RESEARCH ROUNDUP – FEBRUARY 2018

This month’s Research Roundup looks at the relentless march of AI into the health professions, how to measure affect, whether University Departments of Rural Health are making a difference, resources for how to communicate with patients about risk and how teaching is embedded in clinical care.

Read on!

Artificial intelligence and the health professions

Continuing with a theme I’ve had running for a while now, this fascinating paper by Brian Hodges looks at the inroads AI is making into the health professions right here and now.

Prompted by the movie and book, Hidden Figures, which describes the role of 3 African American women as (literally) human computers during the early years of NASA; Hodges says that we are in just such a place in time right now. In Hidden Figures, one of the lead characters sussed out that the human computers would be replaced by the newly invented IBM and began surreptitiously teaching her colleagues how to program it. So when the IBM took over their roles as human computers, the female staff she had trained became computer programmers.

He reports on developments in his own hospital (in Canada) where already an AI system for planning radiation therapy treatment is taking 4 minutes to do what a physicist and an RT took 4 hours to do.

And also refers to drug-dispensing machines, integration of pathology and radiology departments (pattern recognition) as examples that are in evidence right now.

What do we do about it??

Setting aside for a moment the challenge of undergraduate selection, it is interesting that he encourages us all to look to CPD and future-proof that in preparation for the redeployment of health professionals that will inevitably come.

Hard to imagine, he muses, that affective computing will impact areas such as communication and empathy…which takes me to the next paper below!

A paper well worth the read for all you future-watchers like me!

http://doi.org/10.1111/medu.13350

The Griffith University Affective Learning Scale (GUELS)

This paper by Rogers et al tackles the hoary chestnut of assessment in the affective domain (read “professionalism”) and bemoans the dearth of validated instruments to measure it.

And lo and behold! Comes up with one that measures it! Reliably and validly!

But doesn’t include it in the paper (awww) because they wouldn’t want the students to get a hold of it and start writing to it (not much faith in their professionalism there!).

The instrument measures affective learning as demonstrated in undergraduate reflective journal portfolio entries.

Rogers et al call for it to be tried out in other settings such as clinical practice and invites anyone interested in giving it a hit-out to contact the authors directly.

Read about it here:

https://doi.org/10.15694/mep.2018.00002.

University Departments of Rural Health – are they making a difference?

This paper by John Humphreys and David Lyle evaluates the role and contribution of UDRHs to rural and remote Australia via teaching, research and health services.

As you know, the program was established in 1996 and there are 12 UDRHs across Australia with 3 new ones (or at least the funding for them) announced in 2017. Six are located in rural regions and 5 in remote regions (they don’t mention the 12^th one).

The paper contains some interesting tables on numbers of student placements and program reach, peer-reviewed publications, and examples of projects.

They cite that the UDRH network as offered enhanced rural clinical placements to nearly one in five domestic students and that UDRHs have engaged with health services and communities across 40% of Australia. That’s impressive.

Research output has also been busy with over 40% of publications explicitly addressing a rural or remote health issue.

They stop short of answering the killer question: claiming lack of reliable and comprehensive data to indicate whether this all leads to retention of practitioners in rural or remote practice after graduation. More monitoring required.

Some interesting data for those with an interest:

https://www.rrh.org.au/journal/article/4315

This month’s FOAMEd tip

Communicating with patients about risk – open access module

Having difficulty communicating with your patients about risk? Or in guiding your registrar on this topic?

The Australian Commission on Safety and Quality in Health Care released an open access e-learning module to help in December 2017.

Access the module here:

http://contenttest.learningseat.com/safetyandquality/index.html

How physicians teach in the clinical setting – the embedded roles of teaching and clinical care

An interesting paper by Steinert, Basi and Nugus  from McGill University in Canada.

As many of you commented in last year’s National GP Supervisor Survey, being a doctor means being a teacher.

This was a focused ethnographic study that looked at 3 general internal medicine service teams for a total of 6 weeks in 3 tertiary hospitals

They found 3 major things:

That clinical work and teaching are interconnected

The boundaries between these two functions were blurred. They found that the attending physicians asked questions for various teaching, clinical and supervisory goals in order to obtain: factual information on a patient’s medical history; presenting problems or test results; to ascertain learners’ abilities; or to encourage collaborative problem solving as a team.

Scaffolding (guided supervision for graded responsibility) was also used frequently.

Teaching occurred along a spectrum of planned and opportunistic teaching and included both formal and informal learning.

A multiplicity of teachers

Teaching was diffused among different players and flowed in different directions – in other words, it was vertically integrated.

The influence of space and artifacts (no this isn’t about Indiana Jones meets Star Trek)

The physical space and artifacts embedded in it both enabled and constrained teaching – (artifacts is a fancy name for phones, pagers, patient charts, X-rays, whiteboards).

Interestingly, they found that whoever had the phone in their hand was an unspoken sign of power and who was ‘running the show’.

Enclosed spaces like seminar rooms and patient rooms facilitated confidential conversations and formal teaching. Sometimes patient rooms facilitated opportunistic bedside teaching.

Meeting spaces and ‘the back room’ where electronic patient files were updated, cases, reviewed, conversations with other clinicians took place, phone calls were made – facilitated problem solving.

The cafeteria facilitated informal interactions – no surprises there. Educational ‘war stories’ were exchanged, jokes shared, commentaries on current events swapped.

How the authors put all this together was thus:

The broad types of clinical teaching can be envisaged as occurring on two spectra: planned to opportunistic and formal to informal.

They propose that the framework of work-based learning, where work is a catalyst for learning and and includes observation, participation, and expert guidance in authentic environments.

The study showed how the work environment can provide opportunity and determine the types of educational strategies that can be used in particular circumstances.

Worth a read!

https://doi.org/10.1080/0142159X.2017.1360473