What do university students know about cervical cancer and HPV vaccine?

OBJECTIVE

Cervical cancer is one of the most common cancers in women. Infection with high-risk human papillomavirus (HPV) genotypes is responsible for most cervical cancer cases. This study aimed to assess the knowledge of undergraduate medical and non-medical students about cervical cancer and HPV vaccines.

MATERIALS AND METHODS

A cross-sectional questionnaire-based survey was distributed to 172 students in the final 2 years of an undergraduate program at the College of Medicine and the College of Business and Art at the King Saud University.

RESULTS

Thirty-one and 83 students (36% and 96.5%, respectively) in the non-medical and medical cohorts, respectively, answered that cervical cancer is preventable (p < 0.001). Further, there was a significant difference in the two cohorts regarding their responses to the etiology of cervical cancer (p < 0.001). Forty-five of the medical students answered correctly that the vaccine should be administered to boys and girls alike (52.3%), whereas only 19 (22.1%) non-medical students gave this answer. Moreover, 52 of the medical students (60.5%) expressed willingness to take the vaccine, whereas only 23 (26.7%) of the non-medical students were willing to receive the vaccination. The most common primary source of knowledge of the medical students was medical courses (96.5%), whereas for non-medical students was social media (66.28%). Vaccine availability was the commonest obstacle preventing medical students from receiving the vaccine, whereas that of non-medical students was inadequate information.

CONCLUSIONS

Medical students' knowledge about cervical cancer and vaccination was more accurate than that of non-medical students. We expect that the public will have an even lower level of knowledge. We recommend including necessary information about the vaccine in schools, colleges, and community education programs.

Critical evaluation of YouTube videos on colostomy and ileostomy: Can these videos be used as learning resources?

OBJECTIVES

We aimed at identifying and analyzing the accuracy of YouTube videos on colostomy and ileostomy.

METHODS

YouTube website was searched independently by researchers for videos on colostomy and ileostomy posted before the 18th of May, 2019. Based on predetermined inclusion and exclusion criteria, the videos matching the research objective were identified. Data related to each video were collected, and the videos were categorized using standardized criteria.

RESULTS

A total of 357 videos were identified. Finally, 149 videos were included in the study. Of these, 52 (35%) were educationally useful, and 97 (65%) were not useful. None of the video parameters, including the number of viewers, duration, number of likes or dislikes, days on YouTube or number of comments, was able to differentiate between useful or not useful videos. The score of videos was 14.7 ± 0.6 for valuable videos and 11.0 ± 2.0 for not useful videos (p < 0.001).

CONCLUSIONS

While there were a reasonably number of colostomy and ileostomy videos, there was a smaller number on the surgical procedure. Most non-educational videos were not consistent with clinical guidelines.

PRACTICAL IMPLICATIONS

YouTube videos on colostomy/ileostomy care can be an important educational resource to patients. However, a collaboration between patients, nurse educators and universities/hospitals is needed to produce high-quality videos.

Convalescent plasma as a potential management option in COVID-19: a critical review of randomized controlled registered trials

Currently, there is no approved antiviral agent to treat COVID-19. The management is based on reducing the virus spread in communities, providing supportive treatment to patients, and recently receiving immunization. In this critical review, we focus on randomized and controlled clinical trials. ClinicalTrials.gov, Chinese Clinical Trial Registry (ChiCTR), Japan Primary Registries Network (JPRN), the Australian New Zealand Clinical Trials Registry (ANZCTR), and six other Clinical Trials Registers were searched. Only randomized controlled trials covering treatment or prevention with convalescent plasma in COVID-19 patients were included. Data were extracted into summary tables. The matrix developed was used to identify common themes and compare primary and secondary outcomes of each trial against other parameters/characteristics of the trial. Microsoft Excel was used to create grids of numbers, texts and analysis using various formulae. A total of 3109 trial registry entries were identified, and 44 fulfilled the inclusion and exclusion criteria of the study. The majority of trials (n= 42, 95%) explored the therapeutic potential; only two examined prevention use. The trial's outcome measures varied and were 59 primary (median:1, IQR, 0) and 267 secondary measure outcomes (median: 6, IQR, 8). While 17 studies were recruiting for Phase 1 or 2, the remaining 16 studies were in Phase 2, and 3 and 11 studies had no phases. The total number of participants in these studies was 9432, including control groups (median: 120, IQR, 211). This review provides an overall analysis of clinical trials currently available from seventeen countries and highlights critical issues that we can learn from these trials based on available information.

Use of bile acids as potential markers of liver dysfunction in humans: A systematic review

OBJECTIVE

This study aimed to determine the effectiveness of using total, individual serum, or urinary bile acids (BA) as potential markers of liver dysfunction.

METHODS

We searched the PubMed and Web of Science databases using the following keywords- "serum bile acids," "liver dysfunction," "liver injury," "liver disease," "traditional liver function tests," "Chronic liver disease," "acute liver injury". The search was complemented by manual screening of the list of references for relevant articles. We selected only English-language manuscripts for adult patients based on predetermined inclusion and exclusion criteria. Animal studies and studies on neonates and children were not included.

OUTCOME MEASURES

Changes in BA concentrations or ratios at or prior to changes in liver function tests.

RESULTS

A total of 547 studies were identified, of which 28 were included after reading the entire manuscript. These studies included 1630 patients and 836 controls published between 1990 and 2017. The methods used in BA assays varied significantly, and the studies did not agree. on specific individual BA or BA ratios as biomarkers of specific liver injury or dysfunction. Except for the prognostic value of BA in intrahepatic cholestasis of pregnancy (ICP), studies have failed to provide evidence for BA as a liver biomarker.

CONCLUSIONS

Despite the research conducted on BA for over 27 years, there are inconsistencies in the reported results and a lack of solid evidence to support the use of individual BA or BA ratios as biomarkers of liver injury. Adequately conducted studies needed to resolve this limitation in the literature.

COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics

The novel coronavirus disease 2019 (COVID-19) outbreak started in early December 2019 in the capital city of Wuhan, Hubei province, People's Republic of China, and caused a global pandemic. The number of patients confirmed to have this disease has exceeded 9 million in more than 215 countries, and more than 480 600 have died as of 25 June 2020. Coronaviruses were identified in the 1960s and have recently been identified as the cause of a Middle East respiratory syndrome (MERS-CoV) outbreak in 2012 and a severe acute respiratory syndrome (SARS) outbreak in 2003. The current SARS coronavirus 2 (SARS-CoV-2) is the most recently identified. Patients with COVID-19 may be asymptomatic. Typical symptoms include fever, dry cough and shortness of breath. Gastrointestinal symptoms such as nausea, vomiting, abdominal pain and diarrhoea have been reported; neurologically related symptoms, particularly anosmia, hyposmia and dysgeusia, have also been reported. Physical examination may find fever in over 44% of patients (and could be documented in over 88% of patients after admission), increased respiratory rate, acute respiratory disease and maybe decreased consciousness, agitation and confusion. This article aims at presenting an up-to-date review on the pathogenesis, diagnosis and complications of COVID-19 infection. Currently no therapeutics have been found to be effective. Investigational therapeutics are briefly discussed.

Deep learning with convolutional neural networks for identification of liver masses and hepatocellular carcinoma: A systematic review

BACKGROUND

Artificial intelligence, such as convolutional neural networks (CNNs), has been used in the interpretation of images and the diagnosis of hepatocellular cancer (HCC) and liver masses. CNN, a machine-learning algorithm similar to deep learning, has demonstrated its capability to recognise specific features that can detect pathological lesions.

AIM

To assess the use of CNNs in examining HCC and liver masses images in the diagnosis of cancer and evaluating the accuracy level of CNNs and their performance.

METHODS

The databases PubMed, EMBASE, and the Web of Science and research books were systematically searched using related keywords. Studies analysing pathological anatomy, cellular, and radiological images on HCC or liver masses using CNNs were identified according to the study protocol to detect cancer, differentiating cancer from other lesions, or staging the lesion. The data were extracted as per a predefined extraction. The accuracy level and performance of the CNNs in detecting cancer or early stages of cancer were analysed. The primary outcomes of the study were analysing the type of cancer or liver mass and identifying the type of images that showed optimum accuracy in cancer detection.

RESULTS

A total of 11 studies that met the selection criteria and were consistent with the aims of the study were identified. The studies demonstrated the ability to differentiate liver masses or differentiate HCC from other lesions (n = 6), HCC from cirrhosis or development of new tumours (n = 3), and HCC nuclei grading or segmentation (n = 2). The CNNs showed satisfactory levels of accuracy. The studies aimed at detecting lesions (n = 4), classification (n = 5), and segmentation (n = 2). Several methods were used to assess the accuracy of CNN models used.

CONCLUSION

The role of CNNs in analysing images and as tools in early detection of HCC or liver masses has been demonstrated in these studies. While a few limitations have been identified in these studies, overall there was an optimal level of accuracy of the CNNs used in segmentation and classification of liver cancers images.

Challenges Facing the Detection of Colonic Polyps: What Can Deep Learning Do?

Colorectal cancer (CRC) is one of the most common causes of cancer mortality in the world. The incidence is related to increases with age and western dietary habits. Early detection through screening by colonoscopy has been proven to effectively reduce disease-related mortality. Currently, it is generally accepted that most colorectal cancers originate from adenomas. This is known as the "adenoma-carcinoma sequence", and several studies have shown that early detection and removal of adenomas can effectively prevent the development of colorectal cancer. The other two pathways for CRC development are the Lynch syndrome pathway and the sessile serrated pathway. The adenoma detection rate is an established indicator of a colonoscopy's quality. A 1% increase in the adenoma detection rate has been associated with a 3% decrease in interval CRC incidence. However, several factors may affect the adenoma detection rate during a colonoscopy, and techniques to address these factors have been thoroughly discussed in the literature. Interestingly, despite the use of these techniques in colonoscopy training programs and the introduction of quality measures in colonoscopy, the adenoma detection rate varies widely. Considering these limitations, initiatives that use deep learning, particularly convolutional neural networks (CNNs), to detect cancerous lesions and colonic polyps have been introduced. The CNN architecture seems to offer several advantages in this field, including polyp classification, detection, and segmentation, polyp tracking, and an increase in the rate of accurate diagnosis. Given the challenges in the detection of colon cancer affecting the ascending (proximal) colon, which is more common in women aged over 65 years old and is responsible for the higher mortality of these patients, one of the questions that remains to be answered is whether CNNs can help to maximize the CRC detection rate in proximal versus distal colon in relation to a gender distribution. This review discusses the current challenges facing CRC screening and training programs, quality measures in colonoscopy, and the role of CNNs in increasing the detection rate of colonic polyps and early cancerous lesions.

Top-cited articles in medical professionalism: a bibliometric analysis versus altmetric scores

INTRODUCTION

Citation counts of articles have been used to measure scientific outcomes and assess suitability for grant applications. However, citation counts are not without limitations. With the rise of social media, altmetric scores may provide an alternative assessment tool.

OBJECTIVES

The aims of the study were to assess the characteristics of highly cited articles in medical professionalism and their altmetric scores.

METHODS

The Web of Science was searched for top-cited articles in medical professionalism, and the characteristics of each article were identified. The altmetric database was searched to identify report for each identified article. A model to assess the relationship between the number of citations and each of the key characteristics as well as altmetric scores was developed.

RESULTS

No correlations were found between the number of citations and number of years since publication (p=0.192), number of institutes (p=0.081), number of authors (p=0.270), females in authorship (p=0.150) or number of grants (p=0.384). The altmetric scores varied from 0 to 155, total=806, median=5.0, (IQR=20). Twitter (54%) and Mendeley (62%) were the most popular altmetric resources. No correlation was found between the number of citations and the altmetric scores (p=0.661). However, a correlation was found for articles published in 2007 and after (n=17, p=0.023). To further assess these variables, a model was developed using multivariate analysis; did not show significant differences across subgroups. The topics covered were learning and teaching professionalism, curriculum issues, professional and unprofessional behaviour.

CONCLUSIONS

Altmetric scores of articles were significantly correlated with citations counts for articles published in 2007 and after. Highly cited articles were produced mainly by the USA, Canada and the UK. The study reflects the emerging role of social media in research dissemination. Future studies should investigate the specific features of highly cited articles and factors reinforcing distribution of research data among scholars and non-scholars.

Accuracy and Readability of Websites on Kidney and Bladder Cancers

The aim of this study was to assess the scientific accuracy and the readability level of websites on kidney and bladder cancers. The search engines Google™, Yahoo™ and Bing™ were searched independently by assessors in November 2014 using the following keywords: "bladder cancer", "kidney cancer", "patient bladder cancer", "patient kidney cancer" and "bladder and kidney cancer". Only English-language websites were selected on the bases of predetermined inclusion and exclusion criteria. Assessors independently reviewed the findings and evaluated the accuracy and quality of each website by using the DISCERN and the LIDA instruments. The readability of the websites was calculated using the Flesch-Kincaid Grade Level Index and the Coleman-Liau Readability Index. Sixty-two websites were finally included in the study. The overall accuracy scores varied; for the DISCERN, the range was 28 to 76; out of 80 (mean ± SD, 47.1 ± 12.1; median = 46.0, interquartile range (IQR) = 19.2), and for the LIDA, the range was 52 to 125; out of 144 (mean ± SD, 101.9 ± 15.2; median, 103; IQR, 16.5). The creators of these websites were universities and research centres (n = 25, 40%), foundations and associations (n = 10, 16%), commercial and pharmaceutical companies (n = 13, 21%), charities and volunteer work (n = 4, 6%) and non-university educational bodies (n = 10, 16%). The readability scores (mean ± SD) were 11.2 ± 2.2 for the Flesch-Kincaid Grade Level Index and 11.2 ± 1.6 for the Coleman-Liau Readability Index. The accuracy and the quality of the websites on kidney and bladder cancers varied. In most websites, there were deficiencies in clarity of aims, presenting symptoms, investigations and treatment options. The readability matched grades 10-11 literacy levels-a level above the public readability level. The study highlights the needs for further improvement of the online information created for public and patients with kidney and bladder cancers.

What can we learn from top-cited articles in inflammatory bowel disease? A bibliometric analysis and assessment of the level of evidence

BACKGROUND AND OBJECTIVES

Despite increasing number of publications in inflammatory bowel disease (IBD), no bibliometric analysis has been conducted to evaluate the significance of highly cited articles. Our objectives were to identify the top-cited articles in IBD, assessing their characteristics and determining the quality of evidence provided by these articles.

DESIGN AND OUTCOME MEASURES

IBD and related terms were used in searching the Web of Science to identify English language articles. The 50 top-cited articles were analysed by year, journal impact factor (JIF), authorship, females in authorship, institute, country and grants received. The level of evidence was determined using the Oxford Centre for Evidence-Based Medicine guidelines.

RESULTS

The number of citations varied from 871 to 3555 with a total of 74 638, and a median 1339.50 (IQR=587). No correlations were found between the number of citations and number of years since publication (r=0.042, p=0.771), JIF (r=0.186, p=0.196), number of authors (r=0.061, p=0.674), females in authorship (r=0.064, p=0.661), number of institutes (r=0.076, p=0.602), number of countries (r=0.101, p=0.483) or number of grants (r=-0.015, p=0.915). The first authors were from the USA (n=24), the UK (n=6), Germany (n=5), France (n=5), Belgium (n=3) and Canada (n=3). The levels of evidence were 12 articles at level 1b, 9 articles at level 3a and 15 articles at level 3b and fewer were at other levels.

CONCLUSIONS

Research papers represented 66% of articles. The majority of items have reasonably high levels of evidence, which may have contributed to the higher number of citations. The study also shows a gender gap in authorship in this area.

MDM2-p53 Interactions in Human Hepatocellular Carcinoma: What Is the Role of Nutlins and New Therapeutic Options?

Human hepatocellular carcinoma (HCC) is the fifth most common cancer and is associated with poor prognosis worldwide. The molecular mechanisms underlying the pathogenesis of HCC have been an area of continuing interest, and recent studies using next generation sequencing (NGS) have revealed much regarding previously unsettled issues. Molecular studies using HCC samples have been mainly targeted with the aim to identify the fundamental mechanisms contributing to HCC and identify more effective treatments. In response to cellular stresses (e.g., DNA damage or oncogenes), activated p53 elicits appropriate responses that aim at DNA repair, genetic stability, cell cycle arrest, and the deletion of DNA-damaged cells. On the other hand, the murine double minute 2 (MDM2) oncogene protein is an important cellular antagonist of p53. MDM2 negatively regulates p53 activity through the induction of p53 protein degradation. However, current research has shown that the mechanisms underlying MDM2-p53 interactions are more complex than previously thought. Microarray data have added new insight into the transcription changes in HCC. Recently, Nutlin-3 has shown potency against p53-MDM2 binding and the enhancement of p53 stabilization as well as an increment of p53 cellular accumulation with potential therapeutic effects. This review outlines the molecular mechanisms involved in the p53-MDM2 pathways, the biological factors influencing these pathways, and their roles in the pathogenesis of HCC. It also discusses the action of Nutlin-3 treatment in inducing growth arrest in HCC and elaborates on future directions in research in this area. More research on the biology of p53-MDM2 interactions may offer a better understanding of these mechanisms and discover new biomarkers, sensitive prognostic indicators as well as new therapeutic interventions in HCC.

Top-Cited Articles in Problem-Based Learning: A Bibliometric Analysis and Quality of Evidence Assessment

The aims of this study were to identify characteristics of the top-cited articles in problem-based learning (PBL) and assess the quality of evidence provided by these articles. The most frequently cited articles on PBL were searched in April 2015 in the Science Citation Index Expanded database (List A) and Google Scholar database (List B). Eligible articles identified were reviewed for key characteristics. The Oxford Centre for Evidence-Based Medicine guidelines were used in assessing the level of evidence. The number of citations varied (62 to 923 on List A and 218 to 2,859 on List B). Countries that contributed the majority of articles in both lists were the United States, Netherlands, United Kingdom, and Canada. No significant correlations were found between number of citations and number of years since published (p=0.451), number of authors (p=0.144), females in authorship (p=0.189), non-medical authors (p=0.869), number of institutions (p=0.452), and number of grants (p=0.143), but a strong correlation was found with number of countries involved (p=0.007). Application of the Oxford hierarchy of evidence showed that 36 articles were at levels 4 and 5 of evidence. This study found that research articles represented approximately one-third of PBL articles assessed and reported mainly on questionnaire-based studies. The most highly cited articles occupied top-ranking positions in the journals in which they were published. The lower level of evidence observed in most top-cited articles may reflect the significance of innovative ideas or content of these articles. These findings have implications for dental educators and dental researchers.

Inflammatory bowel disease: An evaluation of health information on the internet

AIM

To evaluate the quality and accuracy of websites written to the public on inflammatory bowel disease (IBD) (Crohn's disease and ulcerative colitis) and assess their readability level.

METHODS

Google™, Bing™, and Yahoo™ search engines were searched independently by three researchers in December 2014. Only English-language websites were selected on the basis of predetermined inclusion and exclusion criteria. Researchers independently evaluated the quality of each website by using the DISCERN and the HONcode instruments. The readability levels were calculated using two formulas; the Flesch-Kincaid Grade Level Index, and the Coleman-Liau Readability Index. The agreement between the evaluators was calculated using Cohen kappa coefficient.

RESULTS

Eighty-four websites were finally identified. Scores varied from a minimum DISCERN score of 18 to a maximum of 68 [mean ± SD, 42.2 ± 10.7; median = 41.5, interquartile range, interquartile range (IQR) = 15.8] and a minimum score of HONcode of 0.14 and a maximum of 0.95 (mean ± SD, 0.16 ± 0.19; median = 0.45, IQR = 0.29). Most of these websites were reviewed in 2014 and 2015 (n = 51). The creators of these websites were: universities and research centers (n = 25, 30%), foundations and associations (n = 15, 18%), commercial and pharmaceutical companies (n = 25, 30%), charities and volunteer work (n = 9, 10%), and non-university educational bodies (n = 10, 12%). The Flesch-Kincaid Grade Level readability score (mean ± SD) was 11.9 ± 2.4 and the Coleman-Liau Readability Index score was 12.6 ± 1.5. Significant correlation was found between the two readability scores (R² = 0.509, P = 0.001). The overall agreement between evaluators measured by Cohen kappa coefficient was in the range of 0.804-0.876; rated as "Good".

CONCLUSION

The DISCERN and the HONcode scores of websites varied and the readability levels of most websites were above the public readability level. The study highlights the areas that need further improvement and development in patient education online materials about IBD.

Impact factor of medical education journals and recently developed indices: Can any of them support academic promotion criteria?

Journal Impact Factor (JIF) has been used in assessing scientific journals. Other indices, h- and g-indices and Article Influence Score (AIS), have been developed to overcome some limitations of JIF. The aims of this study were, first, to critically assess the use of JIF and other parameters related to medical education research, and second, to discuss the capacity of these indices in assessing research productivity as well as their utility in academic promotion. The JIF of 16 medical education journals from 2000 to 2011 was examined together with the research evidence about JIF in assessing research outcomes of medical educators. The findings were discussed in light of the nonnumerical criteria often used in academic promotion. In conclusion, JIF was not designed for assessing individual or group research performance, and it seems unsuitable for such purposes. Although the g- and h-indices have demonstrated promising outcomes, further developments are needed for their use as academic promotion criteria. For top academic positions, additional criteria could include leadership, evidence of international impact, and contributions to the advancement of knowledge with regard to medical education.

Bibliometric analysis of the top-cited gastroenterology and hepatology articles

OBJECTIVE

To identify the top-cited articles in gastroenterology and hepatology, and analyse their characteristics.

METHODS

Two searches were conducted in the Science Citation Index Expanded database; a search of 69 journals under the category 'Gastroenterology and Hepatology' (list A) and a keyword search of all journals (list B). The search results were analysed and the inter-rater coefficient of agreement between evaluators was measured using Cohen κ.

RESULTS

The number of citations varied from 1049 to 2959 in list A and from 1929 to 5500 in list B. In both lists, the majority of articles were research papers. No significant correlations were found between the number of citations and the number of years since publication (R(2)=0.00992, p=0.473 and R(2)=0.00202, p=0.757, respectively). However, the mean number of citations of papers published before the year 2000 was lower than those published after 2000 (36.70 ± 19.31 vs 106.03 ± 39.22). No correlation was found between number of authors and the number of citations (R(2)=0.04352, p=0.130), but strong correlations were found between the number of institutes involved or number of countries and the number of citations (R(2)=0.275, p<0.001 and R(2)=0.16181, p=0.003, respectively). Females were under-represented in authorship (45 vs 254, p=0.004). Only 21 papers (of 54) in list A were supported by grants. No correlation was found between number of grants received and the number of citations (R(2)=0.02573, p=0.247). The inter-rater agreement between evaluators had a Cohen κ coefficient 0.76-0.84.

CONCLUSIONS

Top-cited articles were not only published in highly ranked journals specialising in Gastroenterology and Hepatology but also in 14 journals not specialised in this field. The number of citations correlated with the number of institutes and the number of countries involved but not with the number of grants received or the number of authors. Females were under-represented in the authorship.

Accuracy and readability of cardiovascular entries on Wikipedia: are they reliable learning resources for medical students?

OBJECTIVE

To evaluate accuracy of content and readability level of English Wikipedia articles on cardiovascular diseases, using quality and readability tools.

METHODS

Wikipedia was searched on the 6 October 2013 for articles on cardiovascular diseases. Using a modified DISCERN (DISCERN is an instrument widely used in assessing online resources), articles were independently scored by three assessors. The readability was calculated using Flesch-Kincaid Grade Level. The inter-rater agreement between evaluators was calculated using the Fleiss κ scale.

RESULTS

This study was based on 47 English Wikipedia entries on cardiovascular diseases. The DISCERN scores had a median=33 (IQR=6). Four articles (8.5%) were of good quality (DISCERN score 40-50), 39 (83%) moderate (DISCERN 30-39) and 4 (8.5%) were poor (DISCERN 10-29). Although the entries covered the aetiology and the clinical picture, there were deficiencies in the pathophysiology of diseases, signs and symptoms, diagnostic approaches and treatment. The number of references varied from 1 to 127 references; 25.9±29.4 (mean±SD). Several problems were identified in the list of references and citations made in the articles. The readability of articles was 14.3±1.7 (mean±SD); consistent with the readability level for college students. In comparison, Harrison's Principles of Internal Medicine 18th edition had more tables, less references and no significant difference in number of graphs, images, illustrations or readability level. The overall agreement between the evaluators was good (Fleiss κ 0.718 (95% CI 0.57 to 0.83).

CONCLUSIONS

The Wikipedia entries are not aimed at a medical audience and should not be used as a substitute to recommended medical resources. Course designers and students should be aware that Wikipedia entries on cardiovascular diseases lack accuracy, predominantly due to errors of omission. Further improvement of the Wikipedia content of cardiovascular entries would be needed before they could be considered a supplementary resource.

Is Wikipedia a reliable learning resource for medical students? Evaluating respiratory topics

The aim of the present study was to critically evaluate the accuracy and readability of English Wikipedia articles on the respiratory system and its disorders and whether they can be a suitable resource for medical students. On April 27, 2014, English Wikipedia was searched for articles on respiratory topics. Using a modified DISCERN instrument, articles were independently scored by three assessors. The scoring targeted content accuracy, frequency of updating, and quality of references. The readability of articles was measured using two other instruments. The mean DISCERN score for the 40 articles identified was 26.4±6.3. Most articles covered causes, signs and symptoms, prevention, and treatment. However, several knowledge deficiencies in the pathogenesis of diseases, investigations needed, and treatment were observed. The total number of references for the 40 articles was 1,654, and the references varied from 0 to 168 references, but several problems were identified in the list of references and citations made. The readability of articles was in the range of 9.4±1.8 to 22.6±10.7 using the Flesch-Kincaid Grade Level instrument and 10.0±2.6 to 19.6±8.3 using the Readability Coleman-Liau index. A strong correlation was found between the two instruments (r2=0.744, P<0.001). The agreement between the assessors had mean κ scores in the range of 0.712-0.857. In conclusion, despite the effort placed in creating Wikipedia respiratory articles by anonymous volunteers (wikipedians), most articles had knowledge deficiencies, were not accurate, and were not suitable for medical students as learning resources.

Writing for publication in medical education in high impact journals

BACKGROUND

One of the key priorities of a scholarly teacher is to demonstrate the ability to contribute to the advancement of knowledge, and transformation of new knowledge into applications that can be of value to the profession and the teaching/learning community. However, successful contribution to a scholarly activity such as publication is challenging particularly when academics lack confidence in their writing skills.

AIM

The aim of this article is to highlight keys for successful publication in medical education.

METHODS

We reviewed the current literature, recent medical education proceedings, and Association of Medical Education in Europe (AMEE) Guides and explored the basic principles for creating a scholarly publication. We have also reflected on our collective long experience as reviewers to educational, scientific, and clinical journals as well as our roles on editorial boards of medical education and scientific journals.

RESULTS

Using the methods described, we have developed the following twelve tips: (1) Start with the end of mind, (2) Sharpen your idea, (3) Select the right journal, (4) Discuss authorship, (5) Adhere to ethical principles, (6) Prepare the manuscript, (7) Avoid common mistakes, (8) See it from the reviewer's eyes, (9) Prepare a cover letter, (10) Respond to the editor's and reviewers' reports, (11) Don't be discouraged by rejection, and (12) Reflect on your experience.

CONCLUSIONS

Writing for publication in medical education, particularly in journals with high impact ratings, is a challenging task. However, becoming passionate about your contention, and working on transforming your idea into a published work necessitates self-regulation, resilience, visualization of outcomes, and implementing scholarly approaches. Overcoming challenges and focusing on your goal can be reached if these tips are applied.

Understanding pharmacokinetics: are YouTube videos a useful learning resource?

OBJECTIVES

To investigate whether YouTube videos on pharmacokinetics can be a useful learning resource for medical students.

METHODS

YouTube was searched from 01 November to 15 November 2013 for search terms "Pharmacokinetics", "Drug absorption", "Drug distribution", Drug metabolism", "Drug elimination", "Biliary excretion of drugs", and "Renal excretion of drugs".  Only videos in the English and those matching the inclusion criteria were included. For each video, the following characteristic data were collected: title, URL, duration, number of viewers, date uploaded, and viewership per day, like, dislike, number of comments, number of video sharing, and the uploader /creator. Using standardized criteria comprising technical, content, authority and pedagogy parameters, three evaluators independently assessed the videos for educational usefulness. Data were analyzed using SPSS software and the agreement between the evaluators was calculated using Cohen's kappa analysis.

RESULTS

The search identified 1460 videos. Of these, only 48 fulfilled the inclusion criteria. Only 30 were classified as educationally useful videos (62.5%) scoring 13.83±0.45 (mean±SD) while the remaining 18 videos were not educationally useful (37.5%) scoring 6.48±1.64 (mean±SD), p = 0.000. The educationally useful videos were created by pharmacologists/educators 83.3% (25/30), professors from two universities 13.3% (04/30) and private tutoring body 3.3% (01/30). The useful videos were viewed by 12096 (65.4%) and had a total of 433332 days on YouTube, while the non-educationally useful videos were viewed by 6378 (34.6%) viewers and had 20684 days on YouTube. No correlation was found between video total score and number of like (R2 0.258), dislike (R2 0.103), viewers (R2 0.186), viewership/day (R2 0.256), comments (R2 0.250), or share (R2 0.174). The agreement between the three evaluators had an overall Cohen's kappa score in the range of 0.582-0.949.

CONCLUSIONS

YouTube videos on pharmacokinetics and drug elimination showed a range of variability in regard to the contents of their educational usefulness.  Medical educators should be aware of the potential influence of YouTube videos may have on student's understanding of pharmacokinetics and drug elimination. Users who rely on the comments made by viewers or the approval expressed in terms of the number of like given by viewers should become aware that these indicators are not accurate and do not correlate with the scores given to videos.

Evaluation of gastroenterology and hepatology articles on Wikipedia: are they suitable as learning resources for medical students?

BACKGROUND

With the changes introduced to medical curricula, medical students use learning resources on the Internet such as Wikipedia. However, the credibility of the medical content of Wikipedia has been questioned and there is no evidence to respond to these concerns. The aim of this paper was to critically evaluate the accuracy and reliability of the gastroenterology and hepatology information that medical students retrieve from Wikipedia.

METHODS

The Wikipedia website was searched for articles on gastroenterology and hepatology on 28 May 2013. Copies of these articles were evaluated by three assessors independently using an appraisal form modified from the DISCERN instrument. The articles were scored for accuracy of content, readability, frequency of updating, and quality of references.

RESULTS

A total of 39 articles were evaluated. Although the articles appeared to be well cited and reviewed regularly, several problems were identified with regard to depth of discussion of mechanisms and pathogenesis of diseases, as well as poor elaboration on different investigations. Analysis of the content showed a score ranging from 15.6±0.6 to 43.6±3.2 (mean±SD). The total number of references in all articles was 1233, and the number of references varied from 4 to 144 (mean±SD, 31.6±27.3). The number of citations from peer-reviewed journals published in the last 5 years was 242 (28%); however, several problems were identified in the list of references and citations made. The readability of articles was in the range of -8.0±55.7 to 44.4±1.4; for all articles the readability was 26±9.0 (mean±SD). The concordance between the assessors on applying the criteria had mean κ scores in the range of 0.61 to 0.79.

CONCLUSION

Wikipedia is not a reliable source of information for medical students searching for gastroenterology and hepatology articles. Several limitations, deficiencies, and scientific errors have been identified in the articles examined.

Evaluation of the educational value of YouTube videos about physical examination of the cardiovascular and respiratory systems

Background

A number of studies have evaluated the educational contents of videos on YouTube. However, little analysis has been done on videos about physical examination.

Objective

This study aimed to analyze YouTube videos about physical examination of the cardiovascular and respiratory systems. It was hypothesized that the educational standards of videos on YouTube would vary significantly.

Methods

During the period from November 2, 2011 to December 2, 2011, YouTube was searched by three assessors for videos covering the clinical examination of the cardiovascular and respiratory systems. For each video, the following information was collected: title, authors, duration, number of viewers, and total number of days on YouTube. Using criteria comprising content, technical authority, and pedagogy parameters, videos were rated independently by three assessors and grouped into educationally useful and non-useful videos.

Results

A total of 1920 videos were screened. Only relevant videos covering the examination of adults in the English language were identified (n=56). Of these, 20 were found to be relevant to cardiovascular examinations and 36 to respiratory examinations. Further analysis revealed that 9 provided useful information on cardiovascular examinations and 7 on respiratory examinations: scoring mean 14.9 (SD 0.33) and mean 15.0 (SD 0.00), respectively. The other videos, 11 covering cardiovascular and 29 on respiratory examinations, were not useful educationally, scoring mean 11.1 (SD 1.08) and mean 11.2 (SD 1.29), respectively. The differences between these two categories were significant (P<.001 for both body systems). The concordance between the assessors on applying the criteria was 0.89, with a kappa score >.86.

Conclusions

A small number of videos about physical examination of the cardiovascular and respiratory systems were identified as educationally useful; these videos can be used by medical students for independent learning and by clinical teachers as learning resources. The scoring system utilized by this study is simple, easy to apply, and could be used by other researchers on similar topics.

Enhancing learning approaches: practical tips for students and teachers

BACKGROUND

In an integrated curriculum such as problem-based learning (PBL), students need to develop a number of learning skills and competencies. These cannot be achieved through memorization of factual knowledge but rather through the development of a wide range of cognitive and noncognitive skills that enhance deep learning.

AIM

The aim of this article is to provide students and teachers with learning approaches and learning strategies that enhance deep learning.

METHODS

We reviewed current literature in this area, explored current theories of learning, and used our experience with medical students in a number of universities to develop these tips.

RESULTS

Incorporating the methods described, we have developed 12 tips and organized them under three themes. These tips are (1) learn how to ask good questions, (2) use analogy, (3) construct mechanisms and concept maps, (4) join a peer-tutoring group, (5) develop critical thinking skills, (6) use self-reflection, (7) use appropriate range of learning resources, (8) ask for feedback, (9) apply knowledge learnt to new problems, (10) practice learning by using simulation, (11) learn by doing and service learning, and (12) learn from patients.

CONCLUSIONS

Practicing each of these approaches by students and teachers and applying them in day-to-day learning/teaching activities are recommended for optimum performance.

Introducing integrated laboratory classes in a PBL curriculum: impact on student's learning and satisfaction

BACKGROUND

With the introduction of integrated problem-based learning (PBL) program in the medical curriculum, there is a need to create laboratory classes that suit students' learning needs and the changes introduced to the curriculum. This paper outlines the development and implementation of four integrated laboratory classes (ILCs) at King Saud University College of Medicine. It also examines whether core concepts addressed in these classes were learned and retained and how the students perceived the ILCs.

METHODS

ILCs are based on enhancing enquiry-based learning, and encouraging students to work on tasks in small groups (apply and integrate knowledge from biochemistry, pathology and microbiology) and conduct a laboratory procedure (practical part). In two of these ILCs, a pretest comprising 15 multiple-choice questions were administrated at the start of the class and an identical posttest was administrated at the end of these classes. Performance of the students in the Objective Structured Practical Examination (OSPE) at the end of the blocks was also evaluated. Students' perceptions were evaluated using a questionnaire completed at the end of each class.

RESULTS

A total of 247, 252, 238, and 244 students participated in practical classes covering cerebrospinal fluid infection, small intestine, liver function tests and adrenal gland function, respectively. Students got higher scores in posttests compared to pre-test scores in two classes (12.68 ± 2.03 vs 6.58 ± 3.39 and 13.02 ± 2.03 vs 7.43 ± 2.68, respectively). Paired t-test showed that the difference was significant (P < 0.001) in both tests. The mean scores of students in stations dealing with ILCs at the end of the block examinations were not significantly different from the mean scores for other stations not related to ILCs. The questionnaire indicated that most students expressed positive attitude towards working on tasks and applying knowledge learnt. Students also felt that conducting laboratory procedures and interpreting laboratory findings were valuable to their learning.

CONCLUSIONS

Given the increase in the posttest scores (short-term retention) and the satisfactory performance of students at the end of block examinations (long-term retention) together with the students' satisfaction, the study suggests that the core concepts addressed in these classes were learned and retained.

Overview of molecular pathways in inflammatory bowel disease associated with colorectal cancer development

Patients with long-standing inflammatory bowel disease (IBD) are at a higher risk of developing colorectal cancer (CRC). This risk increases with the longer duration of colitis, greater extent of inflammation, a family history of CRC, severity of bowel inflammation, and a coexistent primary sclerosing cholangitis. The cornerstone for comprehending the development of CRC in IBD and hence early detection is based on the understanding of the molecular pathways of IBD itself. At a molecular level, the pathogenesis of CRC is related to understanding the inflammatory changes and involves multiple inter-related pathways including (i) genetic alterations (e.g. chromosomal and microsatellite instability and hypermethylation), (ii) mucosal inflammatory mediators (e.g. COX-2, interleukin-6, interleukin-23, tumor necrosis factor-α, nuclear factor-κB, and chemokines), (iii) changes in the expression of receptors on the epithelial cells, and (iv) oxidant stress, mucosal breakdown, and intestinal microbiota. The aim of this review is to provide an evidence-based approach for the role of chronic inflammatory mechanisms and the molecular basis of these mechanisms in the development of CRC. Therefore, understanding the molecular basis of CRC is an important step for the identification of new biomarkers that can help in the early detection of CRC in these patients.

Nervous system examination on YouTube

BACKGROUND

Web 2.0 sites such as YouTube have become a useful resource for knowledge and are used by medical students as a learning resource. This study aimed at assessing videos covering the nervous system examination on YouTube.

METHODS

A research of YouTube was conducted from 2 November to 2 December 2011 using the following key words "nervous system examination", "nervous system clinical examination", "cranial nerves examination", "CNS examination", "examination of cerebellum", "balance and coordination examination". Only relevant videos in the English language were identified and related URL recorded. For each video, the following information was collected: title, author/s, duration, number of viewers, number of posted comments, and total number of days on YouTube. Using criteria comprising content, technical authority and pedagogy parameters, videos were rated independently by three assessors and grouped into educationally useful and non-educationally useful.

RESULTS

A total of 2240 videos were screened; 129 were found to have relevant information to nervous system examination. Analysis revealed that 61 (47%) of the videos provided useful information on the nervous system examination. These videos scored (mean ± SD, 14.9 ± 0.2) and mainly covered examination of the whole nervous system (8 videos, 13%), cranial nerves (42 videos, 69%), upper limbs (6 videos, 10%), lower limbs (3 videos, 5%), balance and co-ordination (2 videos, 3%). The other 68 (53%) videos were not useful educationally; scoring (mean ± SD, 11.1 ± 3.0). The total viewers of all videos was 2,189,434. Useful videos were viewed by 1,050,445 viewers (48% of total viewers). The total viewership per day for useful videos was 1,794.5 and for non-useful videos 1,132.0. The differences between the three assessors were insignificant (less than 0.5 for the mean and 0.3 for the SD).

CONCLUSIONS

Currently, YouTube provides an adequate resource for learning nervous system examination, which can be used by medical students. However, there were deficiencies in videos covering examination of the cerebellum and balance system. Useful videos can be used as learning resources to medical students.

Becoming a peer reviewer to medical education journals

BACKGROUND

Peer reviewing for medical education journals is an art, a privilege, a responsibility and a service to the profession. Writing a review report requires skills and commitment and takes time. Novice reviewers may be interested in participating in this service, but they might lack sufficient knowledge of their role as peer reviewers and the skills needed to conduct a comprehensive and fair review.

AIMS

The aims of this article are to help novice reviewers in their preparation of manuscript review reports and improve their confidence and skills in their role as reviewers.

METHODS

We reviewed the literature in this area and applied lessons learned from our experience as peer reviewers. In addition, one of the authors has presented several training workshops for faculty reviewers.

RESULTS

Incorporating all the methods described, we have developed a series of simple strategies that medical educators can utilise to perform high-quality reviews of manuscripts.

CONCLUSIONS

Though the development of skills in reviewing medical education papers is the outcome of continuous practice and experience; the strategies described in this article will be of value to those starting their professional contribution as reviewers and enhance their skills in this area.

Twelve tips for constructing problem-based learning cases

BACKGROUND

One of the key elements for introducing a problem-based learning (PBL) programme is constructing good PBL cases. Good cases should reflect the educational principles of PBL including (a) integration of basic and clinical sciences together with professionalism and psychosocial components, (b) encouragement of discussion of cognitive domains such as identification of problems, generation of hypotheses, construction of an enquiry plan, weighing evidence for and against each hypothesis, interpretation of findings, construction of mechanisms, using evidence to refine the hypothesis and construction of a management plan, (c) encouragement of discussion of cases in small groups with an emphasis on student-centred learning, (d) promotion of collaborative learning and contribution of students to the case discussion and (e) encouragement of teamwork and self-directed learning strategies.

AIMS AND METHODS

Despite the importance of construction of good PBL cases to the success of a PBL programme, the art of construction of these cases is understudied or described in the literature. Based on our experience in PBL and evidence from literature, we described 12 tips for constructing good PBL cases.

RESULTS AND CONCLUSIONS

Constructing good PBL cases is an art that necessitates teamwork and input from several different disciplines. Cases should be constructed using a template reflecting the educational objectives of the programme. This approach will ensure optimum learning outcomes and consistency in the design and delivery of cases.

Introducing a problem-based learning program: 12 tips for success

BACKGROUND

Worldwide many universities are changing their curricula and introducing integrated problem-based learning (PBL) programs. However, the introduction of a PBL program is a demanding process and requires resources, a lot of planning, and organisation.

AIMS

This article aims at providing practical tips for preparing a PBL program. It highlights key challenges to create such programs and offers possible solutions to common challenges encountered.

METHODS

Personal experience in introducing PBL programs in several universities together with key principles highlighted in the literature have been presented and discussed in light of the current medical education research.

RESULTS

Introducing an integrated PBL program requires continuous support from the Dean and the Vice Chancellor. An essential step in this process is preparation and engagement of the faculty so that academics and clinicians become aware of the rationales for the change and work as part of a team in the construction of the new program. Consulting with other Departments of Medical Education that have introduced PBL, may help in avoiding common mistakes and providing a practical advice.

CONCLUSION

Although there is no panacea for the introduction of a PBL program, this article addresses keys for successful introduction of such programs.

Problem-based learning: Where are we now? Guide supplement 36.1 - viewpoint

The AMEE Guide No 36 by Taylor and Miflin (2008) provides an excellent resource about the current status of problem-based learning (PBL). The authors discussed the roots of PBL and generated hypotheses about possible causes for the confusion about PBL. They also discussed a number of challenges facing PBL. The guide is worth reading by novice PBL tutors and experienced medical and health educators. In this article, I would like to reflect on some of the challenges facing PBL and provide an insight into practical issues related to these challenges.

Learning surface anatomy: which learning approach is effective in an integrated PBL curriculum?

BACKGROUND

Understanding surface anatomy and surface markings are integral for introducing clinical sciences.

AIM

This study aimed to assess which learning approach is effective in learning surface anatomy.

METHOD

First-year medical students were randomly assigned into two groups and asked to complete an MCQs quiz covering surface anatomy of the abdomen (pre-test). Each student worked on his/her own in each group. Group A students (n = 70) were then provided with a reading material and two images of the abdomen printed on A4 size paper. Students were asked to study the reading material and use the image of the abdomen to draw and label the surface anatomy of six abdominal organs. Group B students (n = 74) were provided with the same reading material but were asked to answer short-answer questions. After 45 minutes, the reading material and answers were collected from both groups and student's performance was compared using the same sets of MCQs (post-test).

RESULTS

Students from both groups showed significant improvement in their post-test scores compared to their pre-test scores. Also the means for paired samples were significantly higher in Group A compared to Group B. A small number of students in both groups scored ≤ 2 in the pre-test and failed the post-test.

CONCLUSION

While both techniques improved students' scores; learning by drawing surface anatomy of abdominal organs showed higher scores.

Medical education at the crossroads: which way forward?

Over the last 30 years, several changes have been introduced in medical education including the introduction of new contextualized approaches to instruction (e.g., problem-based learning [PBL]), the use of multimedia to enhance self-directed learning, the use of an integrated curriculum to address basic and clinical sciences, and the introduction of new formative and summative assessment tools that match with the curriculum changes. However, several challenges face medical education and need to be carefully researched. The list may be long and these challenges may vary depending on the needs of local and international health systems, the availability of resources, the vision of medical leaders and how they see these challenges and their impact. This paper discusses a number of challenges facing medical education including the selection of medical students and the validity of selection tools, students' learning skills, what makes a good medical curriculum, and the challenges facing a PBL curriculum.

Twelve tips for creating trigger images for problem-based learning cases

A trigger is the starting point of problem-based learning (PBL) cases. It is usually in the form of 5-6 text lines that provide the key information about the main character (usually the patient), including 3-4 of patient's presenting problems. In addition to the trigger text, most programs using PBL include a visual trigger. This might be in the form of a single image, a series of images, a video clip, a cartoon, or even one of the patient's investigation results (e.g. chest X-ray, pathology report, or urine sample analysis). The main educational objectives of the trigger image are as follows: (1) to introduce the patient to the students; (2) to enhance students' observation skills; (3) to provide them with new information to add to the cues obtained from the trigger text; and (4) to stimulate students to ask questions as they develop their enquiry plan. When planned and delivered effectively, trigger images should be engaging and stimulate group discussion. Understanding the educational objectives of using trigger images and choosing appropriate images are the keys for constructing successful PBL cases. These twelve tips highlight the key steps in the successful creation of trigger images.

Do we need dissection in an integrated problem-based learning medical course? Perceptions of first- and second-year students

BACKGROUND

The introduction of a problem-based learning (PBL) curriculum at the School of Medicine of the University of Melbourne has necessitated a reduction in the number of lectures and limited the use of dissection in teaching anatomy. In the new curriculum, students learn the anatomy of different body systems using PBL tutorials, practical classes, pre-dissected specimens, computer-aided learning multimedia and a few dissection classes. The aims of this study are: (1) to assess the views of first- and second-year medical students on the importance of dissection in learning about the anatomy, (2) to assess if students' views have been affected by demographic variables such as gender, academic background and being a local or an international student, and (3) to assess which educational tools helped them most in learning the anatomy and whether dissection sessions have helped them in better understanding anatomy.

METHODS

First- and second-year students enrolled in the medical course participated in this study. Students were asked to fill out a 5-point Likert scale questionnaire. Data was analysed using Mann-Whitney's U test, Wilcoxon's signed-ranks or the calculation of the Chi-square value.

RESULTS

The response rates were 89% for both first- and second-year students. Compared to second-year students, first-year students perceived dissection to be important for deep understanding of anatomy (P < 0.001), making learning interesting (P < 0.001) and introducing them to emergency procedures (P < 0.001). Further, they preferred dissection over any other approach (P < 0.001). First-year students ranked dissection (44%), textbooks (23%), computer-aided learning (CAL), multimedia (10%), self-directed learning (6%) and lectures (5%) as the most valuable resources for learning anatomy, whereas second-year students found textbooks (38%), dissection (18%), pre-dissected specimens (11%), self-directed learning (9%), lectures (7%) and CAL programs (7%) as most useful. Neither of the groups showed a significant preference for pre-dissected specimens, CAL multimedia or lectures over dissection.

CONCLUSIONS

Both first- and second-year students, regardless of their gender, academic background, or citizenship felt that the time devoted to dissection classes were not adequate. Students agreed that dissection deepened their understanding of anatomical structures, provided them with a three-dimensional perspective of structures and helped them recall what they learnt. Although their perception about the importance of dissection changed as they progressed in the course, good anatomy textbooks were perceived as an excellent resource for learning anatomy. Interestingly, innovations used in teaching anatomy, such as interactive multimedia resources, have not replaced students' perceptions about the importance of dissection.