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Kalistratova VS, Nisanova A, Shi LZ. Student-run free clinics may enhance medical students' self-confidence in their clinical skills and preparedness for clerkships. MEDICAL EDUCATION ONLINE 2024; 29:2348276. [PMID: 38696139 PMCID: PMC11067551 DOI: 10.1080/10872981.2024.2348276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/23/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Student-run free clinics (SRFCs) offer medical students a unique opportunity to develop their clinical, diagnostic, and social skills while providing care to medically underserved communities. This study aims to evaluate the value of SRFC involvement on students' self-reported confidence in various clinical domains and satisfaction with their medical education. METHODS We conducted a single-center retrospective pre-post assessment at an urban academic institution among second- to fourth-year medical students. We administered a 25-item questionnaire capturing the scope of clinic involvement and assessing self-reported confidence in multiple clinical domains following a one-year-long participation in student-run free clinics. RESULTS Fifty-six students completed the survey. Participation in SRFCs significantly increased self-reported confidence in patient history-taking (p < 0.001), performing oral presentations (p < 0.001) and physical exams (p < 0.001). Students also reported significantly greater confidence in working with translators (p < 0.001) or as part of an interprofessional team (p < 0.001) and understanding the needs of the population served (p < 0.001). Students also found SRCs to significantly improve their confidence in preparedness for clerkships (p < 0.001). SRFC involvement can improve medical students' confidence in their clinical and interpersonal skills and enhance preparedness for clerkships and working with diverse patient groups. CONCLUSION SRFCs are a useful tool in the medical school curriculum that help bridge the gap between classroom learning and clinic and may encourage practice in medically underserved communities. SRFCs also integrate classroom material and clinical practice, although standardized evaluation metrics need to be developed. SRFCs should be incorporated as a learning experience by medical schools nationwide.
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Affiliation(s)
| | - Arina Nisanova
- School of Medicine, University of California Davis, Davis, CA, USA
| | - Lucy Z. Shi
- Department of Internal Medicine, University of California Davis, Davis, CA, USA
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Gomez K, Edwards HL, Kirby J. Livestreaming clinical experience to remotely located learners: A critical narrative review. MEDICAL EDUCATION 2024; 58:1032-1041. [PMID: 38606897 DOI: 10.1111/medu.15392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
CONTEXT Medical education relies on real patient learning (RPL) to provide medical students with essential clinical experience. However, growing demand for clinical placements continues to be a challenge in providing sufficient RPL opportunities. The COVID-19 pandemic forced academic institutions to rethink the delivery of traditional clinical training and innovations in online clinical learning experiences, specifically livestreamed clinical experiences, have emerged which show promise in addressing the capacity limitations of traditional placements. Although previous reviews have explored the use of livestreamed clinical experiences during the pandemic, there is a lack of rigorous theoretical framing to support these innovations. OBJECTIVES The aim of this review is two-fold: to examine the effectiveness of livestreamed clinical experiences through an experience-based learning (ExBL) theory perspective and to provide practical recommendations to optimise and implement these innovations. METHODS A review of literature was conducted to identify journal articles published between September 2019 and January 2023 reporting on innovations relating to livestreamed clinical experiences. The search focused on undergraduate and postgraduate medical education but relevant evidence from other healthcare professions were also included due to a limited evidence base. Strengths and weaknesses were derived from the literature and analysed in relation to ExBL components. RESULTS Principal strengths of livestreamed clinical experiences included expanded access to RPL opportunities and medical specialties, enhanced standardisation of learning experiences and positive perceptions from students regarding convenience. Clinical educators found these innovations enabled teaching at scale. Patients did not perceive such innovations to negatively impact their standard of care. Limitations included the inability to practice physical examination skills, challenges in ensuring learner engagement and connectivity issues. CONCLUSION Livestreamed clinical experiences have the potential to effectively expand placement capacity and provide high-quality educational experiences for medical students. Although certain limitations exist, technological and pedagogical adaptations can help overcome these challenges. The application of theoretical frameworks to future online innovations will be fundamental to ensure effective clinical learning.
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Affiliation(s)
- Kelvin Gomez
- Leeds Institute of Medical Education, Leeds School of Medicine, University of Leeds, Leeds, UK
| | - Helen L Edwards
- Leeds Institute of Health Sciences, Leeds School of Medicine, University of Leeds, Leeds, UK
| | - Jane Kirby
- Leeds Institute of Health Sciences, Leeds School of Medicine, University of Leeds, Leeds, UK
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Herber-Valdez CR, Blow JA, Salazar TT, Horn KV, Herrera DG, Lacy NL, Beinhoff L, de la Rosa JM. The integrated curriculum and student empathy: a longitudinal multi-cohort analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1131-1153. [PMID: 37946064 PMCID: PMC11368989 DOI: 10.1007/s10459-023-10292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Research has demonstrated erosion of empathy in students during medical education. Particularly, U.S. studies have demonstrated empathy declines during clinical training in the third and fourth year of traditional medical programs. Yet, studies conducted outside the U.S. have not confirmed this trend. Timing and extent of patient interactions have been identified as empathy-protective factors. The need to examine empathy within different learning contexts has been noted, as has the need for longitudinal and time-series research designs to analyze trajectories. Between fall 2010 and spring 2019, we assessed empathy longitudinally among six student cohorts (N = 493) at a U.S. medical school, where patient interaction occurs early and throughout an integrated curriculum. Empathy levels of students in each cohort were assessed at five time points utilizing the Jefferson Scale of Physician Empathy-Student version. We hypothesized empathy levels will not degrade by program end, and trajectories will not show patterns of decline in Years Three and Four. Analysis of Variance (ANOVA) and Linear Mixed Model (LMM) analyses were used to analyze differences at baseline and changes in empathy trajectories. ANOVA analyses revealed statistically significant differences at baseline by class cohort (F(5, 487) = [23.28], p < 0.001). LMM analyses indicated empathy was either significantly higher or not different at the end of the program (F(19, 1676) = [13.97], p < 0.001). Empathy trajectories varied among cohorts; yet, none resulted in an overall empathy decline by the end of the program. Findings demonstrate empathy in U.S. medical students can be unchanged or higher by the end of medical education. Outcomes are consistent with reports of non-declining medical student empathy outside the U.S. and support the notion of context-specificity. Results further support recent research, suggesting decreases in empathy during training can stabilize or increase by program end. These findings have important implications for future empathy research context and design considerations, as well as program planning.
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Affiliation(s)
- Christiane R Herber-Valdez
- Office of Academic Affairs, Texas Tech University Health Sciences Center at El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA.
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA.
| | - Julie A Blow
- Office of Institutional Research and Effectiveness, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
| | - Tammy T Salazar
- Department of Family Medicine, Paul L. Foster School of Medicine, Office of Academic Support, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
- The University of Texas at El Paso, El Paso, TX, USA
| | - Kathryn V Horn
- Paul L. Foster School of Medicine, Office of Student Services, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
- University of Houston College of Medicine, Houston, TX, USA
| | - Dyanne G Herrera
- Office of Institutional Research and Effectiveness, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
- Texas Department of Health, Austin, TX, USA
| | - Naomi L Lacy
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
| | - Lisa Beinhoff
- Libraries of the Health Sciences, Texas Tech University Health Sciences Center at El Paso, El Paso, USA
| | - J Manuel de la Rosa
- Department of Pediatrics Paul L. Foster School of Medicine, Office of Outreach and Community Engagement, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
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Howick J, Slavin D, Carr S, Miall F, Ohri C, Ennion S, Gay S. Towards an empathic hidden curriculum in medical school: A roadmap. J Eval Clin Pract 2024; 30:525-532. [PMID: 38332641 DOI: 10.1111/jep.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
The "hidden curriculum" in medical school includes a stressful work environment, un-empathic role models, and prioritisation of biomedical knowledge. It can provoke anxiety and cause medical students to adapt by becoming cynical, distanced and less empathic. Lower empathy, in turn, has been shown to harm patients as well as practitioners. Fortunately, evidence-based interventions can counteract the empathy dampening effects of the hidden curriculum. These include early exposure to real patients, providing students with real-world experiences, training role models, assessing empathy training, increasing the focus on the biopsychosocial model of disease, and enhanced wellbeing education. Here, we provide an overview of these interventions. Taken together, they can bring about an "empathic hidden curriculum" which can reverse the decline in medical student empathy.
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Affiliation(s)
- Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Daniel Slavin
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Sue Carr
- Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fiona Miall
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Chandra Ohri
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Steve Ennion
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Simon Gay
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
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Huang Q, Yan SY, Huang J, Guo Y, Zeng XT, Jin YH. Effectiveness of simulation-based clinical research curriculum for undergraduate medical students - a pre-post intervention study with external control. BMC MEDICAL EDUCATION 2024; 24:542. [PMID: 38750452 PMCID: PMC11097530 DOI: 10.1186/s12909-024-05455-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Simulation is widely utilized in medical education. Exploring the effectiveness of high-fidelity simulation of clinical research within medical education may inform its integration into clinical research training curricula, finally cultivating physician-scientist development. METHODS Standard teaching scripts for both clinical trial and cross-sectional study simulation were designed. We recruited undergraduates majoring in clinical medicine at 3th grade into a pre-post intervention study. Additionally, a cross-sectional survey randomly selected medical undergraduates at 4th or 5th grade, medical students in master and doctor degree as external controls. Self-assessment scores of knowledge and practice were collected using a 5-point Likert scale. Changes in scores were tested by Wilcoxon signed-rank test and group comparisons were conducted by Dunn's tests with multiple corrections. Multivariable quantile regressions were used to explore factors influencing the changes from baseline. RESULTS Seventy-eight undergraduates involved the clinical trial simulation and reported improvement of 1.60 (95% CI, 1.48, 1.80, P < 0.001) in knowledge and 1.82 (95% CI, 1.64, 2.00, P < 0.001) in practice score. 83 undergraduates involved in the observational study simulation and reported improvement of 0.96 (95% CI, 0.79, 1.18, P < 0.001) in knowledge and 1.00 (95% CI, 0.79, 1.21, P < 0.001) in practice. All post-intervention scores were significantly higher than those of the three external control groups, P < 0.001. Higher agreement on the importance of clinical research were correlated with greater improvements in scores. Undergraduates in pre-post study showed high confidence in doing a future clinical research. CONCLUSION Our study provides evidence supporting the integration of simulation into clinical research curriculum for medical students. The importance of clinical research can be emphasized during training to enhance learning effect.
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Affiliation(s)
- Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, #169, East Lake Road, Wuchang District, Wuhan City, Hubei Province, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second School of Clinical Medicine, Wuhan University, Wuhan, 430071, China
| | - Si-Yu Yan
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, #169, East Lake Road, Wuchang District, Wuhan City, Hubei Province, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second School of Clinical Medicine, Wuhan University, Wuhan, 430071, China
| | - Jiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, #169, East Lake Road, Wuchang District, Wuhan City, Hubei Province, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second School of Clinical Medicine, Wuhan University, Wuhan, 430071, China
| | - Yi Guo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, #169, East Lake Road, Wuchang District, Wuhan City, Hubei Province, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second School of Clinical Medicine, Wuhan University, Wuhan, 430071, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, #169, East Lake Road, Wuchang District, Wuhan City, Hubei Province, China.
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second School of Clinical Medicine, Wuhan University, Wuhan, 430071, China.
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, #169, East Lake Road, Wuchang District, Wuhan City, Hubei Province, China.
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second School of Clinical Medicine, Wuhan University, Wuhan, 430071, China.
- Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Rotthoff T. Practical tips to improve bedside teaching using learning theories and clinical reasoning. MEDEDPUBLISH 2024; 13:215. [PMID: 38707219 PMCID: PMC11069040 DOI: 10.12688/mep.19826.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 05/07/2024] Open
Abstract
Bedside teaching strengthens the link between theory and practice. The tips given here, which were derived from various learning theories and models, aim to provide structure to bedside teaching and to make this format effective, even though empirical evidence is still missing for this specific setting. These 10 tips may not always be fully implemented in each bedside teaching, but they should be applied selectively for targeted students. In essence, they are more to be understood as a repertoire of effective methods and are intended to expand the literature and framework concepts already available.
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Affiliation(s)
- Thomas Rotthoff
- Medical Didactics and Education Research (DEMEDA), Augsburg University, Augsburg, 86259, Germany
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Dutt DDCS, Carr SE, Scott TM, Petsoglou C, Grigg J, Razavi H. Educators' consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design. MEDICAL TEACHER 2024; 46:387-398. [PMID: 37703439 DOI: 10.1080/0142159x.2023.2256956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators' consideration and application of student motivation in ophthalmology medical education. MATERIAL AND METHODS Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes. FINDINGS Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists' confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools. CONCLUSION There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.
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Affiliation(s)
- Deepaysh D C S Dutt
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra E Carr
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Tabitha M Scott
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | | | - John Grigg
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Eye Genetics Research Group, Children's Medical Research Institute, Sydney, New South Wales, Australia
- Genetic Medicine and Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hessom Razavi
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Lions Eye Institute, Perth, Western Australia, Australia
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Weingartner LA, Noonan EJ, Shaw MA, Fuselier L. Engaging Premedical Students in Medical Education Research: Benefits of Clinical Skills Observation Studies. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S157-S164. [PMID: 37983408 DOI: 10.1097/acm.0000000000005361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Observations requiring evaluation and critical thinking can be powerful learning experiences. Video-recorded standardized patient encounters are underused resources for evaluation and research. The authors engaged premedical students in medical education research reviewing standardized patient encounters. This study aims to explore participant perceptions of the research experience and how they gained clinical skills. METHOD This mixed-method study was completed between 2019 and 2022. Premedical participants coded medical students' clinical skills in video-recorded standardized patient encounters. Each participant also completed their own new patient history in a standardized patient encounter at both the beginning and end of their research project. Participants then completed an end-of-program debrief to discuss their experiences coding the clinical skills encounters. The authors coded communication skills implemented in the pre/postencounters and completed a thematic analysis of the debrief transcripts. RESULTS All 21 participants demonstrated significant clinical skills gain after their research project, which included spending more time with the patient (pre-M=5 minutes, post-M=19 minutes, t=13.2, P<.001) and asking more questions (pre-M=13, post-M=40, t=9.3, P<.001). Prior clinical experience did not influence pre- or postoutcomes, but the number of videos coded was associated with asking more questions in the postencounter. Participants described learning actively and reflected that their clinical skills research project gave them greater insight into patient-care aspects of medical school and how medical students learn. CONCLUSIONS These data demonstrate that observational studies in which premedical students evaluate standardized patient encounters gave the students context to medical education while enabling them to develop and transfer their own clinical skills. Studies observing standardized patient encounters provide rich insight into clinical skills development, and this work generates both research outcomes and actionable program evaluation data for medical educators. Purposefully engaging premedical students in such experiential learning opportunities benefits the students and helps cultivate early medical education pathways for these learners.
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Affiliation(s)
- Laura A Weingartner
- L.A. Weingartner is assistant professor, undergraduate medical education, University of Louisville School of Medicine, Louisville, Kentucky; ORCID: http://orcid.org/0000-0003-0820-3980
| | - Emily J Noonan
- E.J. Noonan is assistant professor, undergraduate medical education, University of Louisville School of Medicine, Louisville, Kentucky; ORCID: http://orcid.org/0000-0002-7361-8229
| | - M Ann Shaw
- M.A. Shaw is vice dean for undergraduate medical education, University of Louisville School of Medicine, Louisville, Kentucky
| | - Linda Fuselier
- L. Fuselier is chair and professor, Department of Biology, University of Louisville, Louisville, Kentucky
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McLinden D, Hailstone K, Featherston S. History and physical exam: a retrospective analysis of a clinical opportunity. BMC MEDICAL EDUCATION 2023; 23:699. [PMID: 37752450 PMCID: PMC10523620 DOI: 10.1186/s12909-023-04696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND All learners at the Northern Ontario School of Medicine University complete a longitudinal integrated clerkship experience in their third year, which serves to improve learner experience with community and clinical acute and chronic health needs. Early in the program, Muskoka faculty (two of the 15 LIC sites of NOSM U) became aware that learners never had the occasion to complete a full history and physical exam on a real patient with complex needs. Recognizing this as a critical experience, a program was initiated to provide learners with this opportunity. This manuscript reports on the effectiveness and impact of this novel program and outlines the procedure developed to incorporate a similar program should communities see the relevance. METHODS Using a mixed method design, feedback was collected from learners and preceptors following the implementation of a novel learning opportunity for clinical clerks. Learners completed a full history and physical exam on volunteer complex patients, with supervision and immediate feedback. Using semi structured surveys, data was collected from each learner and preceptor to determine the program impact and optimize the program. Laurentian University research ethics board, certificate number 6021120. RESULTS Both learners and preceptors agreed this was a valuable experience for learners, a good use of their time and contributed to essential skills including, communication, time management and appropriate data collection. The use of real patients was reported to be very appropriate by learners and faculty and often highlighted gaps in the learner's knowledge that they were then able to address. CONCLUSION Feedback collected in this study confirms that providing medical learners the opportunity to complete a full history and physical exam with supervision and feedback was significantly beneficial from both a clinical and a skills-based aspect. Requiring learners to complete this task within the established period forced them to manage their time, focus on clinical consideration and remain on task. Enhancing learning opportunities is associated with improved outcomes and understanding in medical learners. Positive community experience is also related to learner retention, which is paramount for attracting new physicians in a time with significantly limited human health resources.
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Affiliation(s)
- David McLinden
- Northern Ontario School of Medicine University, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
- Huntsville Physicians Local Education Group, 100 Frank Miller Drive, Huntsville, ON, P1H 1H7, Canada
- Algonquin Family Health Team, Howland Building, 100 Frank Miller Drive, Huntsville, ON, P1H 1H7, Canada
| | - Krista Hailstone
- Northern Ontario School of Medicine University, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada.
- Huntsville Physicians Local Education Group, 100 Frank Miller Drive, Huntsville, ON, P1H 1H7, Canada.
| | - Sue Featherston
- Huntsville Physicians Local Education Group, 100 Frank Miller Drive, Huntsville, ON, P1H 1H7, Canada
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Ingale MH, Tayade MC, Bhamare S. Early clinical exposure: Dynamics, opportunities, and challenges in modern medical education. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:295. [PMID: 37849881 PMCID: PMC10578560 DOI: 10.4103/jehp.jehp_237_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/10/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Applications of early clinical exposure (ECE) are wide-ranging and reflect the important role that ECE plays in medical education. This review article aimed to highlight the dynamics, opportunities, and challenges of ECE in medical education. STUDY METHODOLOGY This review article was conducted through a comprehensive search of electronic databases including PubMed, Scopus, Web of Science, and Google search engine. The keywords used for the search were "early clinical exposure," "medical education," "clinical skills," "patient contact," and "medical students. The inclusion criteria for selecting the articles were that they should be written in English, peer-reviewed, and provide insights into the dynamics, opportunities, and challenges of ECE in medical education. RESULTS ECE allows students to gain a deeper understanding of the patient experience, and to develop empathy and a patient-centered approach to care. ECE can also help to improve recruitment and retention of medical students, by providing a more engaging and rewarding learning experience. CONCLUSION ECE is a promising teaching method that has the potential to improve clinical skills and patient outcomes. However, it also poses some challenges that must be addressed to ensure its effective implementation.
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Affiliation(s)
- Mayur H. Ingale
- Department of Otorhinolaryngology, Dr. DY Patil Medical College and Hospital, Dr. D Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Motilal C. Tayade
- Department of Physiology, Pravara Institute of Medical Sciences (DU), Loni, Maharashtra, India
| | - Sunil Bhamare
- Department of Microbiology, Government B J Medical College, Pune, Maharastra, India
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Silvestri F, Mellgard G, Goldstein J, Chennareddy S, Tang J, Tran M, Band I, Qian D, Fischer S, Castillo A, Jiang J, Skovran D, Thomas D, Meah YS. How Are We Doing? A Scoping Review of Published Patient-Centered Outcomes Research in United States Student-Run Free Clinics. TEACHING AND LEARNING IN MEDICINE 2023:1-13. [PMID: 37571960 DOI: 10.1080/10401334.2023.2245805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 07/02/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
Phenomenon: Student-run free clinics (SRFCs) serve an integral role in most United States (US) medical schools and contribute substantially to literature on the quality of care to uninsured persons. There has been substantial growth over the past decade of scholarly work produced by SRFCs as they have increased in size and number. Research on patient care outcomes informs better care structures for patients, however there is no current synthesis of patient care outcomes research among SRFCs. This article provides an overview of SRFC research on patient outcomes to understand current research domains and to identify gaps in the literature. Approach: We completed a scoping review by searching Scopus, PubMed, and Journal of Student Run Clinics in June 2021. All peer-reviewed, English-language articles focused on patient-centered outcomes at SRFCs in the US were included. Two independent reviewers performed title, abstract, and full-text screening of relevant works, and eight reviewers conducted data extraction. Descriptive data analysis was performed along with relevant content analysis of patient-centered outcomes. Findings: The search strategy identified 784 studies, of which 87 met inclusion criteria. Most studies were published within the last six years (81.6%), located in California, New York, or Florida (43.7%), and intervention based (33.3%). Many studies (46.0%) had a specific disease of focus of which diabetes was the most researched(19.5%). Patient-centered studies were the leading focus of the study aims (40.2%), where key findings demonstrated primarily improved outcomes in clinic metrics post-intervention (36.8%) or equivalent/better clinical performance than national metrics (20.7%). Insights: This review brings to light gaps in the literature reporting research in SRFCs and can be applied to other low-resource settings. Future efforts to expand SRFC outcomes research should focus on community relationship building, understanding institutional support, and ensuring education on best practices for research within SRFCs. Doing so informs patient care improvement as SRFCs continue to operate as safety net clinics for marginalized populations.
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Affiliation(s)
- Francesca Silvestri
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Mellgard
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, New York Presbyterian - Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan Goldstein
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susmita Chennareddy
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Justin Tang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michelle Tran
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Isabelle Band
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Qian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Abigail Castillo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joy Jiang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Skovran
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Thomas
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yasmin S Meah
- Icahn School of Medicine at Mount Sinai, Brookdale, New York, New York, USA
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Kalusopa VM, Katowa-Mukwato P, Chitundu K, Mvula M, Nzala S, Kabinga-Makukula M, Mwiinga C, Mwila EM, Kampata L, Mumba MK, Chiguntap M, Sichone J, Kwaleyela C, Phiri P, Mutemwa S, Zulu M, Mwaba-Siwale C, Wahila R, Nawa M, Wamunyima MM, Makondo F, Syatalimi C, Kafumukache E, Goma F. Experiences of Early and Enhanced Clinical Exposure for Postgraduate Neonatal Nursing Students at the University of Zambia, School of Nursing Sciences: Lessons and Implications for the Future. OPEN JOURNAL OF NURSING 2023; 13:352-367. [PMID: 37655296 PMCID: PMC10469329 DOI: 10.4236/ojn.2023.136024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background and Objectives Early and Enhanced Clinical Exposure immediately places postgraduate students in a clinical setting and incorporates continual hands-on instruction throughout their studies. It aims to motivate students by strengthening their academics, improving clinical and communication skills, and increasing their confidence. The underlying principles are to provide a clinical context and to ensure that the patient remains the centre of learning. The School of Nursing Sciences implemented this model in 2021 to produce hands-on Masters-level neonatal practitioners who can work in multidisciplinary clinical contexts. Therefore, this study explored the experiences of postgraduate nursing students on the Early and Enhanced Clinical Exposure model and draw implications for the future. Methods A phenomenological study design was utilized at the University of Zambia, School of Nursing Sciences and comprised of eight Master of Science Neonatal Nursing students in their second year. Convenience sampling was used to select the study site and participants. Data was collected between 15th January 2023 and 31st January 2023 using an in-depth interview guide. Audio recording and notes were transcribed immediately after data collection. Data analysis was conducted using thematic analysis and codes and themes were constructed from the coded data. Ethical clearance and permission were sought before conducting the study. Results Four major themes emerged from the study: identity and role confusion, challenging and hectic experiences, positive educational experiences, and personal and professional growth. These themes contributed to the promotion of evidence-based practice by helping students to assess, diagnose, and treat various conditions, as well as gain interest, experience, knowledge, and exposure. Conclusion The model has a significant impact on motivation to learn, as evidenced by reported increased skill level with potential for use in clinical practice. It is recommended that it be implemented in all postgraduate programs for full-time students.
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Affiliation(s)
| | | | - Kabwe Chitundu
- School of Nursing Sciences, University of Zambia, Lusaka, Zambia
| | - Manasseh Mvula
- School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | | | | | | | | | - Linda Kampata
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | | | - James Sichone
- School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Concept Kwaleyela
- School of Medicine and Health Sciences, Mulungushi University, Kabwe, Zambia
| | - Phadaless Phiri
- School of Nursing Sciences, University of Zambia, Lusaka, Zambia
| | - Suzan Mutemwa
- School of Nursing Sciences, University of Zambia, Lusaka, Zambia
| | - Mildred Zulu
- School of Medicine, University of Zambia, Lusaka, Zambia
| | | | - Ruth Wahila
- School of Nursing Sciences, University of Zambia, Lusaka, Zambia
| | - Mukumbuta Nawa
- School of Public Health and Environmental Studies, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | | | | | | | - Fastone Goma
- School of Medicine, University of Zambia, Lusaka, Zambia
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AkbariRad M, Khadem-Rezaiyan M, Ravanshad S, Rafiee M, Firoozi A, Zolfaghari SA, Aghaei HR, Zadehahmad R, Azarkar S, Moodi Ghalibaf A. Early clinical exposure as a highly interesting educational program for undergraduate medical students: an interventional study. BMC MEDICAL EDUCATION 2023; 23:292. [PMID: 37127647 PMCID: PMC10150660 DOI: 10.1186/s12909-023-04244-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Training professional medical experts is so much dependent on the efficacy of the medical curriculum. Bearing this in mind, we aimed to evaluate the attitude of the undergraduate medical students toward the Early clinical exposure (ECE) program as a facilitator transition to the clinical phase. METHODS This quasi-experimental study was conducted on undergraduate medical students at the Mashhad University of Medical Sciences, Mashhad, Iran who were transferring from the pre-clinical course to the externship course from 2021 to 2022 by census method (i.e. all eligible students were included and no sampling was performed). An eight-session ECE intervention was performed on the participants by two professors of the Internal medicine department of Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. The participants' attitude toward the program and the program quality was assessed with the valid and reliable scale developed by Mirzazadeh et al. (Cronbach's alpha = 0.72). Statistical analyses were performed by SPSS software (version.16) with a statistically significant level of less than 0.05. RESULTS A total of 118 undergraduate medical students were enrolled in the study. Our results revealed that this program could familiarize (n = 95,81.2%)the students with the role of basic sciences knowledge in clinical settings, and 104(88.9%) participants believed that this intervention could motivate them toward learning more. The data revealed that this program was highly interesting for international students. There was a significant differentiation between Iranian and international students in familiarity with doctoring skills in medicine(P < 0.001), familiarity with the roles and responsibilities of clinical students(P < 0.001), and utility of early clinical exposure and providing more experiences(P < 0.001). According to the students' reports, the major strengths of the program were familiarizing themselves with the clinical fields, having excellent instructors, and performing admirable training. On the other hand, the major weakness of the program was the short duration and the high population of participants in each group. CONCLUSIONS The ECE program had a positive impact on the students' satisfaction with medical education, and it also enhanced their understanding of the role they will play as future physicians. Therefore, we recommend that this program be implemented as a part of the medical education curriculum in medical universities.
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Affiliation(s)
- Mina AkbariRad
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahar Ravanshad
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Rafiee
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Seyed Ali Zolfaghari
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Reza Aghaei
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reyhaneh Zadehahmad
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Setareh Azarkar
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
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Simmenroth A, Harding A, Vallersnes OM, Dowek A, Carelli F, Kiknadze N, Karppinen H. Early clinical exposure in undergraduate medical education: A questionnaire survey of 30 European countries. MEDICAL TEACHER 2023; 45:426-432. [PMID: 36315584 DOI: 10.1080/0142159x.2022.2137014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Fifteen years ago, a European survey demonstrated widespread adoption of early clinical exposure (ECE) programmes but little emphasis in the curricula of medical schools. We now repeat the survey in light of the ample emerging data suggesting multiple positive outcomes of ECE. METHODS Online cross-sectional survey in European medical schools conducted by the EURACT Basic Medical Education Committee in 2021. Descriptive quantitative analyses and a thematic analysis approach were used. RESULTS Eighy-nine (48%) medical schools in 30 European countries responded. ECE was used in 65 (73%) of the medical schools, and 88% of ECE programmes took place in primary care. The median total time spent on the ECE programme was 5 days. Teaching methods covered unstructured learning opportunities such as observation or shadowing doctors, as well as work-based learning whilst seeing real patients or reflecting on own encounters. Learning goals included knowledge, skills, and attitudes. More than half of the respondents expressed barriers to implementing or expanding ECE. CONCLUSIONS Compared to the previous survey, there was no significant change in the adoption or curricular emphasis of ECE programmes. Institutional attitudes towards certain disciplines and a lack of willingness to experiment with new teaching methods may be partially responsible.
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Affiliation(s)
- Anne Simmenroth
- Faculty of Medicine, Department of Family Medicine, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Alex Harding
- Department of Primary Care, University of Exeter College of Medicine and Health, Exeter, UK
| | | | - Aimee Dowek
- Royal Hampshire County Hospital, Winchester, UK
| | - Francesco Carelli
- Faculty of Medicine, Department of Clinical Medicine, Polo Policlinico, Milan, Italy
| | - Nino Kiknadze
- Faculty of Medicine, Department of Family Medicine, Tbilisi State Medical University, Tbilisi, Georgia
| | - Helena Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Kulkarni B, Dua H. Evaluation of the preclinical hospital visit programme with students' feedback at the University of Nottingham, UK. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:97-103. [PMID: 38692599 DOI: 10.25259/nmji_47_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Background . The General Medical Council's publication Tomorrow's Doctors recommends that medical students should attain professional awareness at an early stage of their education. Accordingly, in the University of Nottingham, basic science teaching is integrated with clinical practice, by attaching medical students to hospital specialty teams and general practices in the community, as regular timetabled 'hospital visits' from the beginning of their medical education. We evaluated the feedback forms of the preclinical (1st and 2nd years) medical students retrospectively based on their experience of the hospital-based clinical teaching programme over 2 years. The hospital visit programme was modified based on the student feedback following which the effectiveness of the modified programme was revaluated post-test. Methods . This study was based on a quasi-experimental design in which comparisons of pre-test and post-test feedbacks with 337 feedback forms in each group were analysed in the study period. Quantitative response questions in the feedback were statistically analysed using independent t-test, and free text questions were qualitatively analysed and grouped into themes. Results . Data analyses showed significant difference (p<0.001) between the pre- and post-test groups. The main feedback themes identified were number of the patients examined, organization of the visit, patient selection, introductory talk, and briefing and debriefing before and after the visit. Conclusion . The structure of the hospital visit programme was influenced by the available infrastructure, flexibility of access and delivery of clinical teaching. The programme helped build professional attitudes in both staff and students and encouraged independent learning.
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Affiliation(s)
- Bina Kulkarni
- Department of Ophthalmology, B-Floor, Eye and ENT Building, Queen's Medical Centre, Derby Road, Nottingham, NG72UH, UK
| | - Harminder Dua
- Department of Ophthalmology, B-Floor, Eye and ENT Building, Queen's Medical Centre, Derby Road, Nottingham, NG72UH, UK
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Bawadi H, Shami R, El-Awaisi A, Al-Moslih A, Abdul Rahim H, Du X, Moawad J, Al-Jayyousi GF. Exploring the challenges of virtual internships during the COVID-19 pandemic and their potential influence on the professional identity of health professions students: A view from Qatar University. Front Med (Lausanne) 2023; 10:1107693. [PMID: 36793877 PMCID: PMC9922901 DOI: 10.3389/fmed.2023.1107693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/04/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction COVID-19 has imposed many shared limitations on medical and health education. Just like other health professions programs at most institutions, the Qatar University health cluster (QU Health) applied a containment approach and shifted all learning online, and onsite training was replaced by virtual internships (VIs) during the first wave of the pandemic. Our study aims to explore the challenges of virtual internships during the COVID-19 pandemic and their influence on the professional identity (PI) of the health cluster students from the College of Medicine, the College of Health Sciences, and the College of Pharmacy at Qatar University. Methods A qualitative approach was employed. In total, eight focus groups with students (N = 43) and 14 semi-structured interviews with clinical instructors from all the health cluster colleges were conducted. Transcripts were analyzed following the inductive approach. Results The major challenges reported by students were mainly related to the lack of the required skills for navigating the VI, professional and social stressors, the nature of VIs and the quality of learning, technical and environmental issues, and the development of students' professional identity in an alternative internship environment. The challenges relating to the development of professional identity included: limited clinical (practical) experience, a lack of experience in fighting a pandemic, a lack of communication and feedback, and a lack of confidence in meeting the internship's goals. A model was constructed to represent these findings. Discussion The findings are important in identifying the inevitable barriers to virtual learning for health professions students and provide a better understanding of how such challenges and different experiences would be affecting the development of their PI. Hence, students, instructors, and policymakers alike should strive to minimize these barriers. Since physical interactions and patient contact are indispensable components of clinical teaching, these extraordinary times demand innovations involving technology and simulation-based teaching. There is a need for more studies that are focused on determining and measuring the short- and long-term effects of the VI on students' PI development.
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Affiliation(s)
- Hiba Bawadi
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Rula Shami
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Alla El-Awaisi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Ayad Al-Moslih
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Hanan Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Xiangyun Du
- College of Education, Qatar University, Doha, Qatar
| | - Joyce Moawad
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Ghadir Fakhri Al-Jayyousi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar,*Correspondence: Ghadir Fakhri Al-Jayyousi ✉
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Fässler C, Sinha T, Schmied CM, Goldhahn J, Kapur M. Problem-solving in virtual environment simulations prior to direct instruction for differential diagnosis in medical education: An experimental study. MEDEDPUBLISH 2023; 12:61. [PMID: 36817616 PMCID: PMC9925172 DOI: 10.12688/mep.19348.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
Background: Despite acquiring vast content knowledge about the functioning of the human body through university teaching, medical students struggle to transfer that knowledge to one of the core disciplinary practices - differential diagnosis. The authors aimed to overcome this problem by implementing computer-based virtual environment simulations in medical education courses. Methods: In an experimental study, the authors compared problem-solving in medical computer-based virtual environment simulations prior to instruction with an instruction-first approach. They compared the effects on isomorphic testing and transfer performance of clinical knowledge and clinical reasoning skills as well as evoked learning mechanisms. The study took place in spring 2021 with undergraduate medical students in the scope of a medical trajectory course. Due to Corona-Virus-19 measures participants completed all study activities remotely from home. Results: The authors did not find any learning activity sequence to be superior to the other. However, when looking at the two learning activities individually, they found that problem-solving in computer-based virtual environment simulations and direct instruction might be equally effective for learning content knowledge. Nevertheless, problem-solving in computer-based virtual environment simulations with formative feedback might be more effective for learning clinical reasoning skills than mere instruction. Conclusions: The findings indicate that problem-solving in computer-based virtual environment simulations might be more effective for learning clinical reasoning skills than mere theoretical instruction. The present study has a high level of ecological validity because it took place in a realistic setting where students had to perform all learning and testing tasks autonomously.
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Affiliation(s)
- Christian Fässler
- Department of Humanities, Social and Political Sciences, ETH Zürich, Zürich, 8092, Switzerland,
| | - Tanmay Sinha
- Department of Humanities, Social and Political Sciences, ETH Zürich, Zürich, 8092, Switzerland
| | - Christian Marc Schmied
- Department of Health Sciences and Technology, ETH Zürich, Zürich, 8092, Switzerland,University Heart Center, University Hospital Zürich, Zürich, 8091, Switzerland
| | - Jörg Goldhahn
- Department of Health Sciences and Technology, ETH Zürich, Zürich, 8092, Switzerland
| | - Manu Kapur
- Department of Humanities, Social and Political Sciences, ETH Zürich, Zürich, 8092, Switzerland
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Himmels JP, Sterz J, Rüsseler M, Kempf VA, Brandt C. [Case-based learning with practical exercises in the course hygiene and microbiology as a model for the implementation of the new medical licensing regulations]. Dtsch Med Wochenschr 2022; 148:e21-e28. [PMID: 36564018 PMCID: PMC9970697 DOI: 10.1055/a-1973-6533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Within the scope of an educational improvement project, the teaching concept of the course hygiene and microbiology at the Goethe-University in Frankfurt was transferred from an organ system-based teaching concept into a case-based teaching concept. Concomitantly, this transformation was qualitatively reviewed to evaluate self-perceived learning success. METHODS 54 participants were included in this qualitative study. 45 students were interviewed in homogeneous focus groups of up to five. Nine physicians were interviewed individually. Following anonymization and transcription, a structured and qualitative text analysis was conducted. RESULTS Both groups, students and physicians, prefer a case-based teaching concept in hygiene and microbiology, especially in combination with a hands-on approach to learn practical skills. Students taught with the case-based approach were more satisfied and reported better knowledge retention. The practical elements of the course hygiene and microbiology were positively remembered by all participants. Regardless of the teaching concept, the individual lecturer is considered most essential in shaping motivation. CONCLUSIONS Overall, the implementation of a case-based teaching concept with practical elements in the course hygiene and microbiology increases the ability of medical students to understand the relevance of core knowledge and improves self-perceived learning. The fusion of theoretical and clinical contents elements in the course hygiene and microbiology meets the new national medical licensing regulations in Germany and promises to be a sustainable concept for clinical-theoretical subjects like hygiene and microbiology.
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Affiliation(s)
- Jan P.W. Himmels
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
| | - Jasmina Sterz
- Frankfurter Interdisziplinäres Simulationszentrum, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
| | - Miriam Rüsseler
- Frankfurter Interdisziplinäres Simulationszentrum, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
| | - Volkhard A.J. Kempf
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
| | - Claudia Brandt
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland,Korrespondenzadresse Priv.-Doz. Dr. med. Claudia Brandt Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsklinikum FrankfurtPaul-Ehrlich-Straße 4060596 Frankfurt am Main
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Undergraduate Medical Education Reform in Viet Nam for a Primary Health Care Workforce. Ann Glob Health 2022; 88:100. [DOI: 10.5334/aogh.3755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
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Boshra M, Lee A, Kim I, Malek-Adamian E, Yau M, LaDonna KA. When patients teach students empathy: a systematic review of interventions for promoting medical student empathy. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:46-56. [PMID: 36440084 PMCID: PMC9684039 DOI: 10.36834/cmej.73058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite growing emphasis on empathic care, numerous studies demonstrate diminishing empathy in medical students. Involving patient educators in medical curricula may be a solution. Therefore, we conducted a systematic review to evaluate patient-involved interventions that promote empathy among medical students. METHOD A literature search of MEDLINE, Embase, PsycINFO, and ERIC databases was performed using the keywords "empathy," "medical student," and their synonyms. Results were independently screened in duplicate. Conflicts were resolved by group consensus. All English studies describing interventions that promote empathy in medical students engaging patient educators were included. Relevant data was extracted and summarized. RESULTS 1467 studies were screened. 14 studies were included, of which 10 were pilot studies. Studies included patient involved interventions such as storytelling (5/14), shadowing patients (3/14), recorded videos (3/14), or combinations of methods (3/14). Qualitative measurements of empathy included written feedback and group discussions. Quantitative measurements included validated scales measuring empathy. All studies demonstrated increase in empathy among medical students. Participants reported satisfaction with training and patients reported being proud of giving back by training future physicians. CONCLUSION Interventions engaging patient educators were shown to have a positive impact on medical student empathy. Furthermore, patient-led education was shown to increase medical student understanding of subject and knowledge retention while empowering patients. Further implementation of patient-involved education is an important step forward in patient-partnered care and may identify additional advantages of patient engagement in medical education.
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Affiliation(s)
- M Boshra
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - A Lee
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - I Kim
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - M Yau
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - KA LaDonna
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ontario, Canada
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Kim J, Rinke EJ, Matusicky ME, Millward LM. Outreach Medicine as an Experiential Teaching Tool to Improve Veterinary Student and Client Education. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:560-567. [PMID: 34342523 DOI: 10.3138/jvme-2020-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Outreach medicine is used to improve students' medical, technical, behavioral, and communication training among health professional schools; it is also used in veterinary schools, but little has been described on its educational impacts among pre-clinical veterinary students. Aiming to train practice-ready graduates, we established a monthly nonprofit vaccine clinic serving low-income clients to provide pre-clinical veterinary students with a realistic experiential learning environment. We developed surveys to assess the educational impacts of outreach medicine on pre-clinical veterinary student and client education. We received 101 student surveys, 26 educator (i.e., veterinarians and registered veterinary technicians) surveys, and 96 client surveys. Veterinarians, students, and technicians reported that students improved in important veterinary skills such as client communication, subcutaneous injection, patient handling, and physical examination. They also reported improved confidence in students' clinical decision making. Veterinarians valued the vaccine clinic as a favorable educational tool to teach behavior assessment and low-stress handling, and they highlighted that experiential learning via the vaccine clinic provided students with a clinical experience representative of most veterinarian practices (i.e., small animal general practitioner). Clients reported that the clinic's students and veterinarians greatly improved their knowledge of their pets' care and vaccines-notably, their knowledge of rabies and leptospirosis improved. Outreach medicine in the form of a vaccine clinic creates valuable experiential learning opportunities that increase veterinary student preparedness and complement didactic, laboratory, and case-based teaching.
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Khalil MS, Alrumaihi N, Feda J, Alnuaim L, Abdulghani H, Fouda K, AlDahri S, Soliman M. Students, faculty perceptions and effectiveness of the early introduction of clinical skills teaching in the medical curriculum. J Taibah Univ Med Sci 2022; 18:310-320. [PMID: 37102079 PMCID: PMC10124110 DOI: 10.1016/j.jtumed.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
Objective We hypothesized that the early introduction of clinical skills (CS) would help students to develop and apply clinical skills appropriately during the clinical years. Evaluating the perceptions of medical students and faculty regarding the early introduction of CS teaching and its effectiveness are important. Methods The CS curriculum was designed by integration with the system-oriented problem-based curriculum in years 1 and 2 at the College of Medicine, KSU, from January 2019 to December 2019. Students and faculty questionnaires were also designed. The impact of CS teaching effectiveness was assessed by comparing OSCE results for year-3 students who received early CS sessions with those who did not. The total number of student respondents was 461/598; and 259 (56.2%) were male and 202 (43.8%) were female. The first- and second-year respondents were 247 (53.6%) and 214 (46.4%), respectively. The number of faculty respondents was 35/43. Results The majority of students and faculty were satisfied that the early introduction of CS increased student confidence when dealing with real patients, provided the opportunity to master skills, consolidated theoretical knowledge and clinical skills, motivated learning, and increased the enthusiasm of students to become doctors. The third-year students who received CS teaching in years 1 and 2 (during 2017-2018 and 2018-2019) showed a significant increase in mean grades (p value; 0.00) in OSCE tests during their courses in surgery (from 32.6 to 37.4 for females; 35.2 to 35.7 for males) and medicine (31.2-34.1 for females; 34.3 to 37.7 for males), respectively, when compared to students who did not receive CS teaching during the academic year 2016-2017 (in surgery, 22.2 and 23.2; in medicine 25.1 and 24.2) for females and males respectively. Conclusion Early exposure of medical students to CS is a positive intervention that bridges the gap between basic sciences and clinical practice.
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Morgenthau A, Margus C, Mackley MP, Miller AP. Rare Disease Education Outside of the Classroom and Clinic: Evaluation of the RARE Compassion Program for Undergraduate Medical Students. Genes (Basel) 2022; 13:genes13101707. [PMID: 36292592 PMCID: PMC9601568 DOI: 10.3390/genes13101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022] Open
Abstract
Launched in 2014, the RARE Compassion Program is the first international educational program to pair medical students with rare disease patients in order to enhance exposure to and comfort with rare diseases. As part of ongoing quality improvement, this study retrospectively reviewed four years of participant registration data to conduct a program evaluation of the RARE Compassion Program between 2014–2018. During the study period, there were 334 student participants, representing 67.3% of Association of American Medical Colleges (AAMC) member medical schools, and 5389 rare disease volunteers. Despite not requiring in-person interaction, 90.64% of student–volunteer interactions were in-person, while only 5.89% and 3.46% were by video messaging or email correspondence, respectively (p = 0.0002). In a limited post participation survey, 91.7% of students, who matched to 19 out of 27 residency specialities, indicated they would recommend the program to their peers. These findings suggest that the RARE Compassion Program, designed to increase medical student engagement with rare disease patients, has broad appeal. It serves as a novel case study of how extracurricular initiatives supported by non-profit organizations can augment the medical training experience and improve understanding of important and often neglected perspectives.
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Affiliation(s)
- Ari Morgenthau
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, ON M5S 3H2, Canada
- Correspondence:
| | - Colton Margus
- Department of Emergency Medicine, Bronxcare Health System, The Bronx, NY 10457, USA
| | - Michael P. Mackley
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Ashley P. Miller
- Department of Medicine, Division of General Internal Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
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Nagatani Y, Imafuku R, Nakai Y. Broadening the Dental Hygiene Students’ Perspectives on the Oral Health Professionals: A Text Mining Analysis. Dent J (Basel) 2022; 10:dj10090160. [PMID: 36135155 PMCID: PMC9497638 DOI: 10.3390/dj10090160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Professional identity formation, an important component of education, is influenced by participation, social relationships, and culture in communities of practice. As a preliminary investigation of dental hygienists’ professional identity formation, this study examined changes in the dental hygiene students’ perceptions of oral health professionals over the three years of their undergraduate program. At a Japanese dental hygiene school, 40 students participated in surveys with open-ended questions about professional groups several times during their studies. The text data were analyzed through content analysis with text mining software. The themes that characterized their dental hygienist profession perceptions in their programs each year were identified as: “Supporters at the dental clinic”; “Engagement with interprofessional care” and “Improved problem-solving skills for clinical issues regarding the oral region”; and “Active contribution to general health” and “Recognition of the roles considering relationships” (in the first, second, and third years, respectively). The students acquired professional knowledge and recognized the significance and roles of oral health professionals in practice. They gained more learning experiences in their education, including clinical placements and interprofessional education. This study provides insight into curriculum development for professional identity formation in dental hygiene students.
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Affiliation(s)
- Yukiko Nagatani
- Department of Dental Hygiene, University of Shizuoka Junior College, 2-2-1 Oshika, Suruga-ku, Shizuoka-shi 422-8021, Japan
- Correspondence: ; Tel.: +81-54-202-2672
| | - Rintaro Imafuku
- Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yukie Nakai
- Department of Dental Hygiene, University of Shizuoka Junior College, 2-2-1 Oshika, Suruga-ku, Shizuoka-shi 422-8021, Japan
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Bawadi H, Abdul Rahim H, Moawad J, Shami R, Du X, El-Awaisi A, Al-Moslih AMI, Diab M, Al-Jayyousi GF. Health sciences students' and instructors' perceptions of the emergency switch to virtual internship amid the COVID-19 pandemic: A case from Qatar. Front Med (Lausanne) 2022; 9:939416. [PMID: 36059828 PMCID: PMC9435433 DOI: 10.3389/fmed.2022.939416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/08/2022] [Indexed: 11/21/2022] Open
Abstract
In efforts to contain the COVID-19 pandemic, health colleges at Qatar University shifted their clinical training to virtual internships (VI) and project-based learning (PBL). The shift was new to students and faculty alike, and a major change that posed many challenges. This study aimed to explore the experience of changing to VIs during the pandemic from both the clinical instructors' and health sciences students' perspectives. A qualitative study was conducted based on the framework of readiness to change. It involved focus group discussions with students from the departments of Public Health and Human Nutrition and in-depth interviews with clinical instructors using appropriate online platforms. A total of 4 focus groups with 20 students and 4 interviews with instructors were conducted. Transcripts were analyzed following the inductive-deductive approach. The major themes that emerged from the analysis described students' and clinical instructors' perceptions of the necessity and efficiency of the switch to VI; the design of the VI and the extent of the clinical/field experience and skills that it offered; confidence in the ability to succeed in this type of internship and confidence about reaching expected goals; academic and moral support from clinical faculty and coordinators and the communication process with faculty and preceptors; and finally, the benefits gained and how employers would view this type of internship. Health sciences students' readiness for VI was generally low. Several student and faculty needs have to be addressed, specifically regarding the design of the program and the level of preceptors' communication with students. The findings would direct health programs, clinical instructors, and preceptors to better understand students' needs and efficiently plan for virtual internships during not only emergencies but also whenever there is a need to deliver online experiential learning courses.
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Affiliation(s)
- Hiba Bawadi
- College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Hanan Abdul Rahim
- College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Joyce Moawad
- College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Rula Shami
- College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Xiangyun Du
- College of Education, QU Health, Qatar University, Doha, Qatar
| | - Alla El-Awaisi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Mohammad Diab
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Ghadir Fakhri Al-Jayyousi
- College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- *Correspondence: Ghadir Fakhri Al-Jayyousi
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Riedel M, Amann N, Recker F, Hennigs A, Heublein S, Meyer B, Karge A, Eisenkolb G, Lammert J, Graf A, Klein E, Weiss M, Riedel F. The COVID-19 pandemic and its impact on medical teaching in obstetrics and gynecology-A nationwide expert survey among teaching coordinators at German university hospitals. PLoS One 2022; 17:e0269562. [PMID: 35930549 PMCID: PMC9355177 DOI: 10.1371/journal.pone.0269562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/24/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has imposed severe challenges on medical education at German university hospitals. In this first German nationwide expert survey, we addressed the responsible university teaching coordinators in obstetrics and gynecology departments and investigated their experiences during the pandemic as well as their opinions on future developments, especially with regard to the broader implementation of e-learning in the standard curriculum. METHODS The questionnaire included 42 items and was disseminated among teaching coordinators at all 41 departments of obstetrics and gynecology at German university hospitals via an email that included a weblink to the online survey provider. Responses were collected between 19 April and 7 June 2021. RESULTS In total, 30 responses were collected from 41 departments across Germany and their respective teaching coordinators in obstetrics and gynecology. The general opinion of the medical teaching provided during the pandemic was positive, whereas the teaching quality in practical skills was considered inferior and not equivalent to the standard face-to-face curriculum. Lectures and seminars had to be substituted by remote-learning alternatives, while clinical clerkships were reduced in length and provided less patient contact. Students in their final year experienced only a few differences in the clinical and teaching routine. Teaching coordinators in obstetrics and gynecology stated that they intend to incorporate more e-learning into the curriculum in the future. CONCLUSION The medical educators' views presented here may help to complement the already-thoroughly investigated experiences of students under the restrictions of the COVID-19 pandemic. Medical educators in obstetrics and gynecology at German university hospitals have successfully established online and hybrid teaching alternatives to their standard face-to-face courses. Building on recent experiences, digitalization could help to improve future medical education.
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Affiliation(s)
- Maximilian Riedel
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Niklas Amann
- Department of Gynecology and Obstetrics, Friedrich–Alexander-University Erlangen–Nuremberg (FAU), Erlangen, Germany
| | - Florian Recker
- Department of Gynecology and Obstetrics, Bonn University Hospital, Bonn, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heublein
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Bastian Meyer
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Anne Karge
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Gabriel Eisenkolb
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Jacqueline Lammert
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Anna Graf
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Martin Weiss
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
- NMI Natural and Medical Sciences Institute, University of Tübingen, Reutlingen, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
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Tapasak B, McCall M, Cheung E, Peppler R. Developing Medical Student Competencies, Clinical Skills, and Self-Efficacy With an Emergency Medical Responder Certification Course. Cureus 2022; 14:e26678. [PMID: 35949736 PMCID: PMC9358984 DOI: 10.7759/cureus.26678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/09/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Previous studies have claimed gap year clinical experiences before medical school matriculation increase student self-efficacy and clinical confidence. At the University of Central Florida College of Medicine, 41 first-year medical students participated in a new certification course to become emergency medical responders before beginning their coursework. This study describes the results of a follow-up study that aims to investigate the impact the course had on student competency, self-efficacy, and clinical efficacy and if the course would prepare students similarly to previous clinical experience. Methods First-year medical students completed a 30-question survey consisting of a Likert scale and free-response questions. Questions were based on the Accreditation Council for Graduate Medical Education core competencies: medical knowledge, practice-based learning and improvement, systems-based practice, patient care, professionalism, and interpersonal and communication skills. Questions on the perceived benefit of the emergency medical responder course and previous clinical experiences were also included. Responses were separated based on participation in the emergency medical responder course and prior clinical experience. Two-tail Welch’s t-tests were performed on the data to determine significance. Results Of 98 responses: 20.4% (20/98) of participants of the emergency medical responder course had previous clinical experience, 21.5% (21/98) of participants of the course had no clinical experience, 26.5% (26/98) did not participate in the course but had previous clinical experience, and 31.6% (31/98) did not participate in the course nor had previous clinical experience. Students with previous clinical experience reported the emergency medical responder course improved both their patient care skills and performance in courses that emphasized patient interviewing and physical exams. Students with clinical experience had significantly higher medical knowledge (p < 0.1) and professionalism (p < 0.1) Likert scores. Eighty-seven percent of students agreed the course had a positive impact on their patient care skills. Conclusion Larger sample size is needed to make stronger conclusions; however, the responses show the emergency medical responder course had a positive subjective impact on students with previous medical experience. Previous clinical experience leads to the most positive subjective reporting of competencies such as medical knowledge and professionalism. Early clinical exposure, such as an emergency medical responder certification course, may improve self-efficacy and patient care skills for medical students with no previous clinical experience.
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Richmond A. The chicken and the egg: Clinical reasoning and uncertainty tolerance. MEDICAL EDUCATION 2022; 56:696-698. [PMID: 35467035 PMCID: PMC9324099 DOI: 10.1111/medu.14814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 06/14/2023]
Abstract
Richmond aruges that clinical reasoning and uncertainty tolerance development occur simultaneously and that deficit in either domain will affect the development of the other. Implications for curriculum design are offered.
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Affiliation(s)
- Anna Richmond
- Department of Medical EducationUniversity of NottinghamNottinghamUK
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29
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Hsu PT, Chen JJ, Ho YF. The effects of narrative pedagogy on increasing nursing students' willingness to practice older people care: A mixed-methods research. Nurse Educ Pract 2022; 62:103356. [DOI: 10.1016/j.nepr.2022.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/29/2022] [Accepted: 04/23/2022] [Indexed: 11/30/2022]
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Liu CI, Tang KP, Wang YC, Chiu CH. Impacts of early clinical exposure on undergraduate student professionalism-a qualitative study. BMC MEDICAL EDUCATION 2022; 22:435. [PMID: 35668444 PMCID: PMC9172165 DOI: 10.1186/s12909-022-03505-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Early clinical exposure (ECE), or authentic human contact in a social or clinical context during preclinical training, has been adopted by many medical schools. This study aims to investigate how medical students' sense of professionalism changed after ECE intervention, with the aim of informing curriculum design to enhance student awareness of the importance of medical professionalism. METHOD Focus groups of ECE students were held to collect data for the study. All participants read interview guidelines before starting. During the focus groups, the students discussed their medical obligations as perceived throughout the course, which offered a choice between four different ECE tracks. They were then asked to report their understanding of the situations they encountered during the course and reflect on their implications. RESULTS Six focus groups of 22 students in total from a medical school in northern Taiwan were held shortly after the students completed an ECE course in September 2019. From their responses, 10 categories relating to medical professionalism were deduced categorized under 5 major dimensions. An additional 8 sub-dimensions on attitudes and 2 sub-dimensions on personal well-being were also identified as new categories separate from but related to medical professionalism. After the ECE intervention, about 59% of participants redefined their understanding of medical professionalism. CONCLUSION ECE and intensive interaction with key stakeholders, including patients and their families, help students in the early stages of medical education form and cultivate a sense of medical professionalism. However, the relationship between participants' personalities, motivations, and clinical activities requires further investigation.
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Affiliation(s)
- Chun-i Liu
- Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kung-pei Tang
- Department of Early Childhood and Family Education, College of Education, National Taipei University of Education, Taipei, Taiwan
| | - Yun-chu Wang
- Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chiung-hsuan Chiu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
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Tago M, Shikino K, Hirata R, Watari T, Yamashita S, Tokushima Y, Tokushima M, Aihara H, Katsuki NE, Fujiwara M, Yamashita SI. General Medicine Departments of Japanese Universities Contribute to Medical Education in Clinical Settings: A Descriptive Questionnaire Study. Int J Gen Med 2022; 15:5785-5793. [PMID: 35774114 PMCID: PMC9236908 DOI: 10.2147/ijgm.s366411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
- Correspondence: Masaki Tago, Department of General Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan, Email
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Risa Hirata
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Shimane, Japan
| | - Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Midori Tokushima
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Motoshi Fujiwara
- Department of General Medicine, Saga University Hospital, Saga, Japan
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Ohta R, Sano C. Reflection in Rural Family Medicine Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095137. [PMID: 35564531 PMCID: PMC9100794 DOI: 10.3390/ijerph19095137] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 12/30/2022]
Abstract
Reflection in medical education is vital for students' development as professionals. The lack of medical educators in rural family medicine can impinge on the effective reflection of residents' learning. Hence, based on qualitative research, we proposed a framework regarding reflection in rural family medicine education, indicating when, where, and how reflection is performed and progresses. The contents of reflection include clinical issues regarding knowledge and skills, professionalism in clinical decisions, and work-life balance. The settings of reflection include conference rooms, clinical wards, residents' desks, and hospital hallways. The timing of educational reflection includes during and after patient examination and discussion with various professionals, before finishing work, and during "doorknob" times (right before going back home). Rural medical teachers need competence as clinicians and medical educators to promote learning in medical residents and sustain rural medical care. Furthermore, medical teachers must communicate and collaborate with medical residents and nurses for educational reflection to take place in rural family medicine education, especially regarding professionalism. In rural family medicine education, reflection can be performed in various clinical situations through collaboration with learners and various medical professionals, aiding the enrichment of residents' learning and sustainability of rural medical care.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
- Correspondence: ; Tel.: +81-90-5060-5330
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan;
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A Systematic Review of Integrated Learning Definitions, Frameworks, and Practices in Recent Health Professions Education Literature. EDUCATION SCIENCES 2022. [DOI: 10.3390/educsci12030165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
International curricular redevelopment and quality improvement efforts include integration within and across disciplines as a focal point. Definitions and applications of the term ‘integration’ vary routinely in health professions education literature, weakening opportunities to enhance our educational practice through collaborative, interprofessional knowledge-sharing. This systematic review examined recent health professions education literature for reported definitions, theories or frameworks, and educational activities around integrated learning, education, curricula, or teaching. A total of 35 articles representing learners from 12 different health professions, between 2017 and 2021, were analyzed through a literature search of seven databases: PubMed, Scopus, CINAHL, JSTOR, the Cochrane Library, LGBTQ + Life, and ERIC. Full-text retrieval and data extraction of the included studies were conducted. Of the 35 articles reviewed, 13 included explicit definitions of integration (an additional six alluded to a definition), 19 referred to an educational theory or framework used to guide integration design efforts, and 27 mentioned teaching methods by which integration was implemented. Misunderstanding what is meant by integrated, how others have planned for it, or how others have sought to bring it about practically, all threaten attempts to improve the cultivation of health professionals as integrated thinkers and holistic care providers.
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Scott NL, Mahran S, Patel R, Culshaw M. Perceptions of transition into clinical placement. CLINICAL TEACHER 2022; 19:129-135. [DOI: 10.1111/tct.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 12/24/2021] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nicola Lawson Scott
- Undergraduate Medical Education Department Nottingham University Hospitals Nottingham UK
| | - Samer Mahran
- Undergraduate Medical Education Department Nottingham University Hospitals Nottingham UK
| | - Rakesh Patel
- Medical education department University of Nottingham Nottingham UK
| | - Martin Culshaw
- Undergraduate Medical Education Department Nottingham University Hospitals Nottingham UK
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Pravder HD, Elkin DJ, Post SG, Chitkara MB. An Innovative Program Using Magic to Provide Early Clinical Experiences for Preclinical Medical Students: Goals, Experiences, and Results of the MagicAid Program. MEDICAL SCIENCE EDUCATOR 2022; 32:111-120. [PMID: 35043080 PMCID: PMC8758224 DOI: 10.1007/s40670-021-01456-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Abstract
Objective Effectively training medical students in compassion, communication, and empathy is essential in fostering a holistic approach to patient care. We sought to address this by implementing an early clinical experience service learning program for medical students in the initial years of their medical education. Methods Medical students at Stony Brook University initiated, designed, and facilitated the volunteer program, which provides students a framework to learn magic therapy and engage with pediatric patients. The program includes an introductory presentation, training course, and organized bedside sessions with patients. To evaluate the program, a sample of participants partook in a focus group, written questionnaire, and/or online survey. Results From 2015 to 2020, 130 students participated in magic therapy rounds, engaging 1391 patients. Nine themes of student benefit emerged from qualitative analysis, including acquisition of familiarity with the hospital and healthcare team, cultivation of communication skills, contribution to improvement of patient affect, development of empathic qualities and techniques, and improvement in psychological health. Students were very satisfied with their experiences and viewed the activity as helpful for patients, parents, staff, and themselves. Conclusions The program engaged students in compassionate patient care within a holistic approach to patient care early in training. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-021-01456-y.
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Affiliation(s)
- Harrison D. Pravder
- Renaissance School of Medicine, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794 USA
- MagicAid, Great Neck, NY 11021 USA
| | - David J. Elkin
- Renaissance School of Medicine, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794 USA
- MagicAid, Great Neck, NY 11021 USA
| | - Stephen G. Post
- Center for Medical Humanities, Department of Family, Population and Preventive Medicine, Compassionate Care and Bioethics, Stony Brook University, HSC, Level 3, Suite 080, Stony Brook, NY 11794 USA
| | - Maribeth B. Chitkara
- Department of Pediatrics, Stony Brook Children’s, 101 Nicolls Road, Stony Brook, NY 11794 USA
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Bremer AE, van de Pol MHJ, Laan RFJM, Fluit CRMG. How an EPA-based curriculum supports professional identity formation. BMC MEDICAL EDUCATION 2022; 22:48. [PMID: 35057788 PMCID: PMC8781044 DOI: 10.1186/s12909-022-03116-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/07/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are widely used in medical education, and they might be an important incentive to stimulate professional identity formation (PIF) of medical students, by actively encouraging participation in the workplace. The goal of this study was to explore the effects of an EPA-based curriculum on the PIF of medical students in undergraduate curricula. METHODS In this study at the Radboud University Medical Center in Nijmegen, the Netherlands, the authors interviewed twenty-one medical students in three focus group interviews (November 2019), and conducted a thematic analysis based on both the synthesizing concepts PIF, communities of practice and EPAs, and newly defined themes. RESULTS Four central themes proved crucial for understanding the influence of EPAs on PIF: creating learning opportunities, managing feedback, dealing with supervision in context and developing confidence. EPAs helped students to create learning opportunities and to choose activities purposefully, and the use of EPAs stimulated their feedback-seeking behavior. The context and way of supervision had a great impact on their development, where some contexts offer better learning opportunities than others. EPAs helped them develop trust and self-confidence, but trust from supervisors hardly appears to result from using EPAs. CONCLUSIONS An EPA-based curriculum does stimulate PIF in the complex context of working and learning by supporting participation in the workplace and by encouraging feedback-seeking behavior. Striking the right balance between participation, feedback-seeking behavior and choosing learning activities is essential. TRIAL REGISTRATION This study was approved by the ethics committee of the Netherlands Association of Medical Education (NVMO, case number 2019.5.12).
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Affiliation(s)
- Anne E. Bremer
- Department of Radboudumc Health Academy, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | | | - Roland F. J. M. Laan
- Department of Radboudumc Health Academy, Postbus 9101, 6500 HB Nijmegen, The Netherlands
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Allen LM, Hay M, Palermo C. Evaluation in health professions education-Is measuring outcomes enough? MEDICAL EDUCATION 2022; 56:127-136. [PMID: 34463357 DOI: 10.1111/medu.14654] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 05/28/2023]
Abstract
INTRODUCTION In an effort to increase the rigour of evaluation in health professions education (HPE), a range of evaluation approaches are used. These largely focus on outcome evaluation as opposed to programme evaluation. We aim to review and critique the use of outcome evaluation models, using the Kirkpatrick Model as an example given its wide acceptance and use, and advocate for the use of programme evaluation models that help us understand how and why outcomes are occurring. METHODS We systematically searched OVID medline, Scopus, CINAHL and Pubmed, and hand searched six leading HPE journals to provide an overview of the use of the Kirkpatrick Model as well as a range of programme evaluation models in HPE. In addition to this, we synthesised the existing critiques of the Kirkpatrick Model as an example of outcome evaluation, to highlight the limitations of such models. RESULTS The use of the Kirkpatrick Model in HPE is widespread and increasing; however, studies focus on categorising outcomes, rather than explaining how and why they occur. The main criticisms of the model are as follows: it is outcomes focused and fails to consider factors that can impact training outcomes; it assumes positive casual linkages between the levels; there is an assumption that the higher-level outcomes are more important; and unintended impacts are not considered. The use of the Kirkpatrick Model by the MERSQI, BEME and WHO contribute to the myth that the Kirkpatrick Model is the gold standard for programme evaluation. DISCUSSION Moving forward, evaluations of HPE interventions must shift from focusing largely on measuring outcomes of interventions with little consideration for how and why these outcomes are occurring to programme evaluation that investigates what contributes to these outcomes. Other models that facilitate the evaluation of the complex processes that occur in HPE should be used instead of Kirkpatrick's.
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Affiliation(s)
- Louise M Allen
- Monash Centre for Professional Development and Monash Online Education, Monash University, Clayton, Victoria, Australia
| | - Margaret Hay
- Monash Centre for Professional Development and Monash Online Education, Monash University, Clayton, Victoria, Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
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Narapureddy BR, Patan SK, Deepthi CS, Chaudhuri S, John KR, Chittooru C, Babu S, Nagoor K, Jeeragyal D, Basha J, Nell T, Reddy RS. Development of a community orientation program (COP) as a community-based medical education method for undergraduate medical students: an experience from India. BMC MEDICAL EDUCATION 2021; 21:626. [PMID: 34949199 PMCID: PMC8697537 DOI: 10.1186/s12909-021-03069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Intra-regional cultural and linguistic differences are common in low- and middle-income countries. To sensitise undergraduate medical students to the social and contextual determinants of health to achieve the 'health for all' goal, these countries must focus on innovative teaching methods. The early introduction of a Community Orientation Program (COP) as a Community-based Medical Education (CBME) method could be a game changing strategy. In this paper the methods, evaluation, and implication of the COP in an Indian setting are described. METHODS The curriculum of the COP was developed based on the analysis, design, development, implementation, and evaluation (ADDIE) model for educational intervention. In this learner-centric and supervised educational program, the key aim was to focus on developing students' communication skills, observation power and enhancing their motivation for learning through collaborative learning. To meet the objectives of the COP, a situated learning model under the constructivism theory was adopted. RESULTS Between 2016 and 2019, 557 students were trained through the COP by visiting more than 1300 households in ten villages. To supplement the students' observations in the community, more than 150 small group discussions, a health education programme for the community and summary presentations were conducted. The students' feedback indicated the need to improve the clinical examinations demonstration quality and increase the number of instruments for clinical examinations. More than 80% of students felt that the program would assist them to improve their communication skills, their understanding of the various socio-demographic factors associated with the common diseases, and it will enable them to respect the local culture during their clinical practice. CONCLUSIONS Early initiation of the COP as a CBME method in the undergraduate medical curriculum in an Indian setting has shown promising results. Further evidence is required to adopt such a program routinely for under-graduate medical teaching in the low- and middle- income settings.
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Affiliation(s)
- Bayapa Reddy Narapureddy
- College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
- Apollo Institute of Medical Sciences and Research, Chittoor, India
| | | | | | | | - K. R. John
- Apollo Institute of Medical Sciences and Research, Chittoor, India
| | | | - Surendra Babu
- Apollo Institute of Medical Sciences and Research, Chittoor, India
- ESIC Medical College, Hyderabad, India
| | | | - Devika Jeeragyal
- Apollo Institute of Medical Sciences and Research, Chittoor, India
| | - Jawahar Basha
- Apollo Institute of Medical Sciences and Research, Chittoor, India
| | - Theo Nell
- Connect To Grow, Yzerfontein, South Africa
| | - Ravi Shankar Reddy
- College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
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Baimas-George M, Watson M, Martinie J, Vrochides D. Curriculum matrix development for a hepato-pancreato-biliary robotic surgery fellowship. Can J Surg 2021; 64:E657-E662. [PMID: 34880057 PMCID: PMC8677573 DOI: 10.1503/cjs.002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Robotic surgery is being increasingly used for complex benign and malignant hepato-pancreato-biliary (HPB) cases. As use of robotics increases, fellowships to excel in complex robotic procedures will be sought after. With this dedicated training, attending surgeon positions can be obtained that can incorporate and teach this skill set. Unfortunately, there are no evidence-based approaches for constructing a curriculum for an HPB robotic surgery fellowship. This paper describes a technique to develop a structured curriculum to ensure competence and fulfil the learning and practice needs for robotic HPB fellows.
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Affiliation(s)
- Maria Baimas-George
- From the Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Michael Watson
- From the Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - John Martinie
- From the Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Dionisios Vrochides
- From the Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
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Saini P, Debroy K, Badger C, Powell C, Thakkar P, Chretien KC. Virtual Shadowing Program for Preclinical Medical Students. MEDICAL SCIENCE EDUCATOR 2021; 31:1575-1580. [PMID: 34155452 PMCID: PMC8208064 DOI: 10.1007/s40670-021-01351-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 06/10/2023]
Abstract
Our annual summer shadowing program for preclinical medical students faced significant challenges due to COVID-19-related safety and resource concerns during Summer 2020. We created a pilot 7-week virtual shadowing program with the goal of providing virtual observational clinical experiences to increase students' clinical exposure and understanding of medical specialties. Faculty and preclinical medical students were matched via student preference selection and mentor availability. A practice guide was developed that outlined suggested virtual shadowing procedures. Afterward, participating faculty and students were surveyed on their experience. Overall, both faculty and students found the program effective and experienced limited technological difficulty.
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Affiliation(s)
- Prashant Saini
- The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Kunal Debroy
- Hershey Medical Center, Penn State University, Hershey, PA USA
| | - Christopher Badger
- The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Cynthia Powell
- The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Punam Thakkar
- The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Katherine C. Chretien
- The George Washington University School of Medicine and Health Sciences, Washington, DC USA
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Hamamoto Filho PT, Lourenção PLTDA, Abbade JF, Cecílio-Fernandes D, Caramori JT, Bicudo AM. Exploring pooled analysis of pretested items to monitor the performance of medical students exposed to different curriculum designs. PLoS One 2021; 16:e0257293. [PMID: 34506599 PMCID: PMC8432842 DOI: 10.1371/journal.pone.0257293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 08/30/2021] [Indexed: 11/18/2022] Open
Abstract
Several methods have been proposed for analyzing differences between test scores, such as using mean scores, cumulative deviation, and mixed-effect models. Here, we explore the pooled analysis of retested Progress Test items to monitor the performance of first-year medical students who were exposed to a new curriculum design. This was a cross-sectional study of students in their first year of a medical program who participated in the annual interinstitutional Progress Tests from 2013 to 2019. We analyzed the performance of first-year students in the 2019 test and compared it with that of first-year students taking the test from 2013 to 2018 and encountering the same items. For each item, we calculated odds ratios with 95% confidence intervals; we also performed meta-analyses with fixed effects for each content area in the pooled analysis and presented the odds ratio (OR) with a 95% confidence interval (CI). In all, we used 63 items, which were divided into basic sciences, internal medicine, pediatrics, surgery, obstetrics and gynecology, and public health. Significant differences were found between groups in basic sciences (OR = 1.172 [CI95% 1.005 CI 1.366], p = 0.043) and public health (OR = 1.54 [CI95% CI 1.25-1.897], p < 0.001), which may reflect the characteristics of the new curriculum. Thus, pooled analysis of pretested items may provide indicators of different performance. This method may complement analysis of score differences on benchmark assessments.
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Affiliation(s)
- Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP–Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
- * E-mail:
| | | | - Joélcio Francisco Abbade
- Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP–Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Dario Cecílio-Fernandes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, UNICAMP–Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Jacqueline Teixeira Caramori
- Department of Internal Medicine, Botucatu Medical School, UNESP–Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Angélica Maria Bicudo
- Department of Pediatrics, School of Medical Sciences, UNICAMP–Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
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Onumah CM, Lai CJ, Levine D, Ismail N, Pincavage AT, Osman NY. Aiming for Equity in Clerkship Grading: Recommendations for Reducing the Effects of Structural and Individual Bias. Am J Med 2021; 134:1175-1183.e4. [PMID: 34144012 DOI: 10.1016/j.amjmed.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Chavon M Onumah
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Cindy J Lai
- Department of Medicine, University of California, San Francisco, School of Medicine
| | - Diane Levine
- Department of Medicine, Wayne State University School of Medicine, Detroit, Mich
| | - Nadia Ismail
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Amber T Pincavage
- Department of Medicine, University of Chicago Pritzker School of Medicine, Ill
| | - Nora Y Osman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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Shikama Y, Chiba Y, Yasuda M, Stanyon M, Otani K. The use of text mining to detect key shifts in Japanese first-year medical student professional identity formation through early exposure to non-healthcare hospital staff. BMC MEDICAL EDUCATION 2021; 21:389. [PMID: 34284770 PMCID: PMC8293517 DOI: 10.1186/s12909-021-02818-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/04/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Professional identity formation is nurtured through socialization, driven by interaction with role models, and supported through early clinical exposure (ECE) programmes. Non-healthcare professionals form part of the hospital community but are external to the culture of medicine, with their potential as role models unexplored. We employed text mining of student reflective assignments to explore the impact of socialization with non-healthcare professionals during ECE. METHODS Assignments from 259 first-year medical students at Fukushima Medical University, Japan, underwent hierarchical cluster analysis. Interrelationships between the most-frequently-occurring words were analysed to create coding rules, which were applied to elucidate underlying themes. RESULTS A shift in terms describing professional characteristics was detected, from "knowledge/skill" towards "pride [in one's work]" and "responsibility". Seven themes emerged: contribution of non-healthcare professionals, diversity of occupation, pride, responsibility, teamwork, patient care and gratitude. Students mentioning 'contribution of non-healthcare professionals' spoke of altruistic dedication and strong sense of purpose. These students expressed gratitude towards non-healthcare professionals for supporting clinical work, from a doctor's perspective. CONCLUSION Socialization with non-healthcare professionals provides important insights into the hospital working environment and cultural working norms. Through role modelling altruism and responsibility, non-healthcare professionals positively influenced student professional identity formation, promoting self-conceptualisation as a doctor.
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Affiliation(s)
- Yayoi Shikama
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yasuko Chiba
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Megumi Yasuda
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Maham Stanyon
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koji Otani
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Wong PS, Chen YS, Saw PS. Influencing factors and processes of interprofessional professional education (IPE) implementation. MEDICAL TEACHER 2021; 43:S39-S45. [PMID: 31603016 DOI: 10.1080/0142159x.2019.1672864] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Interprofessional education (IPE) is an instructional approach for equipping health professions students with essential competencies needed to provide collaborative patient-centred care. The implementation and sustainability of IPE are challenging for many institutions. This qualitative study identified barriers and facilitators in the processes of IPE implementation. METHODS We conducted mixed focus groups (FGs) with faculty members from medicine, dentistry, pharmacy, nutrition and dietetics, nursing, chiropractic, Chinese medicine, and other health sciences programmes; who were involved in the planning of IPE at institutional or programme level, or who participated in IPE activity. Transcripts were analysed using grounded theory. RESULTS We identified 25 barriers and facilitators, clustered under five major categories of commitment, faculty engagement, IPE design, support, and delivery. CONCLUSIONS Successful implementation of IPE may hinge on actions in 5 stages; commitment, faculty engagement, IPE design, support, and delivery. The processes will require consistent leadership to break down professional silos and enhance collaborative effort in IPE implementation.
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Affiliation(s)
- Pei Se Wong
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Yu Sui Chen
- Division of Human Biology, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Pui San Saw
- School of Pharmacy, Monash University, Sunway, Malaysia
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Telemedicine curriculum in undergraduate medical education: a systematic search and review. HEALTH AND TECHNOLOGY 2021; 11:773-781. [PMID: 33996380 PMCID: PMC8109844 DOI: 10.1007/s12553-021-00559-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/05/2021] [Indexed: 12/30/2022]
Abstract
The number of patient-doctor appointments carried out using telemedicine has surpassed in-person appointments. In spite of this, it is unclear that telemedicine curricula in undergraduate medical education reflect the real importance by means of the effectiveness of these approaches. We aimed to systematically search and review the studies that are on undergraduate telemedicine curricula. We searched the Web of Science, PubMed, and Scopus using the keywords such as telemedicine, medical education, and curriculum. Our search was limited to publication dates between January 1, 2000, and February 1, 2020. We elicited the information of the curricula as to their countries, participants, aims or objectives, teaching methods, and evaluation of effectiveness. We also evaluated the quality of the studies using the Joanna Briggs Institute Qualitative Appraisal and Review Instrument. Out of 461 studies, seven articles were selected based on selection criteria for further review. The studies were mostly from the USA. The participant numbers were between seven and 268. There were several modes of delivery but lectures and patient encounters were used mostly. In four studies, the effectiveness was evaluated only by using satisfaction surveys, and the results were satisfactory. A study reported the acquisition and application of skills as a result. There is no well-established telemedicine curriculum in the undergraduate years. The methods vary but the effectiveness of the educational programs does not have a robust evidence base. It is evident that undergraduate medical education needs a curriculum backed by strong scientific data on its effectiveness.
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Torres-Calixto MG. Trends and challenges of medical education. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v69n3.84330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this article is to reflect on the contextual factors that influence medical education, in order to provide some recommendations about the challenges that physicians face.
A literature review was conducted to write this reflection paper, and it was found that the education of health professionals has undergone significant changes that are based on the development of biomedical sciences, technology, and pedagogy, and are influenced by the needs of the general population, the requirements of the health systems of each country, and scientific progress.
These changes have given rise to challenges inherent to the special characteristics of each country and related to the quantity, quality, and relevance of the training of physicians. In this regard, it has been suggested that, in the face of such changes, it is necessary to design curricula that integrate all aspects of health care, consider the supply and demand of medical services, emphasize professionalism, take into account the pedagogical training of health sciences teachers, comply with quality standards, assist students in selecting undergraduate programs adequately (in this case Medicine), and ensure relevant clinical practice scenarios.
It should also be noted that medical education has not adapted adequately to the aforementioned changes in many countries and, therefore, the development of teaching and learning strategies has lagged behind and physicians in such countries do not have the capacity to provide the health care required by the general population in a proper manner.
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Rahm AK, Töllner M, Hubert MO, Klein K, Wehling C, Sauer T, Hennemann HM, Hein S, Kender Z, Günther J, Wagenlechner P, Bugaj TJ, Boldt S, Nikendei C, Schultz JH. Effects of realistic e-learning cases on students' learning motivation during COVID-19. PLoS One 2021; 16:e0249425. [PMID: 33882079 PMCID: PMC8059845 DOI: 10.1371/journal.pone.0249425] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background Keeping up motivation to learn when socially isolated during a pandemic can be challenging. In medical schools, the COVID-19 pandemic required a complete switch to e-learning without any direct patient contact despite early reports showing that medical students preferred face-to-face teaching in clinical setting. We designed close to real-life patient e-learning modules to transmit competency-based learning contents to medical students and evaluated their responses about their experience. Methods Weekly e-learning cases covering a 10-week leading symptom-based curriculum were designed by a team of medical students and physicians. The internal medicine curriculum (HeiCuMed) at the Heidelberg University Medical School is a mandatory part of clinical medical education in the 6th or 7th semester. Case-design was based on routine patient encounters and covered different clinical settings: preclinical emergency medicine, in-patient and out-patient care and follow-up. Individual cases were evaluated online immediately after finishing the respective case. The whole module was assessed at the end of the semester. Free-text answers were analyzed with MaxQDa following Mayring`s principles of qualitative content analyses. Results N = 198 students (57.6% female, 42.4% male) participated and 1252 individual case evaluations (between 49.5% and 82.5% per case) and 51 end-of-term evaluations (25.8% of students) were collected. Students highly appreciated the offer to apply their clinical knowledge in presented patient cases. Aspects of clinical context, interactivity, game-like interface and embedded learning opportunities of the cases motivated students to engage with the asynchronously presented learning materials and work through the cases. Conclusions Solving and interpreting e-learning cases close to real-life settings promoted students’ motivation during the COVID-19 pandemic and may partially have compensated for missing bedside teaching opportunities.
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Affiliation(s)
- Ann-Kathrin Rahm
- Heidelberg University Medical School, Heidelberg, Germany
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
- * E-mail:
| | | | - Max Ole Hubert
- Heidelberg University Medical School, Heidelberg, Germany
| | - Katrin Klein
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - Cyrill Wehling
- Department of Gastroenterology, Infectious Diseases and Intoxication, Heidelberg, Germany
| | - Tim Sauer
- Department of Hematology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Selina Hein
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Janine Günther
- Department of Hematology, Heidelberg University Hospital, Heidelberg, Germany
| | - Petra Wagenlechner
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sophia Boldt
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Heidelberg University Medical School, Heidelberg, Germany
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Mishra VD, Tebha SS, Mittal RJ, Paul A. Effects of the COVID-19 Pandemic on the Competency of Clinical Year Medical Students, With Special Reference to Community and Public Health. Am J Public Health 2021; 111:378-379. [PMID: 33566647 PMCID: PMC7893340 DOI: 10.2105/ajph.2020.306081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Vivaswan Dutt Mishra
- Vivaswan Dutt Mishra is an MBBS student at Motilal Nehru Medical College, Allahabad, India. Sameer Saleem Tebha is an MBBS student at Jinnah Medical and Dental College, Karachi, Pakistan. Rahul Jagdishchandra Mittal is an MBBS student at Gujarat Medical Education & Research Society Medical College, Gandhinagar, Gujarat, India. Aritra Paul is an MBBS student at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sameer Saleem Tebha
- Vivaswan Dutt Mishra is an MBBS student at Motilal Nehru Medical College, Allahabad, India. Sameer Saleem Tebha is an MBBS student at Jinnah Medical and Dental College, Karachi, Pakistan. Rahul Jagdishchandra Mittal is an MBBS student at Gujarat Medical Education & Research Society Medical College, Gandhinagar, Gujarat, India. Aritra Paul is an MBBS student at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Rahul Jagdishchandra Mittal
- Vivaswan Dutt Mishra is an MBBS student at Motilal Nehru Medical College, Allahabad, India. Sameer Saleem Tebha is an MBBS student at Jinnah Medical and Dental College, Karachi, Pakistan. Rahul Jagdishchandra Mittal is an MBBS student at Gujarat Medical Education & Research Society Medical College, Gandhinagar, Gujarat, India. Aritra Paul is an MBBS student at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Aritra Paul
- Vivaswan Dutt Mishra is an MBBS student at Motilal Nehru Medical College, Allahabad, India. Sameer Saleem Tebha is an MBBS student at Jinnah Medical and Dental College, Karachi, Pakistan. Rahul Jagdishchandra Mittal is an MBBS student at Gujarat Medical Education & Research Society Medical College, Gandhinagar, Gujarat, India. Aritra Paul is an MBBS student at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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Insley E, Tedesco K, Litman EA, Mangalapally N, Gicewicz C, Monaco-Brown ML. The NICU Cuddler Curriculum: A Service-Learning Curriculum for Preclinical Medical Students in the Neonatal Intensive Care Unit. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11069. [PMID: 33473379 PMCID: PMC7809928 DOI: 10.15766/mep_2374-8265.11069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/25/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The neonatal intensive care unit (NICU) is often seen as off-limits by preclinical medical students. The NICU cuddler curriculum is a service-learning curriculum that invited preclinical medical students into the NICU to engage with and learn from one of the hospital's most vulnerable populations: neonates. The purpose of this preclinical experience was to provide students with exposure to the NICU and an opportunity to engage with babies, families, and the NICU staff, in order to improve students' clinical and communication skills. METHODS First- and second- year medical students applied and were selected for participation. Participants cuddled neonates in the NICU for at least 10 hours, attended didactic sessions relevant to neonatal care, and debriefed with an attending each semester. The curriculum was evaluated via qualitative analysis and postparticipation surveys. RESULTS To date, a total of 73 students have participated in the NICU cuddler curriculum. Qualitative analysis revealed students felt included in patient care, empowered in their understanding of the social determinants of health, and useful in their role. A postsurvey of clinical medical students following participation revealed the sustained impact of this program. DISCUSSION This service-learning curriculum for preclinical medical students has the potential to enhance student understanding of the social determinants of health, increase exposure to the NICU, and promote interprofessional collaboration, ultimately increasing preparedness of students for their clinical years.
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Affiliation(s)
- Elena Insley
- Medical Student, Department of Medical Education, Albany Medical College
| | - Kathleen Tedesco
- Medical Student, Department of Medical Education, Albany Medical College
| | - Ethan A. Litman
- Medical Student, Department of Medical Education, Albany Medical College
| | | | - Casey Gicewicz
- Registered Nurse, Division of Neonatology, The Bernard and Millie Duke Children's Hospital at Albany Medical Center
| | - Meredith L. Monaco-Brown
- Associate Professor, Division of Neonatology, The Bernard and Millie Duke Children's Hospital at Albany Medical Center
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Khanna P, Roberts C, Lane AS. Designing health professional education curricula using systems thinking perspectives. BMC MEDICAL EDUCATION 2021; 21:20. [PMID: 33407403 PMCID: PMC7789213 DOI: 10.1186/s12909-020-02442-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/10/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Medical students navigate complex personal learning pathways from entry into medical school, through an educational program, and into life-long practice. However, many stakeholders have called for substantive reforms in contemporary curricula, citing concerns about the lack of key abilities amongst newly graduated doctors to work in complex healthcare environments. Despite the need for educators to focus on curricula design, there is a paucity of overarching perspectives that allow synthesis of the various curricular elements in a way that lends meaningfulness and appreciation to the students in terms of navigating the immediate program requirements and beyond. Without such guidance, educators risk creating fragmented program designs that can lead to both unintended and unactionable outcomes for students as well as curriculum designers. Using systems thinking, we set out to address this gap by providing an overarching perspective for curriculum designers to appreciate the relationships and the interactions of the various curricular elements that inform and impact student's preparedness for practice. METHODS By framing a curriculum as a complex adaptive system, we used soft systems thinking to develop an initial prototype of a conceptual curricular toolkit, underpinned by an appraisal of relevant literature within health professional education and the broader educational context. The prototype was further refined iteratively after critical reflection by the authors with a diverse range of national and international colleagues via posters, short communications, and workshops at several conferences, and through social media. RESULTS We describe how the 3P-6Cs toolkit captures a learner's personal journey through an educational program into a field of practice by logically linking the three key elements: the personal, the program, and the practice. We demonstrate its application in three examples related to contemporary health profession education curricula. These are: creating integrated educational designs to capture students' developmental continua, conceptualising immersive clinical placements in non-traditional settings, and complexity-consistent evaluation of curricular interventions. CONCLUSION Applying the 3P-6Cs curricular toolkit to problems of curricula (re)design can provide overarching perspectives that enable educators to have a better understanding of how integration of elements within education programs can inform and impact student's preparation for lifelong practice.
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Affiliation(s)
- Priya Khanna
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Chris Roberts
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
| | - Andrew Stuart Lane
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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