Changing face of medical curricula

Job satisfaction of health workers at a Vietnamese University Hospital and its predicted factors: A cross-sectional study

Background and Aims

Job satisfaction of healthcare workers from conventional and university hospitals (or teaching hospitals) might be different due to several factors, for example medical staff required to carry out multiple clinical and teaching tasks simultaneously. Our study aimed to determine how the job satisfaction among healthcare workers in university hospitals is different from those in conventional hospitals.

Methods

A cross-sectional study was conducted by using the validated and contextualized job satisfaction tool for the Vietnamese context to survey 216 healthcare workers at a university hospital in Vietnam from January to March 2020 with online Google forms.

Results

The results indicated low overall job satisfaction (43.1%) in our study university hospital with the score cutoff of 80%. However, healthcare workers still reported high job satisfaction rates in certain aspects, such as personal empathy (70.8%), discipline, and reward (67.6%), co-worker collaboration (65.3%), training and promotion (63%), workplace environment (57.4%), and salary and allowance (44.9%). Subgroup analysis revealed statistically significant differences in job satisfaction (p < 0.01) related to age (31 to 40-year-old), and job position with ORs 3.9, and 8.6 respectively.

Conclusion

University hospitals need to improve the healthcare workers' job satisfaction. It is recommended that special human resource strategies should be developed focusing on keeping satisfying older healthcare staff by recognizing their contributions and providing appropriate benefits based on their positions in the hospital.

Digital hands-on learning in radiology-design and evaluation of a PACS-based concept for medical students

BACKGROUND

The reorganization of the medical curriculum has increased the demands on medical didactics. For interdisciplinary fields such as radiology this offers the opportunity to be more visible in clinical medical teaching and to emphasize its integrative role in patient care. We present a novel integrative learning concept based on the notion of PACS (picture archiving and communication system) learning. In the initial phase it was available to students in their final-year internships.

METHODS

We designed 100 case vignettes on a designated workstation. Vignettes were prepared in a patient-based format in Aycan PACS (Aycan Medical Systems, NY, USA). The first image of each case included the case description and background information. Students worked through the vignettes independently. Each imaging examination was followed by small quizzes or open questions. Short texts provided additional information on the case, leading to the next examination. The typical case included several imaging modalities (CT, MRI, X‑ray, etc.) in diagnosis and follow-up. After processing the cases, the students completed an evaluation form on a five-point Likert scale.

RESULTS

Students approved the learning concept in terms of knowledge level, didactic structure, and motivation for self-study. A large proportion of respondents indicated that the new concept had sparked their interest in radiology Almost all students stated that they had benefited from the concept and favored its continuation.

CONCLUSION

Our PACS workstation enjoyed high acceptance among students. This underlines the importance of integrative, competence-based teaching models in the medical curriculum. Radiology as a cross-disciplinary discipline is in particular suitable for encouraging students to combine theoretical and practical knowledge and can become a central component in student education through innovative concepts.

Information overdose: Student performance and perceptions of pharmacology resources on exams

Physicians of the future will be expected to synthesize new knowledge and appropriately apply it in patient care. Here, we report on the effects of and student attitudes towards resource-enhanced exams by comparing student performance on closed-book exams with or without access to pharmacology flashcards. Setting: the University of California, San Francisco (UCSF) School of Medicine (SOM), class of 2021 (N = 149), followed over 4 years. We provided pharmacology flashcards for studying purposes in all blocks; flashcards were only accessible during closed-book exams in 2 of 5 blocks. We collected pharmacology open-ended question (OEQ) scores and analyzed results using repeated measures ANOVA (SPSS). We collected MS4 survey data using Qualtrics and conducted a thematic content analysis. Performance on pharmacology questions on exams was not higher with access to pharmacology flashcards during exams. The number of students who passed pharmacology questions without flashcards on exams was as follows: 137 ± 3.7, 132 ± 5.0, and 134 ± 7.9 (average ± SEM). The number of students who passed pharmacology questions with flashcards on exams was as follows: 132 ± 6.6 and 120 ± 7.5. Survey comments revealed several themes. Access to pharmacology flashcards during exams allowed learners to focus on understanding the bigger picture and reduced stress. A subset of students reported having access to flashcards on pre-clerkship exams hurt their preparation for clerkships. Flashcards as exam resources were received well by approximately half the class, who reported benefits including more time to focus on understanding bigger picture concepts and reduced stress.

Pediatric Resident Confidence in Assessing Neurological Cases: A Nationwide Survey

BACKGROUND

A relative shortage of pediatric neurologists in proportion to estimated neurological disorders often results in general pediatricians evaluating and treating children with complex neurological conditions. Dedicated rotations in pediatric neurology are not mandated during medical school or pediatric residency. We evaluated the perceptions of a large cohort of pediatric residents and program directors (PDs) regarding child neurology training.

METHODS

Using an online tool, surveys were sent to pediatric residents and pediatric and pediatric neurology PDs.

RESULTS

Response rates were 41% from pediatric residency programs, yielding 538 resident responses; 31% from pediatric PDs; and 62% from pediatric neurology PDs. Only 27% of the surveyed residents reported completing a neurology rotation during residency, 89% of whom expressed a subjective improvement in confidence with neurological assessments. Factors affecting comfort with eliciting a neurological history included exposure to a neurology rotation during residency, year of training, duration of neurology rotation in medical school, and inpatient exposure to neurological patients, whereas those associated with examination additionally included program size and postresidency plans. Overall, 80% of surveyed residents, 78% of pediatric PDs, and 96% of pediatric neurology PDs acknowledged the potential value of a mandatory pediatric neurology rotation during residency.

CONCLUSION

We suggest that a mandatory pediatric neurology rotation will boost the confidence of current and future pediatric trainees in assessing common neurological conditions of childhood.

Early clinical exposure in medical education: the experience from Debre Tabor University

BACKGROUND

The idea of early clinical exposure in Ethiopian medical schools is a young concept. Old and newly established universities across the nation are shifting towards incorporation of early clinical exposure (ECE) in their curricula. Debre Tabor University introduced ECE in undergraduate medical education from inception. This study generated evidence on students' experience and academic leaders' reflection on early clinical exposure implementation.

OBJECTIVE

This study was carried out to investigate medical students' perception towards early clinical exposure and its implementation process by instructors in undergraduate medical education at Debre Tabor University.

METHOD

A cross-sectional survey design that combines quantitative and qualitative methods was conducted in 2021. We asked fifth year medical students (42) to complete a self-administered questionnaire on 5-point Likert scale. The data were supplemented by semi-structured interview with 6 purposively selected academic leaders on the factors that facilitate or impede early clinical exposure implementation. The quantitative data were entered and analyzed using SPSS 20 to compute frequency, median and interquartile range. The qualitative data were analyzed thematically.

RESULTS

The study findings suggest that early clinical exposure (ECE) has a positive impact on the development of students' professional knowledge, problem-solving skills, motivation, active learning, and community orientation. Specifically, 64.3% of the surveyed students believed that ECE was effective in constructing their professional knowledge, while 52.4% felt that it improved their problem-solving skills and facilitated constructive/active learning. Additionally, 57.1% of students reported that ECE improved their motivation and 50% noted that it facilitated community orientation. The study also identified several barriers to the implementation of ECE, with the heavy workload being the most commonly mentioned (78.6%). Other challenges included a loose linkage between academic and healthcare institutions (59.5%) and a lack of orientation on the implementation process (35.7%). Academic leaders reflected that ECE was beneficial in familiarizing students with the clinical environment, but staff commitment was crucial for its successful implementation. The study also found that heavy workload, lack of assessment dedicated to ECE on the curriculum, and poorly oriented staff about the program impeded its implementation.

CONCLUSION AND RECOMMENDATIONS

The findings of this study suggest that early clinical exposure was beneficial learning method. Teachers' commitment to their roles with adequate preparation, and the contribution of curriculum in providing the learning objective and cases for each session were factors that facilitate effective implementation of ECE. Heavy workload and poor orientation about the program could impede ECE implementation.

Entrustable professional activities for Junior Brazilian Medical Students in community medicine

BACKGROUND

Entrustable professional activities (EPAs) have been defined to promote the workplace participation of undergraduate medical students, generally in the context of high-income countries with a focus on the secondary and tertiary health care sectors. These EPAs have limited applicability to training and health care contexts in low- to middle-income countries that have a focus on primary health care, for instance, the context of community medicine. The purpose of this article is to report the process and results of defining EPAs for undergraduate medical training in a community health care setting.

METHODS

A modified Delphi study was performed to develop EPAs for the training of medical students in community medicine during their first and second years of education at the Marília Medical School (FAMEMA), Brazil. The supervision level was operationalized in terms of a student's ability to perform the EPA autonomously in an effective and safe manner with supervision readily available on request. Panellists (9 physicians and 6 nurses) rated the completeness of the proposed list of EPAs and EPA categories on four-point Likert scales. The threshold for consensus among panellists was a mean content validity index of at least 80%.

RESULTS

Consensus was reached after two Delphi rounds, resulting in 11 EPAs for undergraduate medical education and training in community medicine. These EPAs were organized into three overarching EPA domains: integrality of care for individual health needs in all phases of the life cycle (5 EPAs), integrality of care for family health needs (3 EPAs), and integrality of care for community health needs (3 EPAs). For each EPA, descriptions of the following categories were created: title; specifications and limitations; conditions and implications of the entrustment decision; knowledge, skills, and attitudes; links to competencies; and assessment sources.

CONCLUSION

The resulting 11 EPAs for training medical students in community medicine expand the application of the EPA framework to both early undergraduate medical education and the context of primary health care. This report can support and guide other medical schools in their attempts to train students in primary health care contexts and to incorporate EPAs into their curricula.

Intimate partner violence education in Australian medical schools: has anything changed?

OBJECTIVES

To describe current intimate partner violence (IPV) education delivery to Australian medical students, and the barriers influencing this delivery, including any changes in the quantity and nature of IPV education delivery since 2010.

METHODS

A cross-sectional analysis of Australian medical schools providing primary medical degrees was conducted by identifying one staff member, from each of the disciplines of general practice, obstetrics and gynaecology, paediatrics, and where necessary, medical education, to complete an online survey.

RESULTS

Sixteen of the 17 medical schools provided IPV education, typically within the general practice or obstetrics and gynaecology curriculum. The median contact hour range was 3-6 hours. Key barriers included time constraints and resource shortages. The overall response rate was 89.5%.

CONCLUSION

Most Australian medical students receive limited IPV education and there is substantial variability in the depth and content of education. The proportion of medical schools providing education and the number of contact hours has only slightly increased. Implications for public health: Effective identification and management of IPV by healthcare providers can significantly improve health outcomes for victims and training in IPV may improve attitudes, knowledge and clinical skills. The need to provide more consistent and comprehensive IPV training for future doctors remains, and it is feasible to include integrated IPV education programs within a crowded medical curriculum.

Approaching an undergraduate medical curriculum map: challenges and expectations

BACKGROUND

Feedback received from medical students at University College London Medical School (UCLMS) suggested a lack of clarity regarding the contents and subsequent assessment of the undergraduate curriculum. In order to address these issues, a specialist team was established with the aim of designing and implementing a Curriculum Map (CM), which have been recognised in their ability to provide a centralised, visual representation of the curriculum. While multiple perspectives from educators to stakeholders can be considered here, the need for the CM to remain student centred was identified as key at UCLMS. The aim of this study was therefore to understand the requirements of the CM prior to production from the perspective of the medical students.

METHODS

A mixed-methods sequential study was conducted. The first stage involved gathering quantitative data using a primary online survey. This used 15 questions, rated by Likert scales and focussed around three domains: depiction of content, functionality and students' likely engagement with a CM. There was a free-text question for additional comments. The second stage consisted of multiple student focus groups representing different years of the programme, conducted by trained facilitators following a predetermined scheme. Reflective Thematic Analysis (RTA) was used to synthesise the qualitative data, which was read independently by two researchers. All students at UCLMS were invited to participate in the study.

RESULTS

There were 409 survey responses. 92% of students said they were 'likely' or 'very likely' to use a CM, with their key intended use being to monitor their learning progress and ensure preparedness for assessments. Five key themes emerged from the focus groups, namely that students wanted a CM to be: comprehensive; simple and intuitive; able to link content throughout the course; aligned with assessment; and useful to monitor students' progress.

CONCLUSIONS

Through this study, valuable insight was gained on students' ideal preferences for the CM. Understanding this was important in order to ensure that its co-design remained student-centred prior to its design and launch. This study also highlighted the need to set realistic expectations for students on the role of a CM in preparing them for assessments, and ultimately professional practice.

Curriculum initiatives to enhance research skills acquisition by medical students: a scoping review

BACKGROUND

Although it is accepted that providing medical students with opportunities to engage in research activity is beneficial, little data has been collated on how medical degree curricula may address this issue. This review aims to address this knowledge gap by conducting a scoping review examining curriculum initiatives that seek to enhance research experience for medical students.

METHODS

This review looks to specifically look at 'doing research' as defined by the MEDINE 2 consensus rather than 'using research' for the bachelor component of the Bologna Cycle. The framework developed by Arksey & O'Malley was utilised and a consultation with stakeholders was incorporated to clarify and enhance the framework.

RESULTS

A total of 120 articles were included in this scoping review; 26 related to intercalated degree options and 94 to non-intercalated degree options. Research initiatives from the United States were most common (53/120 articles). For non-intercalated research options, mandatory and elective research projects predominated. The included studies were heterogeneous in their methodology. The main outcomes reported were student research output, description of curriculum initiative(s) and self-reported research skills acquisition. For intercalated degree options, the three main findings were descriptions of more 'novel' intercalated degree options than the traditional BSc, student perspectives on intercalating and the effect of intercalating on medical student performance and careers.

CONCLUSIONS

There are several options available to faculty involved in planning medical degree programmes but further research is needed to determine whether research activity should be optional or mandatory. For now, flexibility is probably appropriate depending on a medical school's resources, curriculum, educational culture and population needs.

Developing Global Health Diplomacy-related Skills Using a COVID-19-like Epidemic Simulation as a Learning Strategy

Public health and global health practitioners need to develop global health diplomacy (GHD) skills to efficiently work within complex global health scenarios, such as the current coronavirus disease (COVID-19) pandemic. Problem-based learning was used as a framework to create a scenario-based activity designed to develop GHD-related skills. The application and effectiveness of this scenario-based activity to develop GHD-related skills were assessed. A mixed-methods approach involving a self-administered survey and one focus group discussion was used. The survey collected baseline participant characteristics as well as understanding and improvements in GHD-related skills using a 5-point Likert scale. The focus group was audio-recorded and thematically analyzed using both inductive and deductive codes. Data integration was achieved by connecting and weaving. Method and investigator triangulation techniques were used. Participants self-reported significantly better postscenario-based activity responses when asked about their understanding of diplomacy, negotiation, communication, and how to address public health emergencies (P < 0.01, Wilcoxon signed rank test). Most participants either agreed or strongly agreed that their GHD-related skills improved with participation in the scenario-based activity (diplomacy = 55.6%; negotiation = 66.5%; communication = 72.2%; addressing public health emergencies = 72.1%). Overall, qualitative data were consistent with results obtained using quantitative methods. The scenario-based activity was effective for improving the self-reported understanding of GHD-related skills. The scenario-based activity was also effective for developing the selected GHD-related skills (as self-reported). This scenario-based activity is likely to reduce cognitive load and avoid participant overload, thereby facilitating learning. Further research is required to elucidate its long-term impact on skills development.

Roadblocks to Integration; Faculty's perspective on transition from Traditional to Integrated Medical Curriculum

OBJECTIVE

This study was conducted to explore the faculty's opinion regarding factors impeding practical transition from traditional to integrated medical curriculum at the outset and a few years after the process.

METHODS

This qualitative exploratory study was conducted from April 2018 to October 2018 at two undergraduate medical colleges; one where integrated curriculum was at the outset and the second running it successfully. A total of 12 semi-structured interviews (six from each college) were recorded and transcribed. Thematic content analysis was carried out and faculty's perceptions about factors impeding practical transition to integrated curriculum were explored at two stages, i.e., at the outset and after its implementation.

RESULTS

Four impediments identified at the outset were deemed genuine by faculty who had gone through the experience including, faculty's resistance, lack of training, lack of incentives, and insufficient resources. Four more impediments were identified after the experience including lack of leadership, lack of attention to faculty's concerns, lack of communication and difficulties in setting appropriate assessment.

CONCLUSIONS

Several factors if ignored can result in failure of integration of curriculum in undergraduate medical colleges. Relevantly appropriate policies should be outlined by the regulatory body to ensure the control on the impediments.

Predicting Performance on Clerkship Examinations and USMLE Step 1: What Is the Value of Open-Ended Question Examination?

PURPOSE

Despite advances in learning sciences that highlight the efficacy of elaborative interrogation, in which students explain and elaborate on concepts in their own words, assessment techniques in medical education have commonly employed multiple-choice questions (MCQs). Educators' reluctance to consider alternatives such as open-ended questions (OEQs) stems from practical advantages of MCQs and the lack of empirical data on the predictability of OEQs for performance on other high-stakes assessments. In this study, the authors compared the predictive value of preclerkship assessments using OEQs for the outcomes of clerkship examinations and United States Medical Licensing Examination (USMLE) Step 1.

METHOD

The authors compared outcomes of 2 assessment formats using multiyear performance data (2015 and 2016 cohorts) on preclerkship MCQ versus OEQ examinations for predicting students' subsequent performance on 6 clerkship examinations and USMLE Step 1. The authors conducted a regression analysis to compare the predictability of MCQs and OEQs by using clerkship exam scores and Step 1 scores as dependent variables and performance on MCQs and OEQs as predictors in the models.

RESULTS

Regression models with OEQs were consistently higher for predicting clerkship exam (NBME shelf-exam) scores, except for one clerkship, compared with models using MCQs. For Step 1, R-square using MCQs was higher with 59% of the variance explained compared with 46% with OEQs, but the OEQ cohort scored significantly higher on Step 1.

CONCLUSIONS

OEQ examinations predict performance on subsequent high-stakes MCQ examinations. Given the predictive value and closer alignment with scientific principles of effective learning, OEQ examinations are an examination format worthy of consideration in preclerkship medical education programs.

Has teaching about intellectual disability healthcare in Australian medical schools improved? A 20-year comparison of curricula audits

BACKGROUND

People with intellectual disability (ID) have multiple and complex health needs, more frequent healthcare episodes, and experience poorer health outcomes. Research conducted two decades ago showed that medical professionals were lacking in the knowledge and skills required to address the complex needs of this patient group. The aim of the current study was to determine whether Australian undergraduate medical schools that offer ID health education content had changed the amount and nature of such teaching over this period.

METHODS

Identical or equivalent questionnaire items were compared across eight Australian medical schools that participated in curricula audits conducted in 1995 (referred to as T1) and 2013/14 (T2). The audits were of the nature of the ID content, methods used to teach it, and who taught it.

RESULTS

There was no significant difference in the number of hours of compulsory ID content offered to medical students at T2 (total = 158.3 h; median = 2.8 h per ID unit) compared with T1 (total = 171 h; median = 2.5 h). At T2 compared with T1, units with ID content taught in the area of general practice had increased (2 units; 3.6% to 7 units; 16.3%), while decreases were seen in paediatrics (22 units; 40.0% to 10 units; 23.3%) and psychiatry (10 units; 18.2% to 4 units; 9.3%). The number of schools using problem- and/or enquiry-based learning rose to six at T2 from one at T1. Inclusive teaching practices (people with ID develop or deliver content) in compulsory/elective units had increased at T2 (10 units; 23.3%) compared with T1 (6 units; 10.9%), but direct clinical contact with people with ID had decreased (29 units; 52.7% to 11 units; 25.6%).

CONCLUSIONS

Overall, little progress has been made to address the gaps in ID education for medical students identified from an audit conducted in 1995. Renewal of ID content in medical curricula is indicated as a key element in efforts to improve workforce capacity in this area and reduce barriers to care, with the aim of reversing the poor health outcomes currently seen for this group.

Medical education from the point of view of medical students: Results from four participatory Delphi panels in Quito, Ecuador

BACKGROUND

Medical curricula have historically been designed in a top-down approach, usually excluding students. While Delphi panels have been used as a tool for medical education curricula design, none have been conducted in Ecuador. In addition, no such approach has ever included students both as panelists and researchers.

MATERIAL AND METHODS

Four Delphi panels were developed and conducted using a participatory approach that allowed medical students to take part both as expert panelists and researchers: specifically, students developed the questionnaire and conducted a qualitative synthesis. Questionnaire responses were anonymized and dispatched online to panelists. The information was organized and collected to develop the qualitative syntheses and prepare the final statements.

RESULTS

Thirty-two medical students participated between February and May 2018. A total of 32 questions were developed, corresponding to five different categories. For some questions, consensus was reached; for other questions, general statements were obtained.Discussion and conclusion: Developing the questionnaire, responding to it and analyzing the answers allowed students to raise significant concerns regarding medical education topics proposing relevant policy and curricula change. Participatory Delphi panels can be an efficient tool to obtain organized feedback, improve student class involvement, and promote research skills.

Faculty's Perception of Their Role as a Medical Teacher at Qassim University, Saudi Arabia

Purpose

Medical teaching is a highly demanding and complex task. The advanced integrated curriculum and modern educational practices demand the roles of the medical teacher be redefined. This study was designed to understand the perceptions of the faculty of the Dental College, Qassim University, about their key roles as a teacher. These perceptions can be used to design faculty development workshops to enhance the awareness of the faculty about their educational responsibilities and achieve their potential.

Methods

It was a cross-sectional descriptive survey conducted on the faculty of the College of Dentistry, Qassim University, KSA. The study used a validated 12-item e-questionnaire to measure the perceptions of faculty about their teaching roles.

Results

A total of 44 faculty members submitted the e-questionnaire. Most faculty members perceived the most important role of the medical teacher as an information provider (90%) in clinical settings, followed by an on-job role model (89%). The least important role perceived was curriculum evaluator (82%) followed by curriculum planner (79%).

Conclusion

The role of a medical teacher has extended beyond the boundaries of information providers. The faculty of Qassim University exhibited their awareness about modern-day medical education and recognized the most important role of a medical teacher to be not only an information provider but also an on-job role model and academic advisor to students.

The AaLplus near-peer teaching program in Family Medicine strengthens basic medical skills-A five-year retrospective study

Background

Basic medical skills such as history taking and physical examination are essential components of clinical work profiles, but nevertheless have been neglected by conventional preclinical curricula. The near-peer-teaching program AaL^plus [living anatomy plus] teaches basic medical skills, especially history taking, physical examination, and venepuncture, to preclinical students. It is a highly popular compulsory course in the first four semesters (320 students/year, 9h/semester) at Heidelberg University and ends with a formative Objective Structured Clinical Examination (OSCE) during which students receive structured in-depth feedback on their performance. AaL^plus is part of the Department of General Practice’s longitudinal curriculum for Family Medicine.

Objectives

This study aims to assess whether the AaL^plus program has positive effects on students’ clinical skill development and subjective confidence in history taking, physical examination and venepuncture.

Methods

From 2015 to 2019, we asked all AaL^plus participants to rate the program and self-assess their medical skills on 5-point Likert scales (min 1, max 5). In 4-station OSCEs, trained tutors rated the students’ performance in all taught skills using standardized checklists.

Results

From 2015 to 2019 n = 1534 questionnaires returned (response rate = 98.6%, 52.7% females). After course completion, students felt able to take a patient’s history (mean 3.97, SD = 0.75) and perform physical examinations (means range 3.82–4.36, SDs range 0.74–0.89) as well as venepuncture (mean 4.12, SD = 0.88). A large majority of students claimed they acquired these skills in the AaL^plus program. During OSCE, 81.9% passed anamnesis, 93.1% passed physical examination, and 95.4% passed venepuncture (of n = 1556). Students mostly rated the feedback they received during the OSCE as “helpful” or “very helpful” (means for different stations 4.69–4.76, SDs 0.50–0.70).

Conclusions

AaL^plus is a positive example of a peer teaching program in the preclinical stage of medical studies. It successfully trains junior students in essential medical abilities and increases their confidence in their skills. A high percentage of students pass the formative OSCE and evaluate it positively. Consistently high ratings indicate the program’s routine viability. Further studies are needed to analyze if programs like AaL^plus could have an impact on the number of graduates choosing career in Family Medicine.

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning

BACKGROUND

What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL).

METHOD

The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times.

RESULTS

A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content.

DISCUSSION

UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training.

Students as catalysts for curricular innovation: A change management framework

Introduction: The role of medical students in catalyzing and leading curricular change in US medical schools is not well described. Here, American Medical Association student and physician leaders in the Accelerating Change in Medical Education initiative use qualitative methods to better define student leadership in curricular change.Methods: The authors developed case studies describing student leadership in curricular change efforts. Case studies were presented at a national medical education workshop; participants provided worksheet reflections and were surveyed, and responses were transcribed. Kotter's change management framework was used to categorize reported student roles in curricular change. Thematic analysis was used to identify barriers to student engagement and activators to overcome these barriers.Results: Student roles spanned all eight steps of Kotter's change management framework. Barriers to student engagement were related to faculty (e.g. view student roles narrowly), students (e.g. fear change or expect faculty-led curricula), or both (e.g. lack leadership training). Activators were: (1) recruiting collaborative faculty, staff, and students; (2) broadening student leadership roles; (3) empowering student leaders; and (4) recognizing student successes.Conclusions: By applying these activators, medical schools can build robust student-faculty partnerships that maximize collaboration, moving students beyond passive educational consumption to change agency and curricular co-creation.

What does it mean to be a physician? Exploring social imaginaries of first-year medical students

OBJECTIVES

To explore if community embedded discussions with local community members reshape the social imaginary of medicine among students and contribute positively to their professional identity.

METHODS

This explorative, qualitative study involved 35 first-year medical students who volunteered to attend a 2-hour forum at a local church to ask community members about their experiences with doctors and healthcare systems.  Student participants were asked to reflect on five structured questions. The written reflections were submitted for analysis, de-identified, and analyzed using Glaser's classic grounded theory, constant comparative analysis, and Taylor's model of modern social imaginaries as an analytical lens.

RESULTS

The results indicate that student participants identified seven main themes regarding what community members expect from their doctors, including active listening (n=22), physical touch (n=18), and compassion (n=16). Responses also indicated that only 5.6% of the students felt that the preclinical curriculum was adequately preparing them for what local community members identified as important to patient care. However, students recognized that two aspects of the curriculum, Physical Diagnosis (n=12) and volunteering/community engagement (n=9), were congruent with the expectations of future patients.

CONCLUSIONS

The results suggest that students identified educational experiences that were congruent with the social imaginary of patients. However, patient expectations were discordant to some aspects of the medical imaginary of medical students. The experience and subsequent reflections may be salient to contributing to each student's professional identity and provide a model for other medical schools to explore how the curriculum is fulfilling the community's perception of ideal patient care.

The road taken - changing one's professional focus at a large research university

The scientific endeavor has many facets, extending well beyond the experimental research bench. However, in most fields, especially in the biomedical sciences, the traditional career pathway for scientists is first joining and later leading an experimental research laboratory or program. As a result, scientific education is often focused on training new bench researchers. My own journey from a traditional bench scientist to that of an educator and educational researcher will be discussed in the context of a large research university environment. Being a scientist with an educational focus at such an institution poses significant challenges, but also opens new opportunities. In my opinion, these two professional pathways are not exclusive or alternative choices, but rather are complementary, both representing important and essential elements of scientific progress.

Have medical students' attitudes towards clinical communication skills changed over a 12- year period? A comparative long-term study

BACKGROUND

Attitudes towards learning clinical communication skills at the end of medical school are likely to reflect the students' training and motivation for the continued development of their skills as doctors. Students from two Norwegian medical schools, one with a traditional, and the other with an integrated curriculum, were approached in 2003 and 2015; with regard to changes in students' attitudes towards acquiring communication skills in two diverse learning environments. This comparison might reveal the effects of the training programs from a long-term perspective, as neither of the medical schools made any major curriculum changes within the study period.

METHODS

The samples comprised final-year medical students. Two separate cross-sectional surveys performed 12 years apart (2003 and 2015) used items from the Communication Skills Attitude Scale in addition to age and gender. The traditional curriculum included only theoretical teaching and no contact with patients was made during the first 2 to 2.5 years of medical school. However, the integrated curriculum combined training in theoretical and clinical communication skills with early patient contact from the beginning.

RESULTS

Attitudes improved from the first to the second survey at both schools, however, students from the integrated school reported more positive attitudes than those from the traditional school. Female students from the integrated school contributed the most to the difference in attitudes in both surveys.

CONCLUSIONS

Students in both traditional and integrated curricula improved their attitudes from the first to the second assessment. However, compared with the traditional curriculum, the integrated one fostered even higher levels of positive attitudes towards acquiring communication skills, and a pronounced influence was observed on female students. These findings suggest that an educational program with greater emphasis on improving attitudes among male students may be required.

Curricular integration of virtual patients: a unifying perspective of medical teachers and students

BACKGROUND

Virtual Patients (VPs) may improve cognitive and behavioral skills better than traditional methods do. The aim of this paper was to investigate challenges faced by teachers and students in order to effectively implement VPs across undergraduate and postgraduate curricula. In addition, differences in student and teacher perceptions that could impact curricular integration of VPs were explored.

METHODS

A two-phase descriptive study was performed: 1) evaluation of the VP design process and curricular integration, conducted upon academic medical teachers; 2) evaluation of learning and clinical reasoning experiences with VPs, from the students' perspective.

RESULTS

The results of this study document high acceptance of VPs by both medical teachers and students (n = 252).VPs seem to fulfill most needs as set by course directors, while they satisfy student needs and create perceptions of improved knowledge and clinical skills reasoning.

CONCLUSIONS

Medical educators have encountered educational challenges upon transforming the curriculum. To develop VPs, academic institutions have to pay equal attention to the needs of potential adopters and VP authors. Strategic development and use of VPs may motivate more widespread integration of VPs and lead to a high quality medical education system.

Practical Tips for Implementing a Student-Led Reflective Writing Workshop Series

Reflective practice may ameliorate the burnout, empathy loss, and depression that medical students experience during clerkships. We describe a student-led reflective writing workshop in a safe and structured small group setting. We provide twelve tips for implementing such a workshop, informed by the existing literature on reflective writing and near-peer teaching, which include developing writing prompts, guiding student facilitators, and obtaining feedback. Common topics include patient suffering, workplace dynamics, and the joys of practicing medicine. Participants develop camaraderie with peers as well as tools they can carry forward as they continue to process the challenging experiences intrinsic to clinical medicine.

How does Donor Dissection Influence Medical Students' Perceptions of Ethics? A Cross-Sectional and Longitudinal Qualitative Study

The contribution of donor dissection to modern anatomy pedagogy remains debated. While short-term anatomy knowledge gains from dissection are questionable, studies suggest that donor dissection may have other impacts on students including influencing medical students' professional development, though evidence for such is limited. To improve the understanding of how anatomy education influences medical student professional development, the cross-sectional and longitudinal impacts of donor dissection on medical students' perceptions of ethics were explored. A cross-sectional and longitudinal qualitative study was undertaken at an Australian university where student responses to online discussion forums and in-person interviews were analyzed. Data were collected across the 1.5 years that undergraduate medical students received anatomy instruction (three semesters during first and second years). A total of 207 students participated in the online discussion forums, yielding 51,024 words; 24 students participated in at least 1 of 11 interviews, yielding over 11 hours of interview data. Framework analysis identified five themes related to ethics in an anatomical education context: (1) Dignity, (2) Beneficence, (3) Consent, (4) Justification for versus the necessity of dissection, and (5) Dichotomy of objectification and personification. The dominant themes of students' ethical perceptions changed with time, with a shift from focusing on donors as people, toward the utility of donors in anatomy education. Additionally, themes varied by student demographics including gender, ancestry, and religiosity. Together this study suggests a strong impact of donor dissection on priming students' focus on medical ethics and provides further advocacy for formal and purposeful integration of medical ethics with anatomy education.

Medical education dilemma: How can we best accommodate basic sciences in a curriculum for 21st century medical students?

Over the years, the medical curriculum has been changed to accommodate a variety of evolving disciplines and an exploding scientific knowledge of the basic sciences to prepare “a competent physician” of the 21st century. Therefore, we must be innovative in our approach of curricular development if we wish to continue to incorporate new basic sciences knowledge in the face of decreasing contact hours to satisfy the buzz word, “integration”. Certainly, the challenges are phenomenal. The question how to best integrate basic sciences, is not easy to answer as the objectives of the courses and outcome vary from one medical school to another and the fact is, one size does not fit all. However, if we believe that basic sciences are the language of medicine and foundation of clinical knowledge, then we must resolve this ongoing dilemma by introducing basic sciences through a better alignment in a given curriculum. The purpose of this review is to evaluate different curricular models for their basic sciences content and address their strengths and weaknesses. In addition, we will introduce a spiral design to integrate basic sciences for senior students. Finally, we will provide some insight as to how learning and retention of basic science content can be sustained.

Community Preceptors' Motivations and Views about Their Relationships with Medical Students During a Longitudinal Family Medicine Experience: A Qualitative Case Study

Phenomenon: Although current evidence emphasizes various benefits of community-oriented programs, little is still known about the nature of the relationships that students and family physicians develop in this educational setting. Our aim in this study was twofold: to identify family physicians' motivations to enroll as preceptors in a longitudinal undergraduate family medicine program and to explore the nature of the student-preceptor relationships built during the course. Approach: This was a qualitative exploratory case study. The case was the first edition of a longitudinal family medicine experience (LFME), a course that makes up part of the novel Medicinae Doctor et Chirurgiae Magister curriculum in place in a Canadian medical school since August 2013. All 173 family physician community preceptors of the academic year 2013-2014 were considered key informants in the investigation. Forty-three preceptors finally participated in one of six focus groups conducted in the spring of 2014. Several organizational documents relative to the LFME course were also gathered. Inductive semantic thematic analysis was performed on verbatim interview transcripts. Documents helped contextualize the major themes emerging from the focus groups discussions. Findings: Enjoying teaching, promoting family medicine, and improving medical education where salient motivations for family physicians to become LFME preceptors. The findings also pointed out the complexity of the student-preceptor exchanges that unfolded over the academic year, and the ambiguous and changing nature of the role that LFME preceptors adopted in their relationships with students: from simply being facilitators of students' clinical observership to behaving as their mentors. Insights: Family physicians were highly motivated to become LFME preceptors of 1st-year medical students. Whereas they consistently valued the relationships built during the academic year with the students assigned to them, they also considered that exchanges did not always happen without difficulties, and gauged the roles they played as complex, ambiguous, and necessarily evolving over time.

A collaborative process for a program redesign for education in evidence-based health care

OBJECTIVE:

We outline the framework of a collaborative process to redesign an existing 5-year health education program, which may prove useful to other similar institutions. The aim was to strengthen evidence-based practice and curriculum alignment.

METHODS:

A whole-of-program approach was used to restructure the existing courses into 3 "streams": professional practice, clinical research, and clinical science. The process incorporated a series of facilitated workshops organized by the department director of learning and teaching and the faculty facilitation team, and it was inclusive of all available members of the department, a clinic supervisor, a sessional (casual teaching) staff member, and a recent graduate of the program.

RESULTS:

Unit content and assessments were restructured to progress the program learning outcomes from year to year. The undergraduate program was redesigned to create a more logical learning pathway for students. Consolidation of subject topics in the postgraduate program allowed for the development of stand-alone research-only units.

CONCLUSION:

The mechanism of curriculum mapping allowed for discussion about the flow of information from year to year and how evidenced knowledge and understanding can be developed. It is necessary that everyone participates and understands the importance of program goals as developed by the process. Because drift in curriculum can occur incrementally over the years, to be effective, the program requires ongoing monitoring and regular collaboration to continue improvements.

Is there a role for GPs in teaching neurology to medical students? A qualitative evaluation

INTRODUCTION

The purpose of this study was to evaluate whether GPs can support medical students in learning basic neurology in the context of a traditional hospital neurology attachment.

METHOD

This was a qualitative evaluation using routinely collected data from stakeholders, consisting of qualitative data in the form of student evaluation questionnaires, course documentation and correspondence from faculty staff.

RESULTS

The addition of GP teaching to the programme increased availability of patients with neurological problems accessible to students and provided a safe, supportive environment for students to learn their fundamental clinical skills. Students gained valuable insights into the impact of neurological disease from the perspective of patients, their families and carers. GP teaching of neurology was well regarded by students. Some GP tutors felt they lacked adequate experience to teach more technical aspects of neurology, and some students shared this concern. Concepts of professional boundaries between generalists and specialists were not observed, but GP teaching was perceived to be 'other' or outside normal medical school activity.

CONCLUSIONS

General practitioners can successfully facilitate students' access to patients with neurological disease and employ their generalist to enhance neurological learning. Some GPs were initially uncomfortable with teaching skills such as detailed neurological physical examination.

"Tweet"-format reflective writing: A hidden needs assessment?

BACKGROUND

Medical student reflection is integral for professional development. Preliminary findings suggest that short-format writing promotes reflection and identifies impactful experiences. We sought to determine whether reflective writing could be used as a clerkship needs assessment.

METHODS

During their surgical clerkship, medical students submitted "tweet"-format reflections and completed a standardized evaluation. "Tweet" content was analyzed using modified grounded theory methods and coded by valence, content, and reflection. Sub-coding was conducted to compare feedback between "tweets" and evaluations.

RESULTS

We analyzed 286 reflections and 214 evaluation comments; 176 "tweets" were reflective (62%). "Tweets" commented on "patient interaction" (53%), "educational experience" (38%), "physician interaction" (26%), and "career decisions" (10%). A significant difference was observed between "tweets" and evaluations with regard to the number that provided feedback on experiences with "critically ill or dying patients."

CONCLUSIONS

Reflections provided real-time reactions to impactful clerkship events, notably those involving critically ill or dying patients. This focus on illness may represent an unmet need for discussions related to end of life care. Overall, reflections provided more actionable feedback compared to evaluations.

Intellectual disability content within tertiary medical curriculum: how is it taught and by whom?

BACKGROUND

Individuals with intellectual disability experience higher rates of physical and mental health conditions compared with the general population, yet have inequitable access to health care services. Improving the workplace capacity of medical professionals to meet the needs of this population is one way to reduce barriers to care and improve health outcomes. Using diverse pedagogy appropriate to learning outcomes to teach medical students about intellectual disability is a necessary step in improving future workplace capacity. However, there is a lack of research into how, and by whom, medical students are taught about intellectual disability. The aim of this study was to investigate this through an audit of Australian medical school curricula.

METHODS

The Deans of Australian universities that provide accredited medical degrees (n = 20) were invited by email to participate in a two-phase audit of intellectual disability content in the curricula. Phase 1 (n = 14 schools) involved the Dean's delegate completing a telephone interview or questionnaire regarding medical course structure. If intellectual disability content was identified, a unit coordinator was invited to complete a survey regarding how this content was taught and by whom (Phase 2; n = 12 schools).

RESULTS

There was considerable variability across Australian medical schools regarding methods used to teach content about intellectual disability. Didactic teaching methods were most frequently used (62% of units included some form of lecture), but workshops and tutorials were reasonably well represented (34% of units contained one or both). Thirty-six percent of units included two or more teaching methods. Almost all schools (83%) used some problem- and/or enquiry-based learning. Educator backgrounds included medicine, nursing, and allied health. A majority of schools (n = 9, 75%) involved people with intellectual disability designing and teaching content, but the extent to which this occurred was inconsistent.

CONCLUSIONS

Renewing curricula around intellectual disability across all medical schools by introducing varied teaching methods and the inclusion of people with intellectual disability would assist students to develop knowledge, skills, attitudes, and confidence in intellectual disability health. Such renewal offers the potential to reduce barriers to service this population regularly face, thereby improving their health outcomes.

Using Maps to Promote Data-Driven Decision-Making: One Library's Experience in Data Visualization Instruction

Data play a crucial role in health research, education, and patient care. Initiatives such as Big Data to Knowledge (BD2K) and Precision Medicine point to the increasing focus and value of data use and reuse. As the universe of data continues to grow exponentially, health education needs to provide students with practical hands-on learning sessions that illustrate the multitude of uses for data and statistics. Giving students early exposure to data reuse provides a solid background for the more complex data they may gather later in their education. This column describes how librarians at a general academic library used data dashboards and Tableau in two library sessions to provide students with hands-on experience in data visualization and its role in decision-making.

VERT, a virtual clinical environment, enhances understanding of radiation therapy planning concepts

INTRODUCTION

The ability to understand treatment plan dosimetry and apply this understanding clinically is fundamental to the role of the radiation therapist. This study evaluates whether or not the Virtual Environment for Radiotherapy Training (VERT) contributes to teaching treatment planning concepts to a cohort of first-year radiation therapy students.

METHODS

We directly compared a custom-developed VERT teaching module with a standard teaching module with respect to the understanding of treatment planning concepts using a cross-over design. Students self-reported their understanding of specific concepts before and after delivery of the VERT and standard teaching modules and evaluated aspects of VERT as a learning experience. In addition, teaching staff participated in a semi-structured interview discussing the modules from an educational perspective.

RESULTS

Both the standard teaching module and VERT teaching module enhanced conceptual understanding and level of confidence in the student cohort after both teaching periods. The proportion of students reporting a perceived increase in knowledge/confidence was similar for the VERT teaching module for all but two scenarios. We propose that an integrated approach, providing a strong theoretical conceptual framework, followed by VERT to situate this framework in the (simulated) clinical environment combines the best of both teaching approaches.

CONCLUSION

This study has established for the first time a clear role for a tailored VERT teaching module in teaching RT planning concepts because of its ability to visualise conceptual information within a simulated clinical environment.

Untying the Gordian knot: remediation problems in medical schools that need remediation

This position paper discusses on-going academic remediation challenges within the field of medical education. More specifically, we identify three common contemporary problems and propose four recommendations to strengthen remediation efforts. Selecting or determining what type of remediation is needed for a particular student is akin to analyzing a Gordian knot with individual, institutional and systemic contributors. More emphasis, including multi-institutional projects and research funding is needed. Recommendations regarding language use and marketing of such programs are given.

Inter-examiner reliability of the clinical parts of MRCPsych part II examinations

Aims and Method

The aim of the study was to investigate the interrater reliability of the clinical component of the MRCPsych part II examinations, namely the individual patient assessment and the patient management problems. In the study period, there were 1546 candidates and 773 pairs of examiners. Kappa scores for pairs of examiners in both these assessments were calculated.

Results

The kappa scores for exact numerical agreement between the pairs of examiners in both individual patient assessment and patient management problems were only moderate (0.4 –0.5). However, the kappa scores for agreement between pairs of examiners for the reclassified pass and fail categories were very good (0.8).

Clinical Implications

The poor reliability of the traditional long case and oral examinations in general is one of the most potent arguments against their use. Our finding suggests that the College clinical examinations are at least not problematic from this point of view, particularly if global pass or fail judgements rather than discrete scores are applied.

Bridging the Chasm: Challenges, Opportunities, and Resources for Integrating a Dissemination and Implementation Science Curriculum into Medical Education

BACKGROUND

Physicians are charged with implementing evidence-based medicine, yet few are trained in the science of Dissemination and Implementation (D&I). In view of the potential of evidence-based training in D&I to help close the gap between research and practice, the goal of this review is to examine the importance of D&I training in medical education, describe challenges to implementing such training, and provide strategies and resources for building D&I capacity.

METHODS

We conducted (1) a systematic review to identify US-based D&I training efforts and (2) a critical review of additional literature to inform our evaluation of the challenges and opportunities of integrating D&I training in medical education.

RESULTS

Out of 269 unique articles reviewed, 11 described US-based D&I training. Although vibrant and diverse training opportunities exist, their capacity is limited, and they are not designed to meet physicians' needs. Synthesis of relevant literature using a critical review approach identified challenges inherent to changing medical education, as well as challenges related to D&I science. Finally, selected strategies and resources are available for facilitating incorporation of D&I training into medical education and overcoming existing challenges.

CONCLUSIONS

Integrating D&I training in the medical education curriculum, and particularly in residency and fellowship training, holds promise for bridging the chasm between scientific discoveries and improved patient care and outcomes. However, unique challenges should be addressed, including the need for greater evidence.

Must we remain blind to undergraduate medical ethics education in Africa? A cross-sectional study of Nigerian medical students

BACKGROUND

As the practice of medicine inevitably raises both ethical and legal issues, it had been recommended since 1999 that medical ethics and human rights be taught at every medical school. Most Nigerian medical schools still lack a formal undergraduate medical ethics curriculum. Medical education remains largely focused on traditional medical science components, leaving the medical students to develop medical ethical decision-making skills and moral attitudes passively within institutions noted for relatively strong paternalistic traditions. In conducting a needs assessment for developing a curriculum germane to the Nigerian society, and by extension most of Sub-Saharan Africa, this study determined the views of Nigerian medical students on medical ethics education, ethical issues related to the doctor-patient relationship and the ethical/professional dilemmas they are confronted with.

METHODS

Using self-administered 63-item structured questionnaires, a cross-sectional survey of the final year medical students of the University of Nigeria was conducted in July 2015.Using the Statistical Package for the Social Sciences software (SPSS Version 17), frequency counts and percentages were generated.

RESULTS

The sample included 100 males (71.4%) and 40 females (28.6%), with the respective mean (SD) age being 24.6(5.61) and 21.8 (6.38) years. Only 35.7% were satisfied with their medical ethics knowledge, and 97.9% indicated that medical ethics should be taught formally. Only 8.6% had never witnessed a medical teacher act unethically. The dilemmas of poor communication between physicians and patients, and the provision of sub-standard care were reported highest for being encountered 'often'. A majority (60.7%) indicated that "a doctor should do his best always, irrespective of the patient's wishes". No significant difference in responses across gender was noted.

CONCLUSION

There is a strong desire by the contemporary Nigerian medical student for medical ethics education. Their lack of exposure in medical ethics in an ethically challenging environment suggest a dire need for the development of an appropriate medical ethics curriculum for them and the provision of an ethically conducive learning environment.

The role of general practitioners in medical school admission interview panels in the UK (2012-2014): a national survey

Objective

Recent primary care workforce pressures in the UK have prompted national reviews. Recommendations to increase the proportion of medical students entering general practice have led to interest in the role of medical schools in career choices. This study sought to identify the career backgrounds of admissions leads at UK medical schools and the proportion of general practitioners on admission interview panels.

Design

A national survey using a proforma circulated to all UK medical school admission leads via the Medical Schools Council.

Setting

UK medical schools.

Participants

UK medical schools.

Main outcome measures

Prevalence of assessment lead and panel members' professional groups.

Results

Responses were received from 18 (54.5%) of the 33 UK medical schools. General practitioners led the admissions process in 2 (11%) of these. Fifteen schools were able to furnish detailed data about interview panel composition, having held a combined total of 876 distinct interview panels during the 2012–2013 and 2013–2014 admission years; 683 panels (78%) included a secondary care physician, but only 261 panels (29.8%) included general practitioners. General practitioner representation ranged from 3.8% to 100% of individual schools’ panels; however, eight schools (about half the respondents able to offer numbers of participants) omitted general practitioner representation in more than half of their interview panels.

Conclusions

Despite the UK policy focus to increase the proportion of medical students becoming general practitioners, doctors from this clinical background are not proportionately represented as admissions leads or on admissions interview panels. Increasing general practitioner involvement in admissions processes may be one way in which medical schools can support general practice as a career aspiration.

Assessing the effectiveness of problem-based learning in physical diagnostics education in China: a meta-analysis

Problem-based learning (PBL) has been extensively applied as an experimental educational method in Chinese medical schools over the past decade. A meta-analysis was performed to assess the effectiveness of PBL on students' learning outcomes in physical diagnostics education. Related databases were searched for eligible studies evaluating the effects of PBL compared to traditional teaching on students' knowledge and/or skill scores of physical diagnostics. Standardized mean difference (SMD) with 95% confidence interval (CI) was estimated. Thirteen studies with a total of 2086 medical students were included in this meta-analysis. All of these studies provided usable data on knowledge scores, and the pooled analysis showed a significant difference in favor of PBL compared to the traditional teaching (SMD = 0.76, 95%CI = 0.33-1.19). Ten studies provided usable data on skill scores, and a significant difference in favor of PBL was also observed (SMD = 1.46, 95%CI = 0.89-2.02). Statistically similar results were obtained in the sensitivity analysis, and there was no significant evidence of publication bias. These results suggested that PBL in physical diagnostics education in China appeared to be more effective than traditional teaching method in improving knowledge and skills.

Medical educators: How they define themselves - Results of an international web survey

BACKGROUND

Little is known about medical educators' self-definition.

AIMS

The aim of this study is to survey an international community of medical educators focusing on the medical educators' self-definition.

METHODS

Within a comprehensive, web-based survey, an open question on the participants' views of how they would define a "medical educator" was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe. The free text definitions were analysed using qualitative thematic analysis.

RESULTS

Of the, 2200 medical educators invited to participate, 685 (31.1%) provided a definition of a "medical educator". The qualitative analysis of the free text definitions revealed that medical educators defined themselves in 13 roles, primarily as "Professional Expert", "Facilitator", "Information Provider", "Enthusiast", "Faculty Developer", "Mentor", "Undergraduate and Postgraduate Trainer", "Curriculum Developer", "Assessor and Assessment Creator", and "Researcher".

CONCLUSIONS

Our survey revealed that medical educators predominantly define themselves as "Professional Experts" and identified 12 further self-defined roles of a medical educator, several of which not to have been reported previously. The results can be used to further the understanding of our professional identity.

Exploring the value and role of integrated supportive science courses in the reformed medical curriculum iMED: a mixed methods study

BACKGROUND

Heterogeneous basic science knowledge of medical students is an important challenge for medical education. In this study, the authors aimed at exploring the value and role of integrated supportive science (ISS) courses as a novel approach to address this challenge and to promote learning basic science concepts in medical education. ISS courses were embedded in a reformed medical curriculum.

METHODS

The authors used a mixed methods approach including four focus groups involving ISS course lecturers and students (two each), and five surveys of one student cohort covering the results of regular student evaluations including the ISS courses across one study year. They conducted their study at the University Medical Center Hamburg-Eppendorf between December 2013 and July 2014.

RESULTS

Fourteen first-year medical students and thirteen ISS course lecturers participated in the focus groups. The authors identified several themes focused on the temporal integration of ISS courses into the medical curriculum, the integration of ISS course contents into core curriculum contents, the value and role of ISS courses, and the courses' setting and atmosphere. The integrated course concept was positively accepted by both groups, with participants suggesting that it promotes retention of basic science knowledge. Values and roles identified by focus group participants included promotion of basic understanding of science concepts, integration of foundational and applied learning, and maximization of students' engagement and motivation. Building close links between ISS course contents and the core curriculum appeared to be crucial. Survey results confirmed qualitative findings regarding students' satisfaction, with some courses still requiring optimization.

CONCLUSIONS

Integration of supportive basic science courses, traditionally rather part of premedical education, into the medical curriculum appears to be a feasible strategy to improve medical students' understanding of basic science concepts and to increase their motivation and engagement.

Cognitive Load and Self-Determination Theories Applied to E-Learning: Impact on Students' Participation and Academic Performance

BACKGROUND

Emergency clerkships expose students to a stressful environment that require multiple tasks, which may have a direct impact on cognitive load and motivation for learning. To address this challenge, Cognitive Load Theory and Self Determination Theory provided the conceptual frameworks to the development of a Moodle-based online Emergency Medicine course, inspired by real clinical cases.

METHODS

Three consecutive classes (2013-2015) of sixth-year medical students (n = 304) participated in the course, during a curricular and essentially practical emergency rotation. "Virtual Rounds" provided weekly virtual patients in narrative format and meaningful schemata to chief complaints, in order to simulate real rounds at Emergency Unit. Additional activities such as Extreme Decisions, Emergency Quiz and Electrocardiographic challenge offered different views of emergency care. Authors assessed student´s participation and its correlation with their academic performance. A survey evaluated students´ opinions. Students graduating in 2015 answered an online questionnaire to investigate cognitive load and motivation.

RESULTS

Each student produced 1965 pageviews and spent 72 hours logged on. Although Clinical Emergency rotation has two months long, students accessed the online course during an average of 5.3 months. Virtual Rounds was the most accessed activity, and there was positive correlations between the number of hours logged on the platform and final grades on Emergency Medicine. Over 90% of students felt an improvement in their clinical reasoning and considered themselves better prepared for rendering Emergency care. Considering a Likert scale from 1 (minimum load) to 7 (maximum load), the scores for total cognitive load were 4.79±2.2 for Virtual Rounds and 5.56±1.96 for real medical rounds(p<0,01).

CONCLUSIONS

A real-world inspired online course, based on cognitive and motivational conceptual frameworks, seems to be a strong tool to engage students in learning. It may support them to manage the cognitive challenges involved in clinical care and increase their motivation for learning.

A review of creative and expressive writing as a pedagogical tool in medical education

CONTEXT

The act of writing offers an opportunity to foster self-expression and organisational abilities, along with observation and descriptive skills. These soft skills are relevant to clinical thinking and medical practice. Medical school curricula employ pedagogical approaches suitable for assessing medical and clinical knowledge, but teaching methods for soft skills in critical thinking, listening and verbal expression, which are important in patient communication and engagement, may be less formal. Creative and expressive writing that is incorporated into medical school courses or clerkships offers a vehicle for medical students to develop soft skills. The aim of this review was to explore creative and expressive writing as a pedagogical tool in medical schools in relation to outcomes of medical education.

METHODS

This project employed a scoping review approach to gather, evaluate and synthesise reports on the use of creative and expressive writing in US medical education. Ten databases were searched for scholarly articles reporting on creative or expressive writing during medical school. Limitation of the results to activities associated with US medical schools, produced 91 articles. A thematic analysis of the articles was conducted to identify how writing was incorporated into the curriculum.

RESULTS

Enthusiasm for writing as a pedagogical tool was identified in 28 editorials and overviews. Quasi-experimental, mixed methods and qualitative studies, primarily writing activities, were aimed at helping students cognitively or emotionally process difficult challenges in medical education, develop a personal identity or reflect on interpersonal skills. The programmes and interventions using creative or expressive writing were largely associated with elective courses or clerkships, and not required courses.

CONCLUSIONS

Writing was identified as a potentially relevant pedagogical tool, but not included as an essential component of medical school curricula.

Building a Generation of Physician Advocates: The Case for Including Mandatory Training in Advocacy in Canadian Medical School Curricula

There is an increasing focus on the social accountability of physicians as individuals, and of medicine itself. This has led to increasing emphasis on physician advocacy from a wide variety of institutions. The physician advocacy concept is now part of the Health Advocacy competency mandated by the Royal College of Physicians and Surgeons of Canada. Despite its growing prominence, physician advocacy remains poorly integrated into current medical undergraduate curricula. The authors recommend how and why curricular reform should proceed; they focus on Canadian medical education, although they hope their views will be useful in other countries as well.The authors discuss conflicting definitions of physician advocacy, which have previously hampered curriculum development efforts, and suggest a way of reconciling the conflicts. They review current gaps in advocacy-related curricula, suggest that these can be addressed by incorporating practice-based and skills acquisition elements into current didactic teaching, and offer several strategies by which an advocacy curriculum could be implemented, ranging from small modifications to current curriculum to developing new competencies in medical education nationally.The authors present a case for making an advocacy curriculum mandatory for every Canadian medical trainee; they argue that teaching trainees how to fulfill their professional responsibility to advocate may also help them meet the social accountability mandate of medical school education. Finally, the authors explain why making the development and implementation of a mandatory, skill-based curriculum in advocacy should be a priority.

Designing evidence-based medicine training to optimize the transfer of skills from the classroom to clinical practice: applying the four component instructional design model

Evidence-based medicine (EBM) skills, although taught in medical schools around the world, are not optimally practiced in clinical environments because of multiple barriers, including learners' difficulty transferring EBM skills learned in the classroom to clinical practice. This lack of skill transfer may be partially due to the design of EBM training. To facilitate the transfer of EBM skills from the classroom to clinical practice, the authors explore one instructional approach, called the Four Component Instructional Design (4C/ID) model, to guide the design of EBM training. On the basis of current cognitive psychology, including cognitive load theory, the premise of the 4C/ID model is that complex skills training, such as EBM training, should include four components: learning tasks, supportive information, procedural information, and part-task practice. The combination of these four components can inform the creation of complex skills training that is designed to avoid overloading learners' cognitive abilities; to facilitate the integration of the knowledge, skills, and attitudes needed to execute a complex task; and to increase the transfer of knowledge to new situations. The authors begin by introducing the 4C/ID model and describing the benefits of its four components to guide the design of EBM training. They include illustrative examples of educational practices that are consistent with each component and that can be applied to teaching EBM. They conclude by suggesting that medical educators consider adopting the 4C/ID model to design, modify, and/or implement EBM training in classroom and clinical settings.

The Blooming Anatomy Tool (BAT): A discipline-specific rubric for utilizing Bloom's taxonomy in the design and evaluation of assessments in the anatomical sciences

Bloom's taxonomy is a resource commonly used to assess the cognitive level associated with course assignments and examination questions. Although widely utilized in educational research, Bloom's taxonomy has received limited attention as an analytical tool in the anatomical sciences. Building on previous research, the Blooming Anatomy Tool (BAT) was developed. This rubric provides discipline-specific guidelines to Blooming anatomy multiple-choice questions (MCQs). To test the efficacy of the BAT, a group of volunteers were randomly split up and asked to Bloom a series of anatomy MCQs using either the BAT or a traditional Bloom's reference called Bloom's Learning Objectives (BLO). Both groups utilized each rubric for a different series of MCQs. Examination question categorizations made using each rubric were tested for accuracy and interrater reliability. In addition, previous experience in anatomy and Bloom's taxonomy were considered. Results demonstrated that volunteers using the BAT had consistently higher levels of interrater reliability, but accuracy varied and was similar between rubrics. Neither measure was substantially impacted by experience in Bloom's taxonomy or anatomy. A poststudy survey indicated that volunteers strongly preferred the BAT and felt it was more helpful in categorizing anatomy MCQs than the BLO. These results suggest that the BAT can be useful in educational research in the anatomical sciences to aid in aligning observer judgment on Bloom taxonomic levels and improve consistency, especially when used in conjunction with a norming session prior to data collection.

Specialty Training's Organizational Readiness for curriculum Change (STORC): development of a questionnaire in a Delphi study

BACKGROUND

In postgraduate medical education (PGME), programs have been restructured according to competency-based frameworks. The scale and implications of these adjustments justify a comprehensive implementation plan. Organizational Readiness for Change (ORC) is seen as a critical precursor for a successful implementation of change initiatives. Though, ORC in health care settings is mostly assessed in small scale settings and in relation to new policies and practices rather than educational change. Therefore our aim with this work was to develop an instrument to asses Specialty Training's Organizational Readiness for curriculum Change (STORC).

METHODS

A Delphi procedure was conducted to examine the applicability of a preliminary questionnaire in PGME, which was based on existing instruments designed for business and health care organizations. The 41 panellists (19 trainees and 22 supervisors from 6 specialties) from four different countries who were confronted with an apparent curriculum change, or would be in the near future, were asked to rate the relevance of a 89-item web-based questionnaire with regard to changes in specialty training on a 5-point Likert scale. Furthermore, they were invited to make qualitative comments on the items.

RESULTS

In two rounds the 89-item preliminary questionnaire was reduced to 44 items. Items were either removed, kept, adapted or added based on individual item scores and qualitative comments. In the absence of a gold standard, this Delphi procedure was considered complete when the overall questionnaire rating exceeded 4.0 (scale 0-5). The overall item score reached 4.1 in the second round, meeting our criteria for completion of this Delphi procedure.

CONCLUSIONS

This Delphi study describes the initial validating step in the development of an instrument to asses Specialty Training's Organisational Readiness for curriculum Change (STORC). Since ORC is measured on various subscales and presented as such, its strength lies in analysing these subscales. The latter makes it possible for educational leaders to identify and anticipate on hurdles in the implementation process and subsequently optimize efforts for successful curriculum change.