IN AN OSTEOPATHIC MEDICAL PROGRAM AND RURAL PRACTICE.(2013-04-12) Chiapa, Ana LuzPurpose: : It is widely acknowledged that the U.S. is experiencing a shortage of physicians, especially in primary care. Currently, the shortage of PCPs is of 7,400 nationwide; by 2025 that number will have ballooned to 65,800. A more significant problem, however, is the maldistribution of primary care providers in rural areas and areas of greater need. In response to this problem, the Texas College of Osteopathic Medicine (TCOM) established the Rural Family Medicine Track. This rural track was a longitudinal program designed to prepare medical students for family practice in a rural community. The purpose of this project was to assess the relationship between rural track participation and rural practice. Methods: : Information about Rural Track graduates was collected and entered into a comprehensive database. Graduate information was obtained from academic records and medical board websites. Information regarding graduates' demographic characteristics and current practice location was examined using descriptive statistics. A logistic regression was used to assess the relationship between rural track participation and rural practice. Results: Of the 218 students that participated in a rural track or clerkship, 67% completed the rural track, and 60% (n=132) were female. In terms of ethnicity, the majority were white (73%, n=150), with 10% (n=23) Hispanic, 14% (n= 30) Asian, and 1% (n=2) Black. Once in practice, 20% (n=39) of graduates practiced in a rural county, 40% (n=76) practiced in a Medically Underserved Area (MUA), and 16% practiced in a Health Profession Shortage Area (HPSA). A logistic regression was performed to assess the association between rural track participation and rural practice; no statistically significant relationship was found. Conclusions: Results show that there was no statistical significant relationship between rural track participation and rural practice. However, the rural track has produced graduates that practice in rural and underserved areas. The current ROME curriculum will continue the success of the Rural Track and plans to place a greater number of students in rural practice.