Janet P Hafler

Publications (13)37.99 Total impact

• Source

  Available from: Daniel A Leffler

  Article: Using medical students to enhance curricular integration of cross-cultural content.

  Helen M Shields, Vinod E Nambudiri, Daniel A Leffler, Chitra Akileswaran, Edith R Gurrola, Rachel Jimenez, Amy Saltzman, Peter A Samuel, Kara Wong, Augustus A White Iii, Janet P Hafler, Jane N Hayward, Stephen R Pelletier, Richard P O'Farrell, Paola G Blanco, Steven M Kappler, Roxana Llerena-Quinn
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  ABSTRACT: We hypothesized that an interested medical student group would be helpful in reviewing tutorial cases and giving relevant feedback on the curricular integration of cross-cultural content using case triggers in a preclinical gastrointestinal pathophysiology course. Self-selected student leaders (n = 9) reviewed pre-existing problem-based learning tutorial cases (n = 3) with cross-cultural triggers, and provided narrative feedback to course faculty. The cases were modified and used for the entire class in the following 2 years. Participating course students' comments and teaching faculty feedback were also noted. Outcomes were a change in case content, student global evaluations of the course, and self-reported faculty comfort with teaching the cases. All three tutorial cases were reviewed by a separate group of 2-3 students. Major and minor revisions were made to each case based on the student feedback. These cases were used in 2007 and 2008 and were the major change to the course during that time. Overall course evaluation scores improved significantly from 2006 to 2008 (p = 0.000). Tutors (n = 22 in 2007; n = 23 in 2008) expressed relief during tutor meetings that students had reviewed the cases. A general framework for eliciting student feedback on problem-based cases was developed. Student feedback, consisting of self-selected students' case reviews and solicited course and tutor comments, added value to a curricular reform to improve the integration of cross-cultural content into a problem-based learning curriculum. Our study underscores the fundamental link between teachers and students as partners in curricular development.
  The Kaohsiung journal of medical sciences 10/2009; 25(9):493-502. · 0.61 Impact Factor
• Source

  Available from: Daniel A Leffler

  Article: Integration of racial, cultural, ethnic, and socioeconomic factors into a gastrointestinal pathophysiology course.

  Helen M Shields, Daniel A Leffler, Augustus A White, Janet P Hafler, Stephen R Pelletier, Richard P O'farrell, Roxana Llerena-Quinn, Jane N Hayward, Sheila Salamone, Andrea M Lenco, Paola G Blanco, Antoinette S Peters
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  ABSTRACT: Our study describes a faculty development program to encourage the integration of racial, cultural, ethnic, and socioeconomic factors such as obesity, inability to pay for essential medications, the use of alternative medicine, dietary preferences, and alcoholism in a gastrointestinal pathophysiology course. We designed a 1-hour faculty development session with longitudinal reinforcement of concepts. The session focused on showing the relevance of racial, ethnic, cultural, and socioeconomic factors to gastrointestinal diseases, and encouraged tutors to take an active and pivotal role in discussion of these factors. The study outcome was student responses to course evaluation questions concerning the teaching of cultural and ethnic issues in the course as a whole and by individual tutorials in 2004 (pre-faculty development) and in 2006 to 2008 (post-faculty development). Between 2004 and 2008, the proportion of students reporting that "Issues of culture and ethnicity as they affect topics in this course were addressed" increased significantly (P = .000). From 2006 to 2008, compared with 2004, there was a significant increase in the number of tutors who "frequently" taught culturally competent care according to 60% or greater of their tutorial students (P = .003). The tutor's age, gender, prior tutor experience, rank, and specialty did not significantly impact results. An innovative faculty development session that encourages tutors to discuss racial, cultural, ethnic, and socioeconomic issues relevant to both care of the whole patient and to the pathophysiology of illness is both effective and applicable to other preclinical and clinical courses.
  Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 11/2008; 7(3):279-84. · 5.64 Impact Factor
• Article: Spaced education improves the feedback that surgical residents give to medical students: a randomized trial.

  Kimberly A Matzie, B Price Kerfoot, Janet P Hafler, Elizabeth M Breen
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  ABSTRACT: Surgery residents teach medical students; feedback is one critical teaching skill. We investigated whether feedback given by surgery residents to students could be improved through an online spaced education program. Surgery residents were randomized to receive either a weekly spaced education e-mail during a 9-month period containing teaching bullets on how to provide effective feedback, or no intervention. Medical students rated the frequency and quality of feedback they received from the residents. Students reported 45% (67 of 149) of the spaced education residents gave frequent feedback, compared with 31% (55 of 175) of control residents (relative risk [RR], 1.43; P = .016). Students reported resident feedback was "helpful in their learning" in 92% (132 of 143) of their evaluations of spaced education residents, compared with 82% (132 of 161) of their evaluations of control residents (RR, 1.13; P = .01). Educational programs using feedback bullets e-mailed weekly can significantly improve the frequency and quality of feedback that surgical residents provide medical students.
  American journal of surgery 09/2008; 197(2):252-7. · 2.36 Impact Factor
• Article: Formal art observation training improves medical students' visual diagnostic skills.

  Sheila Naghshineh, Janet P Hafler, Alexa R Miller, Maria A Blanco, Stuart R Lipsitz, Rachel P Dubroff, Shahram Khoshbin, Joel T Katz
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  ABSTRACT: Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation. To improve students' visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care. Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis. Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training. Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session. The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation. Following the course, class participants increased their total mean number of observations compared to controls (5.41 +/- 0.63 vs. 0.36 +/- 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A 'dose-response' was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03). This interdisciplinary course improved participants' capacity to make accurate observations of art and physical findings.
  Journal of General Internal Medicine 07/2008; 23(7):991-7. · 2.83 Impact Factor
• Source

  Available from: Elizabeth A Rider

  Article: Pediatric residents' perceptions of communication competencies: Implications for teaching.

  Elizabeth A Rider, Kevin Volkan, Janet P Hafler
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  ABSTRACT: Medical regulatory organizations worldwide require competency in communication skills. Pediatric communication competencies are unique, and little is known about pediatric residents' perceptions regarding these skills. The purpose of this study was to examine pediatric residents' attitudes about communication skills, their perceptions of the importance of learning 15 specific communication skills relevant to pediatrics, confidence in these skills, and relevant program supports. We developed a 47-item cross-sectional questionnaire to study pediatric residents' attitudes and perceptions regarding communication competencies. 104 pediatric housestaff in a university-affiliated program in the US were asked to complete the questionnaire. Scale variables were created and evaluated for reliability. Data were analysed using descriptive and univariate statistics. Response rate was 86% (89/104). Cronbach's alpha reliabilities of the Importance Scale (r = 0.92) and Confidence Scale (r = 0.90) were excellent. Ninety nine percent of the participants agreed that learning to communicate effectively with patients was a priority. All agreed it is important to demonstrate empathy and caring, and to teach medical students to communicate effectively with patients. Pediatric residents agreed that the 15 communication competencies studied were important to learn. Most reported confidence in core communication competencies (interviewing, listening, building rapport, demonstrating caring and empathy), but only half or fewer were confident in 7 more advanced communication skills (ability to discuss end-of-life issues, speaking with children about serious illness, giving bad news, dealing with the 'difficult' patient/parent, cultural awareness/sensitivity, understanding psychosocial aspects, and understanding patients' perspectives). Few reported the availability of relevant program supports for learning these skills. Pediatric residents perceive communication competencies as important and a priority for learning, yet report a lack of confidence in advanced communication skills and insufficient program supports. Our measurement scales can add to the evaluation of residency programs, and may provide suggestions for pediatric curricular content in core and advanced communication skills.
  Medical Teacher 02/2008; 30(7):e208-17. · 1.22 Impact Factor
• Article: The ACGME competencies in the operating room.

  Jacob A Greenberg, Jennifer L Irani, Caprice C Greenberg, Maria A Blanco, Stuart Lipsitz, Stanley W Ashley, Elizabeth M Breen, Janet P Hafler
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  ABSTRACT: In 1999, the ACGME introduced the 6 competencies that have become the basis for resident education. Since the operating room (OR) has traditionally been the major focus for resident teaching in surgery, we performed an observational study to determine whether it is an appropriate setting for the teaching and/or assessment of the competencies. A 3-person team observed 11 operations and recorded all teaching events. Observers then determined whether each event involved the teaching of a competency by faculty or demonstration of a competency by residents. Frequency counts, mean times, and ranges were calculated for each competency taught and demonstrated. The Patient Care competency was both the most commonly taught and demonstrated. Faculty spent an average of 33% of operative time instructing in patient care, and residents demonstrated it 65% of the time. The Interpersonal/Communication Skills (4%) and Practice-Based Learning/Improvement (4%) competencies were also occasionally demonstrated by residents. The remaining competencies were addressed less frequently. OR teaching was primarily devoted to the Patient Care competency. The OR was also an appropriate setting for evaluating resident performance in this area. New approaches to OR teaching or educational efforts in other settings such as the clinic are necessary for teaching and assessing the remaining competencies.
  Surgery 09/2007; 142(2):180-4. · 3.10 Impact Factor
• Article: A faculty development program to train tutors to be discussion leaders rather than facilitators.

  Helen M Shields, Daniel Guss, Samuel C Somers, B Price Kerfoot, Brian S Mandell, Win J Travassos, Sonal M Ullman, Seema Maroo, James P Honan, Laurie W Raymond, Eric M Goldberg, Daniel A Leffler, Jane N Hayward, Stephen R Pelletier, Alexander R Carbo, Laurie N Fishman, Barbara J Nath, Michele A Cohn, Janet P Hafler
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  ABSTRACT: During 2003, 2004, and 2005, the role of 70 tutors was changed from that of facilitator to discussion leader, in a preclinical PBL learning course, Gastrointestinal Pathophysiology, by use of three key business school teaching strategies: questions, summaries, and schematics. The purpose of this study was to learn what difference this new approach made. During each of the three study years, 171 (2003), 167 (2004), and 170 (2005) students were given Likert-scale attitudinal questionnaires to rate whether their tutors encouraged student direction of the tutorials and whether the summaries and closure schematics benefited their learning. Students' overall course evaluations and mean USMLE scores were quantitatively analyzed, pre- and postintervention. A variety of statistical tests were used to assess the statistical significance of means at the confidence level of .05. In the third year of the program, student ratings indicated that their tutors were significantly better at encouraging student direction of the tutorials than in the first year (P < .05). The students reported that the tutorial made a more important contribution to their learning (P < .05), and the course objectives were better stated (P = .038) and better met (P = .007). Overall satisfaction with the course also improved significantly (P = .006). Part I gastrointestinal system mean scores of the USMLE showed a statistically significant increase in 2005 compared with 2001 or 2002. The tutor as a discussion leader who questions, summarizes, and uses schematics to illustrate concepts had a significant and positive impact on learning in tutorials, achieving course objectives, improving overall course satisfaction, and increasing a standardized national exam's mean score.
  Academic Medicine 05/2007; 82(5):486-92. · 3.52 Impact Factor
• Article: The impact of duty hour restrictions on teaching by surgical residents.

  B Price Kerfoot, Kate S Nabha, Janet P Hafler
  Medical Education 06/2005; 39(5):528-9. · 3.18 Impact Factor
• Source

  Available from: Kevin Volkan

  Article: Developing and evaluating a residents' curriculum.

  Janet P Hafler, Kara M Connors, Kevin Volkan, Henry H Bernstein
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  ABSTRACT: This study examines the impact of a Bright Futures-based curriculum designed to teach pediatric residents how to integrate health education principles into everyday clinical practice. A two-phase study was conducted to evaluate the curriculum using both quantitative and qualitative methods. To measure the curriculum's impact on residents' clinical performance, a pre- and post-objective structured clinical examination (OSCE) design was administered to 14 residents in two groups: a control group (n=8) and an intervention group (n=6). Performance scores improved in the intervention group from pre- to post-testing in three core curriculum concepts (there was no change in the control group); performance in a fourth concept improved in both groups; and for the remaining two concepts, there was no change among the intervention group but an improvement in scores among those in the control group. Residents in the intervention group reported the curriculum to be of high quality and low difficulty. This study demonstrated that the curriculum had a positive impact on a resident's perceptions of his or her practice one year after participating in the intervention. The data suggest that each of the modules can be taught, the content learned and the principles applied to one's clinical practice.
  Medical Teacher 06/2005; 27(3):276-82. · 1.22 Impact Factor
• Source

  Available from: jhmi.edu

  Article: Influence of new educational technology on problem-based learning at Harvard Medical School.

  B Price Kerfoot, Barbara A Masser, Janet P Hafler
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  ABSTRACT: Computers with 50-inch, wall-mounted plasma screens and broadband Internet access were installed in all small group tutorial rooms at Harvard Medical School. This study examines how the introduction of this educational technology impacted on the problem-based learning tutorials. A total of 37 tutorial groups, stratified by year of student, were observed at separate timepoints (autumn 2002, spring 2003) to document the patterns of use of the technologies. Based on these observations, end-of-course surveys were developed and distributed to students and tutors. Observational field notes and open-ended survey responses were qualitatively analysed for themes. Using a 5-point rating scale, both students and tutors indicated that the technologies had a positive impact on their tutorials. In autumn 2002, plasma screens were used for an average of 17.8 and 22.1 minutes per 1-hour observation in Year 1 and 2 tutorials, respectively; in spring 2003, usage declined to 6.9 and 5.9 minutes, respectively. Resources utilised included Internet sites (54% total use time), PowerPoint presentations by students (22%), and course-specific postings (24%). Marked course-specific variation in usage was noted. Observational and survey data revealed that the technologies interrupted the flow of tutorial discussion. Students and tutors expressed concerns that the plasma screens might be altering the process of problem solving in the tutorials. Both students and tutors reported that the introduction of computers and wall-mounted plasma screens had impacted positively on tutorials. Questions were raised as to how this technology might alter tutorial dynamics. Further research will be needed to investigate these pedagogical concerns.
  Medical Education 05/2005; 39(4):380-7. · 3.18 Impact Factor
• Article: Impact of a preventive medicine and nutrition curriculum for medical students.

  Molly B Conroy, Helen K Delichatsios, Janet P Hafler, Nancy A Rigotti
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  ABSTRACT: United States public health goals call for increased physician counseling about diet and exercise, but many medical schools lack adequate curriculum on these topics. At Harvard Medical School, second-year students take a preventive medicine and nutrition (PMN) course. This study evaluated the impact of this innovative curriculum on students' confidence about addressing patients' diet and exercise patterns and on their own health habits. Students enrolled in the 2003 PMN course (N =137) completed a confidential 43-item written survey before and after the course. Surveys were completed by 134 students (98%) and 118 students (86%), respectively. The survey assessed students' diet and exercise habits and students' confidence in their ability to address diet and exercise with patients and family members. Students' confidence in their ability to assess and counsel about diet and exercise significantly improved after the course (all p <0.001). The course was also associated with a decrease in students' self-reported consumption of saturated fat (p =0.002) and trans fatty acids (p <0.001). Following the course, 72% of students perceived an improvement in their diet but only 18% perceived an improvement in exercise habits. An innovative PMN course improved medical students' confidence in diet and exercise counseling and perceived dietary habits. Improving these mediators of physician counseling in medical students may translate into changes in their practice patterns.
  American Journal of Preventive Medicine 07/2004; 27(1):77-80. · 4.04 Impact Factor
• Article: How does the introduction of computers and wall-mounted plasma screens Impact small group tutorials? Preliminary results.

  B Price Kerfoot, Barbara A Masser, Janet P Hafler
  Medical Education 06/2003; 37(5):478-9. · 3.18 Impact Factor
• Article: Residents as teachers: a process for training and development.

  Janet P Hafler
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  ABSTRACT: Of the many roles that residents fill, an important one is that of teacher. Residents spend many hours teaching a variety of learners-peers, patients, medical students, the general public-in a range of environments, from the bedside and clinic, to the OR, conference room and lecture hall. Such diverse audiences and surroundings almost command the use of a wide array of teaching strategies appropriate both to the setting and to the learner. This paper addresses how residents can learn to be effective teachers without taxing an already-overloaded schedule. This focus is on the process of developing a learning format that is appropriate to any given discipline by means of a partnership among an educator, a faculty member and residents from within a discipline. A brief review of the educational literature provides the basis on which are built actual teaching strategies for teaching residents to be teachers.
  Journal of Nutrition 03/2003; 133(2):544S-6S. · 3.92 Impact Factor