Skip to main content

Karen Mann

Dalhousie University, Medical Education, Faculty Member

Followers

60

Following

12

Co-authors

12

Public Views

Jocelyn Lockyer

University of Calgary

Könings Karen D.

Maastricht University, Faculty of Health Medicine and Life sciences

Constance Leblanc

Dalhousie University

Christopher Harrison

Michelle Marshall

McMaster University

Interests

Uploads

Papers by Karen Mann

Factors influencing responsiveness to feedback: on the interplay between fear, confidence, and reasoning processes

by Karen Mann and Jocelyn Lockyer

Advances in Health Sciences Education, 2012

Self-appraisal has repeatedly been shown to be inadequate as a mechanism for performance improvem... more Self-appraisal has repeatedly been shown to be inadequate as a mechanism for performance improvement. This has placed greater emphasis on understanding the processes through which self-perception and external feedback interact to influence professional development. As feedback is inevitably interpreted through the lens of one's selfperceptions it is important to understand how learners interpret, accept, and use feedback (or not) and the factors that influence those interpretations. 134 participants from 8 health professional training/continuing competence programs were recruited to participate in focus groups. Analyses were designed to (a) elicit understandings of the processes used by learners and physicians to interpret, accept and use (or not) data to inform their perceptions of their clinical performance, and (b) further understand the factors (internal and external) believed to influence interpretation of feedback. Multiple influences appear to impact upon the interpretation and uptake of feedback. These include confidence, experience, and fear of not appearing knowledgeable. Importantly, however, each could have a paradoxical effect of both increasing and decreasing receptivity. Less prevalent but nonetheless important themes suggested mechanisms through which cognitive reasoning processes might impede growth from formative feedback. Many studies have examined the effectiveness of feedback through variable interventions focused on feedback delivery. This study suggests that it is equally important to consider feedback from the perspective of how it is received. The interplay observed between fear, confidence, and reasoning processes reinforces the notion that there is no simple recipe for the delivery of effective feedback.

Knowledge translation in interprofessional education: what difference does interprofessional education make to practice?

Cancer Care Nova Scotia developed an Interprofessional Core Curriculum for Nova Scotia health pro... more Cancer Care Nova Scotia developed an Interprofessional Core Curriculum for Nova Scotia health professionals, using a provincial educational needs assessment of health professionals caring for patients with cancer. This paper reports on the educational outcomes of the Interprofessional Core Curriculum programme, particularly the translation of learning into changes in practice and interprofessional interaction, and factors influencing change. The evaluation was guided by Kirkpatrick's model for assessing educational outcomes and Green and Kreuter's PRECEDE model of factors promoting and impeding change. In total, 411 participants attended the sessions, including nurses (54%), pharmacists (23%), and physicians (11%). We used selfreport questionnaires to assess the transfer of learning into changes in practice and interprofessional interactions. High percentages of participants reported changes in both clinical practice and interprofessional interactions 3 months after the sessions. Frequently reported changes to interprofessional interactions were improved communication, increased confidence and assertiveness in interactions with other health professionals and being more respectful of other professions. Participants identified time and work-load as major barriers to change as well as lack of micro-and macro-system level support. The most common reported enabler of change was having attended the educational session. Overall, participants were highly supportive of interprofessional education, although when compared to nurses and pharmacists, physicians were less supportive and had proportionately lower attendance.

Telephone support group intervention for persons with hemophilia and HIV/AIDS and family caregivers

International Journal of Nursing Studies, 2001

The purpose of this pilot project was to test the feasibility of a telephone support group interv... more The purpose of this pilot project was to test the feasibility of a telephone support group intervention for persons with hemophilia and HIV/AIDS and for their family caregivers. Their support needs were unique because they did not identify with predominant groups of persons with AIDS and were geographically dispersed from peers. The 12 week intervention involved separate telephone support groups for hemophiliacs and for family caregivers. The two groups, comprised of a predetermined maximum of six people, were co-led by a professional and a peer. The support group for family caregivers involved six people and the group for men with hemophilia included ®ve people, including one peer facilitator and one professional facilitator in each group. The telephone support group discussions were taped, transcribed, and analyzed for prevalent themes. The peer and professional facilitators maintained weekly ®eld notes. All participants reported that the telephone groups had a positive impact on meeting their support needs. They believed that they had bene®tted from sharing information and that the support groups had decreased their feelings of isolation and loneliness. Participants, however, contended that the intervention should be longer than 12 weeks. 7

Orienting Teaching Toward the Learning Process

Academic Medicine, 2004

Development of a behaviour change communication tool for medical students: The ‘Tent Pegs’ booklet

by Karen Mann and J. Hart

Patient Education and Counseling, 2014

Background: Intermittent preventive treatment of malaria in infants (IPTi) using sulphadoxine-pyr... more Background: Intermittent preventive treatment of malaria in infants (IPTi) using sulphadoxine-pyrimethamine and linked to the expanded programme on immunization (EPI) is a promising strategy for malaria control in young children. As evidence grows on the efficacy of IPTi as public health strategy, information is needed so that this novel control tool can be put into practice promptly, once a policy recommendation is made to implement it. This paper describes the development of a behaviour change communication strategy to support implementation of IPTi by the routine health services in southern Tanzania, in the context of a five-year research programme evaluating the community effectiveness of IPTi.

A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8

by Karen Mann, John Spencer, and David Prideaux

Medical Teacher, 2006

Background: Preparing healthcare professionals for teaching is regarded as essential to enhancing... more

The many faces of problem-based learning: a framework for understanding and comparison

by Bernard Charlin and Karen Mann

Medical Teacher, 1998

There is much literature on problem -based learning (PBL), both within and outside m edical educa... more There is much literature on problem -based learning (PBL), both within and outside m edical education. The literature addresses such questions as what is PBL and how does it w ork, and m any exam ples are given; yet it is often dif® cult to determine from these descriptions whether the educational approach being described is actually PB L. The goal of this article is to provide planners and/or assessors of PBL curricula with a fram ework that would facilitate analyses of this educational approa ch. W e propose to categorize educational activities as PBL or non-PB L according to three core principles: (1) the problem acts as a stim ulus for learning; (2) it is an educational approa ch, not an isolated instructional technique, and (3) it is a student-centered approa ch, and four criteria concerning their effect on student learning: (1) active processing of inform ation;

Defining fitness and aptitude to practice medicine

by Karen Mann and Brian Hennen

Medical Teacher, 1990

This article describes the use of the critical incident technique to define noncognitive behaviou... more This article describes the use of the critical incident technique to define noncognitive behaviours, referred to as &#39;fitness and aptitude&#39;, that physicians should demonstrate in their practice. A total of 484 behaviours were categorized under four categories: attitude and personal attributes; communication; practice organization; and professional competence. Each category was further subdivided into subcategories. The communication category was by far the largest, representing 46% of all behaviours. The behaviours were written as objectives so that they could be included in a medical school curriculum and evaluated with much less subjectivity.

Strategic planning in medical education: enhancing the learning environment for students in clinical settings

Medical Education, 2000

Background The 1999 Cambridge Conference was held in Northern Queensland, Australia, on the theme... more Background The 1999 Cambridge Conference was held in Northern Queensland, Australia, on the theme of clinical teaching and learning. It provided an opportunity for groups of academic medical educators to consider some of the challenges posed by recent changes to health care delivery and medical education across a number of countries. Purpose This paper describes the issues raised by the practical challenges posed by the current environment and how they might be addressed in ways that could promote more effective learning in clinical settings. Method A SWOT analysis is a tool that can help in forward planning by identifying the strengths, weaknesses, opportunities and threats presented by any situation. Our SWOT analysis was used to generate a list of items, from which we chose those most feasible and most likely to promote positive change. Results Twenty different issues were identi®ed, with four of them chosen by consensus for further elaboration. The discussion gave rise to four main recommended strategies: ensuring that clinical teachers thoroughly understand the purpose and process of learning in clinical settings; equipping learners with `survival skills'; making the best use of learning resources within different clinical environments and making judicious use of information technology to enhance learning ef®ciency. The four strategies were selected not only because of their inherent importance, but also because of their feasibility. Modest changes can motivate students to feel part of a clinical team and a `community of practice' and enhance their capacity for self-regulated practice.

Basic sciences in problem-based learning and conventional curricula: students' attitudes

Medical Education, 1997

greater in the areas of students' programme evaluations,

Challenges in multisource feedback: intended and unintended outcomes

by Karen Mann and Douglas Sinclair

Medical Education, 2007

CONTEXT Multisource feedback (MSF) is a type of formative assessment intended to guide learning a... more CONTEXT Multisource feedback (MSF) is a type of formative assessment intended to guide learning and performance change. However, in earlier research, some doctors questioned its validity and did not use it for improvement, raising questions about its consequential validity (i.e. its ability to produce intended outcomes related to learning and change). The purpose of this qualitative study was to increase understanding of the consequential validity of MSF by exploring how doctors used their feedback and the conditions influencing this use.

Exploring family physicians' reactions to multisource feedback: perceptions of credibility and usefulness

Medical Education, 2005

PURPOSE Physician performance is comprised of several domains of professional competence. Multiso... more PURPOSE Physician performance is comprised of several domains of professional competence. Multisource feedback (MSF) or 360-degree feedback is an approach used to assess these, particularly the humanistic and relational competencies. Research studying responses to performance assessment shows that reactions vary and can influence how performance feedback is used. Improvement does not always result, especially when feedback is perceived as negative. This small qualitative study undertook preliminary exploration of physicians' reactions to MSF, and perceptions influencing these and the acceptance and use of their feedback.

Hidden curriculum in continuing medical education

Journal of Continuing Education in the Health Professions, 2004

In developing curricula for undergraduate and graduate medical education, educators have become i... more In developing curricula for undergraduate and graduate medical education, educators have become increasingly aware of an interweaving of the formal, informal, and hidden curricula and their influences on the outcomes of teaching and learning. But, to date, there is little in the literature about the hidden curriculum of medical practice, which takes place after graduation and certification. This article initiates that discussion with influences of the hidden curriculum on the actions physicians take or do not take in caring for patients. Hafferty&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s framework of institutional policies, evaluation activities, resource-allocation decisions, and institutional slang, along with our knowledge of health services research and the continuing medical education (CME) research literature, suggests that there is a hidden and powerful curriculum that affects physician performance. Determining whether the hidden curriculum conflicts with the messages that we are delivering through formal CME (courses, clinical practice guidelines, peer review journals) may contribute to improving our impact on physician performance.

Identification of individuals with elevated cholesterol in family physicians' offices

by Karen Mann and Wayne Putnam

Journal of Continuing Education in the Health Professions, 1998

Increasing physician involvement in cholesterol-lowering practices

Journal of Continuing Education in the Health Professions, 1996

The study tested a multifaceted educational intervention designed to increase physician cholester... more The study tested a multifaceted educational intervention designed to increase physician cholesterol-lowering practices. This three-group randomized controlled trial involved 51 Nova Scotia family physicians. Seventeen group I and 19 group IIphysicians attended a training workshop addressing the management of elevated serum cholesterol. Supporting print materials were provided for physicians and patients. Access to consultants was provided throughout the study. Group II physicians also used a "cuing" intervention to facilitate identification of eligible patients. Fifteen control group physicians received no intervention. Physician management practice was measured by medical record audit, dietary counselling practice by patient telephone interview. Patient serum cholesterol levels were measured on three occasions: baseline, 6 weeks, and 6 months. Physician patient management scores on chart audit were similar across study groups. Howevec physician dietary counselling scores were significantly higher for both intervention groups than the control. Patient serum cholesterol levels were not significantly different across study groups. Howevel; in the intervention groups, patients' low-density lipoprotein levels decreased significantly overall from baseline to second follow-up, compared to increases in the control group. This intervention produced a change in physician dietary counselling associated with lowered patient low-density lipoprotein levels. Physician behavior change, leading to small changes in cardiovascular risk, may contribute to improved patient health outcomes.

Videoconferencing for practice-based small-group continuing medical education: Feasibility, acceptability, effectiveness, and cost

Journal of Continuing Education in the Health Professions, 2003

Small-group, practice-based learning is an effective and well-accepted method of continuing medic... more Small-group, practice-based learning is an effective and well-accepted method of continuing medical education (CME). However, one limitation is that many physicians work in communities with fewer than the minimum number recommended for an effective learning group. Videoconferencing has the potential to remove this limitation. The purpose of this study was to evaluate the feasibility, acceptability, effectiveness, and cost of conducting practice-based, small-group CME learning by videoconference. Through a videoconferencing link, 10 learners in three communities were guided through four practice-based learning modules by a trained facilitator at a fourth site. Data were collected through evaluation questionnaires, direct observation by the research team, pre- and post-knowledge tests, a focus group, and an interview. A total of 31 learners participated in the four modules. Videoconferencing was generally well accepted by learners. The facilitator and research team observers noted that muting microphones, video quality, audio quality, and audio lag all somewhat hindered discussion. Overall, the facilitator found moderating by videoconference only slightly more difficult than a face-to-face session. There was evidence of knowledge gain, with post-test scores being 20% higher than pretest scores (p = .006). Learners reported nine practice changes from taking the modules. At commercial rates, telecommunications costs per videoconferenced module were approximately CAN$1,200. Videoconferencing has the potential to bring the benefits of small-group, practice-based learning to many physicians; however, strict attention to videoconferencing techniques is required. Cost is also an important consideration.

Living with haemophilia and HTV/AIDS: support and coping

Journal of Advanced Nursing, 2006

Achievement of Students in a Conventional and Problem-Based Learning (PBL) Curriculum

Advances in Health Sciences Education, 1999

This study compared student performance in problem-based (PBL) and conventional curricula on: 1) ... more This study compared student performance in problem-based (PBL) and conventional curricula on: 1) basic science knowledge following two preclinical years; 2) the Medical Council of Canada Qualifying Examination (MCC) Part I, written upon completion of the four year MD, and 3) Part II of the MCC Qualifying Examination, an assessment of clinical performance after 17 months of postgraduate education. Students

Providing evidence-based information to patients in general practice and pharmacies: what is the acceptability, usefulness and impact on drug use?

Health Expectations, 2003

Background A common and often integral method of delivering patient information is the use of pat... more Background A common and often integral method of delivering patient information is the use of patient guides. However, the acceptability, utility and impact of evidence-based therapeutic guides on physicians, pharmacists and patients have not been well evaluated. Methods This study was a prospective evaluation of 53 general practitioners' offices and 30 community pharmacies from three locations in Canada. Evidence-based guides were provided to 1176 patients who presented to either a general practitioner or a community pharmacist and were interested in receiving information about sore throat, heartburn, or osteoporosis ( canadadrugguide). The acceptability, utility and impact of the guides were assessed via structured patient telephone interviews, structured health professional interviews, and patient chart audits. Results Eighty to 90% of patients reported that the guides were Ôvery easyÕ to understand. Fifty six per cent/47%/38% (sore throat/ heartburn/osteoporosis) of patients rated the guides as ÔveryÕ or ÔextremelyÕ useful. Seventy-two per cent/67%/58% of respondents reported that the information helped them make decisions about their treatment. Ninety eight per cent of physicians and 92% of pharmacists reported that the guides helped their patients understand the issues involved in their treatment. None of the analyses showed any significant differences in prescribing of medications between the intervention and control groups. Interpretations Patients found these evidence-based guides to be useful, easy to understand, and that they helped them in their understanding of treatment options and the decision-making process. Physicians and pharmacists reported that the guides helped their patients understand the issues involved in their treatment. Further research is required to determine the degree to which providing evidence-based guides to patients can impact on prescribing and patient outcomes.

2010 Canadian Hypertension Education Program (CHEP) recommendations: The scientific summary – an update of the 2010 theme and the science behind new CHEP recommendations

by Simon Bacon and Karen Mann

Canadian Journal of Cardiology, 2010

To provide updated, evidence-based recommendations for the diagnosis and assessment of adults wit... more To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension. EvIdEnCE: MEDLINE searches were conducted from November 2008 to October 2009 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only. RECOmmEndaTIOnS: Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use

Factors influencing responsiveness to feedback: on the interplay between fear, confidence, and reasoning processes

by Karen Mann and Jocelyn Lockyer

Advances in Health Sciences Education, 2012

Self-appraisal has repeatedly been shown to be inadequate as a mechanism for performance improvem... more Self-appraisal has repeatedly been shown to be inadequate as a mechanism for performance improvement. This has placed greater emphasis on understanding the processes through which self-perception and external feedback interact to influence professional development. As feedback is inevitably interpreted through the lens of one's selfperceptions it is important to understand how learners interpret, accept, and use feedback (or not) and the factors that influence those interpretations. 134 participants from 8 health professional training/continuing competence programs were recruited to participate in focus groups. Analyses were designed to (a) elicit understandings of the processes used by learners and physicians to interpret, accept and use (or not) data to inform their perceptions of their clinical performance, and (b) further understand the factors (internal and external) believed to influence interpretation of feedback. Multiple influences appear to impact upon the interpretation and uptake of feedback. These include confidence, experience, and fear of not appearing knowledgeable. Importantly, however, each could have a paradoxical effect of both increasing and decreasing receptivity. Less prevalent but nonetheless important themes suggested mechanisms through which cognitive reasoning processes might impede growth from formative feedback. Many studies have examined the effectiveness of feedback through variable interventions focused on feedback delivery. This study suggests that it is equally important to consider feedback from the perspective of how it is received. The interplay observed between fear, confidence, and reasoning processes reinforces the notion that there is no simple recipe for the delivery of effective feedback.

Knowledge translation in interprofessional education: what difference does interprofessional education make to practice?

Cancer Care Nova Scotia developed an Interprofessional Core Curriculum for Nova Scotia health pro... more Cancer Care Nova Scotia developed an Interprofessional Core Curriculum for Nova Scotia health professionals, using a provincial educational needs assessment of health professionals caring for patients with cancer. This paper reports on the educational outcomes of the Interprofessional Core Curriculum programme, particularly the translation of learning into changes in practice and interprofessional interaction, and factors influencing change. The evaluation was guided by Kirkpatrick's model for assessing educational outcomes and Green and Kreuter's PRECEDE model of factors promoting and impeding change. In total, 411 participants attended the sessions, including nurses (54%), pharmacists (23%), and physicians (11%). We used selfreport questionnaires to assess the transfer of learning into changes in practice and interprofessional interactions. High percentages of participants reported changes in both clinical practice and interprofessional interactions 3 months after the sessions. Frequently reported changes to interprofessional interactions were improved communication, increased confidence and assertiveness in interactions with other health professionals and being more respectful of other professions. Participants identified time and work-load as major barriers to change as well as lack of micro-and macro-system level support. The most common reported enabler of change was having attended the educational session. Overall, participants were highly supportive of interprofessional education, although when compared to nurses and pharmacists, physicians were less supportive and had proportionately lower attendance.

Telephone support group intervention for persons with hemophilia and HIV/AIDS and family caregivers

International Journal of Nursing Studies, 2001

The purpose of this pilot project was to test the feasibility of a telephone support group interv... more The purpose of this pilot project was to test the feasibility of a telephone support group intervention for persons with hemophilia and HIV/AIDS and for their family caregivers. Their support needs were unique because they did not identify with predominant groups of persons with AIDS and were geographically dispersed from peers. The 12 week intervention involved separate telephone support groups for hemophiliacs and for family caregivers. The two groups, comprised of a predetermined maximum of six people, were co-led by a professional and a peer. The support group for family caregivers involved six people and the group for men with hemophilia included ®ve people, including one peer facilitator and one professional facilitator in each group. The telephone support group discussions were taped, transcribed, and analyzed for prevalent themes. The peer and professional facilitators maintained weekly ®eld notes. All participants reported that the telephone groups had a positive impact on meeting their support needs. They believed that they had bene®tted from sharing information and that the support groups had decreased their feelings of isolation and loneliness. Participants, however, contended that the intervention should be longer than 12 weeks. 7

Orienting Teaching Toward the Learning Process

Academic Medicine, 2004

Development of a behaviour change communication tool for medical students: The ‘Tent Pegs’ booklet

by Karen Mann and J. Hart

Patient Education and Counseling, 2014

Background: Intermittent preventive treatment of malaria in infants (IPTi) using sulphadoxine-pyr... more Background: Intermittent preventive treatment of malaria in infants (IPTi) using sulphadoxine-pyrimethamine and linked to the expanded programme on immunization (EPI) is a promising strategy for malaria control in young children. As evidence grows on the efficacy of IPTi as public health strategy, information is needed so that this novel control tool can be put into practice promptly, once a policy recommendation is made to implement it. This paper describes the development of a behaviour change communication strategy to support implementation of IPTi by the routine health services in southern Tanzania, in the context of a five-year research programme evaluating the community effectiveness of IPTi.

A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8

by Karen Mann, John Spencer, and David Prideaux

Medical Teacher, 2006

Background: Preparing healthcare professionals for teaching is regarded as essential to enhancing... more

The many faces of problem-based learning: a framework for understanding and comparison

by Bernard Charlin and Karen Mann

Medical Teacher, 1998

There is much literature on problem -based learning (PBL), both within and outside m edical educa... more There is much literature on problem -based learning (PBL), both within and outside m edical education. The literature addresses such questions as what is PBL and how does it w ork, and m any exam ples are given; yet it is often dif® cult to determine from these descriptions whether the educational approach being described is actually PB L. The goal of this article is to provide planners and/or assessors of PBL curricula with a fram ework that would facilitate analyses of this educational approa ch. W e propose to categorize educational activities as PBL or non-PB L according to three core principles: (1) the problem acts as a stim ulus for learning; (2) it is an educational approa ch, not an isolated instructional technique, and (3) it is a student-centered approa ch, and four criteria concerning their effect on student learning: (1) active processing of inform ation;

Defining fitness and aptitude to practice medicine

by Karen Mann and Brian Hennen

Medical Teacher, 1990

This article describes the use of the critical incident technique to define noncognitive behaviou... more This article describes the use of the critical incident technique to define noncognitive behaviours, referred to as &#39;fitness and aptitude&#39;, that physicians should demonstrate in their practice. A total of 484 behaviours were categorized under four categories: attitude and personal attributes; communication; practice organization; and professional competence. Each category was further subdivided into subcategories. The communication category was by far the largest, representing 46% of all behaviours. The behaviours were written as objectives so that they could be included in a medical school curriculum and evaluated with much less subjectivity.

Strategic planning in medical education: enhancing the learning environment for students in clinical settings

Medical Education, 2000

Background The 1999 Cambridge Conference was held in Northern Queensland, Australia, on the theme... more Background The 1999 Cambridge Conference was held in Northern Queensland, Australia, on the theme of clinical teaching and learning. It provided an opportunity for groups of academic medical educators to consider some of the challenges posed by recent changes to health care delivery and medical education across a number of countries. Purpose This paper describes the issues raised by the practical challenges posed by the current environment and how they might be addressed in ways that could promote more effective learning in clinical settings. Method A SWOT analysis is a tool that can help in forward planning by identifying the strengths, weaknesses, opportunities and threats presented by any situation. Our SWOT analysis was used to generate a list of items, from which we chose those most feasible and most likely to promote positive change. Results Twenty different issues were identi®ed, with four of them chosen by consensus for further elaboration. The discussion gave rise to four main recommended strategies: ensuring that clinical teachers thoroughly understand the purpose and process of learning in clinical settings; equipping learners with `survival skills'; making the best use of learning resources within different clinical environments and making judicious use of information technology to enhance learning ef®ciency. The four strategies were selected not only because of their inherent importance, but also because of their feasibility. Modest changes can motivate students to feel part of a clinical team and a `community of practice' and enhance their capacity for self-regulated practice.

Basic sciences in problem-based learning and conventional curricula: students' attitudes

Medical Education, 1997

greater in the areas of students' programme evaluations,

Challenges in multisource feedback: intended and unintended outcomes

by Karen Mann and Douglas Sinclair

Medical Education, 2007

CONTEXT Multisource feedback (MSF) is a type of formative assessment intended to guide learning a... more CONTEXT Multisource feedback (MSF) is a type of formative assessment intended to guide learning and performance change. However, in earlier research, some doctors questioned its validity and did not use it for improvement, raising questions about its consequential validity (i.e. its ability to produce intended outcomes related to learning and change). The purpose of this qualitative study was to increase understanding of the consequential validity of MSF by exploring how doctors used their feedback and the conditions influencing this use.

Exploring family physicians' reactions to multisource feedback: perceptions of credibility and usefulness

Medical Education, 2005

PURPOSE Physician performance is comprised of several domains of professional competence. Multiso... more PURPOSE Physician performance is comprised of several domains of professional competence. Multisource feedback (MSF) or 360-degree feedback is an approach used to assess these, particularly the humanistic and relational competencies. Research studying responses to performance assessment shows that reactions vary and can influence how performance feedback is used. Improvement does not always result, especially when feedback is perceived as negative. This small qualitative study undertook preliminary exploration of physicians' reactions to MSF, and perceptions influencing these and the acceptance and use of their feedback.

Hidden curriculum in continuing medical education

Journal of Continuing Education in the Health Professions, 2004

In developing curricula for undergraduate and graduate medical education, educators have become i... more In developing curricula for undergraduate and graduate medical education, educators have become increasingly aware of an interweaving of the formal, informal, and hidden curricula and their influences on the outcomes of teaching and learning. But, to date, there is little in the literature about the hidden curriculum of medical practice, which takes place after graduation and certification. This article initiates that discussion with influences of the hidden curriculum on the actions physicians take or do not take in caring for patients. Hafferty&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s framework of institutional policies, evaluation activities, resource-allocation decisions, and institutional slang, along with our knowledge of health services research and the continuing medical education (CME) research literature, suggests that there is a hidden and powerful curriculum that affects physician performance. Determining whether the hidden curriculum conflicts with the messages that we are delivering through formal CME (courses, clinical practice guidelines, peer review journals) may contribute to improving our impact on physician performance.

Identification of individuals with elevated cholesterol in family physicians' offices

by Karen Mann and Wayne Putnam

Journal of Continuing Education in the Health Professions, 1998

Increasing physician involvement in cholesterol-lowering practices

Journal of Continuing Education in the Health Professions, 1996

The study tested a multifaceted educational intervention designed to increase physician cholester... more The study tested a multifaceted educational intervention designed to increase physician cholesterol-lowering practices. This three-group randomized controlled trial involved 51 Nova Scotia family physicians. Seventeen group I and 19 group IIphysicians attended a training workshop addressing the management of elevated serum cholesterol. Supporting print materials were provided for physicians and patients. Access to consultants was provided throughout the study. Group II physicians also used a "cuing" intervention to facilitate identification of eligible patients. Fifteen control group physicians received no intervention. Physician management practice was measured by medical record audit, dietary counselling practice by patient telephone interview. Patient serum cholesterol levels were measured on three occasions: baseline, 6 weeks, and 6 months. Physician patient management scores on chart audit were similar across study groups. Howevec physician dietary counselling scores were significantly higher for both intervention groups than the control. Patient serum cholesterol levels were not significantly different across study groups. Howevel; in the intervention groups, patients' low-density lipoprotein levels decreased significantly overall from baseline to second follow-up, compared to increases in the control group. This intervention produced a change in physician dietary counselling associated with lowered patient low-density lipoprotein levels. Physician behavior change, leading to small changes in cardiovascular risk, may contribute to improved patient health outcomes.

Videoconferencing for practice-based small-group continuing medical education: Feasibility, acceptability, effectiveness, and cost

Journal of Continuing Education in the Health Professions, 2003

Small-group, practice-based learning is an effective and well-accepted method of continuing medic... more Small-group, practice-based learning is an effective and well-accepted method of continuing medical education (CME). However, one limitation is that many physicians work in communities with fewer than the minimum number recommended for an effective learning group. Videoconferencing has the potential to remove this limitation. The purpose of this study was to evaluate the feasibility, acceptability, effectiveness, and cost of conducting practice-based, small-group CME learning by videoconference. Through a videoconferencing link, 10 learners in three communities were guided through four practice-based learning modules by a trained facilitator at a fourth site. Data were collected through evaluation questionnaires, direct observation by the research team, pre- and post-knowledge tests, a focus group, and an interview. A total of 31 learners participated in the four modules. Videoconferencing was generally well accepted by learners. The facilitator and research team observers noted that muting microphones, video quality, audio quality, and audio lag all somewhat hindered discussion. Overall, the facilitator found moderating by videoconference only slightly more difficult than a face-to-face session. There was evidence of knowledge gain, with post-test scores being 20% higher than pretest scores (p = .006). Learners reported nine practice changes from taking the modules. At commercial rates, telecommunications costs per videoconferenced module were approximately CAN$1,200. Videoconferencing has the potential to bring the benefits of small-group, practice-based learning to many physicians; however, strict attention to videoconferencing techniques is required. Cost is also an important consideration.

Living with haemophilia and HTV/AIDS: support and coping

Journal of Advanced Nursing, 2006

Achievement of Students in a Conventional and Problem-Based Learning (PBL) Curriculum

Advances in Health Sciences Education, 1999

This study compared student performance in problem-based (PBL) and conventional curricula on: 1) ... more This study compared student performance in problem-based (PBL) and conventional curricula on: 1) basic science knowledge following two preclinical years; 2) the Medical Council of Canada Qualifying Examination (MCC) Part I, written upon completion of the four year MD, and 3) Part II of the MCC Qualifying Examination, an assessment of clinical performance after 17 months of postgraduate education. Students

Providing evidence-based information to patients in general practice and pharmacies: what is the acceptability, usefulness and impact on drug use?

Health Expectations, 2003

Background A common and often integral method of delivering patient information is the use of pat... more Background A common and often integral method of delivering patient information is the use of patient guides. However, the acceptability, utility and impact of evidence-based therapeutic guides on physicians, pharmacists and patients have not been well evaluated. Methods This study was a prospective evaluation of 53 general practitioners' offices and 30 community pharmacies from three locations in Canada. Evidence-based guides were provided to 1176 patients who presented to either a general practitioner or a community pharmacist and were interested in receiving information about sore throat, heartburn, or osteoporosis ( canadadrugguide). The acceptability, utility and impact of the guides were assessed via structured patient telephone interviews, structured health professional interviews, and patient chart audits. Results Eighty to 90% of patients reported that the guides were Ôvery easyÕ to understand. Fifty six per cent/47%/38% (sore throat/ heartburn/osteoporosis) of patients rated the guides as ÔveryÕ or ÔextremelyÕ useful. Seventy-two per cent/67%/58% of respondents reported that the information helped them make decisions about their treatment. Ninety eight per cent of physicians and 92% of pharmacists reported that the guides helped their patients understand the issues involved in their treatment. None of the analyses showed any significant differences in prescribing of medications between the intervention and control groups. Interpretations Patients found these evidence-based guides to be useful, easy to understand, and that they helped them in their understanding of treatment options and the decision-making process. Physicians and pharmacists reported that the guides helped their patients understand the issues involved in their treatment. Further research is required to determine the degree to which providing evidence-based guides to patients can impact on prescribing and patient outcomes.

2010 Canadian Hypertension Education Program (CHEP) recommendations: The scientific summary – an update of the 2010 theme and the science behind new CHEP recommendations

by Simon Bacon and Karen Mann

Canadian Journal of Cardiology, 2010

To provide updated, evidence-based recommendations for the diagnosis and assessment of adults wit... more To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension. EvIdEnCE: MEDLINE searches were conducted from November 2008 to October 2009 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only. RECOmmEndaTIOnS: Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use