To ensure medical residents are prepared to work in complex and evolving settings, postgraduate medical education is transitioning to competency-based medical education, which is known as Competence by Design (CBD) in Canada. To understand how CBD is operationalized within specific residency programs and how it contributes to patient, faculty, and learner outcomes, there is a need to engage in program evaluation. However, the actual extent that, reasons for, and methods in which CBD programs are engaging in program evaluation remain unclear. Furthermore, minimal attention has been given to building program evaluation capacity within medical education programs (i.e., doing evaluation and using evaluation findings). In this research project, I explore and formally document: (a) the extent that and the ways in which CBD programs are engaging in program evaluation, (b) the reasons why these programs are engaging or not engaging in program evaluation, (c) the actual and potential positive and negative consequences of these programs engaging in program evaluation, (d) the ways that these programs build their capacities to do program evaluation and use evaluation findings, (e) the ways that program evaluators currently support these programs, and (f) the ways that program evaluators can help stakeholders build their capacities to do program evaluation and use evaluation findings. Through this research, I contribute to the limited body of empirical research on program evaluation in medical education. Confirming how CBD programs are engaging in program evaluation can advise stakeholders and program evaluators on how best to support CBD programs in building their capacities to do program evaluation and use evaluation findings, inform the design and implementation of other medical education programs, and, ultimately, enlighten program evaluation research on authentic and current evaluation practices in medical education. To meet the objectives of this study, I used a three-phase, sequential mixed methods approach. In Phase 1, I conducted a survey of Canadian program directors whose programs have transitioned to CBD to determine: (a) the extent to which CBD programs are engaging in program evaluation, and (b) the reasons why CBD programs are engaging or not engaging in program evaluation. In Phase 2, I interviewed interested program directors to explore: (c) how CBD programs are engaging in program evaluation, and (d) the ways in which CBD programs can build their capacities to do program evaluation and use evaluation findings. In Phase 3, I interviewed Canadian program evaluators to investigate: (e) how program evaluators are currently supporting CBD programs in program evaluation, and (f) how program evaluators can help CBD programs build their capacities to do program evaluation and use evaluation findings. Overall, the Phase 1 findings show that: (a) over three quarters of respondents indicated that their program does engage in program evaluation and most invite stakeholders to participate. However, most programs rarely leverage the expertise of a program evaluator and acknowledge interpreting quantitative program evaluation data is a challenge. Additionally, (b) most programs engage in program evaluation to improve their program and make decisions. However, most programs do not have an employee whose primary responsibility is program evaluation. They do not receive funding for program evaluation which affects their abilities to engage in program evaluation. Moreover, some programs do not engage in program evaluation because they do not know how to do program evaluation. The Phase 2 findings show that: (c) when program directors do engage in program evaluation, they are using ad hoc evaluation methods and a team-based format. However, program directors of CBD programs are struggling to engage in program evaluation because of limited available resources (i.e., time, financial, human resources, and technology infrastructure) and buy-in. Additionally, (d) program directors are building their capacity to do evaluation and use the findings from their specialty/subspecialty program evaluation. The Phase 3 findings show that: (e) program evaluators are supporting CBD programs by responding in a reactive way as temporary and external evaluation consultants. Finally, (f) program evaluators can help CBD programs build their capacities to do program evaluation and use the findings by using a participatory evaluation approach, leveraging existing data, encouraging the use of program evaluation approaches that are appropriate to the CBD implementation context, or encouraging programs to share findings which establishes an accountability cycle. In light of these findings, I discuss ways to engage in program evaluation, build capacity to do evaluation, and build capacity to use evaluation findings in CBD programs.

The doctor-patient relationship is a very important aspect of a patient's health and wellbeing. It is a complex relationship that requires trust and understanding by both parties. Doctor shopping and changes in technology that allow patients to independently learn about their health have further complicated this relationship. This study looks at how participants perceive controlling language depending on the gender of the doctor. Participants were 339 University of Central Florida undergraduate students (112 men and 227 women, age M= 19.29, SD = 3.60) recruited through SONA. Participants first listened to a recording of a male or female doctor speaking to a patient using high or low level controlling language. They then answered questions about their opinion of the doctor, how they would behave in the patient's situation, and their beliefs about the role of doctors in the doctor-patient relationship. Results indicated both level of controlling language and doctor gender had significant effects on participants' perception of the doctor. Doctors who spoke with high level controlling language were seen as less helpful and supportive than doctors who spoke with low level controlling language. Participants also were less likely to recommend them to another person. Male doctors were seen as ruder than female doctors. These results suggest that doctors must communicate with each patient in that makes them both the most comfortable, and that male doctors may need to work harder to communicate empathy to their patients.

Introduction The purpose of this project is to implement an innovative, and engaging knowledge transfer pedagogy for 5th grade science students. This project utilized Stealth Learning, a learning pedagogy developed by Dr. James Rosser.99,100,109,110 The program featured applied learning to develop skill sets in general and drone aviation, as well as minimally invasive surgery techniques. This was facilitated through the use of computers, table simulators, and drones. Methodology This project took standardized subject matter from the Florida Comprehensive Assessment Test (FCAT) and converted it into content featuring the Stealth approach. The section that was converted was the "Practice of Science and the Characteristics of Scientific Knowledge" portion of the FCAT. This program includes curriculum workbooks and worksheets, mini drones, scientifically-validated video games (Super Monkey Ball 2), Stealth Learning music-vocab videos (Animotos), surgical simulation skill drills (Bean Drop), and competitions material (Spelling Bee). A website was also made to allow students to review material at home. This program was administered with the assistance of healthcare and aviation professionals to provide a mentoring component. The program included an execution phase consisting of seven sessions, which took place for 45 minutes each during the Spring Semester (April 2016). Preliminary Findings There are preliminary results for this project, which must be explored further in future studies. This project first analyzed the Science FCAT scores for 72 students in the 5th grade. Of the 72 students in the class, 22 (30.5%) passed the exam. Eleven of the students were enrolled in our program and 54% (6 of 11) passed in comparison to twenty-six percent of the students that underwent standard preparation passed the exam. Conclusion Especially for minorities and the socioeconomically disadvantaged, student performance on state standard exams is one of the most pressing challenges faced in education today. This study suggests that a state standard-based 5th grade curriculum can be converted into an innovative brain-based lesson plan to enhance performance on state standard exams. This initial investigation offers some encouragement for others to further pursue this research.

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The purpose of the study was to investigate and analyze some sources of validity evidence acquired from data (i.e., scores) of comprehensive clinical competency-focused components of the assessment system within the context of one school of dentistry through retrospective analysis of students’ data. Assessments in dental education need some form of evidence of validity to support the proposed interpretations of scores. The approach for evaluating evidence on test scores is presented as an argument, based on theory and logic, according to the four inferences in Kane’s view on validity: scoring, generalization, extrapolation, and implication. Based on our available data sets, we selected and organized specific sources of evidence to serve our purpose. Our primary approach to the evaluation of the data was through the use of a multitrait multimethod (MTMM) matrix and a multiple regression model. The analysis combined data from three cohorts to provide more reliable estimates. The analyses in this study discussed three sources of validity evidence – reliability, construct validity, and predictive criterion-related validity – in the specific assessment context that support the extrapolation component of the argument. The other three components were presented based on qualitative evaluation, not relying heavily on psychometric data. The results from this preliminary study indicated that the assessment components employed are supported by psychometric reliability and validity qualities. Results of the statistical analysis indicated that the overall intrinsic reliability using Cronbach’s of the OSCE tests, nonetheless, were lower than research standards. Findings on construct validity using the MTMM matrix showed evidence on convergent and divergent validity based on the intercorrelations between the assessment components. Using multiple regression modeling, results supported evidence of incremental predictive validity explained by the change in proportion of variation accounted for in the criterion variable in the series of analyses. The reported evidence is vital for sharing knowledge and contributes to the overall validity argument of the assessment program, but only represents a preliminary step and identifies the basis for future research.

<p>This dissertation examines the influence of Keats's medical training and knowledge on his poems and letters, an influence that has usually been ignored or denied. While a fair amount of attention has been focused on the immediate biographical facts of Keats's five-year apprenticeship to the surgeon Thomas Hammond and his year of training at Guy's Hospital, very little has been paid to the influence of medical science on his thought; no comprehensive study of such influence has been attempted previously.</p> <p>As a certain amount of confusion still surrounds the details of Keats's personal experiences as a medical student, the first chapter examines the biographical facts of his training. In addition, it outlines the state of medical education in the early nineteenth century, generally in England and specifically at Guy's Hospital. The subsequent chapters trace the influence of Keats's medical knowledge on his thought, a single chapter being devoted to each of the subjects Keats studied as a medical student: chemistry, botany, anatomy and physiology, and pathology and medicine. In each case, specific images and metaphors, as well as broader ideas and attitudes, are examined in the poetry and correspondence.</p> <p>The chapter on chemistry examines the influence of chemical terms and concepts on Keats's ideas concerning artistic creativity and the workings of the imagination, as expressed in the letters. The chapter on botany deals with specific natural images of plants, trees, flowers, and vegetables in the poems, as well as with Keats's broader approach to the creative and destructive forces in nature. The chapter on anatomy and physiology examines the descriptions of the body, particularly of the brain, in the poetry and letters, as well as Keats's ideas on sensation and imagination, in light of his anatomical and physiological knowledge. The final chapter deals with the influence of Keats's knowledge of pathology and medicine on his understanding of his own illnesses and on his descriptions of the diseased states of his protagonists; in addition, it traces the development of his view of life, love, and creativity in metaphorical terms of disease and health, and examines his concept of the poet as a physician. Throughout, my purpose has been to enhance our understanding of the poetry.</p> / Thesis / Doctor of Philosophy (PhD)

The physician-patient dichotomy is reinforced continuously in medical education and medical practice. The physician possesses knowledge that will be used to help the patient in some way. However, as human beings, physicians are subject to the illnesses and diseases that affect their patients. Physicians moved by this role-reversal may feel compelled to record their experiences, leading to an accumulation of “physician-as-patient literature.” Five examples of “physician-as-patient” literature illustrate five fundamental lessons that can be adapted by physicians: relating to patient vulnerability, fostering hope for patients, mobilizing support systems, recognizing physical consequences of disease, and appreciating patient quality of life. By generalizing these individual stories, it is not necessary for physicians to experience the exact disease or illness they treat. Rather, they can draw from their unique life experiences to practice empathy. The concept of empathetic medicine can be introduced in medical school training by integrating empathy education into scientific curriculum. Current practitioners can benefit from narrative exercises, reflection and physician self-disclosure in efforts to promote empathy. Medical practice requires solid relationships between human beings, physicians and patients. This basic principle is further emphasized in “physician-as-patient” literature and concerted efforts by institutions and individual physicians can lead to a foundation for a culture of empathy. / Urban Bioethics

Canadian national survey of oncology residency program directors and trainees; randomized trial of medical education intervention / Purpose: This work addresses teaching communication skills for eliciting cardiopulmonary resuscitation (CPR) wishes, or code status discussions, with cancer patients. The objectives of this thesis include: 1) define current teaching practices for code status communication training in Canadian oncology residency programs, and 2) examine the effect of teaching a novel communication framework for code status discussions to oncology residents. Methods: All current residents and program directors in Canadian medical and radiation oncology residency programs were surveyed regarding education, perceived gaps in training, attitudes towards and patterns of clinical practice for code status discussions with cancer patients. We carried out a multicentre randomized trial to determine the effect of teaching a code status communication framework to oncology learners. Residents completed a training workshop and were evaluated in simulated patient encounters (observed structured clinical exam [OSCE]). Participants were randomized to complete the training before the OSCE (experimental arm), or after the OSCE (control arm). The primary outcome was objective rating of code status communication skills. Results: Current postgraduate oncology curricula lack formal teaching and evaluation of code status communication skills. Educators support the need for innovative teaching tools in this field. Accordingly, a novel six-step communication framework was created in which core themes were summarized by the mnemonic acronym PULSES (Prognosis, Underlying values, Long-term outcome and Short-term outcome of CPR, provision of an Educated recommendation, Summary, style and documentation). A total of 46 oncology residents from 3 training centres participated in the randomized trial. Overall, learners in the experimental group had higher mean content-specific, general communication, and global rating communication scores than those in the control group. The training program conferred the greatest benefit among junior residents. Scores across rating tools were highly correlated. Conclusions: Communication training for code status discussions in Canadian oncology residency programs is lacking. With use of a novel communication framework, we have shown that structured teaching on code status discussions can improve competence in this challenging communication task. Moreover, we have developed educational resources that can be implemented in current curricula. Building capacity for clear and effective code status communication with cancer patients will contribute to high quality end of life care in Canada. / Thesis / Master of Science (MSc) / Medical learners in oncology (cancer care) training programs often lead discussions with cancer patients about code status, that is, patients’ wishes for use or non-use of life-sustaining resuscitation interventions including CPR. Learners receive little training for these complex encounters; yet, decisions regarding resuscitation wishes can influence the quality of care received by cancer patients at end of life. In this study we conducted a survey of trainees and program directors in Canada to better understand current educational practices and attitudes towards education on this topic. Most trainees are not receiving formal teaching or evaluation, and new educational resources are needed. We then developed a 6-step communication guide for code status discussions. We studied the effect of a training workshop in which the communication guide was taught to learners in oncology. We found that the training program improved communication ability among learners with the greatest impact seen among junior learners.