Unveiling the Hurdles in Cultivating Humanistic Physicians in the Clinical Setting: An Exploratory Study

Background

The importance of cultivating a humanistic physician has gained attention in medical education. Humanistic values are established in early education and medical schools should provide a suitable environment to nurture and grow these values into professional identity. The clinical setting has a significant impact due to its direct involvement of students in real-life situations.

Objectives

The present study aims to explore the hurdles in cultivating humanistic physicians in the clinical setting.

Methods

We conducted a qualitative study involving medical students in the clinical phase, as well as residents, clinical teachers, and module administrators in the clinical setting under study.

Results

Respondents from different groups of stakeholders shared the same definition for 'humanistic physician': a physician who provides patient-centred care while demonstrating empathy, respect, compassion, integrity, knowledge, competence and a collaborative spirit. Despite changes in the healthcare system and technological advancements, humanistic physicians are still needed.

Conclusion

Cultivating humanistic physicians is a complex process, requiring various methods and assessments. Role models play a significant role in this process, which included not only clinical teachers but also peers. Feedback from peers was perceived as an important factor. The key hurdles identified were negative role models, and a less humanistic learning environment and the students' personal backgrounds.

Role Modeling for Female Surgeons in Japan

Japan is still a patriarchal society. There is an increasing number of female doctors who wish to follow a career path in surgery. This new generation of female surgeons need support not only in their career but also in work-life balance, especially after they have a family. We founded the Japan Association of Women Surgeons (JAWS) with the aims to advance females in surgery by providing networking and to develop leadership, mentorship, education, expertise and advocacy. This article describes our philosophy and activities, and our concept of role modeling. To find a single perfect role model is impossible in Japan, because lifestyle and family situations are quite different among individuals. Many young doctors in Japan find difficulties in identifying role models appropriate to their own situations. Our concept of remote role modeling is to identify multiple outstanding persons with excellent roles that one wishes to emulate; classify them by field of work, lifestyle, family situations, and others; then select the parts that one needs and assemble them to customize one's own ideal role model. This type of role modeling is probably the most practical approach. While modern technology is good for communication, meeting role models in person at meetings and social occasions is important in building an ideal role model.

Association of Existence of Third Places and Role Model on Suicide Risk Among Adolescent in Japan: Results From A-CHILD Study

Objective: Low self-esteem among adolescents can be considered a risk factor for suicidal behavior in adolescents. Thus, the purpose of this study is to investigate the association between the existence of a third place and role model on self-esteem among adolescents in Japan, where low self-esteem is prevalent among adolescents. Methods: We analyzed data from the 2016 Adachi Child Health Impact of Living Difficulty (A-CHILD) study, in which a school-based questionnaire was conducted among children in grades 4, 6, and 8 living in Adachi City, Tokyo (N = 1,609). Children self-rated their own levels of self-esteem. Low self-esteem was defined as lower 10 percentile group. The existence of a third place was defined as a place where children spent time after school other than the home or school campus, and role model was defined as having someone, other than a parent, who they looked up to, and these concepts were assessed via questionnaire. Results: Adolescents without a third place and role model accounted for 10.5 and 6.1%, respectively. We found that children who lacked a third place also showed a significant association with low self-esteem (OR: 1.75, 95% confidence interval (CI): 1.09-2.81), and those who lacked a role model were 3.34 times more likely to have lower self-esteem (95% CI: 1.98-5.62). Conclusion: The existence of a third place and a role model may be important to prevent low self-esteem among adolescents in Japan.

When imitating successful others fails: Accidentally successful exemplars inspire risky decisions and can hamper performance

We examined the impact of viewing exemplars on people's behaviour in risky decision-making environments. Specifically, we tested if people disproportionally choose to view and then imitate the behaviour of successful (vs. unsuccessful) others, which in the case of risky decision-making increases risk-taking and can hamper performance. In doing so, our research tested how a fundamental social psychological process (social influence) interacts with a fundamental statistical phenomenon (regression to the mean) to produce biases in decision-making. Experiment 1 (N = 96) showed that people indeed model their own behaviour after that of a successful exemplar, resulting in more risky behaviour and poorer outcomes. Experiment 2 (N = 208) indicated that people disproportionately choose to examine and then imitate most successful versus least successful exemplars. Experiment 3 (N = 381) replicated Experiment 2 in a context where participants were offered the freedom to examine any possible exemplar, or no exemplar whatsoever, and across different incentive conditions. The results have implications for decision-making in a broad range of social contexts, such as education, health, and finances where risk-taking can have detrimental outcomes, and they may be particularly helpful to understand the role of social influence in gambling behaviour.

Perceptions Regarding Tobacco Cessation Counselling among Dental Students and Graduates: A Cross-Sectional Study

Background:

Tobacco usage is a global concern and it is essential to curb its usage and increase awareness among patients. Dental professionals’ contribution in tobacco cessation will definitely make a stark difference. Thus it is important to assess dental students’ and graduates’ knowledge, attitude and practice towards Tobacco cessation counselling (TCC).

Materials and Methods:

The descriptive, cross-sectional survey was carried out among 286 students of a dental college in South India. A well-structured, pretested, self-administered questionnaire consisting of 17 close-ended questions was employed to assess knowledge, attitude and practice towards TCC.

Results:

Almost all study participants agreed that tobacco cessation counselling is under the scope of dental practice and admitted that it is the responsibility of dental professionals to educate patients for the same. Majority of graduates responded that they have done tobacco cessation counselling whereas less than two-third of undergraduates have done the same and difference between two groups was statistically significant (p<0.001). A significantly higher number of graduates (79%) were aware of 5A’s and 5R’s protocol for TCC as compared to undergraduates (50%). But less than one-fifth of study population have actually applied this protocol for TCC in clinical practice.

Conclusion:

There is a need to modify the dental curriculum and motivate young graduates and students about TCC. This will develop a more professional competence and helps to encourage the dental professionals in developing a preventive mind set about tobacco use. Thus, it will help in enhancing the long-term rates of quitting tobacco among patients, which will prove beneficial in controlling tobacco related diseases in near future.

How to be a great occupational physician: Lessons from Tar-Ching Aw

Tar Ching Aw (1948-2017) or Ching, as he was known to many of us, was highly regarded as an excellent occupational physician and role model. He was an inspirational teacher, a selfless mentor and a great advocate for the discipline of occupational medicine. Among the lessons we can learn from Ching on how to be an excellent occupational physician are the importance of: getting the right training (including clinical training); having good teachers and role models; believing in and being passionate about one's work; delivering quality work on time; networking and being culturally sensitive; thinking of future generations and mentoring them; and having fun and a healthy work life balance.

Practicing what we preach: A pilot study on oral health practices of dentists in Massachusetts

AIM

Dentists are perceived as leaders and role models of good oral health, but do dentists practice what they preach? The current study was a pilot evaluation dentists of the oral health and oral health practices of dentists in Massachusetts.

METHODS

The Massachusetts Dental Society sent emails to 3957 member dentists for whom an email contact was available. One reminder was sent 3 months later, and there was no incentive offered. Institutional review board approval was acquired prior to administering the survey through the Harvard Medical School Committee on Human Studies.

RESULTS

A total of 4.9% of dentists had a comprehensive oral examination more than 8 years ago, and 3.1% had diagnostic bitewings 3-5 years ago. Our study revealed that 5.8% had untreated caries and only 70.8% reported having no oral health problems. A total of 37% reported that lack of time was a barrier in seeking care, and 7.8% reported financial barriers. Finally, 4.1% reported that a non-dentist coworker examined and managed their oral health.

CONCLUSIONS

The current study revealed that many dentists are not following American Dental Association guidelines for prevention for themselves. Subsequently, many in our profession are recommending preventive care for their patients that they are not adhering to themselves.

Role models and professional development in dentistry: an important resource: The views of early career stage dentists at one academic health science centre in England

BACKGROUND

The importance of role models, and their differing influence in early, mid- and late careers, has been identified in the process of professional development of medical doctors. There is a paucity of evidence within dentistry on role models and their attributes.

AIM

To explore the views of early career dentists on positive and negative role models across key phases of professional development, together with role models' attributes and perceived influence.

METHODS

This is a phenomenological study collecting qualitative data through semi-structured interviews based on a topic guide. Dentists in junior (core training) hospital posts in one academic health science centre were all invited to participate. Interviews were recorded, transcribed verbatim and analysed using framework analysis.

RESULTS

Twelve early career stage dentists, 10 of whom were female, reported having role models, mainly positive, in their undergraduate and early career phases. Participants defined role models' attributes in relation to three distinct domains: clinical attributes, personal qualities and teaching skills. Positive role models were described as "prioritising the patient's best interests", "delivering learner-centred teaching and training" and "exhibiting a positive personality", whilst negative role models demonstrated the converse. Early career dentists reported having largely positive dentist role models during- and post-dental school and report their impact on professional values and aspirations, learning outcomes and career choice.

CONCLUSION

The findings suggest that these early career dentists in junior hospital posts have largely experienced and benefitted from positive role models, notably dentists, perceived as playing an important and creative influence promoting professionalism and shaping the career choices of early career stage dentists.

Do family physicians suffer an identity crisis? A perspective of family physicians in Bangalore city

Background:

The need of the hour in Indian healthcare is well-qualified, competent family physicians, but there is an overwhelming importance given to specialized medical care. Family physicians feel that they do not get the recognition they deserve. This study was undertaken to explore the views and perceptions of family physicians and residents about their specialty.

Materials and Methods:

This cross-sectional study was conducted among 110 doctors who are undergoing family medicine (FM) residency and practicing family physicians in Bangalore. The questionnaire was developed with domains on patient or family relationship, balancing breadth and depth in practice, comprehensive nature of patient care, career flexibility, and patient advocacy. Data were analyzed using SPSS version 17.0, and P value less than 0.05 was considered as statistically significant.

Results:

The majority of the participants (55.5%) felt that there is poor acceptance among the people about FM doctor as a specialist. A significant proportion (39.1%) of them indicated that thought of “Jack of all trades and Master of none” bothers them much. More than 90% of respondents felt a sense of pride being family physicians. FM practitioners (28.4 ± 3.1) had a good perception score when compared with residents (27 ± 3.6) (P < 0.05). There was a significant difference among FM residents and practitioners on being pride of FM physician sense of belonging to larger community FM physicians.

Conclusion:

FM residents go through more identity crisis when compared with practitioners. This can be addressed well by incorporating FM curriculum in undergraduate medical training and strong FM department where students have role model as mentors and take FM as specialty as their preferred choice.

Lessons learned from narrative feedback of students on a geriatric training program

Geriatrics continues to draw insufficient numbers of medical students today. Currently, little is known regarding how education can motivate students to choose geriatrics. The authors' aim was to examine geriatrics from the students' perspective to identify elements that can be useful in education and improving attitudes toward, interest in, and knowledge about geriatrics. The authors analyzed narrative reflection essays of 36 students and clarified the themes from the essays during focus group sessions. Four overarching themes that influenced students' perspective on geriatrics were identified: professional identity, perception of geriatrics, geriatric-specific problems, and learning environment. Students have an inaccurate image of clinical practice and the medical professional identity, which has a negative impact on their attitude toward, interest in, and knowledge of geriatrics. Furthermore, this study yielded the important role of the hidden curriculum on professional identity, the novelty of geriatric-specific problems to students, and the importance of educational approach and good role models.

Entrepreneurship education revisited: perceived entrepreneurial role models increase perceived behavioural control

Relying on Bandura's (1986) social learning theory, Ajzen's (1988) theory of planned behaviour (TPB), and Dyer's (1994) model of entrepreneurial careers, this study aims to highlight the potential of entrepreneurial role models to entrepreneurship education. The results suggest that entrepreneurial courses would greatly benefit from real-life experiences, either positive or negative. The results of regression analysis based on 426 individuals, primarily from Austria, Finland, and Greece, show that role models increase learners' entrepreneurial perceived behaviour control (PBC) by increasing their self-efficacy. This study can inform the research and business communities and governments about the importance of integrating entrepreneurs into education to stimulate entrepreneurial PBC. This study is the first of its kind using its approach, and its results warrant more in-depth studies of storytelling by entrepreneurial role models in the context of multimedia entrepreneurship education.

The influence of role models in undergraduate nurse education

AIMS AND OBJECTIVES

To explore the concept of role modelling in undergraduate nurse education and its effect on the personal and professional development of student nurses.

BACKGROUND

Effective educative strategies are important for student nurses, who have to cope with learning in both clinical and university settings. Given the contemporary issues facing nurse education and practice in the United Kingdom (UK), it is timely and important to undertake pedagogical research into the concept of role modelling as an effective educative method.

DESIGN

A descriptive narrative approach.

METHODS

Unstructured interviews were conducted with 14 current/recently discontinued students from Adult and Mental Health branches of nursing degree programmes in the north-west region of England, United Kingdom (UK). Data were thematically analysed.

RESULTS

Students valued exposure to positive role models in clinical and university settings and viewed them as beneficial to their learning. Exposure to negative role models occurred, and this provided students with opportunities to consider the type of nurse they aspired to become. In some cases, students' exposure to perceived poor practice had an adverse effect on their learning and led to negative feelings about nursing work. Clinical staff might be perceived as more relevant role models than those in the university setting although there were still opportunities for academic staff to model professional behaviours.

CONCLUSION

The study found that role modelling is an effective way to support learning and led to student satisfaction across both clinical and university settings. The findings support the use of role models in nurse education, and further research about conscious positive modelling of practice is required.

RELEVANCE TO PRACTICE

Exploring the use of role models is important when examining ways in which the quality of nurse education might be developed.

Development of Physical Activity-Related Parenting Practices Scales for Urban Chinese Parents of Preschoolers: Confirmatory Factor Analysis and Reliability

BACKGROUND

Valid instruments of parenting practices related to children's physical activity (PA) are essential to understand how parents affect preschoolers' PA. This study developed and validated a questionnaire of PA-related parenting practices for Chinese-speaking parents of preschoolers in Hong Kong.

METHODS

Parents (n = 394) completed a questionnaire developed using findings from formative qualitative research and literature searches. Test-retest reliability was determined on a subsample (n = 61). Factorial validity was assessed using confirmatory factor analysis. Subscale internal consistency was determined.

RESULTS

The scale of parenting practices encouraging PA comprised 2 latent factors: Modeling, structure and participatory engagement in PA (23 items), and Provision of appropriate places for child's PA (4 items). The scale of parenting practices discouraging PA scale encompassed 4 latent factors: Safety concern/overprotection (6 items), Psychological/behavioral control (5 items), Promoting inactivity (4 items), and Promoting screen time (2 items). Test-retest reliabilities were moderate to excellent (0.58 to 0.82), and internal subscale reliabilities were acceptable (0.63 to 0.89).

CONCLUSION

We developed a theory-based questionnaire for assessing PA-related parenting practices among Chinese-speaking parents of Hong Kong preschoolers. While some items were context and culture specific, many were similar to those previously found in other populations, indicating a degree of construct generalizability across cultures.

Nurses' Perceptions of Self as Role Models of Health

This study purposed to determine the relationship between nurses' personal health practices and their perceptions of themselves as role models for health promotion, and assess the relationship of personal and professional characteristics both on perception of self as role model and on the practice of healthy behaviors. In this study of 804 Tennessee registered nurses, 4% report smoking, 24.9% drink alcohol, 34% are overweight, and 30% are obese. Approximately 70% do not meet the weekly physical activity recommendations of 150 min, and 36.2% follow guidelines for a healthy diet only 50% of the time or less. There were significant correlations between following a healthy diet or physical activity and the Self as a Role Model of Health Promotion (SARMHEP) scores. Based on the regression analysis, working in an acute care or ambulatory setting negatively affected the SARMHEP, as opposed to age and sex having a positive effect on the SARMHEP score.

Should nurses be role models for healthy lifestyles? Results from a modified Delphi study

AIM

To explore the expectation that nurses should be role models for healthy behaviours.

BACKGROUND

Nurses are expected to be role models for healthy behaviours. Whether this is a realistic and acceptable expectation has not been explored.

DESIGN

Modified Policy Delphi study with two rounds of data collection.

METHOD

Purposive sampling was used to explore areas of agreement and disagreement among six stakeholder groups who influence nursing roles: practising nurses, nursing students, service users, policy makers, workforce development leads and stakeholders working in nurse education. Two rounds of a modified Policy Delphi study were conducted between February - June 2015. The first round used telephone interviews for an open exploration of opinions. The second round used attitude statements to explore convergence and divergence of opinions across stakeholder groups. Responses were analysed thematically.

RESULTS

Policy and professional discourse that asserts that nurses should be healthy role models was seen as unrealistic and unhelpful. Contrary to the view that nurses should epitomize and demonstrate healthy behaviours to encourage patients and to be credible in advice, stakeholders agreed that it was more important to be seen as 'human' and understand the challenges of health behaviour change. Student and practising nurses did not see role modelling healthy behaviours as a reasonable professional expectation.

CONCLUSIONS

The findings challenge the assumptions underpinning the argument that nurses be healthy role models. Further research is needed to understand the views of frontline nurses and to further explore avenues by which health services staff health can be improved.

Innovative integrative bedside teaching model improves tutors' self-assessments of teaching skills and attitudes

INTRODUCTION

Patient bedside is the ideal setting for teaching physical examination, medical interviewing, and interpersonal skills. Herein we describe a novel model for bedside teaching (BST) practiced during tutor training workshop and its resulting effect on practitioners' self assessment of teaching skills and perceptions.

METHODS

One-day tutor training workshop included theoretical knowledge supplementation regarding tutors' roles as well as implementing practical tools for clinical education, mainly BST model. The model, which emphasizes simultaneous clinical and communication teaching in a stepwise approach, was practiced by consecutive simulations with a gradual escalation of difficulty and adjusted instruction approaches. Pre- and post-workshop-adjusted questionnaires using a Likert scale of 1 to 4 were completed by participants and compared.

RESULTS

Analysis was based on 25 out of 48 participants who completed both questionnaires. Significantly improved teaching skills were demonstrated upon workshop completion (mean 3.3, SD 0.5) compared with pre-training (mean 2.6, SD 0.6; p<0.001) with significant increase in most examined parameters. Significantly improved tutor's roles internalization was demonstrated after training completion (mean 3.7, SD 0.3) compared with pre-workshop (mean 3.5 SD 0.5; p=0.002).

DISCUSSION

Successful BST involves combination of clinical and communication skills. BST model practiced during the workshop may contribute to improved teaching skills in this challenging environment.

Multiset Statistics for Gene Set Analysis

An important data analysis task in statistical genomics involves the integration of genome-wide gene-level measurements with preexisting data on the same genes. A wide variety of statistical methodologies and computational tools have been developed for this general task. We emphasize one particular distinction among methodologies, namely whether they process gene sets one at a time (uniset) or simultaneously via some multiset technique. Owing to the complexity of collections of gene sets, the multiset approach offers some advantages, as it naturally accommodates set-size variations and among-set overlaps. However, this approach presents both computational and inferential challenges. After reviewing some statistical issues that arise in uniset analysis, we examine two model-based multiset methods for gene list data.

Lay perspectives on the social and psychological functions of heroes

Declaring and thinking about heroes are common human preoccupations but surprisingly aspects of heroism that reinforce these behaviors are not well-understood. In four thematically consistent studies, we attempt to identify lay perspectives about the psychological functions served by heroes. In Study 1, participants (n = 189) freely generated open-ended descriptions of hero functions, which were then sorted by independent coders into 14 categories (e.g., instill hope, guide others). In Study 2, in an attempt to identify the most important functions associated with heroes, participants (n = 249) rated how each function corresponded with their personal views about heroes. Results from a confirmatory factor analysis suggested that a three-factor model of hero functions fit the data well: participants thought that heroes enhanced the lives of others, promoted morals, and protected individuals from threats. In Study 3 (n = 242), participants rated heroes as more likely to fulfill a protecting function than either leaders or role models. In Studies 4A (n = 38) and 4B (n = 102), participants indicated that thinking about a hero (relative to a leader or an acquaintance) during psychological threat fulfilled personal enhancement, moral modeling, and protection needs. In all, these findings provide an empirical basis to spur additional research about the social and psychological functions that heroes offer.

Facilitating the initiation of the physician's professional identity: Cornell's urban semester program

Calling for major reform in medical education, the Carnegie Institute report 'Educating Physicians' espoused the importance of assisting student trainees in forming their professional identities. Here, we consider the question: At what educational stage should future physicians begin this process? The literature suggests that the process begins when students matriculate in medical school; we posit, however, that premedical students can begin their proto-professional development as college undergraduates. We describe here the pedagogy of Cornell University's urban semester program (USP), which enables college students to participate in shadowing experiences as part of an integrated structured study programme. USP students report improved communicative competency, changes in their perceptions and attitudes toward medical practice, and powerful influences on their personal and professional development upon completion of the programme. We suggest the solution to the question of 'When and under what conditions should shadowing take place?' is to utilize a structure that combines the exposure of college students to the professional environment with a didactic and self-reflective curriculum, thereby supporting students in their early professional development. We conclude that educational efforts aimed at developing professional identity and behaviour can begin before students enter medical school.

Role models play the greatest role - a qualitative study on reasons for choosing postgraduate training at a university hospital

Objective: Why physicians choose a certain specialty at a university hospital for their postgraduate training is incompletely understood. Our aim was to identify factors that led physicians from different generations to opt for postgraduate training in a specialty with high or low patient contact at a university hospital.

Methods: We conducted 14 semi-structured interviews with residents and attending physicians from the departments of Internal Medicine (high patient contact) and Laboratory Medicine (low patient contact) at the University Hospital Hamburg-Eppendorf, Germany. We used template analysis to code the interview transcripts and iteratively reduced and displayed the data. Initial codes and concepts were shaped into categories until agreement on the final template was reached.

Results: We identified five main categories of factors that influenced postgraduate specialty selection. Role models with a civilized code of behavior and expertise in their specialty had had the greatest influence on participants’ choice of a specialty across generations. Electives and a doctoral thesis project had also influenced participants’ decisions, mainly because of meeting a role model in their supervisor. Patient contact and intellectual challenges were identified as contributing factors in the selection of a specialty with high patient contact. As reasons for selecting a university hospital for postgraduate education four categories were identified: the possibility to participate in scientific research, a broad spectrum of activities, personal contacts and future career opportunities.

Conclusions: The professional attitudes of teachers as role models were identified as having the greatest influence on postgraduate education choices. Besides other actions to attract students to certain specialties for their postgraduate education, the aspect of being perceived as a role model while teaching requires particular attention when preparing medical faculty for undergraduate medical teaching.

Mentorship

The world of medicine is in a state of flux with major and substantive changes in its educational model. Students, residents, and junior attendings can no longer rely entirely on experiential development through clinical immersion. Instead, to attain similar levels of knowledge, technique, and situational comfort, there must be innovations in medical education that take advantage of the experience of mentors. Mentoring has been a part of medicine and surgery since the days of apprenticeship. Mentors must now teach more basic medicine than ever before and adapt to changes in the structure of medical education such as the use of simulation, yet still continue to foster career development among trainees and junior colleagues. For mentoring to succeed and benefit mentees, it must be supported. This patronage starts with each local university or hospital system but eventually must permeate the greater medical culture.

Experiences of role model instructors and nursing students about facilitator factors of role-modeling process: A qualitative research

BACKGROUND

One of the key strategies in students' learning is the influence of models on them. Understanding the factors affecting the implementation of role-modeling process in education will help to make greater use of this training strategy. This study aimed to understand the experiences of role model instructors and nursing students about the facilitator factors in the role-modeling process.

MATERIAL AND METHODS

This qualitative study was carried out by using thematic analysis method and purposeful sampling. Data were collected until saturation by using three focus group discussions (n = 20) and two individual interviews with nursing instructors, as well as six semi-structured face-to-face interviews with role model instructors from five nursing faculties of Tehran universities in 2011.

RESULTS

Six themes, "effort for humanistic and professional growth of students," "individual and managerial empowerment of instructor," "instructor and student's modeling," "motivation and effort of student," "strategies governing the education system," and "appropriate facilities and equipment," were extracted as the facilitating factors.

CONCLUSIONS

For development of role-modeling process in nursing education, paying attention to personal and environmental factors, especially effort for professional and humanistic growth of nursing students is necessary.

Benefits of off-campus education for students in the health sciences: a text-mining analysis

BACKGROUND

In Japan, few community-based approaches have been adopted in health-care professional education, and the appropriate content for such approaches has not been clarified. In establishing community-based education for health-care professionals, clarification of its learning effects is required. A community-based educational program was started in 2009 in the health sciences course at Gunma University, and one of the main elements in this program is conducting classes outside school. The purpose of this study was to investigate using text-analysis methods how the off-campus program affects students.

METHODS

In all, 116 self-assessment worksheets submitted by students after participating in the off-campus classes were decomposed into words. The extracted words were carefully selected from the perspective of contained meaning or content. With the selected terms, the relations to each word were analyzed by means of cluster analysis.

RESULTS

Cluster analysis was used to select and divide 32 extracted words into four clusters: cluster 1-"actually/direct," "learn/watch/hear," "how," "experience/participation," "local residents," "atmosphere in community-based clinical care settings," "favorable," "communication/conversation," and "study"; cluster 2-"work of staff member" and "role"; cluster 3-"interaction/communication," "understanding," "feel," "significant/important/necessity," and "think"; and cluster 4-"community," "confusing," "enjoyable," "proactive," "knowledge," "academic knowledge," and "class."

CONCLUSIONS

The students who participated in the program achieved different types of learning through the off-campus classes. They also had a positive impression of the community-based experience and interaction with the local residents, which is considered a favorable outcome. Off-campus programs could be a useful educational approach for students in health sciences.

The art of medical education

Is the art of medical education just making sure to provide sufficient up to date medical knowledge and a lot of clinical experience? It is much more. The art of medical education is about a teaching program that is designed to serve the community of the near future. The program is the result of a thorough evaluation of societal needs and is capable of influencing the properties of future care. New care professionals who are trained in the program will -become instrumental in solving complex problems in health systems. The art of medical education is about the change of traditional ideas of how to cope with these health systems. This change will raise anger and resistance. Effective change management is essential to survive attacks from laggards and to maintain enthusiasm to invest in the health care of the future. Educationalist science provides several important insights that help us find the optimal shape of the program. Good role models and a learning environment that is an example of the intended professional and organisational behaviour, learning by doing, simulation programs, educational tools like e-learning systems, a good assessment and feedback system, and a portfolio to prove and discuss professional progress are all pivotal components of the ideal program. To achieve mastery within the art of medical education, a quality improvement program will be the crown of the process. Medical education is a multifaceted process and so the quality improvement should be. The art of medical education is a great challenge. The health care of your future deserves it.

Clinical pharmacy consultation for pharmacogenetic testing

The clinical application of pharmacogenetic testing will help to bring personalized medicine into clinical practice. Due to the complex process involved in delivering pharmacogenetic testing, optimal clinical implementation of pharmacogenetic tests will require the coordinated effort of multiple disciplines including medicine, clinical laboratory medicine and clinical pharmacy. This will help to bridge the gap between the basic and laboratory science, and the clinical application of these results. How may clinical pharmacy contribute to the clinical application of pharmacogenetic testing as a member of a multidisciplinary team? In this perspective, we propose a potential new role for pharmacists: as an interpreter of pharmacogenetic test results. Interpreting the results of pharmacogenetic tests, particularly, those intended to guide drug dosing, requires an understanding of pharmacogenetics, pharmacokinetics and pharmacodynamics. Pharmacists who are knowledgeable in these areas may play an important role in interpretation of the test results.