Optimizing engagement of undergraduate students in medical education research: The eMERG training network

Undergraduate research- a tale of three African institutions

Background

The inclusion of research in undergraduate medical curricula benefits students as well as the scientific community. Multiple studies report the presence of one or more barriers to research training in these curricula.

Objectives

This paper presents and compares three studies done regarding the teaching of research in undergraduate medical curricula in South Africa, Sudan and Uganda.

Methods

Two cross-sectional study designs (South Africa and Sudan) and one interventional study design (Uganda) were conducted. Both cross-sectional studies used mixed methods while the Ugandan study used a quantitative method. A total of 41 faculty members and 554 students participated. The studies used a combination of surveys, focus group discussions, key informant interviews and document analysis.

Results

Participants from all three studies valued research and considered it useful and relevant to their studies. The findings from the South African and Sudanese studies align with the 'Four I's' framework that summarise the barriers to research training as lack of initiative, impulse, incentive and idols. The Ugandan study demonstrated improved self-reported knowledge and attitude (specifically anxiety) among participants after completion of a short course on research.

Medical research: what to expect in a student-supervisor relationship

BACKGROUND

A medical research supervisor is of crucial importance to the undergraduate student enrolled in a research methodology course. A solid relationship between the two is vital to the success of the research project and the overall well-being of the student. The structure of the relationship between a student and a research supervisor is seldom discussed in the context of undergraduate medical research. This study evaluates students' expectations of their research contributions and their supervisors' roles.

METHODS

This was an observational study in a large health university in Saudi Arabia. A total of 320 medical students enrolled in a two-year medical research program completed an online survey, of a previously validated instrument, that is, Role Perceptions Rating Scale. Demographic questions such as the current level in the research program (junior or senior) were added.

RESULTS

The results showed that most students expected the responsibility to be equally shared between the supervisor and student during the development and execution of the research project. Additionally, students expected the research supervisor to be responsible for the research themes and contents, ensuring access to facilities, and assisting in the actual writing of the final research manuscript. Furthermore, the results indicated differences in expectations between junior and senior students.

CONCLUSION

This study demonstrates that medical students expect their research supervisors to support them to a significant extent. Understanding medical students' expectations in a supervisor-student relationship is essential to successful research and collaboration. The evidence gathered in this study has practical implications for educational institutes to base their research training program on these insights. Providing clarity on the expectations and responsibilities of those participating in the research program is crucial, as this would, in turn likely advance the output of the research program and encourage clinicians to join the program as research supervisors.

In vivo Simulation-Based Learning for Undergraduate Medical Students: Teaching and Assessment

An increasing emphasis on simulation has become evident in the last three decades following fundamental shifts in the medical profession. Simulation-based learning (SBL) is a wide term that encompasses several means for imitating a skill, attitude, or procedure to train personnel in a safe and adaptive environment. A classic example has been the use of live animal tissue, named in vivo SBL. We aimed to review all published evidence on in vivo SBL for undergraduate medical students; this includes both teaching concepts as well as focused assessment of students on those concepts. We performed a systematic review of published evidence on MEDLINE. We also incorporated evidence from a series of systematic reviews (eviCORE) focused on undergraduate education which have been outputs from our dedicated research network (eMERG). In vivo SBL has been shown to be valuable at undergraduate level and should be considered as a potential educational tool. Strict adherence to 3R (Reduce, Refine, Replace) principles in order to reduce animal tissue usage, should always be the basis of any curriculum. In vivo SBL could potentially grant an extra mile towards medical students' inspiration and aspiration to become safe surgeons; however, it should be optimised and supported by a well-designed curriculum which enhances learning via multi-level fidelity SBL.

Teaching Medical Research to Medical Students: a Systematic Review

PHENOMENON

Research literacy remains important for equipping clinicians with the analytical skills to tackle an ever-evolving medical landscape and maintain an evidence-based approach when treating patients. While the role of research in medical education has been justified and established, the nuances involving modes of instruction and relevant outcomes for students have yet to be analyzed. Institutions acknowledge an increasing need to dedicate time and resources towards educating medical undergraduates on research but have individually implemented different pedagogies over differing lengths of time.

APPROACH

While individual studies have evaluated the efficacy of these curricula, the evaluations of educational methods and curriculum design have not been reviewed systematically. This study thereby aims to perform a systematic review of studies incorporating research into the undergraduate medical curriculum, to provide insights on various pedagogies utilized to educate medical students on research.

FINDINGS

Studies predominantly described two major components of research curricula-(1) imparting basic research skills and the (2) longitudinal application of research skills. Studies were assessed according to the 4-level Kirkpatrick model for evaluation. Programs that spanned minimally an academic year had the greatest proportion of level 3 outcomes (50%). One study observed a level 4 outcome by assessing the post-intervention effects on participants. Studies primarily highlighted a shortage of time (53%), resulting in inadequate coverage of content.

INSIGHTS

This study highlighted the value in long-term programs that support students in acquiring research skills, by providing appropriate mentors, resources, and guidance to facilitate their learning. The Dreyfus model of skill acquisition underscored the importance of tailoring educational interventions to allow students with varying experience to develop their skills. There is still room for further investigation of multiple factors such as duration of intervention, student voluntariness, and participants' prior research experience. Nevertheless, it stands that mentoring is a crucial aspect of curricula that has allowed studies to achieve level 3 Kirkpatrick outcomes and engender enduring changes in students.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-020-01183-w.

Student Views on a Novel Holistic Surgical Education Curriculum (iG4): A Multi-national Survey in a Changing Landscape

AIM

Essential Skills in the Management of Surgical Cases (ESMSC Marathon Course™₎ Integrated Generation 4 (iG4) is the first reported multifaceted undergraduate surgical course aiming to provide holistic surgical teaching. In this prospective observational study, we explored students' views on the iG4 curriculum, and identified how it can potentially address modern challenges in surgical training.

MATERIAL AND METHODS

Medical students were invited to apply to the course online and were screened against pre-defined criteria. A multi-national structured questionnaire incorporating five domains related to the course curriculum and our dedicated research network, was designed and distributed to participants after successful completion of the course.

RESULTS

Forty-one students from European and Asian medical schools completed the course and filled in the survey. The median overall evaluation score of the course was 4.73 out of 5 (interquartile range=4.21-4.72) and all students found that iG4 served the vision of holistic surgical education. ESMSC had a positive motivational effect towards following a career in surgery (p=0.012) and 92.7% of students declared that it should be an essential part of a future medical school curriculum. There was no statistically significant difference (p>0.05) in results between participants of different countries of study, year of studies or age group.

CONCLUSION

The ESMSC Marathon Course™ is perceived as a unique course model, with an established educational value and a positive motivational effect towards surgery. It might potentially be implemented in future medical school curricula as an essential element of undergraduate surgical education. The iG4 curriculum has opened a new exciting horizon of opportunities for advancing undergraduate holistic surgical education.

A Novel Multi-faceted Course Blueprint to Support Outcome-based Holistic Surgical Education: The Integrated Generation 4 Model (iG4)

BACKGROUND/AIM

We present a novel multi-faceted, internationally adaptable course curriculum blueprint, which provides holistic surgical education at the undergraduate level.

MATERIALS AND METHODS

The Integrated Generation 4 (iG4) course (Essential Skills in the Management of Surgical Cases - ESMSC Marathon course) curriculum consists of four essential learning components: core skills-based learning, case-based discussions, basic science workshops and soft-skills. These are all clustered in a specialty-led network architecture. Every cluster consists of modules from the four learning cores, while network nodes are modules that are mutually shared by more than one clusters.

RESULTS

We produced a standardized blueprint of 50 modules based on the 4 learning cores, covering 9 surgical specialties. This resulted in a curriculum map where every module is described using 3 parameters: χ axis (skills component), y axis (knowledge component), z axis (specialty component).

CONCLUSION

iG4 proof of concept sets the ground for a novel, reproducible and standardised effort to produce a portfolio of undergraduate surgical skills serving the vision of holistic surgical education.

ABC of Surgical Teaching: Time to Consider a Global Blueprint for Holistic Education

BACKGROUND

Educating and equipping students and trainees into clinicians capable of meeting healthcare demands and service provision needs is essential. Unprecedented events like COVID-19 pandemic, highlight urgent need for reformation of training to ensure high quality education is maintained. To this end, we describe an innovative and globally adaptable blueprint for establishing a surgical curriculum, aiming to optimize preparation of future surgeons.

METHODS

We used a structured protocol to synthesize evidence from previous systematic reviews focused on surgical education alongside a series of focused original educational studies. This approach allowed incorporation of prospectively applied novel ideas into the existing landscape of published evidence. All material used for this proof of concept derives from the outputs of a dedicated research network for surgical education (eMERG).

RESULTS

We propose the foundation blueprint framework called "Omnigon iG4" as a globally applicable model. It allows adaptation to individual local educational environments for designing, appraising and/or refining surgical curricula. We also describe the "Omnigon iG4 Hexagon Pragmatic Model," a novel perspective model which assesses the performance of our blueprint in a multi-layer fashion. This "Hexagon" model is the first to introduce pragmatic outcomes in curricula performance assessment.

CONCLUSIONS

This proof of concept, "Omnigon iG4," proposes an adaptable version of a curriculum blueprint. The framework allows educators to establish a surgical curriculum with the ability to map out competencies, permitting full control over their intended learning outcomes. This can form the basis for developing globally adaptable multifaceted Simulation-Based learning (SBL) courses or even surgical curricula for undergraduates.

Studies on acceptance, evaluation and impact of the Cologne program "Research and Medical Studies"

Introduction: The curricular implementation of events (or programs) for science-related training in human medicine has been on the agenda of the medical faculties since the publication of the Federal-State Working Group [1]. The Medical Faculty of the University of Cologne developed and established a systematic, longitudinal science curriculum together with the start of the model curriculum in human medicine in 2003. Here, we investigate the questions of whether the described (para-) curricular elements are accepted by students and lecturers and how they are evaluated, especially by students. In addition, we investigate whether selected parameters can be used to demonstrate changes in the students' scientific activities. Project description: The program "Research and Medical Studies" (RaMS) consists of several components: these elements of the mandatory curricular (Scientific Projects, SP) and optional components (Research in Medical Studies (RiMS), Research Track (RT), Research Fair Cologne (RFC)) are described here. Results were recorded at various levels: Likert Scale evaluation of the event's elements were collected as satisfaction parameters from the studentsProcess data on participation in the voluntary events were collected and evaluated as absolute and relational figures (WS 12/13-SS 17). Data on the outcome of the RaMS program were collected: Type of scientific projects in the academic years 2011/12-2014/15), number and type of available projects offered at the RFC (in the years 2011-18) and number of student research funding applications in a comparison of the periods 2010-13 vs. 2014-17). Results: The students' acceptance of mandatory and paracurricular courses of the RaMS program is pleasingly high, which is not surprising, at least in the case of the voluntary courses. The participation of students in RiMS, RT and RFC is satisfactory for voluntary courses. In the case of the RT, with certified participation of approximately 47% of all registrations (corresponding to 10% of the total cohort), this is comparable to similar programs. It can be shown that the number of experimental science projects has more than doubled over time in parallel with the development of RaMS. The average number of provided projects according to the RFC is 42 (which corresponds to a placement rate of approx. 1:4). The number of successful student applications for a research support grant during the period the measures were implemented has doubled. Discussion and conclusion: The RaMS program shows a route for the implementation of the SP required by the next licensing regulations in medical education, which was initially supported and expanded solitarily, later by further elements (RiMS), also in the sense of a science-based career development (RT, RFC). The student acceptance and the measured success, in the form of successful participation in the Research Track, increased choice of experimental projects, significant increase of submitted as well as approved research grants and the high project placement rate of the Research Fair, encourage the further development of the program, which is indicated in the conclusion.

Increasing motivation and engagement in neurosurgery for medical students through practical simulation-based learning

Background

Simulation-based learning (SBL) is an essential adjunct to modern surgical education. Our study aimed to evaluate the educational benefit and motivational impact of a pilot practical neurosurgical module.

Materials and methods

38 clinical medical students from several EU Medical Schools attended an international surgical course focused on teaching and learning basic surgical skills. We designed a pilot neurosurgical workshop instructing students to insert an intracranial pressure bolt using an ex vivo pig model. Each delegate was assessed by two consultant neurosurgeons using a validated assessment tool. Structured questionnaires were distributed on completion of the module.

Results

Delegate performance increased (p < 0.001) with no difference in performance improvement across year of study (p = 0.676) or medical school (p = 0.647). All delegates perceived this workshop as a potential addition to their education (median 5/5, IQR = 0), and indicated that the course provided motivational value towards a neurosurgical career (median 4/5, IQR = 1), with no difference seen between year of study or medical school (p > 0.05).

Conclusion

Our pilot neurosurgical workshop demonstrated the educational value of practical SBL learning for motivating students towards a surgical career. Homogeneous views across year of study and medical school underline the value of developing a unified strategy to develop and standardise undergraduate surgical teaching with a practical focus.