Impact of the Medical Education Programs in the Interdisciplinary Staff Practice

¶ … Medical Education on Interdisciplinary Staff Practice

The research question I am addressing is the impact of continuing medical education on interdisciplinary staff practice. Researchers of the past decade produced systematic reviews of continuing medical education (CME) and other strategies intended to improve patient outcomes. The subjects of the reviews included such concepts as audit and feedback, chart-based reminders, clinical practice guidelines, and formal lectures. Defined as interventions to change interdisciplinary staff practice, the effects of those strategies were inconsistent across practitioners, settings, and behaviors. As a result, in the midst of contemporary discussions about quality improvement and the effects of continuing education, there is no singularly effective method for improving interdisciplinary staff performance.

Research Methods/Literature Searches

The literature to be studied will come under the rubric of medical education. Medical education journals such as JAMA, Journal of Continuing Education in the Health Professions, and nursing journals such as the Journal of Clinical Nursing will be searched for the topics of the impact of medical education on interdisciplinary staff practice. Search engines employed Google and Yahoo; databases include PubMed, Google Scholar, JSTOR, Proquest and Project Muse. Parameters of searches include "impact of medical education on staff practice," "continuing medical education interdisciplinary staff practice," or variants thereof.

The types of literature searched will include scholarly articles, journal commentaries, scholarly monographs and edited collections, involving the professions and disciplines of medical education, nursing, hospital studies, medicine and clinical practice, radiology, orthopedics, pediatrics, nutrition, among others. There are the international contexts of Britain and Canada, which will be investigated. Dates include from the late twentieth century to the present time.

Intended Outcomes/Models/New Agendas

There is a certain amount of reflexivity when undertaking a literature-based study, wherein an awareness of the methodology for undertaking a literature-based study is demonstrated. Literature-based studies are a powerful method to critically analyze a large number of papers and relate them to my research question. From these literature-based studies, I will be able to offer examples of how staff have taken medical education courses and been affected by them. Here are three case examples:

Lecture-based courses are common in orthopaedic surgery; however, their effectiveness in improving medical knowledge has not been widely assessed. The Orthopaedic Trauma Association conducts a resident trauma course that occurs four to six weeks prior to the Orthopaedic In-Training Examination (OITE). Karam and Marsh (2010) conducted study to determine whether residents who had taken this course performed better on the trauma domain of the OITE and to compare the effect of the course with the effect of a focused rotation in orthopaedic trauma. The percentile scores on the trauma domain of the OITE for forty-seven residents in postgraduate year (PGY) 2 were reviewed. Twenty-nine residents who took a trauma course within six weeks before the OITE were compared with eighteen residents who took the course after the OITE. As a secondary analysis, the effect of a trauma rotation for the same PGY-2 residents before and after the OITE was also assessed. Baseline orthopaedic knowledge was assessed with use of the overall OITE percentage scores.

The trauma domain scores were not significantly better among the residents who took the course (mean and standard deviation, 62.2 ± 9.9) compared with those who had not taken it (mean, 59.2 ± 6.2) (p = 0.2). A significant difference (p = 0.04) was found for a trauma rotation, with the residents who had a trauma rotation scoring better (mean, 64.5 ± 6.8) than the residents who had not (mean, 58.8 ± 8.9). The subgroup of residents who had both a course and a trauma rotation before the test scored significantly better (p = 0.01) than the subgroup that had neither of these experiences before the test (mean, 65.6 ± 8.0 and 56.9 ± 6.4, respectively).

They concluded that an orthopaedic trauma course alone does not enhance an orthopaedic resident's trauma medical knowledge as assessed on a standardized test. However, a trauma rotation before, and in particular the combination of both a course and a trauma rotation, can improve trauma test scores.

Second, historically, nutrition education has been underrepresented at many medical schools and residency programs. Our surveys over a decade show that most medical schools in the United States are still not ensuring adequate nutrition education, and they are not producing graduates with the nutrition competencies required in medical practice. Physicians, residents, and medical students clearly need more training in nutrition assessment and intervention.

The Nutrition in Medicine (NIM) project, established to develop and distribute a core nutrition curriculum for medical students, offers a comprehensive online set of courses free of charge to medical schools. The NIM medical school curriculum is widely used in the United States and abroad. A new initiative, Nutrition Education for Practicing Physicians, offers an innovative online medical nutrition education program for residents and other physicians-in-training, but with targeted, practice-based educational units designed to be completed in 15 minutes or less. The NIM project is strengthening medical nutrition practice by providing a free, comprehensive, online nutrition curriculum with clinically relevant, evidence-based medical education for undergraduate and postgraduate learners (Adams et al. 2010).