Medical Education Research Interest Group

Publishers Respond to Pandemic

Two major publishers of medical education research have responded to the COVID-19 pandemic with special editions and related information. 
 

Academic Medicine

"NEW COVID-19 Collection of Articles

"Thanks to COVID-19, educational practices are likely changed forever. Fortunately, we are not starting from scratch because of the efforts of a dedicated community of researchers who have been studying issues relevant to this very moment for decades. In this virtual issue we offer, free of charge, some particularly valuable pieces of research that helped us think better about how context influences learning and performance, how professional competence and identity develop, and feedback/assessment practices." Link

How to Cite a DR MERL Review

Kim S. Are Entrustment Ratings Reliable in the Era of EPA’s? DR MERL. https://drmerl.wordpress.com/2019/10/02/are-entrustment-ratings-reliable-in-the-era-of-epas/. Published October 2, 2019. Accessed October 3, 2019.

New PubMed Instructions

Simulation Game In Emergency Medicine

Colleen M. Donovan, MD, FACEP

What's your latest project?

I'm currently working on a text-based virtual Choose Your Own Adventure/Escape Room Game, centering on ischemic heart disease, acute coronary syndrome and cardiogenic shock. It will be offered to our 3rd and 4th year medical students, but may also be used for residents.

It is technically a "serious game," meaning that it is a game to be played, intended to be fun and interactive, but the ultimate goal is not necessarily to win, but for the player to learn something important. Text-based games and Interactive Fiction lend themselves to well to this objective. In a text-based game, for example, a player might find themselves on a road in the game story. At the end of the paragraph, they have the option to turn right or turn left. The choice they make effects their downstream game play and the course of the story.

The storyline of our game opens on the player, a 3rd year medical student, getting ready for the first day of clinical rotations in the hospital tomorrow. Too nervous to go to bed, the player accidentally falls asleep watching TV. When the player awakens, there's a stranger in the kitchen who turns out to be Donna, The Ever Present, Ever Wise.

For those of you who may have done high fidelity simulations with me in the past, Donna is a character that I created for almost all of my sim sessions. She often acts as the charge nurse, and helps prompt the students in the right direction by asking leading questions. She doesn't provide direct answers, and makes the students reason out their next steps. She's a very socratic character. The student player will see Donna again in our small group simulations throughout the year.

Donna whisks the player into the hospital and the adventure begins when the player gets nudged into a room where a sick patient is waiting for their help.

Using Qualtrics as a make-shift platform, the rest of the storyline is full of interactive free-text puzzles, a word search, an interactive 3D model, videos, sound clips and various other media. The player must interact with these prompts and puzzles in order to move forward in the story. For example, in the physical exam puzzle, the student has to listen to embedded audio clips of heart and lung sounds, and view a video and still picture of physical exam findings for our sick patient. They then have to complete a puzzle where identifying the correct physical exam findings earns them the key to unlock the next phase of the story.

Ultimately, in order to complete the game, the player must:

• Take a history
• Perform and interpret the physical exam
• Come up with a differential diagnosis and rank the likelihood of each choice
• Defend their rationale for the ranking
• Consider and interpret diagnostic tests
• Confirm the diagnosis
• Focus on the pathophysiology down to the organ and cellular/molecular levels to choose the right treatment for definitive care
• Consent the patient for that care
• And hand off the patient to the ICU/consultant

While the objectives don't sound particularly fun, it is my hope that the storyline and embedded media create an entertaining immersive environment and a safe place for the player to learn.

Where did you get the idea?

A good friend and former RWJMS attending, Dana Herrigel, shared a COVID epidemiology-based Escape Room Game with me in April. She created it for or her students to provide content in a fun and interesting way during the anxiety of initial university closures.

I wanted to create something that the students could do on their own, that would tackle critical care pathology and drill down to the organ and cellular/molecular levels. I wanted to demonstrate how basic science informs daily medical decision making (ie longitudinal integration of the curriculum). And I wanted it to be engaging and interactive. The Choose Your Own Adventure/Escape Room format seemed like a great way to make this pipe dream a reality.

What obstacles have you faced?

Finding a platform to deliver this content has been a challenge. I originally started writing and embedding media in Microsoft Word, but that quickly proved to be a suboptimal choice. It would be too easy to skip over sections just to "beat the game," which as mentioned above, isn't really the main goal of the experience.

I tested out other formats, such as Google Forms and Microsoft Forms, but they didn't have the question options that I needed. I wanted the students to think and supply their own answers, not just click radio buttons for yet another multiple choice test. I ended up using Qualtrics because it offered the broadest variety of question types and relatively user-friendly logic flow. While I was able to manipulate it to my purposes, Qualtrics isn't a perfect vehicle for this type of teaching tool. I'm not sure a perfect vehicle currently exists.

It took a long time to get the storyline and the content mapped out, but once I had a framework, everything fell into place. I did have trouble finding people to beta test it for me, as it is long (takes about 30min to an hour to complete). While I have a small core of beta-testers now, I'm still looking for help if anyone is interested.

Describe any collaboration with others on design and development.

I recently met with Sarang Kim and Jim Galt, who suggested I map the basic science content to the specific lectures from the M1 and M2 years. In the early days of brainstorming this project, I had asked Rob Zachow and Siobhan Corbett for their slides on the topics addressed in the story. Much of that content is included in the storyline. Based on these suggestions and contributions, I was able to not only reference the appropriate lectures, but also directly link to the lecture recordings and slide handouts in AMP. I thought this was an interesting way to reinforce the longitudinal integration of the curriculum, and allow the player to review related content that they have already been exposed to. Great mental bridges are made from the thought, "where have I seen this before?" and then doing the legwork to pull that information back to the forefront. This simplifies that process a little bit.

How are you planning to measure efficacy?

Right now, I'm just wondering if this idea has been worth all of the time it has taken to create. I think that it is a really exciting idea, but if the students don't like it or don't find it useful, then it won't be worth the effort. I'm hoping to send surveys to the students after they complete the game for their feedback.

Do you have plans to publish?

I would love to publish, but I'm not sure where this type of project would be best received. It's a relatively innovative concept, and I'm not sure who the target audience should be. I'm happy to take suggestions!

Where would you like to be with this project in twelve months from now?

Ideally, students will find this a helpful exercise. If they do, based on their feedback, I would hope to hone this iteration of the game. I would also consider making more and different storylines, especially to help with social distancing and remote learning this year. And of course, I'd like to publish this first attempt.

I've also considered reaching out to the Rutgers Computer Science department. It might be interesting to work with the Game Design professors on better ways of delivering the content. Stay tuned...

And if you'd like to sign on as a beta-tester, email me and I'll send you the link (donovac1@rwjms.rutgers.edu).

Colleen M. Donovan, MD, FACEP
Assistant Professor, Emergency Medicine
Simulation Medical Director, Rutgers-RWJMS

Teaching During A Pandemic

"...Webex enabled faculty [based in New Brunswick] to have a larger role in the courses [based in Piscataway]." Schein
 

Which course do you teach? When did you start?

I am the Course Director for two M1 courses – Immunity and Microbiology. These courses are in April and May of the M1 curriculum. In the fall, I also am the Course Director for the Microbiology and Immunology course in. the Master of Biomedical Sciences Program of the School of Graduate Studies.

What has been the biggest change you've had to make to your course in response to the COVID-19 pandemic?

There are several major changes to the M1 Immunity and Microbiology courses since COVID-19 appeared in New Jersey. The entire curriculum is now remotely taught. This change occurred one week before my Immunity Course began. For the lectures, I immediately posted all of the podcasts of last year’s lectures on-line for the students. Several of the lectures, as the semester went on, were presented on Webex in real-time. They were also recorded for those students who were sheltering-in-home in different time zones. For our small group sessions, I developed a “how-to Webex” podcast for the students. This enabled them to meet in their small groups via Webex. Being concerned about the lack of face-to-face interaction between the students and faculty, I instituted a weekly Q and A on Webex. This enabled the students to ask questions in real-time and to actually see the faculty. Exams, too, were now remote. This means that the students were taking them at home, without a proctor, on the honor system. Since our normal exams are secure and we use them from year to year, I wanted to make up new questions for this “take-home” exam. Lastly, the single biggest change was for the bacteriology wet labs in the Microbiology Course. Obviously, they could not be performed in the lab, so I approached Jim Galt, our Curriculum Development/Instructional Design Specialist to aid me in developing an on-line replica of the labs. For each of the 3 labs we created, it involved giving each student a different unknown organism and having them key in the appropriate tests. Images of each test result were displayed. The students needed to use clinical reasoning and critical thinking to put their results together to formulate a diagnosis and identify their unknown organism.

Do you feel there is parity between the online and in-class learning experience for your course?

Teaching the course remotely was not that different from in-class, for many aspects. As far as lectures go, normally, when we have live lectures, only 25-50% of the class attends the lectures. All lectures are recorded, so students prefer to watch the podcasts at their own pace. So, this is not very different. The small group session were basically similar to the in-class sessions, except that there was no faculty facilitator present.

What has been lost in the switch from in-class to online learning for your course?

The largest loss with remote teaching is the faculty-student interaction. I feel that was missed by the students (as well as the faculty). The personal touch is very important for many students. These are the students who come to lecture and attend all sessions. 

What has been gained in the switch from in-class to online learning for your course?

The only benefit that I noticed from remote learning is the ease of interaction. It is difficult for faculty who are located across the river – in New Brunswick – to attend many activities in Piscataway, such as Q and A sessions, small group session and listening to other faculty’s lectures. Webex enabled faculty to have a larger role in the courses, since they did not need to travel to attend. Likewise, students meeting in small groups from their homes was more convenient than traveling into the school to meet.

What has been the faculty reaction to the changes in your course?

Initially, I think some faculty were glad that I posted last year’s lectures and they did not need to deal with technology to deliver their lectures this year. Many faculty, however, once time progressed and they became more familiar with the technology, agreed to lecture remotely.

How do you predict students will react to having an online course?

I believe the students are more adept with technology that the majority of the faculty. Their overall reactions, so far, have been positive. I have noticed that many of the students prefer the “live” Webex lectures to just podcasts. I assume these are the same students who usually prefer to attend the lectures.

What aspects of your course would you be most interested studying?

I am curious how well the students will have learned from the remote small group sessions and labs. Will they have benefited from the sessions even though faculty facilitators were not present.

What do you predict you will gain most from this experience when you return to the in-class format? Will everything return to how it once was for your course?

I think that some activities, such as Question and Answer sessions can be done remotely. This way more faculty can participate. Maybe small groups sessions, also. That way clinical faculty from New Brunswick will also be able to participate, which would be beneficial to the students.

Lee Ann Schein, Ph.D, ACUE

M1 Block Director, Mechanisms of Disease and Defense 
Program Director, Medical Physics Certificate Program

MBS Program, Course Director

Assistant Professor, Department of Pharmacology

Rutgers - Robert Wood Johnson Medical School 

Technology In A Pandemic

What course(s) do you teach?

• Patient-Centered Medicine (PCM) 1, 2, & 3
• Digital and Connected Health elective
• Boot Camp (Patient Safety & Quality Improvement section)

I also am the Director for the Distinction in Medical Innovation and Entrepreneurship (DiMIE) Program where the curriculum includes topics such as Design Thinking and developing a Business Plan.

What has changed for you as a medical educator during the pandemic?

It has been an abrupt and dramatic shift from exclusively in person education to all virtual for didactic presentations, small group activities, and our PCM 2 clinical OSCEs. I also have become much more adept with multiple teaching and meeting platforms (Canvas, Microsoft Teams, Zoom, & WebEx). Further, I am even more attuned to the attention and energy levels of small groups.

It has been written that the COVID-19 pandemic is accelerating history, not reshaping it. Does this apply to medical education as well? If so, how?

Most definitely! The use of virtual and learning management platforms has broadened with accelerated adoption. In addition, the integration of telemedicine-like teaching also has occurred more rapidly than expected.

How long do you think any recent changes to medical education will last?

These changes will be enduring. I also foresee further evolution and transformation in the mix of in person and virtual pre-clerkship and clerkship phase education. I do not expect that we will completely return to the pre-pandemic environment.

Has the quality of medical education improved or deteriorated during the pandemic?

It has improved as we have become more innovative and creative in our learning approaches. Further, the door has opened for new courses especially those that can be offered partially or completely virtual.

What new technology is being deployed for the prevention and treatment of coronavirus infection?

For prevention: UV light for cleaning surfaces, temperature sensors including ones on drones for large outdoor spaces to detect individuals with fevers; touchless screens to avoid infection; another area to watch is the development of vaccines which is very active but anywhere from 6 - 24 months away.

For treatment: watch for new ventilators and artificial intelligence to speed up development of new medications to treat COVID-19.

How might the use of new technologies on the clinical-side influence medical education?

With broader use of technologies, educators will need to add new simulation programs and technology based experiences to permit students and post-graduate trainees to increase their readiness to learn and contribute to team-based care in a more technology focused clinical environment.


Post-pandemic, what new questions should medical education researchers be asking?

We should ask what/where/how can I improve what I am currently doing? We also should be reviewing thoughtful and constructive feedback from patients, students, and peers for ideas to evolve our educational techniques and offerings.

Further, who else should be on the team who may not be now such as patients or patient-family council members.

Paul Weber, MD RPh MBA

Associate Dean, Continuing Medical Education
Assistant Professor of Medicine
Patient-Centered Medicine (PCM) 1, 2, & 3 Course Co-Director
Health Systems Science Curriculum Thread Director

Data & Medical Education Research

Laura Willet, MD

"I think you are going to find things that sometimes are true just by chance, and then sometimes you're going to find results that were presupposed by the people doing the study."  Willett
 

After reviewing for the DR MERL blog more than150 journal articles on medical education research over the past seven years, what trends have you seen come and go in medical education research? 

What's really trendy now is wellness.  There are a lot of articles about wellness of people at all stages: students, residents and practicing physicians.  

Another trendy thing is application inflation. There are a lot of residency programs that can, maybe, admit ten or twenty residents, but they may get six thousand, eight thousand, ten thousand applications. [The programs] …really don't have the resources to review all those applications in depth which has led to an unfortunate reliance on things like Step 1 and 2 scores for deciding who to consider for fellowship or residency.  I don't know if anyone has a good solution to that, but it is a big problem and one that is getting quite a lot of attention.  

So those are two things that are pretty popularly written about currently.  Over these past seven years, teaching techniques, simulation, and duty hours have been popular topics […for DR MERL]. 
 

Why is wellness trending now? 

I think there's more data that suggest that patient care may be adversely affected when their care providers are not doing well for various reasons, and it costs health systems money in terms of lost productivity.  So I think both of those things are driving that interest. 

How strong are most articles in medical education in terms of data?

I think many articles in medical education are not that strong at least as compared to articles in the medical journals in general.  Most of us do our studies without any major outside funding, which probably is some of it.  And the other thing is that important outcomes in medical education research, I think, are hard to define.  What you want to produce is a good clinician sometime in the future and that has so many inputs it is hard to know [that] your probably small intervention is going to make a difference in that large outcome down the line.  Also, due to lack of resources, very strong methods like randomized controlled studies are usually not done in medical education research.  

What's the quickest way for a reader to distinguish between strong and weak data?

Honestly, I think you should use the same tools looking at any article.  So the same criteria you would use for looking at hypertension treatment, or anything else - you should use those same types of research thoughts that you would have when you are looking at medical education data.  Such as: is the outcome an important outcome, is this situation something that I can see my learners dealing with, is the intervention something I can perform?  So it would be pretty much the same types of decisions.

What about the "N" or number of data points? 

You know in medical education research sometimes you have very large "N's".  I mean sometimes you are looking at everybody who has taken a board exam across the country, so you can achieve very large numbers. For example, I think there was a recent study saying that people who had scored poorly on board exams were more likely to get cited for trouble by their state board associations.  So, in order to find that, you would have to look at many thousands of people.  If you are even looking at a whole class of medical students, you may be looking at 100 to 200 people, depending on which school is doing the study, so that is usually a large enough number to be able to find differences.  In small residency or fellowship settings, you may have trouble getting a large enough number of people. 

Can research with weak data still make valid points? 

I don't think so myself.  I think you are going to find things that sometimes are true just by chance, and then sometimes you're going to find results that were presupposed by the people doing the study.  For example, you just look at the methods.  For example, I think that active learning is an important thing, so I buy that active learning and active teaching methods are good, but I looked at an article and they said "Oh we taught people (I can't remember what skill they were teaching with active learning method)…anyway, they said people who got taught this way did much better than people who weren't taught this way. But when you looked at the comparison group, the comparison group hadn't been taught the skill in any way, so it's not terribly surprising that people were taught something with active learning did better than people who were not taught the topic at all.  And so you have to look at articles at least a little bit critically even if you agree with their conclusions. 

What's the most important tip for those getting started in medical education research?

Reach out for other people in your institution who have published on medical education so that you have a group of people so that you can bounce ideas off of to see: are they new ideas, interesting ideas, is the outcome an interesting outcome.  And start looking at the literature to see what's out there.  It may be useful to target trendy topics that might make you more likely to get published like wellness or empathy.  Those types of topics are currently trendy.  But more important is having something that you think is going to be of interest to the education community in general.  

Laura Rees Willett, MD, FACP
Professor of Medicine, Division of Education
Associate Program Director, Internal Medicine Residency
Co-Course Director, M2 Foundations course

Anatomy of a Collaboration

"No one person can do it alone."  Parikh

How did you come together as a team? 

The start was truly at the  Medical Education Research Learning Community that Dr. Sarang Kim created, with active participation for ideas from Jim Galt, Victoria Wagner, and physician attendees.  Given that it is an open forum to discuss projects, Dr. Catherine Chen, Dr. Paul Weber, and I were discussing the work we have done with the quality and safety portion of Boot Camp.  Dr. Kristen Coppola mentioned that NEGEA submission deadline was coming up in just under two weeks.  At that meeting, she offered to look at our pre-and post surveys and test.  And it went off from there.  Given the time crunch, Drs. Weber, Chen and I began to code the pre-post tests and surveys (as they were initially on paper), after which Dr. Coppola analyzed the data for us.  Concurrently Dr. Weber began writing down the sections needed for the submission.  The most impressive part was the few hours we all blocked out the day before the submission deadline where we wrote utilizing each of our strengths.  

What is your overall feeling about this collaborative effort? 

I truly feel that collaboration is key to any success, whether it is in patient care, systems improvement, or research.  Identifying each individual's strengths and then working to weave them into the writing was the best part of this collaborative effort.  I personally, feel that it went well especially because of the manner in which everyone was able to weigh in at just the right time. 

 How did you divide up the work?

Drs. Weber, Chen and I did the data entry, Dr. Coppola did the data analysis.  Afterwards, we all met - both virtually and physically, to write out various portions of the abstract. We really utilized our self identified strengths to write out specific sections and then edit as we were going.  Really, those two hours are the most powerful I have every been involved with because we took the initial plan and created an output that we were all happy with.

How did you handle leadership among your collaborators?

This was easy as we have all worked together before. That being said, at the outset we identified our strengths and then I delegated the specific tasks to each member involved (from data entry to analysis to writing of sections).  We were all leaders in this together; leaders for our own section.  I finalized and revised on the day of submission to make sure our collective voice was reflected. 

Which form of communication among team members worked best for you? 

We used all forms of communication, from initial in-person meeting and inception of the idea to email communication for a week and then regrouping to face-to-face communication with the goal of submitting the work to the NEGEA.  

Based on this experience, how might you change your approach to collaboration on future medical education research projects? 

Collaboration is key.  Identifying each other's strengths is the second key.   Definitely making it a team effort and identifying the strengths of those involved early on to drive his or her own portion.  I feel that the individual interest combined with the overall goal for a shared project leads to a successful submission outcome.  No one person can do it alone.  The Medical Education Research Learning Community is valuable for this because it brings together people from different backgrounds, and different interests with the common goal: to advance medical education through writing. 

Payal Parikh, MD, FACP

Assistant Professor of Medicine
Core Faculty, Internal Medicine Residency
Vice Chair of Quality and Safety 
Department of General Internal Medicine 
Rutgers Robert Wood Johnson Medical School 

Academic Collaboration

"Look to the literature first to see what others have done."  Coppola

What is your current medical education research project and how will you measure outcomes?

I think it will be helpful to give you a little background on the current state of medical care at the end of life in NJ to set up the problem we are addressing in the current research project. You may be surprised to learn that patients in NJ are treated with more aggressive end-of-life care than patients in any other state in the country. This high-intensity, high-cost care is often unwanted and burdensome to both patients and their caregivers. Key reasons for this burdensome care are the lack of professional education about end-of-life care and comfort level discussing end-of-life care options which results in a scarcity of thorough, patient-centered discussions and documentation of patients’ wishes.

RWJMS has joined an academic collaborative group consisting of all NJ medical schools and the Goals of Care Coalition of New Jersey (GOCCNJ), a 501(c)(3) nonprofit organization to examine the scope, intensity, and effectiveness of end-of-life education received by medical students and residents training in the state of NJ. The objective of this project is to understand if our current educational programs may be a contributing factor to the overly burdensome care patients in NJ ultimately receive and what core competencies should exist for education about end of life/palliative care.

What interested you in this topic?

When I was a first year graduate student, I had the option to work for a project that examined psychological risk factors of women in inner- city Cleveland (but required a car) or a project that examined end of life preferences of older adults and the effectiveness of advance directive documents in improving accuracy in clinical decision-making for patients. At that time, our stipend as a graduate student was about $7,000/year, and I couldn’t afford to pay for car insurance, so the first project was out. Turns out, I had a natural ability to talk about death and dying with people and so that began my career in studying end-of-life issues.

Are you working alone on this project or is this a team effort?

For the first phase of what will likely be a multi-year research program, we are conducting a survey of medical students in NJ to learn about what types of courses, seminars, or small group education they have been exposed to, the impact of what they have learned, and their comfort level in working with patients near the end of life (depending on their training level). I have been a part of designing the survey with Dr. Biren Saraiya of the Cancer Institute as well as Dr. David Barile of GOCCNJ and we have now sent the survey out to the other schools to examine and make modifications.

How far are you into the research?

Just starting off. Still making modifications like, “do we need to add an additional question here..” or “this question is worded really awkwardly, let’s modify”, which although tedious, helps to produce clearer results when we get to the analysis and interpretation phase.

Have you found resources or strategies that might be useful for others trying to engage in similar research?

My suggestion for any type of curricular modification is to look to the literature first to see what others have done and how they measured their outcomes. For this project, we are modeling a lot of what we will doing on the Massachusetts Coalition for Serious Illness Care and will adapt our plans once we have measured the current state of our end-of-life care curriculum.
 

Kristen Coppola, Ph.D

Assistant Professor, Cognitive Skills Program
Rutgers Robert Wood Johnson Medical School

Peer Observation of Teaching

David Cohen, MD
 

"Peer Observation of Teaching would fit incredibly well in our current education system here." -- Cohen

What is your current medical education research project?

The plan for my research project is to implement a Peer Observation evaluation of teaching effectiveness at the four RWJMS-affiliated hospitals where our medical students rotate for internal medicine (clerkship or sub-internship).  Peer Observation of Teaching (POT) is a proven method of evaluating teaching, and can offer formative feedback to faculty as a means of improving education of learners.

Where are you in development?

I am in the very early stages of development.

The first step in rolling out the Peer Observation project (as with any) is to get buy-in from stakeholders.  I have identified my stakeholders:

• RWJMS leadership, who have expressed interest and support
• Learners
• Faculty buy-in

I have done background research on POT, particularly using the Medical Teacher Twelve Tips article and personal past experience engaging in POT as an observee, observer, and organizer.

What challenges (for example, lack of resources) have you encountered so far?

I have two main problems thus far. 

1...Lack of an identifiable and measurable outcome.  With so many educators of different backgrounds at different sites teaching different students with different baseline knowledge levels and different interests, it would not be possible to use tests (such as the Shelf exam).  One possible avenue might be how much time is spent teaching (comparing time spent teaching prior to the observation as opposed to after the observation), though this is not necessarily the goal of POT.  I could measure one aspect of teaching (i.e. critical thinking or high value care), but one important aspect of a good POT program is allowing the interviewee to choose what area he/she wants to be evaluated on.

2...Buy-in from faculty- as always, a program like this needs buy-in from all stake holders, and in this case, faculty may feel uncomfortable about being observed due to time constraints, busy workloads, and fear of scrutiny and criticism. We will need to reassure everyone that the purpose of POT is formative, not summative. 

What lessons have you learned that might be useful to others in our medical education community?

PLAN!!

I often don’t do this myself, but I need to do a better job planning the path of the project ahead of time, particularly focusing on goals/objectives, outcomes, resources needed, and buy-in from stakeholders.

For those getting started with a project, I find using worksheets to guide me very effective.  Here's a good resource.

Describe your current level of enthusiasm for this project.

Right now I am at a 7 out of 10.  I am a 10 out of 10 excited about the idea of POT.  I think that this would fit incredibly well in our current education system here, where we have learners that describe inconsistencies in the teaching they receive, and POT may improve quality of teaching for all of our educators by providing formative feedback and allowing our faculty to share best practices. However, the challenges I describe above (defining a measurable outcome, getting buy-in from everyone) sometimes lower my degree of enthusiasm. HELP!!

David A. Cohen MD
Assistant Professor of Medicine Vice Chair of Education
Department of Medicine Director
Thyroid Nodule and Biopsy Clinic Internal Medicine Sub-Internship Director Rutgers Robert Wood Johnson Medical School