resident evaluation of a web-based integrative medicine curriculum: the function of formative...
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Resident Evaluation of a Web-based Integrative Medicine Curriculum: The Function of Formative Evaluation
Ben Kligler, M.D., Patricia Lebensohn, M.D., Sally Dodds, Ph.D., Raymond Teets, M.D., & Victoria Maizes, M.D.
Presentation Objectives
The objectives of this presentation are to:
▫ Describe the function of formative evaluation for curriculum development.
▫ Review the results from learners’ evaluation of the Integrative Medicine in Residency curriculum.
▫ Describe the procedures used in applying feedback from learners’ evaluations to guide curriculum changes and revisions.
Integrative Medicine in Residency (IMR) is…
• Competency-based, online, 200-hour, curriculum.• In-depth training in Integrative Medicine.• Incorporated through all 3 years of Family Medicine
residency.• Piloted at 8 residencies nationwide.• Seamless, online evaluation of the curriculum and the
residents.• Responds to ACGME competency requirements.• Evaluation developed simultaneously with the
curriculum.
University of Arizona
University of Texas Medical Branch
Hennepin County
Carolinas Medical Center
Beth Israel
Maine-Dartmouth
Maine Medical Center
University of Connecticut
IMR Program Locations
Tools in Integrative Medicine
Prevention and
Wellness
Women’s Health
Chronic Illness
Pediatrics
Acute Care
IMR Curriculum Units
Introduction to Integrative Medicine
Prevention and Wellness:• U.S. Preventive Health Services• Nutrition and Diet • Supplements for Prevention• Physical Activity• Sleep • Stress and Mind-Body Medicine • Spirituality• Clinical Integration
Tools in Integrative Medicine:• Integrative Medicine Intake and Care Plan • Botanicals• Mind-Body Medicine• Manual Medicine • Introduction to Energy Medicine and Whole
Systems • Practice Management• Motivational Interviewing for Behavioral
Change
Acute Care:• Acute Back Pain,• Urinary Tract Infection,• Gastroenteritis,• Otitis Media,• Vaginitis,• Atypical Chest Pain,• Upper Respiratory Infection
Pediatric Topics:• ADD/ADHD• Chronic Pain Syndrome• Asthma and Allergies
Women’s Health Topics:• PMS/PMDD• Dysmenorrhea• Menopause• Fibromyalgia• Osteoporosis • Depression • Eating Disorders • Pregnancy and Lactation
Chronic Illness: • Cardiovascular Disease• Type II Diabetes• Osteoarthritis • Rheumatoid Arthritis• Obesity • Irritable Bowel Syndrome• Chronic Back Pain
Special Topics:• HIV/AIDS • Cancer Survivorship• Environmental Medicine
Units and Courses
IMR: Educational Methods Needs assessment informed curriculum design. Web-based curriculum written and edited by
Integrative Medicine educators. Competencies aligned with the ACGME Outcomes
Project. Flexible modular format to meet the needs of
residency schedules. Case-based, interactive learning and streaming
video. Experiential exercises and process-oriented group
activities at the residency sites. A community of learners through online dialogues
with faculty and peers. Emphasis on teaching and promoting physician
well-being and self-care.
IMR User Interface
Online portfolios
Flexible modular format
Resources and Links
Direct Observation Checklists
Reflections
“When the cook tastes the soup, that’s formative; when the guests taste the soup, that’s summative.” - Robert Stakes
What is Formative Evaluation?
Formative Evaluation…
• Helps form and strengthen programs by:▫ Examining the need for them,▫ Their delivery or technology▫ The quality of their implementation▫ Assessing their organizational contexts, procedures, and
resources (Scriven, 1991).
• Methods emphasize data collection and analysis prior to completion.
Why Use Formative Evaluation in the IMR?
• Medical knowledge in Integrative Medicine is dynamic, evolving rapidly; revisions are largely driven by new information.
• Distributed, web-based curricula requires feedback from learners to be successful.
• In the IMR, formative methods include:1.Preliminary needs assessment2.Feedback from resident evaluation of courses
1. IMR Needs Assessment(Benn, Maizes, Guerrera, Sierpina, Cook, & Lebensohn, 2009)
• Methods▫ 222 faculty and residents from 8 family medicine
programs (60.2% response rate).▫ Online survey w/ structured and open-ended questions.
• Results▫ Preferred IM be woven throughout all curriculum areas
(67%).▫ Top topics: Nutrition, Supplements, and Physician
Wellness.▫ Top curricular areas for IM enhancement: Chronic
illness, behavioral health, and outpatient medicine▫ Viewed IM central to family medicine training, patient
care, and the field of family medicine (84%). ▫ Top challenges: Limitations in time, resources, and
acceptance.
2. IMR Course Evaluations
• Measures assess learners’ ratings of the course in:▫ Meeting course objectives▫ Clinical utility of the course▫ Time needed to complete the course▫ Functionality of the online technology
Analyzed when 50% of pilot residents complete a course.▫ Ratings < 8o% and open-ended comments targeted for review.
Review of 01 pilot group suggested Likert-type response categories be changed from 4 to 5 points to increase precision and variability.
Resident Demographics2011 (n =
67)2012 (n = 64) Controls (n = 31)
SexFemaleMale
64%36%
64%36%
45%55%
Mean Agerange
32 (27 – 43)
32(24 – 56)
30(26 – 38)
Marital StatusMarriedLive w/ partnerSingleUnk.
45%13%27%15%
27% 6%34%33%
58%10%32%0%
Graduate StatusUS MDUS DOFMGUnk.
51%18%27% 4%
41%26%28% 5%
55%16%16%13%
Did Course Meet Learning Objectives?Year 01 Content
Intro
Prev
en...
Nut
rition
Suppl
em...
Phys
Ac...
Stres
s...
Sleep
Spirit
ua...
Clin In
teg
92%94% 94%
82%
91%
95% 94%
89%
95%92%
94%96%
91%
Very definitely/Definitely
2011 2012
*Currently, data are available for 4 courses for the 2012 class.
Clinical Utility of the Course?Year 01 Content
Intro
Prev
entio
n
Nut
rition
Suppl
em...
Phys
Ac...
Stres
s...
Sleep
Spirit
ualit
y
Clin In
teg
78%
95% 93%99% 96%
89% 91%
47%
93%
74%
96% 97%86%
Very Useful/Useful
2011 2012
*Currently, indicators are available for 4 courses for the 2012 class.
How Smooth was the Online Technology?Year 01 Content
Intr
o
Preve
n...
Nutr
ition
Supplem
...
Phys A
c...
Stres
s...
Sleep
Spiritu
a...
Clin In
teg
78%
91% 95% 97% 94% 90% 93%
81% 85%82% 83%94% 94%
Very Smoothly/Smoothly
2011 2012
*Currently, indicators are available for 4 courses for the 2012 class.
Meet Learning Objectives? Clinical Utility?
ADHD Allergy, Asth
Pedi Pain
PMD/PMDD
100% 98% 100%94%
Very Useful/Useful
ADHD Allergy, Asth
Pedi Pain
PMD/PMDD
97% 98% 100% 100%Very Definitely/Definitely
Year 02 Course EvaluationsCourses currently at 50% threshold
Year 02 Course EvaluationsCourses currently at 50% threshold
Smooth Online technology?
ADHD Allergy, Asth
Pedi Pain
PMD/PMDD
92%
82%
100%
77%
Very smooth/Smooth
Length of Time SpentYear 01 &Year 02 Content
Class Course < 1 hr 1-2 hr 2-3 hr 3-4 hr 4-5 hr 5-6 hr
2011 Introduction 34% 44% 13% 5% 4%
2012 34% 36% 26% 4%
2011 Supplements 32% 35% 12% 12% 5% 3%
2012 50% 36% 9% 5%
2011 Nutrition & Diet 13% 25% 31% 16% 6% 7%
2012 21% 42% 29% 4% 4%
2011 Physical Activity 61% 38% 2%
2012 66% 28% 7%
2011 Stress & Mind Body 34% 43% 17% 3% 2%
2011 Spirituality 72% 26% 2%
2011 Sleep & Health 94% 6%
2011 Preventive Services 59% 32% 7%
2011 Clinical Integration 17% 38% 21% 8% 9% 8%
2011 Allergy/Asthma 11% 43% 27% 11% 3% 5%
2011 ADHD 48% 48% 4%
2011 Pediatric Pain 55% 27% 14% 4%
2011 PMD/PMDD 53% 40% 7%
Year 1
Year2
What Residents Say…
I enjoyed the interactive nature of the modules.
The tools are amazing!Did an excellent job of relating
spirituality to health care.I think sleep is one thing most
neglected in health care topics. This course has rightly identified it.
The ability to self reflect as well as think about our patients.
I loved the video lecture – very engaging and interesting.
This is a very comprehensive topic.Great links and resources.The seven cases. Great way to pull all
of these courses together!
The buttons aren’t working.There was a lot of data in this module
[Nutrition and Diet], but not enough interactive learning.
Too lengthy and too in-depth.Some links were not available.Too many resources were given and I
did not have enough time to thoroughly review them.
Too much reading, too many links, and too many videos.