A web-based e-learning programme for training external post-mortem examination in curricular medical education

Current status of undergraduate teaching in forensic & legal medicine in Europe

The European Council of Legal Medicine (ECLM) is the body established in 1992 to represent practitioners forensic & legal medicine and is composed of delegates of the countries of the European Union (EU) and from other countries which form part of Europe to a current total of 34 member countries. The aims of this study were to determine the current status of undergraduate forensic & legal medicine teaching in the curriculum of medical studies in ECLM countries and to use the results of this study to determine whether it would be appropriate to develop new guidelines and standards for harmonising the content of undergraduate forensic medicine training across ECLM member countries. A detailed questionnaire was sent to all individuals or organisations listed on the ECLM contact database. Responses were received from 21 of 33 countries on the database. These responses showed considerable emphasis on undergraduate teaching of forensic medicine in all countries with the exception of Belgium and the United Kingdom. There was great general consistency in the subjects taught. The data from this survey provide a baseline which should assist in developing a strategy to harmonise forensic & legal medicine undergraduate training in member countries of the ECLM. The ECLM is now in a good position to establish a pan-European working group to coordinate a consensus document identifying an appropriate and modern core undergraduate forensic medicine curriculum that can be presented to the medical education authorities in each country, and which can be adapted for local requirements, based on available personnel, the forensic medicine structure in the country, and most importantly, the needs of the local population.

External post-mortem examination in virtual reality-scalability of a monocentric application

Conducting external post-mortem examinations is an essential skill required of physicians in various countries, regardless of their specialization. However, the quality of these examinations has been a subject of continuous debates, and notable errors were reviled. In response to these shortcomings, a virtual reality (VR) application was developed at Halle's medical department in Germany, focusing on the scene of discovery and the completion of death certificates. The initial trial of this VR application in 2020 involved 39 students and 15 early-career professionals. Based on the feedback, the application underwent improvements and was subsequently introduced to the medical department in Dresden, Germany, in 2022. Its primary objective was to showcase the VR training's adaptability and scalability across various educational structures and levels of medical expertise. Out of 73 students who participated, 63 completed the evaluation process. 93.1% (n = 58) of the evaluators reported increased confidence in conducting external post-mortem examinations, and 96.8% (n = 61) felt more assured in filling out death certificates, crediting this progress to the VR training. Additionally, 98.4% (n = 62) believed that repeating forensic medical aspects in their coursework was crucial, and 96.8% (n = 61) viewed the VR examination as a valuable addition to their academic program. Despite these positive responses, 91.6% (n = 55) of participants maintained that training with real corpses remains irreplaceable due to the insufficiency of haptic feedback in VR. Nevertheless, the potential for enhancing the VR content and expanding the training to additional locations or related disciplines warrants further exploration.

The need for mandatory autopsy teaching in Forensic Medicine for medical students

The effectiveness of the autopsy as an educational tool in forensic medicine courses has been widely acknowledged, and medical students were expected to attend regularly. Nevertheless, the use of autopsies for teaching has dramatically declined in recent years and worldwide despite their high-value benefits. This study aims to understand the importance and relevance of attending autopsies during forensic teaching sessions and identify any challenges that may impede attendance. A self-administered online questionnaire that assesses the knowledge, attitudes, and practices related to autopsies attendance was distributed to fourth-year medical students at the National Defence University of Malaysia and Universiti Sains Islam Malaysia. A total of 99 respondents were involved in this study. Our findings indicate that most respondents (over 85%) demonstrated good knowledge of forensic medicine. Pearson's statistical test revealed a significant correlation between the knowledge and students' attitudes toward autopsy. This study demonstrates the need to strategically integrate autopsy attendance into medical curricula to encourage constructive attitudes and practices among medical students. Students gain the most benefits from frequently attending autopsies. Passionate educators can conduct preparatory sessions to set expectations and address concerns, encourage students to process their experiences, and reinforce learning outcomes in the mortuary setting. Mandatory autopsy teaching should be integrated into the curriculum to ensure medical students have the necessary skills and knowledge to become competent doctors.

Adventure Legal Medicine: a free online serious game for supplementary use in undergraduate medical education

Serious games (computer-based learning games) are increasingly used in medical education at various levels, as user access is independent of location and time and promotes non-linear learning. In legal medicine, interactive digital media are still scarce. The freely accessible online serious game "Adventure Legal Medicine" was developed as part of the "Hamburg Open Online University". The goal was to teach the basics of forensic casework in a point-and-click adventure setting consisting of five cases. During development, 40 medical students were asked to evaluate the game anonymously. The System Usability Scale (SUS) resulted in a mean score of 86.7 (SD 8.3), which corresponds to above-average usability. Further specific evaluations revealed a good to very good rating of the game with no differences in terms of gender (p = 0.214), first-year versus advanced students (p = 0.393) and students who never/rarely or sometimes/often played computer games (p = 0.780). Since there are only a few digital media so far that allow curricular integration into undergraduate teaching in legal medicine, this serious game represents a possibility to integrate digital media into both face-to-face teaching and distance learning and to use it as a supplement to the medical school's own teaching offer, encouraging users to actively engage with the subject.

[Student training in forensic medicine in Germany: testing and evaluation]

Seit der Umsetzung der Approbationsordnung für Ärzte 2002 haben sich erhebliche Veränderungen in den Bereichen Lehre, Prüfungen und Evaluation ergeben. Zur Erfassung der aktuellen Situation im Fach Rechtsmedizin erfolgte eine standardisierte Befragung unter den rechtsmedizinischen Instituten in Deutschland mittels eines Online-Fragebogens. Der Rücklauf betrug 80 %. Die Ergebnisse der Befragung weisen auf ein Überwiegen faktenbasierter Prüfungen hin. Anpassungen an die häufig praktisch ausgerichteten Unterrichtsformate erscheinen hier erforderlich. Die Evaluationsergebnisse zeigen überwiegend eine hohe studentische Zufriedenheit mit der Lehre im Fach Rechtsmedizin. Famulaturen und praktisches Jahr können aktuell von etwa 90 % der Institute angeboten werden. Die für die Lehre zur Verfügung stehende Stundenzahl wird von einem relevanten Teil der befragten Institute als nicht ausreichend bewertet.

Could COVID-19 Trigger a Rebirth in Anatomy Education? A Glimpse of Anatomists' Responses to Pandemics of the Past and Present

Pandemics are nothing unusual but indeed lead to devastating effects that play a pivotal role in reshaping human history. The COVID-19 outbreak is currently responsible for major educational crises globally as most of the world has been faced with a mandated lockdown, and forced closure of educational institutions, including medical colleges. Anatomists have therefore been challenged to unlock technology in effort to achieve best deliverables for their discipline, without the use of traditional teaching aids such as the cadaver, osteological banks, prosected specimens, models, and microscopic slides. At present, the virtual classroom is the only option for the anatomist, thereby omitting vital aspects of the hidden curriculum such as ethical-reasoning, empathy, respect, professionalism, interpersonal, and communication skills. As body donations dwindle, the era of teaching in a cadaverless environment is upon us. This marks the beginning of a paradigm shift in education and research for anatomists worldwide. Given the variable pathological-morphological presentation in COVID-19-related deaths, it is also likely that the autopsy component of anatomic pathology will be resuscitated to demystify the underlying mechanisms of the virus. Since COVID-19 may never disappear completely, we would like to recommend that international anatomical societies collectively reach out to statutory bodies to devise a standardized method of teaching anatomy, employing readily available cost-effective resources, in the face of pandemics. However, if anatomy as a discipline has survived a millennium, surely anatomists can fight the “scourges” that have plagued them as various perspectives have been bandied about to welcome in a new normal.

Using simulation mannequins and actors in training for external post-mortem examinations -experiences from use in medical students and police officers

In the daily practice of external post-mortem examinations and dealing with surviving dependents, striking failures can be observed regularly, pointing to an increased demand for training of the various professional groups involved. In this study, the experience gained from using simulation mannequins and actors for post-mortem examination training in medical students and police officers are presented. Since 2017, a training station has been offered at the Medical Faculty of the Technical University of Dresden (Germany) for practicing examinations in death scene and establishing communication with grieving relatives. It is conducted in small groups of up to 5 people, both for medical students and for police officers and police recruits. These courses are evaluated by means of questionnaires including 3 and 11 items respectively for the different groups. The questionnaires have been completed by 679 medical students and 67 police participants. Both groups of participants evaluated their previous experience as average. They assessed the course as having a high degree of practical and professional relevance. The didactic transfer of the teaching contents and its competent support were rated remarkably positive by the participants. Additionally, the police group reported high rates of approval for the use of feedback, the learning effect, and the appropriateness of the group size. The establishment and continuation of the simulation-based external post-mortem examination in the form of small-group teaching is associated with a considerable expenditure of equipment, material and personnel. In addition, its implementation requires sound cooperation structures. On the other hand, introduction and continuation of these types of additional teaching and learning methods, with a large practical component, can increase confidence in daily practice, and thus improve the quality of external post-mortem examination. Ultimately, this can also improve the cooperation between forensic medicine and the investigating authorities.

A systematic review of serious games in medical education: quality of evidence and pedagogical strategy

INTRODUCTION

The literature shows an optimistic landscape for the effectiveness of games in medical education. Nevertheless, games are not considered mainstream material in medical teaching. Two research questions that arise are the following: What pedagogical strategies do developers use when creating games for medical education? And what is the quality of the evidence on the effectiveness of games?

METHODS

A systematic review was made by a multi-disciplinary team of researchers following the Cochrane Collaboration Guidelines. We included peer-reviewed journal articles which described or assessed the use of serious games or gamified apps in medical education. We used the Medical Education Research Study Quality Instrument (MERSQI) to assess the quality of evidence in the use of games. We also evaluated the pedagogical perspectives of such articles.

RESULTS

Even though game developers claim that games are useful pedagogical tools, the evidence on their effectiveness is moderate, as assessed by the MERSQI score. Behaviourism and cognitivism continue to be the predominant pedagogical strategies, and games are complementary devices that do not replace traditional medical teaching tools. Medical educators prefer simulations and quizzes focused on knowledge retention and skill development through repetition and do not demand the use of sophisticated games in their classrooms. Moreover, public access to medical games is limited.

DISCUSSION

Our aim was to put the pedagogical strategy into dialogue with the evidence on the effectiveness of the use of medical games. This makes sense since the practical use of games depends on the quality of the evidence about their effectiveness. Moreover, recognition of said pedagogical strategy would allow game developers to design more robust games which would greatly contribute to the learning process.

Knowledge, competencies and attitudes regarding external post-mortem physical examination: A survey among German post-graduate trainees in general practice

Background: The external post-mortem examination (EPME) is an important medical, legal and socio-economic task with far-reaching relevance; however, due to discrepancies between findings from EPMEs and actual cause of death, improvements in accuracy and quality are needed.

Objectives: To investigate knowledge, competencies and attitudes regarding EPME in general practitioner (GP) post-graduate trainees.

Methods: Before four post-graduate training courses on the EPME for general practitioner trainees, organized in 2014 in the German federal state of Baden-Wuerttemberg, a questionnaire on the EPME was distributed by the lecturer, completed by the GP post-graduate trainees and returned to the lecturer. The questionnaire consisted of 19 items related to three main categories: knowledge, competencies and attitudes.

Results: Out of 380 GP post-graduate trainees, 128 completed and returned the questionnaire (response rate 33.7%). Less than 18% felt adequately confident in identifying a natural cause of death and less than 5% felt adequately confident in identifying an unnatural cause of death. Only 33% consistently fully uncover the corpse for the EPME.

Conclusion: We found an important uncertainty in GP post-graduate trainees regarding their EPME knowledge and competencies.

[Blended-learning in psychosomatics and psychotherapy - Increasing the satisfaction and knowledge of students with a web-based e-learning tool]

OBJECTIVES

To improve the synergy of established methods of teaching, the Department of Psychosomatics and Psychotherapy, University Hospital Münster, developed a web-based elearning tool using video clips of standardized patients. The effect of this blended-learning approach was evaluated.

METHODS

A multiple-choice test was performed by a naive (without the e-learning tool) and an experimental (with the tool) cohort of medical students to test the groups' expertise in psychosomatics. In addition, participants' satisfaction with the new tool was evaluated (numeric rating scale of 0-10).

RESULTS

The experimental cohort was more satisfied with the curriculum and more interested in psychosomatics. Furthermore, the experimental cohort scored significantly better in the multiple-choice test.

CONCLUSION

The new tool proved to be an important addition to the classical curriculum as a blended-learning approach which improves students' satisfaction and knowledge in psychosomatics.

Medical student attitudes to the autopsy and its utility in medical education: a brief qualitative study at one UK medical school

Attending postmortems enables students to learn anatomy and pathology within a clinical context, provides insights into effects of treatment and introduces the reality that patients die. Rates of clinical autopsies have declined and medical schools have cut obligatory autopsy sessions from their curricula making it difficult to assess medical student perceptions of, and attitudes towards, the educational value of autopsy. Our aim was to investigate these perceptions by designing a brief qualitative study comprising nominal technique and focus group discussions with Cambridge Graduate Course students, all of whom had attended autopsies. Three general themes emerged from the focus group discussions: the value of autopsy as a teaching tool and ways the experience could be improved, the initial impact of the mortuary and the autopsy itself, and the "emerging patient"-an emotional continuum running from cadaver to autopsy subject and living patient. Educational benefits of autopsy-based teaching included greater understanding of anatomy and physiology, greater appreciation of the role of other health care professionals and an enhanced appreciation of psycho-social aspects of medical practice. Students suggested improvements for ameliorating the difficult emotional consequences of attendance. We conclude that autopsy-based teaching represents a low-cost teaching technique which is highly valued by students and has application to many diverse medical specialties and skills. However, careful preparation and organization of sessions is required to maximize potential educational benefits and reduce any negative emotional impact.

Blended learning in surgery using the Inmedea Simulator

BACKGROUND

Recently, medical education in surgery has experienced several modifications. We have implemented a blended learning module in our teaching curriculum to evaluate its effectiveness, applicability, and acceptance in surgical education.

METHODS

In this prospective study, the traditional face-to-face learning of our teaching curriculum for fourth-year medical students (n = 116) was augmented by the Inmedea Simulator, a web-based E-learning system, with six virtual patient cases. Student results were documented by the system and learning success was determined by comparing patient cases with comparable diseases (second and sixth case). The acceptance among the students was evaluated with a questionnaire.

RESULTS

After using the Inmedea Simulator, correct diagnoses were found significantly (P < 0.05) more often, while an incomplete diagnostic was seen significantly (P < 0.05) less often. Significant overall improvement (P < 0.05) was seen in sixth case (62.3 ± 5.6 %) vs. second case (53.9 ± 5.6 %). The questionnaire revealed that our students enjoyed the surgical seminar (score 2.1 ± 1.5) and preferred blended learning (score 2.5 ± 1.2) to conventional teaching.

CONCLUSION

The blended learning approach using the Inmedea Simulator was highly appreciated by our medical students and resulted in a significant learning success. Blended learning appears to be a suitable tool to complement traditional teaching in surgery.