Shmuel Reis
The Hebrew University of Jerusalem, Medicine, Department Member
- Bar-Ilan University, Faculty Development, Faculty Memberadd
- Shmuel Reis MD MHPE. is a family physician in Northern Israel, more than 40 years in practice . He is Academic Head o... moreShmuel Reis MD MHPE. is a family physician in Northern Israel, more than 40 years in practice . He is Academic Head of the Center for medical Education in the Hebrew U/Hadassah Faculty of medicine, Jerusalem, Israel. He was also the chair of the Israeli Association for Medical Education (HEALER). He is Professor emeritus and former chair of Faculty Development and Clinical Skills course director in the Bar Ilan University Azrielli Faculty of Medicine in the Galilee and past Chairperson of the Division of Family Medicine and past-chair of Medical Education in the Technion [Israel Institute of Technology] Rappaport Faculty of Medicine, Haifa, Israel. He also coordinated the Galil Center for Medical Informatics and Telemedicine in the same faculty. His Master of Health Professions Education was earned in Maastricht, Holland in a combined web-based and residential program two decade ago. His present focus is on the teaching and learning of doctoring, reflective competence, communication skills, Patient-Doctor-Computer communication, professionalism , and Holocaustedit
Research Interests:
Competence-based medical education (CBME) re-shaped medical education in North America and in Europe and is making its first steps in Israel in recent years. This article reviews the literature regarding the Mini-Clinical Evaluation... more
Competence-based medical education (CBME) re-shaped medical education in North America and in Europe and is making its first steps in Israel in recent years. This article reviews the literature regarding the Mini-Clinical Evaluation Exercise (mini-CEX), a tool for the evaluation of clinical competencies in CBME. The mini-CEX has been adopted by the American Board of Internal Medicine (ABIM) and the European Federation of Internal Medicine (EFIM) and is cited in leading documents of these organizations on medical education. The mini-CEX allows direct observation on a clinical encounter of a learner (medical student or resident) and a patient by a skilled clinician (observer). The mini-CEX provides the basis for the provision of feedback to the learner by the observer following the observation.
Research Interests:
ABSTRACT hPurpose/Objective: As electronic medical records (EMRs) become ubiquitous, concerns have been raised about their impact on patient-clinician communication. Communication has been associated with patient satisfaction, conflict... more
ABSTRACT hPurpose/Objective: As electronic medical records (EMRs) become ubiquitous, concerns have been raised about their impact on patient-clinician communication. Communication has been associated with patient satisfaction, conflict resolution, adherence to treatment, and a myriad of health outcomes. Research has shown that the use of EMRs affects patient consultation various ways. On the positive side, the use of EMR improves the exchange of medical information between physicians and patients. However, it often interferes with maintaining eye contact, establishing rapport, and psychological and emotional communication. In previous research, we identified strategies and best practices employed by physicians to minimize the negative impacts and maximize the benefits of using the EMR in the clinical encounter. We built on these findings to develop a series of educational interventions. In this presentation we will describe the development of one of these interventions, a computer-based simulation, and results from a pilot study of its impact on Family Medicine residents’ skills and attitudes. Methodology/Approach: We employed the following process to develop 3 prototype computer-based simulation modules: 1. Defining the learning objectives and drafting a case synopsis (a brief narrative of the case); 2. Mapping the story by creating a flow chart of the case events with a detailed description of the actors’ actions, conversations, decisions that would be made by trainees, results of these decisions and visual elements; 3. Designing the storyboard by creating sketches of the simulation slides based on the story maps. Additionally, the storyboards include the feedback provided to the trainees based on their decisions and technical infrastructure details of developing the simulation in an authoring tool (Adobe Captivate), such as variables, standard actions, conditional actions and navigation objects; and 4. Developing the prototype in the authoring tool. We conducted a usability test of the simulation prototype with 3 Master of Information students, followed by a pilot study with 16 Family Medicine residents. The pilot study included pre- and post-test surveys of competencies and attitudes related to using the EMR in the consultation and acceptability of the simulation (based on the Technology Acceptance Model), as well as free text comments and ‘think aloud’ observation of 6 residents. Findings/Results: After using the simulation prototypes, the mean scores for both self-reported competencies and attitudes improved from 14.88±2.63 to 15.63±2.80 (M±SD; out of maximum 20 points possible) and from 22.25±2.44 to 23.13±2.16 (M±SD; out of maximum 30 points possible), respectively. The difference for competencies was significant (paired t-test; t=-2.535, p=0.023). Mean scores for perceived usefulness and ease of use of the simulation were good (3.81 and 4.10, respectively, on a 5-point scale) and intention to use the simulation and overall assessment of the session were average (3.50 and 3.16, respectively). Issues identified in usability testing include confusing interaction with some of the software features, and preferences for more interactive representation of the EMR and shared decision making opportunities. Conclusions/Implications/Recommendations: Computer-based simulation may be an effective and acceptable tool for teaching Family Medicine residents how to better use the EMR in the consultation. This potential should be further explored in future research. http://www.e-healthabstracts.ca/abstract_view.php?abs_id=8059
Research Interests:
Luder shows that there is a lack of correlation between lecture attendance in medical school and examination performance, and thus draws attention to a discourse concerning the place of lectures and lecture attendance enforcement in 2015... more
Luder shows that there is a lack of correlation between lecture attendance in medical school and examination performance, and thus draws attention to a discourse concerning the place of lectures and lecture attendance enforcement in 2015 and beyond. The paper addresses 4 questions: First, what is the current place of the traditional lecture in the education of medical students? Second, are there alternatives to this format of teaching? Third, what are the educational consequences of mandating lecture attendance; and fourth, should there be such enforcement? The author discusses these questions and concludes that lectures should be used sparingly, after a careful evaluation that they have an added value over learning away from the classroom. Furthermore, that there are clear guidelines on how to make the traditional lecture enhanced and educationally effective, as well as alternatives such as the "flipped classroom", e-learning and more to lectures. In addition, that lectures frequently drive learning negatively and enforcing attendance in Israel entails serious unintended consequences such as a need to monitor attendance, and a host of disciplinary adverse reactions. Finally, that besides lecture efficiency and economy (when having added value) one reason to consider compulsory attendance, may be when poor attendance negatively influences teachers morale.
Research Interests:
The Holocaust is presently part of the universal human identity in the 21st century, as well as a component of Jewish and Israeli identity. Contemplating the role of medicine in the Holocaust is crucial for health professionals' identity... more
The Holocaust is presently part of the universal human identity in the 21st century, as well as a component of Jewish and Israeli identity. Contemplating the role of medicine in the Holocaust is crucial for health professionals' identity formation. This paper narrates the story of the Bergen-Belsen concentration camp, the events preceding its liberation and the months that followed in universal, Jewish, medical and personal dimensions. A British book (After Daybreak by S.Shepard, Shocken Books, 2005) addresses the Bergen-Belsen Liberation on 15.4.45 and focuses on the medical relief operation mounted by the British. It tells the story, among others, of 96 volunteer medical students flown in from London to assist in the survivors' care. I have also heard the tales of Bergen-Belsen in those days from my late father who was there and was fortunately Liberated by the same British soldiers. My mother too stayed in Bergen-Belsen and left two months prior to liberation. By the end of May 1945 the British soldiers had left, the camp was transformed into a refugee camp, and it became a transit camp for preparation for Aliya and immigration. In 1948 my mother's younger sisters spent time there on their way to joining a kibbutz in Palestine. This is how I found myself caught in the duality of seeing, in my mind's eye, the picture portrayed by the book, the gaze of the camp's liberators and healers, as well as imagining myself in the shoes of my family members in the same place and time. This article conveys the dual gaze: the medicaL, that the health professionals present on the one hand, and the personal outlook--on the other hand.
Research Interests:
Research Interests:
Research Interests:
A growing interest in the realization, understanding and lessons of medicine and physicians' behavior during the Holocaust, is noted in the last two decades. In this incomprehensible time, the dark and enlightened faces of medicine... more
A growing interest in the realization, understanding and lessons of medicine and physicians' behavior during the Holocaust, is noted in the last two decades. In this incomprehensible time, the dark and enlightened faces of medicine reached an unprecedented (and hopefully will not ever recur) climax. We learn of the criminal conduct of Nazi medicine and Nazi physicians on the one hand, and the noble, faithful to the Hippocratic oath, behavior of some prisoner physicians and nurses on the other hand. The understanding that learning about medicine during and beyond the Holocaust is a unique platform with exceptional impact on professional identity formation for present and future health professionals, is becoming clearer. In the present paper we will briefly delineate the historical background, its place in the professional discourse, describe a seminal conference that took place in Israel in 2017 that also launched the Galilee Declaration, and thoughts for the future. In Israel, Professor Shaul Shasha's initiative to hold a yearly meeting on medicine and health in the Holocaust in the Medical Center for the Galilee in Naharia, for the last 20 years, is central to this important subject. This paper is dedicated to him with profound gratitude.
Research Interests:
During the last decades the dominant paradigm, in which the duration of a rotation/course, the required content to be learnt (the material covered) and a test (usually a multiple choice one) evaluating the knowledge of the content, were... more
During the last decades the dominant paradigm, in which the duration of a rotation/course, the required content to be learnt (the material covered) and a test (usually a multiple choice one) evaluating the knowledge of the content, were paramount, is being replaced by a new paradigm: outcome/competency based medical education (CBME, OBME). In this paper the reasons for adopting this change in the developed world are presented, its nature and basic assumptions enumerated and national examples of its adoption from Scotland, Canada, UK and USA described. We will present in some detail the changes this approach entails, the new definitions it adopts, the learning outcomes it aspires to and how to evaluate them. Finally, we will present a draft outcomes proposal adapted to the Israeli reality. Since the Medicine Deans Forum and the Scientific Council of the Israeli Medical Association have adopted the new paradigm for the training of Israeli physicians, it is an opportune moment to expose the readership of Harefuah (i.e. Israel's physicians and medical students) to this relatively new paradigm.
Research Interests:
The digital age has profoundly transformed our lives, including health and healthcare. The computer, the smart cellphone, digital communication, social networks, applications, the Electronic Medical Record, web-based medical knowledge... more
The digital age has profoundly transformed our lives, including health and healthcare. The computer, the smart cellphone, digital communication, social networks, applications, the Electronic Medical Record, web-based medical knowledge availability, tele-medicine and a host of additional tools progress rapidly and seem to leave physicians behind, while the public adapts them willingly. This article enumerates the characteristics of the digital era in healthcare, Israel's leadership in health care application of information technology, the different domains of impact, additional competencies they mandate presently and, in the future, as well as associated ethical dilemmas. Subsequently, a road map is outlined to achieving the additional skills in all stages of the professional life cycle and through competency-based medical education, together with a vision of future medicine and the future physician. In conclusion, the hope that Israel's' doctors will resume a leadership role in the digital transformation of healthcare is expressed.
Research Interests:
Research Interests:
Research Interests:
ABSTRACT He is a visiting medical educator from abroad, a research maven, a family doc, a family man. I know this because we have already exchanged family photographs as a means of introduction. These are our resumes, the stuff of which... more
ABSTRACT He is a visiting medical educator from abroad, a research maven, a family doc, a family man. I know this because we have already exchanged family photographs as a means of introduction. These are our resumes, the stuff of which we are most proud, and this is a warm and friendly way to jump-start our research collaboration in narrative medicine. We are both privileged to be teaching in a “Doctoring” course for first- and second-year medical students that integrates student-generated narratives (“field notes”) on a spectrum of topics, including memorable patient encounters.
Research Interests:
Research Interests:
Research Interests:
BACKGROUND The COVID-19 pandemic is a demonstration of an unforeseen event that disrupts normal life routine and greatly affects medical training. With its outbreak, clinical studies in medical schools were discontinued throughout the... more
BACKGROUND The COVID-19 pandemic is a demonstration of an unforeseen event that disrupts normal life routine and greatly affects medical training. With its outbreak, clinical studies in medical schools were discontinued throughout the country, and the pre-clinical studies channeled into online learning, like all other university teaching activities. Since similar situations occurred in most western countries, a methodological approach of online teaching is required - principles, goals and implementation, with reference to the tension between the duty of care versus the duty of maintaining the clinician's and student's health. In this paper we will present the dilemmas faced by the various medical education institutions in the world, along with the ways of coping and the experience gained from similar situations - including in Israel. We will discuss the techno-pedagogical principles that are at the heart of online teaching, demonstrate the experience gained in Israel and around the world, and offer a framework for comprehensive discussion for situations that threaten medical education learners. Finally, we will provide a list of online teaching resources for clinical teaching (that are mostly free and can be readily used by medical education faculties).
Research Interests:
The medical profession played its part in the atrocities committed during Hitler's Third Reich. Shmuel Reis and Uri Weinberg document the involvement of doctors
Research Interests:
The purpose of clinical practice guidelines is to delineate an evidence-based common approach to a prevalent medical problem. Guidelines for Chronic Low Back Pain (CLBP) care were never published in Israel previously, contrary to the... more
The purpose of clinical practice guidelines is to delineate an evidence-based common approach to a prevalent medical problem. Guidelines for Chronic Low Back Pain (CLBP) care were never published in Israel previously, contrary to the Acute Low Back Pain (ALBP) guidelinges. This year, such guidelines are disseminated sponsored by the IMA. In the present paper a summary of the new CLBP care guideline is reported. To each recommendation an evidence level is attached, enabling the practitioner to examine his deliberations against the existing evidence. The guidelines are adapted from a recent European multidisciplinary document and will stay valid with periodic updating. Clinical practice guidelines are not intended to replace careful clinical judgment and personal acquaintance with the patient in. They may support decisions by bringing a summary of the existing evidence in the domain.
Research Interests:
Research Interests:
Research Interests:
The present study aimed to explore attitudes of medical students following a course in integrative medicine (IM) focused on palliative and supportive cancer. Attitudes to IM among pre-clerkship medical students were assessed following a... more
The present study aimed to explore attitudes of medical students following a course in integrative medicine (IM) focused on palliative and supportive cancer. Attitudes to IM among pre-clerkship medical students were assessed following a 3-day required course, which included interviews with international experts in IM and “hands-on” workshops mentored by IM and non-IM healthcare professionals. Student reflections were analyzed qualitatively, and written narratives were examined thematically. Of 161 students, 102 (63.4%) provided post-course reflections. The main narrative themes included pre-course attitudes, attitude changes and influencing factors, and insights on implementing IM in clinical practice. Pre-course attitudes were predominantly skeptical, with post-course attitudes more open and non-judgmental, addressing research on IM effectiveness and safety. Students looked favorably on the implementation of IM in clinical practice and felt the course enhanced communication with pa...
Research Interests:
Source Citation Van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. The effectiveness of acupuncture in the management of acute and chronic low back pain: a systematic review within the framework ...
Research Interests:
OBJECTIVES To describe and deepen our understanding of patient-centeredness, empathy, and boundary management in challenging conversations. Previous studies show frequent physician self-disclosure, while empathy and boundary management... more
OBJECTIVES To describe and deepen our understanding of patient-centeredness, empathy, and boundary management in challenging conversations. Previous studies show frequent physician self-disclosure, while empathy and boundary management are infrequent. METHODS Three standardized patients (SPs) portrayed cancer patients consulting a new community-based physician, resulting in 39 audio-recorded SP visits to 19 family physicians and 20 medical oncologists. Transcripts underwent qualitative iterative thematic analysis, informed by grounded theory, followed by directed content analysis. We further defined the identified communicative categories with descriptive and correlational calculations. RESULTS We identified patient-centered physician response categories--empathy, affirmation, and acknowledgement; and physician-centered categories-transparency, self-disclosure, and projection. Acknowledgement and affirmation responses were frequent and empathy rare. Physician transparency and self-disclosure were common. Useful and not useful self-disclosures were highly correlated; empathy, useful and not useful transparency, and projection were moderately correlated. Most physicians used self-disclosure but few of these were judged patient-centered. CONCLUSIONS Physicians expressing empathy and patient-centered transparency were also more likely to use projection and physician-centered transparency, thus engaging in communication "boundary turbulence." Patients may benefit from physicians' improved use of empathy and boundary management.
Research Interests:
OBJECTIVE To examine the impact of an integrative medicine (IM) course on self-perceived IM-related communication and research skills. METHODS A 3-day mandatory "hybrid" (online and in-person) IM course was held within COVID-19... more
OBJECTIVE To examine the impact of an integrative medicine (IM) course on self-perceived IM-related communication and research skills. METHODS A 3-day mandatory "hybrid" (online and in-person) IM course was held within COVID-19 restrictions for 161 pre-clerkship medical students, with workshops facilitated by mentor healthcare professionals (IM and non-IM) and student-directed tasks. Self-perceived levels of 6 IM-related skills were scored (from 1 to 5) for history-taking; communicating with patients with "alternative" health-beliefs; referral to IM consultations; assessing risks/benefits; and working with non-medical IM practitioners. RESULTS 137 students (85.1%) completed pre-/post-course questionnaires, with overall scores improving from pre-course (1.98 ± 0.92) to post-course (3.31 ± 0.63; p < 0.0001), for the entire group and student subgroups (with vs. without prior IM experience). Multivariate analysis found no association between age, gender, primary language or prior experience with IM and improvement in skill scores. CONCLUSIONS The IM course increased self-perceived skill levels, reflecting the course curriculum and workshops. Further research needs to explore the application of these skills during clinical training. PRACTICE IMPLICATIONS Teaching medical students about IM in a course comprising communication and research skills was shown to be feasible and effective. The application of IM-related skills needs to be evaluated during the clinical clerkship.
Research Interests:
As we saw in the previous chapters, various educational interventions have been designed and implemented to prepare health care professionals to practice in the information and Information and Communication Technology (ICT)-rich... more
As we saw in the previous chapters, various educational interventions have been designed and implemented to prepare health care professionals to practice in the information and Information and Communication Technology (ICT)-rich environment of the twenty-first century. However, for interventions to be effective there is a need for more evidence: we need to know what interventions work best, for what, for whom, and under which conditions. Evaluation is critical for providing this evidence. In this chapter, we will discuss the evaluation of educational interventions in general and of interventions related to challenges of the digital era in particular. We start by defining evaluation and discussing the relationship between evaluation and research, Then, we will describe the three intervention types (simple, complicated, and complex), and the different implications of each. Next, the five attributes of evaluation (reliability, validity, feasibility, acceptability, and educational impact) will be introduced, and the various levels of evaluation discussed with an emphasis on the need to consider cost-effectiveness and the process that learners go through. Subsequently, we will highlight the challenges involved in evaluating educational interventions in general and the specific issues pertaining to informatics-related interventions. Finally, we will use case studies from our own and other's research to illustrate these issues.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Patients' evaluations can be used to improve health care and compare general practice in different health systems. To identify aspects of general practice that are generally evaluated positively by patients and to compare opinions of... more
Patients' evaluations can be used to improve health care and compare general practice in different health systems. To identify aspects of general practice that are generally evaluated positively by patients and to compare opinions of patients in different European countries on actual care provision. An internationally-validated questionnaire was distributed to and completed by patients in 10 European countries. A stratified sample of 36 practices per country, with at least 1080 patients per country, was included. A set of 23 validated questions on evaluations of different aspects of care was used, as well as questions on age, sex, overall health status, and frequency of visiting the GP. The patient sample included 17,391 patients in 10 different countries; the average response rate was 79% (range = 67% to 89%). In general, patients visiting their general practitioner (GP) were very positive about the care provided. For most of the 23 selected aspects of care more than 80% viewed...
Research Interests: General Practice, Family Medicine, Health Care, Culture, British, and 15 moreInternational Cooperation, Family Practice, Medicine, Humans, Europe, Female, Pubmed, Male, Active Listening, Patient Satisfaction, International comparisons, Confidentiality, Middle Aged, Public health systems and services research, and Delivery of Health Care
Research Interests:
Research Interests:
Research Interests:
Purpose Reflective writing (RW) curriculum initiatives to promote reflective capacity are proliferating within medical education. The authors developed a new evaluative tool that can be effectively applied to assess students'... more
Purpose Reflective writing (RW) curriculum initiatives to promote reflective capacity are proliferating within medical education. The authors developed a new evaluative tool that can be effectively applied to assess students' reflective levels and assist with the process of providing individualized written feedback to guide reflective capacity promotion. Method Following a comprehensive search and analysis of the literature, the authors developed an analytic rubric through repeated iterative cycles of development, including empiric testing and determination of interrater reliability, reevaluation and refinement, and redesign. Rubric iterations were applied in successive development phases to Warren Alpert Medical School of Brown University students' 2009 and 2010 RW narratives with determination of intraclass correlations (ICCs). Results The final rubric, the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT), consisted of four reflective capacit...
Background and Objectives: The United States of America is currently experiencing a shortage of physicians caring for underserved populations, perpetuated in part by increasingly negative attitudes during medical school towards working... more
Background and Objectives: The United States of America is currently experiencing a shortage of physicians caring for underserved populations, perpetuated in part by increasingly negative attitudes during medical school towards working with these populations. The objective of this study is to provide a baseline assessment of the attitudes of all medical students at our institution towards caring for the underserved that will then guide the development, implementation and evaluation of a multi-pronged, 5-year intervention. Methods: For this mixed methods, cross-sectional study, we administered the validated Medical Student Attitudes Towards the Underserved (MSATU) survey to all 4 classes at one medical school within one academic year. Statistical analysis was performed through bivariate analyses followed by multivariate regression analyses for significant bivariate associations. Three focus groups involving a total of 23 second-, third- and fourth-year medical students provided quali...
Research Interests:
INTRODUCTION The Israeli state accords the status of "specialist", after an authorization by the Israeli Medical Association (IMA) Scientific Council and Ministry of Health (MOH), to physicians who fulfilled the requirements for... more
INTRODUCTION The Israeli state accords the status of "specialist", after an authorization by the Israeli Medical Association (IMA) Scientific Council and Ministry of Health (MOH), to physicians who fulfilled the requirements for the title in the 56 recognized specialties in the country. An "expert" and "specialist" are synonyms in Hebrew. However, there is no doubt that these two terms are not identical. The scientific council defines the specialist it approves as the practitioner who can practice independently in the professional domain in which he was authorized. The literature in the domain portrays a more nuanced scale, starting from novice, to advanced novice, competent, proficient, expert and finally master. Research on expertise is associated with Anders Ericsson's name, who coined the "ten thousand hours" as the average time needed to attain expertise. Ericsson also asserts that it is not just about time, but also about the method....
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Psychology, Culture, Family Practice, Medicine, Learning, and 14 moreSelf Efficacy, Continuing Medical Education, Humans, Needs Assessment, United States, Female, Male, Academic Medicine, Adult, Curriculum and Pedagogy, Cross Sectional Studies, Personal autonomy, internship and residency, and Interviews as topic
Research Interests: Primary Care, Primary Health Care, Coping Strategies, Focus Groups, Family Medicine, and 12 moreGeneral Internal Medicine, Doctor-patient communication, Humans, Focus Group, Conceptual Model, Data Collection, Life Cycle, Confidentiality, Clinical Sciences, General practitioner, Family Physician, and Psychological Models
1. Background and aims The motivation to use information systems in healthcare is driven by the expectations that these systems will improve the quality of care, increase patients' safety and cut down medical costs. It has been... more
1. Background and aims The motivation to use information systems in healthcare is driven by the expectations that these systems will improve the quality of care, increase patients' safety and cut down medical costs. It has been demonstrated that the use of information technology improves healthcare by increasing adherence to medical guidelines, clinical monitoring based on large-scale screening, data aggregation which is not feasible with paper, and reduction of medical errors.
Research Interests:
Clerkship-specific interactive reflective writing (IRW)-enhanced reflection may enhance professional identity formation (PIF), a fundamental goal of medical education. PIF process as revealed in students? reflective writing (RW) has been... more
Clerkship-specific interactive reflective writing (IRW)-enhanced reflection may enhance professional identity formation (PIF), a fundamental goal of medical education. PIF process as revealed in students? reflective writing (RW) has been understudied. The authors developed an IRW curriculum within a Family Medicine Clerkship (FMC) and analyzed students? reflections about challenging/difficult patient encounters using immersion-crystallization qualitative analysis. The qualitative analysis identified 26 unique emergent themes and five distinct thematic categories (1. Role of emotions, 2. Role of cognition, 3. Behaviorally responding to situational context, 4. Patient factors, and 5. External factors) as well as an emergent PIF model from a directed content analysis. The model describes students? backgrounds, emotions and previous experiences in medicine merging with external factors and processed during student?patient interactions. The RWs also revealed that processing often involve...