Using the Postgraduate Hospital Educational Environment Measure to Identify Areas for Improvement in a Singaporean Residency Program

ABSTRACT Background Attributes of the clinical learning environment (CLE) are a measure of quality in postgraduate medical education, and assessing the CLE is a component of the New Accreditation System being introduced in Singapore by the Accreditation Council for Graduate Medical Education International. There is a dearth of published studies of CLE quality in Singapore. Objective Our study had 3 aims: (1) to measure the CLE in 1 Singaporean residency program; (2) to compare trainee perceptions by sex, training level, and experience; and (3) to identify areas for improvement. Methods Between October and December 2017, we conducted a mixed assessment of the CLE in an internal medicine program in Singapore, using the Postgraduate Hospital Educational Environment Measure (PHEEM) and qualitative exploration using a focus group. Results Of 153 IM residents, 136 (89%) provided PHEEM responses and 8 participated in the focus group. Total PHEEM scores and scores for the 3 subscales were higher than published data on the use of the PHEEM in international settings. Exploration of selected PHEEM responses via a focus group identified attributes associated with negative perceptions of the CLE: excessive workload, inadequate faculty presence in the CLE, and unmet trainee needs. It also suggested senior residents' clinical workloads, greater responsibilities, and pending examinations may contribute to their less positive perceptions of the CLE. Conclusions Our analysis using the PHEEM showed overall positive perceptions of the CLE, along with areas for improvement amenable to interventions. Our approach has relevance to an accreditation model with ongoing evaluation of the CLE.

The Vital Importance of Faculty Presence in an Online Learning Environment

One of the instructional methods, which is favored by students and which could arguably provide high quality educational opportunities, is faculty presence, as it makes possible the interaction between instructor and students and between students and students in a virtual learning environment. Online instructors and academic administrators in higher education cannot simply hold an assumption that quality online courses or student learning could largely depend upon good internet connectivity, high quality equipment, solid content knowledge of instructors, and beautifully designed online courses. The presence of an online instructor cannot ever be neglected or marginalized in online students' learning success. Therefore, it is highly significant to address the roles that instructors play in an online learning environment in order to underscore the crucial importance of faculty presence in the success of student learning.

On(line) Being Relational: A Case Study

This study describes a master’s program cohort in the Southeast transitioning from a traditional to an online paradigm. This study examined through narrative analysis the online dialogue of engagement between students and faculty through the lens of social constructivism, specifically focusing on barriers creating monologue and facilitators creating “online” dialogue (Gergen, 1999). Transformative dialogue was more difficult in the online transition because of technology structures and differing expectations. Results suggest that faculty and students must be prepared to use online technology in a pedagogical setting that requires greater responsibility for students to “manage their education.” The “boundedness” of an online environment requires faculty to encourage a shift from blame to responsibility. Although online dialogue was considered “stilted,” even by experienced participants, the convenience is evident for students as well as faculty. The results demonstrated the need for faculty presence through the use of online tools to make the online environment meaningful. Reviewing these narratives may help administrators prepare for a transition to an online program.

Guyana’s paediatric training program: a global health partnership for medical education

Guyana is a low-middle income country on the northern coast of South America between Venezuela and Suriname. Guyana has relatively high child mortality and a notable gap in health care provision. As of 2011, there were no paediatricians in the public sector where approximately 90% of the population seek care. In response to this unmet need, Guyanese diaspora living in Canada, in partnership with Canadian paediatricians and the main teaching hospital, Georgetown Public Hospital Corporation (GPHC), developed a Master’s program in paediatrics. The postgraduate program was designed with adapted training objectives from the Royal College of Physicians and Surgeons of Canada and the American Board of Paediatrics. Innovative strategies to overcome the lack of qualified paediatric faculty in Guyana included web-conferencing and a volunteer North American paediatric faculty presence at GPHC with a goal of 1-2 weeks every month. By November 2016, 10 graduates will have passed through a rigorous program of assessment including a two-day final examination with an objective structured clinical examination (OSCE) component.

Using a Team-Based Learning Approach at National Meetings to Teach Residents Genomic Pathology

ABSTRACT Background Accumulating data suggest that team-based learning (TBL) is more effective than lecture-based teaching strategies. Educational sessions at national meetings, however, tend to be lecture-based, and unlike most examples of TBL, involve participants who do not know each other or the instructor. Objective We evaluated a 1-day TBL genomic pathology workshop for residents held at 3 national meetings. Methods A committee of experts developed the workshop. Prior to attending, participants were provided access to readings and asked to answer preparation questions. Each of the 4 modules within the workshop consisted of a 60-minute TBL activity flanked by 15- to 30-minute preactivity and postactivity lectures. We used surveys to acquire participant evaluation of the workshop. Results From 2013–2014, 86 pathology residents from 61 programs participated in 3 workshops at national meetings. All workshops were well received, with over 90% of attendees indicating that they would recommend them to other residents and that the material would help them as practicing pathologists. An incremental approach facilitated decreasing faculty presence at the workshops: the first 2 workshops had 7 faculty each (1 facilitator for each team and 1 circulating faculty member), while the final workshop involved only 2 faculty for 6 teams. For this final session, participants agreed that circulating faculty provided adequate support. Participant “buy-in” (requiring completion of a preworkshop survey) was critical in enabling a TBL approach. Conclusions These results demonstrate that TBL is a feasible and effective strategy for teaching genomic medicine that is acceptable to pathology residents at national meetings.