Papers by Sylvia Bereknyei Merrell
American journal of surgery, Jan 19, 2015
The flipped classroom has been proposed as an alternative curricular approach to traditional dida... more The flipped classroom has been proposed as an alternative curricular approach to traditional didactic lectures but has not been previously applied to a surgery clerkship. A 1-year prospective cohort of students (n = 89) enrolled in the surgery clerkship was taught using a flipped classroom approach. A historical cohort of students (n = 92) taught with a traditional lecture curriculum was used for comparison. Pretest and post-test performance, end-of-clerkship surveys, and National Board of Medical Examiners (NBME) scores were analyzed to assess effectiveness. Mean pretest and post-test scores increased across all modules (P < .001). There was no difference between mean NBME examination score in the prospective and historical cohorts (74.75 vs 75.74, P = .28). Mean ratings of career interest in surgery increased after curriculum completion (4.75 to 6.50, P < .001), with 90% reporting that the flipped classroom contributed to this increase. Implementation of a flipped classroom ...
Joint Commission journal on quality and patient safety / Joint Commission Resources, 2015
Emergency manuals (EMs)-context-relevant sets of cognitive aids such as crisis checklists-are use... more Emergency manuals (EMs)-context-relevant sets of cognitive aids such as crisis checklists-are useful tools to enhance perioperative patient care. Studies in high-hazard industries demonstrate that humans, regardless of expertise, do not optimally retrieve or deploy key knowledge under stress. EM use has been shown in both health care simulation studies and other industries to help expert teams effectively manage critical events. However, clinical adoption and use are still nascent in health care. Recognizing that training with, access to, and cultural acceptance of EMs can be vital elements for successful implementation, this study assessed the impact of a brief in situ operating room (OR) staff training program on familiarity with EMs and intention to use them during critical events. Nine 50-minute training sessions were held with OR staff as part of a broader perioperative EM implementation. Participants primarily included OR nurses and surgical technologists. The simulation-based...
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, Jan 21, 2015
ABSTRACT Beginning in April 2015, students seeking admission to medical school will take the fift... more ABSTRACT Beginning in April 2015, students seeking admission to medical school will take the fifth version of the Medical College Admission Test (MCAT). The MCAT2015 will in many respects resemble the MCAT1991, but differences between the two tests are important, especially for the profession of psychiatry. The MCAT2015 is in part a response to “outreach and survey data [that] highlighted ethics, philosophy, cultural studies, and population health as important new disciplines to include” [1, p. 563]. The new exam will continue to emphasize basic biomedical sciences and yet will give greater attention to “concepts that tomorrow’s doctors need to know in order to serve an increasingly diverse population and have a clear understanding of the impact of behavior on health” [2]. As the Association of American Medical Colleges (AAMC) [3] states regarding the new exam:“The natural sciences sections reflect recent changes in science and medical education; the addition of the social and behavioral scienc ...
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013
Sexually Transmitted Infections, 2013
The number of persons living with HIV/AIDS, the number of new infections and the number of person... more The number of persons living with HIV/AIDS, the number of new infections and the number of persons at risk for HIV infection are the foundations of evidence-based prevention, treatment and care planning. However, few jurisdictions have complete and accurate estimates of these indicators. HIV/AIDS case reporting, which includes only persons diagnosed with infection and reported to health departments, does not reflect all HIV/AIDS cases, thus underestimating the true size of the epidemic. Obtaining direct measures of HIV incidence is methodologically challenging. Moreover, no censuses exist for the number of persons at highest risk for infection, including men who have sex with men (MSM). We present an approach of triangulation that draws upon multiple empirical and overlapping sources of information through different methods to synthesise data-based estimates of the prevalence, incidence and denominator of MSM at risk for infection in San Francisco. We further use existing data to establish plausible upper and lower bounds for each estimate. We arrived at an overall population size of 66 487 of MSM in San Francisco as of 31 December 2010. The number of MSM living with HIV/AIDS was 15 873, corresponding to an HIV prevalence of 23.9%. We projected 806 new cases in 2010, translating to an incidence rate of 1.59% per year. While not without limitations, our estimates provide useful information for the purpose of HIV/AIDS prevention and care planning, drawing from diverse sources that may be available in local health jurisdictions. We believe that our approach enhances the credibility of such estimates by mitigating bias from only one source of data or one methodological approach.
Journal of General Internal Medicine, Mar 30, 2010
Collective lessons learned from curriculum implementation by principal investigators (PIs) have t... more Collective lessons learned from curriculum implementation by principal investigators (PIs) have the potential to guide similar educational endeavors.
Academic Medicine, 2015
To systematically review the evidence for high-quality and effective educational strategies to tr... more To systematically review the evidence for high-quality and effective educational strategies to train health care professionals across the education continuum on chronic disease care. A search of English-language publications and conference proceedings was performed in November 2013 and updated in April 2014. Studies that evaluated a newly developed curriculum targeting chronic disease care with learner outcomes were included. Two primary reviewers and one adjudicating reviewer evaluated the studies and assessed their quality using the validated Medical Education Research Study Quality Instrument (MERSQI). Studies were also mapped onto elements of Wagner&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s chronic care model (CCM) to evaluate their use of established evidence-based models for chronic care delivery. Miller&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s classification of clinical competence was used to assess the quality of learner achievements for each educational intervention. A total of 672 articles were found for this review. Twenty-two met criteria for data extraction. The majority of studies were of moderate quality according to MERSQI scoring. Only three studies reported both learner and patient outcomes. The highest-quality studies incorporated more elements of Wagner&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s CCM and showed high-level learner competence according to Miller&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s classification. Successful interventions redesigned health care delivery systems to include team-based care, emphasized training of health care professionals on patient self-management, and included learner-based quality improvement initiatives. The growing number of children and adults with chronic disease necessitates improved educational interventions for health care professionals that involve evidence-based models for restructuring chronic care delivery, aim for high-level learner behavioral outcomes, and evolve through quality improvement initiatives.
MedEdPORTAL Publications, 2009
Academic Medicine, 2014
A faculty development curriculum aimed at increasing health literacy and awareness of patient car... more A faculty development curriculum aimed at increasing health literacy and awareness of patient care issues in ethnogeriatrics is essential to address serious deficiencies in faculty and health professionals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; training and to prepare future health care professionals to care for older adults. Authors from the Stanford Geriatric Education Center developed and implemented a faculty development program in Health Literacy and Ethnogeriatrics (HLE). The goal was to enhance faculty and health professionals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge, skills, and attitudes in HLE-related areas (e.g., health disparities, low health literacy, quality of care for ethnically diverse elders, patient/provider communication). The curriculum was implemented during an intensive weeklong program over a three-year period (2008-2010). The eight-module core curriculum was presented in a train-the-trainer format, supplemented by daily resource sessions. Thirty-four faculty participants from 11 disciplines, including medicine, came from 19 institutions in 12 states. The curriculum positively affected participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge, skills, and attitudes related to topics in HLE. Participants rated the curriculum&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s usefulness highly, and they reported that over 57% of the content was new. The HLE curriculum provided a mechanism to increase the self-assessed knowledge, skills, and attitudes of participants. It also fostered local curricular change: Over 91% of the participants have either disseminated the HLE curriculum through seminars conducted at their home sites or implemented HLE-related projects in their local communities, reaching diverse patient populations. Next steps include measuring the impact on the participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; teaching skills and at their home sites through their trainees and patients.
MedEdPORTAL Publications, 2015
Academic Medicine, 2014
To quantify the prevalence of social and behavioral sciences (SBS) topics during patient care and... more To quantify the prevalence of social and behavioral sciences (SBS) topics during patient care and to rate team response to these topics once introduced. This cross-sectional study used five independent raters to observe 80 inpatient ward teams on internal medicine and pediatric services during attending rounds at two academic hospitals over a five-month period. Patient-level primary outcomes-prevalence of SBS topic discussions and rate of positive responses to discussions-were captured using an observational tool and summarized at the team level using hierarchical models. Teams were scored on patient- and learner-centered behaviors. Observations were made of 80 attendings, 83 residents, 75 interns, 78 medical students, and 113 allied health providers. Teams saw a median of 8.0 patients per round (collectively, 622 patients), and 97.1% had at least one SBS topic arise (mean = 5.3 topics per patient). Common topics were pain (62%), nutrition (53%), social support (52%), and resources (39%). After adjusting for team characteristics, the number of discussion topics raised varied significantly among the four services and was associated with greater patient-centeredness. When topics were raised, 38% of teams&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; responses were positive. Services varied with respect to learner- and patient-centeredness, with most services above average for learner-centered, and below average for patient-centered behaviors. Of 30 SBS topics tracked, some were addressed commonly and others rarely. Multivariable analyses suggest that medium-sized teams can address SBS concerns by increasing time per patient and consistently adopting patient-centered behaviors.
Objective: Existing observational data describing rounds in teaching hospitals are 15 years old, ... more Objective: Existing observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty, institution, patient-census, and team participants upon time at the bedside and education occurring on rounds.
MedEdPORTAL Publications, 2012
Patient Education and Counseling, 2012
Objective-To explore older adults' views of existing Informed Decision Making (IDM) elements and ... more Objective-To explore older adults' views of existing Informed Decision Making (IDM) elements and investigate the need for additional elements.
Medical Decision Making, 2012
To measure the extent of informed decision making (IDM) about prostate cancer screening in physic... more To measure the extent of informed decision making (IDM) about prostate cancer screening in physician-patient encounters, describe the coding process, and assess the reliability of the IDM measure. Audiorecoded encounters of 146 older adult men and their primary care physicians were obtained in a randomized controlled trial of mediated decision support related to prostate cancer screening. Each encounter was dual coded for the presence or absence of 9 elements that reflect several important dimensions of IDM, such as information sharing, patient empowerment, and engaging patients in preference clarification. An IDM-9 score (range = 0-9) was determined for each encounter by summing the number of elements that were coded as present. Estimates of coding reliability and internal consistency were calculated. Male patients tended to be white (59%), married (70%), and between the ages of 50 and 59 (70%). Physicians tended to be white (90%), male (74%), and have more than 10 years of practice experience (74%). IDM-9 scores ranged from 0 to 7.5 (mean [SD], 2.7 [2.1]). Reliability (0.90) and internal consistency (0.81) of the IDM-9 were both high. The IDM dimension observed most frequently was information sharing (74%), whereas the dimension least frequently observed was engagement in preference clarification (3.4%). In physician-patient encounters, the level of IDM concerning prostate cancer screening was low. The use of a dual-coding approach with audiorecorded encounters produced a measure of IDM that was reliable and internally consistent.
Medical Care, 2008
Excellent communication between surgeons and patients is critical to helping patients to make inf... more Excellent communication between surgeons and patients is critical to helping patients to make informed decisions and is a key component of both high quality of care and patient satisfaction. Understanding racial disparities in communication is essential to provide quality care to all patients. To examine the content and process of informed decision-making (IDM) between orthopedic surgeons and elderly white versus African American patients. To assess the association of race and patient satisfaction with surgeon communication. Analysis of audiotape recordings of office visits between orthopedic surgeons and patients. Eighty-nine orthopedic surgeons and 886 patients age 60 years or older in Chicago, Illinois. Tapes were analyzed by coders for content using 9 elements of IDM and for process using 4 global ratings of the relationship-building component of communication (responsiveness, respect, listening, and sharing). Ratings by race were compared using chi analysis. Patients completed a questionnaire rating satisfaction with surgeon communication and the visit overall. Logistic analysis was used to assess the effect of race on satisfaction. Overall there were practically no significant differences in the content of the 9 IDM elements based on race. However, coder ratings of relationship were higher on 3 of 4 global ratings (responsiveness, respect, and listening) in visits with white patients compared with African American patients (P &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;lt; 0.01). Patient ratings of communication and overall satisfaction with the visit were significantly higher for white patients. The content of IDM conversations does not differ by race. Yet differences in the process of relationship building and in patient satisfaction ratings were clearly present. Efforts to enhance cultural communication competence of surgeons should emphasize the skills of building relationships with patients in addition to the content of IDM.
Journal of General Internal Medicine, 2007
BACKGROUND: Increasing prevalence of limited English proficiency patient encounters demands effec... more BACKGROUND: Increasing prevalence of limited English proficiency patient encounters demands effective use of interpreters. Validated measures for this skill are needed.
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Papers by Sylvia Bereknyei Merrell