Learning Curves in Medical Education
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Dr. Martin Pusic (Columbia University) speaks about Learning Curves and Degradation of knowledge as it applies to medical education through his studies on medical education assessments and educational technology.
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Learning Curves in Medical Education
- 1. Learning Curves for Medical Education Martin V. Pusic MD PhD Division of Pediatric Emergency Medicine Children’s Hospital of NY-Presbyterian Columbia University
- 2. Acknowledgements • Kathy Boutis MD • Martin Pecaric PhD • Royal College Medical Education Grants Acknowledgements
- 3. Outline • Learning Curve General Principles • Medical Example of Learning Curves • Implications
- 9. What is the Atomic Unit of Emergency Medicine Practice?
- 10. The Atomic Unit of Emergency Medicine DECISION
- 11. The Atomic Unit of Emergency Medicine DO TEST DON’T
- 12. The Atomic Unit of Emergency Medicine TREAT DON’T TREAT
- 13. The Atomic Unit of Emergency Medicine ADMIT DISCHARGE
- 14. The Atomic Unit of Emergency Medicine ADMIT ADMIT
- 15. Rash
- 16. ECG
- 17. Radiograph
- 18. Ankle Radiology Example • PERC collaborative project • Div of Pediatric Emergency Medicine – University of Toronto – Columbia University • Image Bank of 234 Ankle X-ray Cases – Others in Development
- 19. Screen shot of application
- 24. Item Bank Case 1
- 25. Item Bank Case 1 Case2
- 26. Item Bank . . . Case 1 Case2 Case3 Case4 Case 5 Case xx
- 27. Advantages of Image Bank • Fidelity • Repetitive Deliberate Practice
- 28. Dilemma #1 How do we measure the learning?
- 29. 2 x 2 Table Significant Pathology + No Pathology -- User Says + a b a+b User Says -- c d c+d a+c b+d a+b+c+d
- 30. Ankle Study • Recruited broad spectrum of subjects: • All responses logged in a MySQL database Medical Students 20 Residents 6 Fellows 12 PEM 5 Radiologists 3
- 31. Results • Five institutions participated • Took approximately 4 hours to complete all 234 • Overall Cohen’s Effect Size for the intervention was 0.55 (95% CI: -0.4, 1.5)
- 32. Five Levels of Expertise -.50.511.52 dPrime MS RES FELLOW PEM RAD
- 33. Dilemma #2 How do we detect the learning that is happening along the way?
- 34. Five Levels of Expertise -.50.511.52 dPrime MS RES FELLOW PEM RAD
- 35. Rater 99 LR+ and LR- 0.00 0.50 1.00 1.50 2.00 2.50 3.00 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 Case Number LREstimate LR-- LR+
- 36. Rater 101 LR+ and LR- 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 Case Number LREstimate LR-- LR+
- 37. Rater 105 LR+ and LR- 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 Case Number LREstimate LR-- LR+
- 38. Rater 107 LR+ and LR- 0.00 0.50 1.00 1.50 2.00 2.50 3.00 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 Case Number LREstimate LR-- LR+
- 39. LR+ and LR- 0.00 1.00 2.00 3.00 4.00 5.00 6.00 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 Case Number LREstimate LR-- LR+ Rater 84
- 42. Rater 107 LR+ and LR- 0.00 0.50 1.00 1.50 2.00 2.50 3.00 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 Case Number LREstimate LR-- LR+
- 44. Five Levels of Expertise -.50.511.52 dPrime MS RES FELLOW PEM RAD
- 45. 0.1.2.3.4.5.6.7.8.91 (mean)dPrime 0 50 100 150 200 250 Sequence MS RES FELLOW PEM RAD dPrime
- 46. Summary • Roughly 2/3rd follow the Thurstone Pattern • Not all curves same form: – Medical Students Shallow Curves – Residents and Fellows Steepest – Attendings Plateau • Overall Education Management • Individual Feedback
- 47. Ericsson 1993
- 49. Ability to interpret heart sounds overAbility to interpret heart sounds over time (Butterworth 1960)time (Butterworth 1960)
- 50. Outline • Learning Curve General Principles • Useful Parameters • Medical Example of Learning Curves • Examples abound • Group vs. Individual Considerations • Implications • Trajectories more accurate representation
Notas del editor
- Figure 1: The Thurstone learning curve where a measure of performance is graphed against time spent learning
- Figure 1: The Thurstone learning curve where a measure of performance is graphed against time spent learning
- For x-ray reading, lack of decline related to the quality of feedback on diagnoses provided in some clinical environments.