Problem-based learning in academic health education. A systematic literature review

Facilitators and barriers to online group work in higher education within health sciences - a scoping review

INTRODUCTION

In health education, group work is essential to prepare students for working in health care and medical teams. Following the widespread adoption of online teaching, group work increasingly takes place in online environments. Although successful group work can provide good learning outcomes, it is unclear what facilitates or hinders online group work in health science education, and to what extent this topic has been addressed. Thus, this scoping review aimed to identify the facilitators and barriers to online group work in higher health education, provide an overview of the scientific literature related to the topic, and identify knowledge gaps in the research.

METHODS

This scoping review was guided by the methodological framework described by Arksey and O'Malley, and reporting is in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR). Eight online databases were searched for scientific articles published between 2012 and 2022. At least two researchers independently screened records and full-text articles and charted data including article characteristics and key information related to the research question. Findings were categorized and summarized based on the Community of Inquiry Framework.

RESULTS

After screening 3671 records and 466 full-text articles, 39 articles met the inclusion criteria. The review revealed smaller group size, consistency in group composition and joint responsibility to be facilitators. Challenges with group communication, scheduling synchronous meetings and technical issues were identified as barriers. Our findings supported the importance of all three elements of the Community of Inquiry Framework: social, cognitive, and teaching presence.

CONCLUSION

This review provides an overview of facilitators and barriers to online group work in health science education. However, there is a need for further investigation of these factors and studies addressing this topic from the teachers' perspective.

Medical education challenges in Mainland China: An analysis of the application of problem-based learning

BACKGROUND

The medical education system in mainland China faces numerous challenges and the lack of learner-centered approaches may contribute to passive learning and reduced student engagement. While problem-based learning (PBL) is common in Western medical schools, its feasibility in China is questioned due to cultural differences. This systematic review aims to summarize the application of PBL in medical education in mainland China based on existing literature, as well as to identify the challenges and opportunities encountered in its implementation.

METHODS

A systematic literature review was conducted using electronic databases, including MEDLINE, Cochrane Library, EMBASE, Web of Science, Wan fang and CNKI databases. Grey literature sources were explored using Google Scholar. The search was limited to articles that include at least one English abstract up to May 1st, 2023. The inclusion criteria were studies that reported the use of PBL in medical education in mainland China.

RESULTS

A total of 21 articles were included in the final analysis. The findings indicate that PBL is a well-adopted and effective learning method in most medical education, especially for developing critical thinking, problem-solving, and teamwork skills. However, the application of PBL in mainland China is limited due to various challenges, including faculty resistance, inadequate resources and cultural barriers. To effectively address these challenges, it is essential to provide faculty training, develop appropriate assessment methods to evaluate student progress within the PBL framework and create conducive spaces and resources that support collaborative learning and critical thinking.

CONCLUSION

The utilization of PBL in mainland China holds potential for enhancing medical education. However, its successful implementation requires significant efforts to address the identified challenges. It is crucial to engage stakeholders in a collaborative effort to promote the application of PBL and ultimately improve the quality of medical education in mainland China.

Problem-Based Learning for Interprofessional Education: A Review of the Concept and Its Application in a Geriatric Team

The global population is aging, with those aged 65 years or over increasing in number and accounting for a growing share of the population. There are increasing demands for geriatric care which makes the development and delivery of effective geriatric team training a priority. Training in geriatrics is complex because of the multiplicity of medical, psychosocial, and functional issues in elderly individuals which need to be addressed by a multidisciplinary approach using interprofessional education (IPE). Problem-based learning, a student-centered educational model that brings several natural strengths to IPE, is a unique curriculum replacing the traditional lecture-based learning model. This model enhances physician competency after graduation, mainly in psychosocial and teamwork issues that are fundamentally essential for geriatrics. IPE has been shown to have a substantial positive impact on team collaboration, individual development, and healthcare improvement. In this paper, we summarize the current findings from recent studies on training professionals from different healthcare disciplines to deliver care for the elderly in collaborative practice. We also discuss if an interprofessional problem-based geriatric team program in geriatrics is a promising solution to enhance professional collaboration and quality of patient care.

Effects of six teaching strategies on medical students: protocol for a systematic review and network meta-analysis

INTRODUCTION

Mounting evidence has suggested that novel teaching strategies have a positive impact on the quality and efficiency of medical education. However, the comprehensive evidence about the superiority among various strategies is not clear. To address this issue, we aim to conduct a systematic review and network meta-analysis (NMA) to evaluate the effects of six main strategies on medical education, including case-based learning, problem-based learning, team-based learning, flipped classrooms, simulation-based education and bridge-in, objective, preassessment, participatory learning, postassessment and summary.

METHODS AND ANALYSIS

A systematic search will be conducted in PubMed, Embase, Web of Science and the Cochrane Library, covering studies published from database inception to November 2023. Randomised controlled trials which evaluated the different teaching methods and meet the eligibility criteria will be included. The effectiveness of medical students' learning, which is evaluated by theoretical test score, experimental or practical test score, will be analysed as the primary outcomes. Besides, the secondary outcomes consist of learning satisfaction of students and formative evaluation score. The study selection and data extraction will be independently performed by two authors. The risk of bias in each study will be assessed using V.2 of the Cochrane risk-of-bias tool for randomised controlled trials. To compare the effects of six teaching strategies, pairwise meta-analysis and NMA will be performed using Rev Man, STATA and R software. Statistical analyses including homogeneity tests, sensitivity analysis, consistency tests, subgroup analysis, Egger's test and publication bias will also be completed.

ETHICS AND DISSEMINATION

No formal research ethics approval is required because this study is a meta-analysis based on published studies. The results will be disseminated to a peer-reviewed journal for publication.

PROTOCOL REGISTRATION NUMBER

CRD42023456050.

Bridge to Practice: A Qualitative Evaluation of Joint Medical Program (JMP) International Medical Graduates Perceived Preparedness for Professional Practice

OBJECTIVES

This study sought to examine the views of international graduates regarding how they perceived the Joint Medical Program Bachelor of Medicine (JMP BMed) undergraduate training prepared them to practice in a health system different from that in which they had studied. Eighteen international graduates of the JMP between 2010 and 2017 inclusive agreed to be interviewed face-to-face.

METHODS

JMP BMed international graduates were interviewed using 18 standardized questions to elicit perceptions of their preparedness to practice and reflections on their training experience. The interview data were qualitatively analyzed, and the main themes were identified and categorized.

RESULTS

Overall, the international graduates of the JMP BMed curriculum felt well-prepared for tasks associated with communication, self-directed learning, and approaching mental health issues. Conversely, they perceived the level of clinical exposure and experience as inadequate in preparing them for the expected level of medical knowledge and responsibility. They also felt underprepared for navigating a different health system.

CONCLUSIONS

The strengths and weaknesses identified in the JMP BMed program in its preparation of international graduates, particularly those who chose to practice in their country of origin, are of relevance for all medical schools that enrol international students. Greater awareness of the needs of international medical students returning home to practice may be of value for future curriculum planning purposes to ensure that medical schools optimally prepare their graduates to practice with confidence in a range of healthcare systems.

Active learning in undergraduate classroom dental education- a scoping review

INTRODUCTION

Previous reviews on active learning in dental education have not comprehensibly summarized the research activity on this topic as they have largely focused on specific active learning strategies. This scoping review aimed to map the breadth and depth of the research activity on active learning strategies in undergraduate classroom dental education.

METHODS

The review was guided by Arksey & O'Malley's multi-step framework and followed the PRISMA Extension Scoping Reviews guidelines. MEDLINE, ERIC, EMBASE, and Scopus databases were searched from January 2005 to October 2022. Peer-reviewed, primary research articles published in English were selected. Reference lists of relevant studies were verified to improve the search. Two trained researchers independently screened titles, abstracts, and full-texts articles for eligibility and extracted the relevant data.

RESULTS

In total, 93 studies were included in the review. All studies performed outcome evaluations, including reaction evaluation alone (n = 32; 34.4%), learning evaluation alone (n = 19; 20.4%), and reaction and learning evaluations combined (n = 42; 45.1%). Most studies used quantitative approaches (n = 85; 91.3%), performed post-intervention evaluations (n = 70; 75.3%), and measured student satisfaction (n = 73; 78.5%) and knowledge acquisition (n = 61; 65.6%) using direct and indirect (self-report) measures. Only 4 studies (4.3%) reported faculty data in addition to student data. Flipped learning, group discussion, problem-based learning, and team-based learning were the active learning strategies most frequently evaluated (≥6 studies). Overall, most studies found that active learning improved satisfaction and knowledge acquisition and was superior to traditional lectures based on direct and indirect outcome measures.

CONCLUSION

Active learning has the potential to enhance student learning in undergraduate classroom dental education; however, robust process and outcome evaluation designs are needed to demonstrate its effectiveness in this educational context. Further research is warranted to evaluate the impact of active learning strategies on skill development and behavioral change in order to support the competency-based approach in dental education.

Assessing predictors of students' academic performance in Ethiopian new medical schools: a concurrent mixed-method study

BACKGROUND

Since 2012 the Ethiopian Federal Ministry of Health and Education implemented a new medical curriculum in 13 institutions. The new curriculum introduced some questions on its admission policy: students can join with different educational backgrounds. Students' performance on qualifying exams and grade point average are lower than desired. Therefore, the aim of the study was to investigate what factors predict the academic performance of students in the New Medical Education Initiative in Ethiopia.

METHODS

A concurrent mixed method of survey and qualitative was used; for the survey, a structured self-administered questionnaire was distributed to students of four randomly selected medical schools from December 2018 to January 2019. The questionnaire includes questions about socio-demographic and educational background of participants. Multiple linear regression analysis was used in order to identify the factors associated with academic performance. In-depth interviews were conducted with 15 key informants to explore qualitatively.

RESULTS

In the multiple linear regressions, stress was associated with lower academic performance. Students with prior education in the field of health science outperformed students with other bachelors. The cumulative grade point average of the previous bachelor degree and the score on the entrance exam to join medicine also significantly predicted performance. Although some more variables are identified from the qualitative interviews, its findings supported the survey results.

CONCLUSIONS

Of the number of predictor variables analyzed in the model, only stress, prior educational degree, performance in the prior degree and entrance exam score were significantly correlated with the performance of students in their preclinical medical engagement.

Evidence-based teaching in contact lenses education: Teaching and learning strategies

INTRODUCTION

Contact lens (CL) practice is an ever-changing field with clinical knowledge, techniques and equipment continuously evolving. These new developments are backed with clinical trials and research to ensure that practitioners feel confident that there is an evidence base to support these advances. Evidence-based practice is now a crucial part of CL practice, and its importance also filters down to CL education. For example, lectures are one of the most popular tools for an educator but, is standing at the front of a lecture theatre full of students a more effective way of teaching than providing the same material for students to read by themselves? What evidence exists specific to CL education?

METHOD

An expert panel of educators completed a comprehensive literature review of current evidence of teaching methods in CL training, or if not available then what can be learnt from other health care professional training that could be potentially applicable to CL education.

RESULTS

Due to the amount of evidence available in the overall subject area relating to healthcare education, the initial plan of compiling evidence into one narrative review paper was discarded in favour of producing two linked papers. Here, the first paper details definitions of terminology, and also teaching methods. The second paper focuses on assessment and specific clinical training required to attain CL practice competency. In this first paper, no direct evidence of the spreading and benefit of new education strategies evidence such as flipped classrooms, spaced learning, test-enhanced learning, group work, CBL, PBL, TBL, and reflective practice in CL education was found. The only technique that was widely used in the CL field was case reports and the group discussion of them. Nevertheless, the authors found a consensus of opinion from other disciplines that are transferable to CL teaching and could help students meet the intended learning outcomes.

CONCLUSION

There is a small amount of evidence supporting CL education, but most of this seems to be related to the practical element of the training. However, there is a lot of evidence in the field of healthcare education from related disciplines which provides additional but important learning tools that may be effectively implemented in CL education.

Experiential student study groups: perspectives on medical education in the post-COVID-19 period

BACKGROUND

Undergraduate medical curricula often fail to integrate experiential learning methodologies. Thus, a pilot series of interactive pathology lessons was designed and implemented in an attempt to promote experiential learning.

METHODS

Thirty pre-graduate medical students voluntarily participated in the interactive study groups at the First Department of Pathology of the National and Kapodistrian University of Athens, Medical School. A questionnaire was designed to investigate the satisfaction of students regarding their participation in pathology study groups and to identify the characteristics that shape students' perceptions of the foundations of medical education. Descriptive statistics (mean values) were used to describe the students' evaluations of the pathology study groups, and thematic analysis was conducted to investigate the data collected using open-ended questions.

RESULTS

Interactions with the professor and the option of co-observing the slides using dual-view optical microscopes and virtual slides were each evaluated as "Excellent" by ≅ 95% of the students. Four overarching themes were identified regarding the core characteristics of medical education according to the students' perspectives: 1) educational background in medical education, 2) interaction with educators in medical education, 3) educational material in medical education and 4) assessment in medical education.

CONCLUSIONS

The high rates of acceptance of the pathology study groups reflect the desire and need for active learning methodologies to be implemented in modern medical education. Nearly all the students mentioned the need for practical skill acquisition, the integration of theory into practice and ethics in medical education. The success of these optional pathology study groups highlights the need for similar modalities to be incorporated into the main medical education curriculum.

Flipped Classroom Formats in a Problem-Based Learning Course: Experiences of First-Year Bachelor European Public Health Students

Objectives: Students would like to see more creativity and flexibility in the performance of problem-based learning (PBL). Therefore, we applied flipped classroom formats in a course of the Bachelor European Public Health at Maastricht University to investigate the experiences of the students. The main objective was to stimulate interaction between students mutual, and between students and teachers.

Methods: 304 first-year students following the course on “Ageing in Europe” in three academic years, were asked to fill out questions focussing on prior knowledge, preparation work, and group session parameters, e.g., duration, content, extent of interaction and format group session.

Results: In-class activities, such as debate, making a mind map, giving a pitch, role-play e.g., were highly appreciated by students, especially the interactivity and discussions with the experts during these sessions. Students felt they applied knowledge.

Conclusion: Flipped classroom formats can be used to extend the Maastricht University PBL design and students do recommend this. It can be a relevant and challenging answer on the articulated request for more creativity and flexibility in the regular PBL format.

Facilitating small group learning in the health professions

There is now good evidence that small group teaching provides a fruitful academic environment, which optimises learning, particularly in the healthcare setting, and especially when compared to lectures. An individual student's understanding of knowledge is increased when they are able to actively compare and build on their own understanding in conjunction with their peers. Small group teaching provides opportunities for learners to work collaboratively, and promotes team-building skills - skills that are essential to work within healthcare settings. The aim of this paper is to provide health professional students and early career health professionals involved in peer and near peer teaching, with an overview of approaches and tips to improve learner engagement when facilitating small groups.

Frightened of the pulp? A qualitative analysis of undergraduate student confidence and stress during the management of deep caries and the exposed pulp

AIM

To evaluate sources of student confidence and stress during the management of deep carious lesions and the exposed pulp during undergraduate clinics. Further aims were to identify barriers and facilitators, which could result in educational or practical improvements in the delivery of teaching and provision of treatment in this area.

METHODOLOGY

A exploratory qualitative study design was used, based on recorded focus group interviews, guided by 12 predetermined questions. The discussions were transcribed verbatim and analysed by inductive qualitative content analysis. Common categories were identified to aid understanding. Forty undergraduate dental students from 4th and 5th years in Dublin Dental University Hospital participated in the study.

RESULTS

Student stress and confidence were multifactorial and broadly linked to specific domains: clinical procedure, academic education, clinical training, evaluation/grading, organization and equipment, vital pulp biomaterial and the patient. Most students expressed a preference for one-stage selective carious removal to soft dentine rather than potential pulp exposure in deep carious lesions, noting that although it helped to decrease their immediate stress, it also caused longer-term concern by leaving caries close to the pulp. Nevertheless, their confidence was affected by limited clinical experience of carrying out selective removal procedures in deep caries. A recurrent finding was students citing high levels of stress after pulp exposure. Feelings including anger, fear, embarrassment and denial were associated with pulp exposure during deep caries management. Generally, the students felt able to manage pulp capping procedures, but were less certain about partial pulpotomy, suggesting that although they are aware of its advantages, they were unsure about the appropriate volume of pulp tissue to remove. To reduce stress, students suggested that laboratory teaching should employ new 3-D printed solutions and clinics should establish clear consensus amongst supervising teachers about the best way to manage the exposed pulp.

CONCLUSIONS

Students lacked confidence as they neared the pulp and prefer selective caries removal techniques, which reduce the likelihood of pulp exposure. Students identified stressors and suggested improvements in several domains that would improve confidence. These ameliorations could lead to enhancements in student ability to perform these conservative techniques, and improve the provision of treatment in this area.

A review to identify key perspectives in PBL meta-analyses and reviews: trends, gaps and future research directions

In the past 50 years, the original McMaster PBL model has been implemented, experimented, revised, and modified, and is still evolving. Yet, the development of PBL is not a series of success stories, but rather a journey of experiments, failures and lessons learned. In this paper, we analyzed the meta-analyses and systematic reviews on PBL from 1992 to present as they provide a focused lens on the PBL research in the past 5 decades. We identified three major waves in the PBL research development, analyzed their impact on PBL research and practice, and offered suggestions of research gaps and future directions for the field. The first wave of PBL research (polarization: 1990-mid 2000) focused on answering the question "Does PBL work?" and the outcomes. The results were conflicting. The researchers took polarizing positions and debated over the merits of PBL throughout this wave. However, the contradictory results and the debates in fact pushed the researchers to look harder for new directions to solve the puzzle. These efforts resulted in the second wave (from outcomes to process: mid 2000-mid 2010) that focused on the question "How does PBL work?" The second wave of PBL research targeted at investigating the effects of implementation constituents, such as assessment formats or single versus curriculum wide implementations. The third wave (specialization: mid 2010 and onward) of PBL research focused on "How does PBL work in different specific contexts?" These research widened our perspectives by expanding our understanding of how PBL manifests itself in different contexts. Given the diversification of PBL and more hybrid PBL models, we suggest "Why does PBL with particular implementation characteristics for specific outcomes work or not work in the condition where it is implemented?" to be the question to answer in the next wave of PBL research.

Top-Cited Articles from Dental Education Journals, 2009 to 2018: A Bibliometric Analysis

The number of citations an article receives is an important indicator to quantify its influence in its field. The aim of this study was to identify and analyze the characteristics of the 50 top-cited articles addressing dental education published in two journals dedicated to dental education (European Journal of Dental Education and Journal of Dental Education). The Web of Science database was searched to retrieve the 50 most-cited articles from the two journals in December 2018. The top-cited articles were analyzed for journal of publication, number of citations, institution and country of origin, year of publication, study type, keywords, theme and subtheme, and international collaborations. The results showed the 50 top-cited articles were cited between 24 and 146 times each. The majority of these top-cited articles (n=34) were published in the Journal of Dental Education Half (n=25) of the articles were by authors in the U.S. The most common study types were surveys (n=26) and reviews (n=10). The main themes of these top-cited articles were curriculum and learner characteristics. This bibliometric analysis can serve as a reference for recognizing studies with the most impact in the scholarship of dental education.

Student engagement and higher order skill proficiency: a comparison of traditional didactic and renewed integrated active learning curricula

A large, multicampus, public medical school underwent curricular renewal, emphasizing a student-centered approach with 50% of all course contact time devoted to active learning. Determining the impact of active learning on student engagement and higher order skill (HOS) proficiency was the primary aim of this study. Following Institutional Review Board approval, two cohort groups of first-year medical students were enrolled. The first cohort ( n = 54) included students before curriculum reform in the legacy curriculum (LC). The second cohort ( n = 73) included students completing studies in the renewed curriculum (RC). Near the end of the first year of medical school, both cohorts completed a validated survey of student engagement, and a proctored problem-based assessment of HOS proficiency [Collegiate Learning Assessment (CLA+)]. Results indicated RC students perceived greater levels of engagement than LC (39.5+5.8 vs. 33.3+5.6), and greater reliance on HOS, including analysis, synthesis, and application. However, there were no significant differences between cohorts in proficiency of HOS when assessed by the CLA+ (LC = 1,878 ± 161 vs. RC = 1,900 ± 157). Additionally, poor correlation between engagement and HOS for both LC and RC indicated more engaged students do not necessarily possess greater HOS proficiency. Ceiling effect may explain results as medical students enter medical school as highly skilled learners with potentially little room for improvement. It will be informative to continue to track engagement and HOS of both cohort groups as they continue their medical studies.

Effectiveness of PBL methodology in a hybrid dentistry program to enhance students' knowledge and confidence. (a pilot study)

BACKGROUND

Knowledge and self-confidence are two critical determinants of future success of dental students. The present pilot study was conducted with an objective to simultaneously assess both knowledge and confidence gained by dental undergraduate students in the Head and Neck Anatomy course by employing didactic lecture-based and problem-based learning methods.

METHODS

A paper-based assessment tool comprising of 30 Multiple choice questions to assess knowledge, followed by a Likert's scale to assess students' confidence to answer the given knowledge question was designed. This tool was used in a cohort of first year dental students before the commencement of Head and Neck Anatomy course (Pre-course), immediately after the completion of Head and Neck Anatomy course (Post-course), and again in third year before the same cohort entered their clinical courses (Pre-clinics). The difference in students' knowledge and confidence through both pedagogies was evaluated by Paired 't' test. Pearson correlation analysis was done to determine the correlation between knowledge scores and self-reported confidence.

RESULTS

A statistically significant increase (p < 0.05) was noted in the mean knowledge and confidence scores in the post-course evaluation, through both didactic lecture-based and problem-based learning methods. On the other hand, a significant decrease (p < 0.05) in the mean knowledge and confidence scores of didactic lecture-based items in comparison to problem-based items was noted in the pre-clinics evaluation.. The post-course evaluation results yielded a Pearson correlation coefficient of r = 0.514, p = 0.002 for lecture-based items and r = 0.495, p = 0.003 for problem-based items, denoting a positive moderate correlation between the knowledge and confidence scores for both lecture-based and problem-based methods.

CONCLUSION

A significant improvement in both knowledge and self-reported confidence demonstrated at the end of Head and Neck Anatomy course proves both didactic lectures and problem-based learning methods to be equally effective in a hybrid dentistry program in the short term. However, the non-significant reduction in the pre-clinics knowledge and confidence scores among the PBL lessons proves it to be a potent learning tool for long term retention of knowledge, and sustainability of confidence.

Engagement and higher order skill proficiency of students completing a medical physiology course in three diverse learning environments

The primary aim of this study was to determine whether levels of student engagement, higher order skill proficiency, and knowledge acquisition demonstrated by medical students would differ when completing the same course in three diverse learning environments. Following Institutional Review Board approval, 56 first-year medical students, registered at the same medical school but attending class at three different campus centers, were enrolled in the study. All participants were completing a medical physiology course that utilized the same learning objectives but relied on different faculty incorporating diverse methodologies (percentage of class devoted to active learning strategies), course format (6-wk block vs. 17-wk semester), and student attendance. Students completed a validated survey of student engagement (SSE), a proctored online problem-based assessment of higher order skill proficiency [Collegiate Learning Assessment (CLA+); http://cae.org ], and the National Board of Medical Examiners (NBME) Physiology subject exam. In this limited sample, results indicate no significant differences between campus sites for any of the variables assessed. Levels of engagement were lower than expected compared with published values for graduate students. Higher order skill proficiency assessed by CLA+ was significantly higher than values reported for college seniors nationally. Surprisingly, SSE offered no prediction of performance on CLA+ or NBME, as there were no significant correlations between variables. These data indicate that, although first-year medical students may not perceive themselves as highly engaged, they are adept in using higher order skills and excel in meeting course learning objectives, regardless of learning environment.

Developing a Dental Curriculum for the 21st Century in a New Dental School in Saudi Arabia

The aims of this study were to develop, implement, and assess a contemporary dental curriculum that would be competitive internationally and take into consideration the specific needs of the community in a newly established all-female dental school in Saudi Arabia: Princess Nourah bint AbdulRahman University College of Dentistry (PNUCD). A six-step approach to curriculum development was used. Problem identification, general needs, and target needs were identified, and goals, objectives, and educational strategies were defined. The new curriculum emphasizes producing competent dentists focused on prevention and geared toward the needs of women and children. Leadership attributes, patient-centered care, and research are emphasized in the curriculum. Contemporary educational methods are used to implement the curriculum. In the assessment part of the study, evaluations of the curriculum by students, faculty, and external stakeholders (part-time instructors, program evaluators, and patients) have been mainly positive. Overall, PNUCD provided the opportunity to develop a curriculum that reflects the explosion of scientific knowledge, based on principles of modern educational theory in a unique cultural environment.

Development of a curriculum and training program in Woman Veterans Health for Internal Medical Residents

INTRODUCTION

Internal Medicine residents must develop competency as Primary Care Providers, but a gap exists in their curriculum and training with regard to women's reproductive health. With increasing need in VA due to new influx of women veterans it poses problems in recruitment of competent physicians trained in Women's health.

METHODS

An intensive, one-month women's reproductive health curriculum with hands on experience for Internal Medicine residents was provided. Curriculum was taught to the residents who rotated at the Women's Health Clinic for one month. Pre-test and post-test exams were administered. Increase in knowledge of residents in providing gender specific evaluations and management was objectively assessed by changes in post-test scores. Data were analyzed for statistically significant improvement in written tests scores.

RESULTS

Total of 47 Internal Medicine residents rotated through Women's Health Center during the evaluation period. All residents completed both pre-test and post-test exams. The average time to complete the pre-test was 20.5 ± 5.4 min and 19.5 ± 4.8 min for post-test. There was no correlation between the time to complete the pre-test exam and the post-test exam. The total score was significantly improved from 8.5 ± 1.6 to 13.2 ± 1.8 (p < 0.0001).

CONCLUSION

This study shows how to equip physicians in training with information on women's health that enables them to provide safe and gender appropriate care in primary care settings. This practice will reduce the need for frequent referrals for specialized care and thus provide cost saving for patient and health care on the whole.

Escola médica e Sistema Único de Saúde (SUS): criação do curso de medicina da Universidade Federal de São Carlos, SP, Brasil (UFSCar) sob perspectiva de docentes e estudantes

A Universidade Federal de São Carlos (UFSCar) implantou seu curso de Medicina em 2006, com currículo baseado em competências e aprendizado prático integrado ao SUS. O objetivo deste trabalho é apresentar uma pesquisa com docentes e graduandos da Primeira Turma da Medicina-UFSCar, realizada por meio da metodologia da História Oral de Vida. As narrativas indicam que o currículo favoreceu o desenvolvimento de competências como: capacidade de busca, pensamento crítico-reflexivo e autogerenciamento do aprendizado, apesar de relatos sobre deficiências em infraestrutura. A prática integrada ao SUS, especialmente nas Unidades de Saúde da Família, aprimorou as dimensões intelectivas, relacionais e afetivas do cuidado, favorecendo a autonomia profissional.

Bioinformatics Education in Pathology Training: Current Scope and Future Direction

Training anatomic and clinical pathology residents in the principles of bioinformatics is a challenging endeavor. Most residents receive little to no formal exposure to bioinformatics during medical education, and most of the pathology training is spent interpreting histopathology slides using light microscopy or focused on laboratory regulation, management, and interpretation of discrete laboratory data. At a minimum, residents should be familiar with data structure, data pipelines, data manipulation, and data regulations within clinical laboratories. Fellowship-level training should incorporate advanced principles unique to each subspecialty. Barriers to bioinformatics education include the clinical apprenticeship training model, ill-defined educational milestones, inadequate faculty expertise, and limited exposure during medical training. Online educational resources, case-based learning, and incorporation into molecular genomics education could serve as effective educational strategies. Overall, pathology bioinformatics training can be incorporated into pathology resident curricula, provided there is motivation to incorporate, institutional support, educational resources, and adequate faculty expertise.

Undergraduate Confidence When Undertaking Root Canal Treatment and Their Perception of the Quality of Their Endodontic Education

The General Dental Council expects graduating dentists to be competent at treating pulpal disease. Previous studies have found dental undergraduates to have low levels of confidence with respect to endodontic treatments. The aim of this study was to investigate the confidence of undergraduate dental students at the University of Bristol when performing root canal treatment, and to investigate their perception of the quality of their endodontic education. An anonymous questionnaire, based upon one used in a 2015 study at Cardiff University, was distributed to all (n = 204) undergraduate students in Years 3-5 at the University of Bristol. The results were analysed using the Statistical Package for the Social Sciences software (SPSS). There was a 59% (n = 120) response rate and a significant (p < 0.01) difference in confidence levels for root canal treatments (RCTs) completed between these students. All (100%) Year-5 students felt confident in completing anterior RCTs, and 91% felt confident in completing posterior RCTs. The majority (93%) of Year-4 students felt confident in completing anterior RCTs, and 77% felt confident in completing posterior RCTs. Over one-half (56%) of Year-3 students felt confident in anterior RCTs and 17% in posterior RCTs. With respect to the individual stages of RCT (access cavity, cleaning and shaping of root canal system, and obturation/filling), results showed that there was a significant difference (p < 0.01) in confidence levels between year groups. Many students thought the amount of time spent on endodontic teaching and the quality of teaching to be satisfactory. Improvements suggested for future endodontic teaching included higher numbers of staff supervision and additional endodontic practice on extracted teeth before seeing patients. There was a strong association between students' clinical experience and their levels of confidence when completing RCT. Increasing the amount of clinical experience of RCTs could enhance students' confidence further.

How effective the problem-based learning (PBL) in dental education. A critical review

The purpose of this critical review is to explore the research supporting the effectiveness of problem-based learning (PBL) as a teaching method in dental education. PBL was developed more than 40 years ago in reaction to the problems and limitations of traditional teaching approaches. Here, aspects of the PBL teaching approach are reviewed, and the reasons for the substantial effect of this approach on dental education are discussed. Evidence shows that students in PBL-based courses exhibit superior professional skills and effective learning compared with those instructed using traditional approaches.

Differential impact of student behaviours on group interaction and collaborative learning: medical students' and tutors' perspectives

BACKGROUND

Collaboration is of increasing importance in medical education and medical practice. Students' and tutors' perceptions about small group learning are valuable to inform the development of strategies to promote group dynamics and collaborative learning. This study investigated medical students' and tutors' views on competencies and behaviours which promote effective learning and interaction in small group settings.

METHODS

This study was conducted at UNSW Australia. Five focus group discussions were conducted with first and second year medical students and eight small group tutors were interviewed. Data were transcribed verbatim and thematic analysis was conducted.

RESULTS

Students and tutors identified a range of behaviours that influenced collaborative learning. The main themes that emerged included: respectfulness; dominance, strong opinions and openness; constructiveness of feedback; active listening and contribution; goal orientation; acceptance of roles and responsibilities; engagement and enthusiasm; preparedness; self- awareness and positive personal attributes. An important finding was that some of these student behaviours were found to have a differential impact on group interaction compared with collaborative learning. This information could be used to promote higher quality learning in small groups.

CONCLUSION

This study has identified medical students' and tutors' perceptions regarding interactional behaviours in small groups, as well as behaviours which lead to more effective learning in those settings. This information could be used to promote learning in small groups.

[Medical habilitation in German-speaking countries : Quantitative assessment of content and elaboration of habilitation guidelines]

BACKGROUND

Habilitation defines the qualification to conduct self-contained university teaching and is the key for access to a professorship at German, Austrian and Swiss universities. Despite all changes implemented in the European higher education systems during the Bologna process, it is the highest qualification level issued through the process of an university examination and remains the core concept of scientific careers in these countries. In the field of medicine, this applies not only to scientific staff at the universities but also to those medical doctors aiming at a clinical career track.

OBJECTIVES

To provide a quantitative analysis of the scientific, didactic, and procedural criteria for medical habilitation in German-speaking countries.

MATERIALS AND METHODS

Based on the guidelines of all 43 medical academic institutions, the criteria which candidates are required to fulfil prior to habilitation as well as formal requirements related to the habilitation procedure itself have been acquired and quantitatively analyzed.

RESULTS

Having evaluated all habilitation guidelines by means of 87 items, the quantitative analysis revealed significant differences in terms of number, kind and scale of criteria stated therein. Most habilitation guidelines scarcely define the capabilities applicants have to prove: concerning the scientific qualifications on types of publications for instance, no item was mentioned in more than half of all habilitation guidelines.

CONCLUSION

Based on this data analysis, the authors discuss the related literature and describe five main distinguishing areas of habilitation guidelines in terms of the set of the formal and procedural framework as well as the prequalification and postqualification criteria imposed on habilitation candidates. There are therefore substantial differences in the organization of the habilitation for medicine.

Evaluating differently tutored groups in problem-based learning in a German dental curriculum: a mixed methods study

BACKGROUND

It is still unclear to what extent the PBL tutor affects learning in PBL-sessions. This mixed-methods study (Part 1 and 2) evaluated the effects of facilitative (f) versus non-facilitative (nf) tutoring roles on knowledge-gain and group functioning in the field of endodontics.

METHODS

Part 1 was a quantitative assessment of tutor effectiveness within a prospective, experimental, single-blind, stratified, randomized, two-group intervention study. Participants attended PBL in the context of a hybrid curriculum. A validated questionnaire was used and knowledge assessments were conducted before and after the intervention. External observers rated tutor performance. Part 2 was a qualitative assessment of tutor effectiveness and consisted of semi-structured expert interviews with tutors and focus group discussions with students.

RESULTS

Part 1: f tutors obtained significantly higher scores than nf tutors with respect to learning motivation and tutor effectiveness (p ≤ 0.05). nf tuition resulted in a slightly larger knowledge gain (p = 0.08). External observers documented a significantly higher activity among facilitative tutors compared to non-facilitative tutors. Part 2: Tutors found the f role easier although this led to a less autonomous working climate. The students rated f tutoring as positive in all cases.

CONCLUSIONS

With respect to PBL-group performance, students felt that groups guided in a non-facilitative fashion exhibited a higher level of independence and autonomy, especially with increasing PBL experience. In addition, students reported that more preparation was necessary for sessions guided by a non-facilitative tutor. Tutors were able to modify their role and influence group processes in a controlled manner. Results are useful for future "Train-the-Teacher" sessions.

The confidence of undergraduate dental students when performing root canal treatment and their perception of the quality of endodontic education

AIM

This article aims to gain understanding into the perception of undergraduate dental students in terms of their confidence and competence at performing root canal treatment and their perception of the quality of endodontic education.

METHODS

An online questionnaire was distributed to all 3rd, 4th and 5th year dental students at Cardiff University via their academic e-mail addresses. The questionnaire utilised both scaled response and open questions to gain an insight into undergraduate opinion.

RESULTS

Out of a possible 208 students, 98 responses were obtained (response rate = 47%). Perception of competence and confidence were significantly greater amongst the more senior year groups (P < 0.01). However, 49% (n = 38) of participants did not feel competent performing root canal treatment on anterior, single-rooted teeth, whilst 74% (n = 70) did not feel competent performing root canal treatment on posterior, multirooted teeth. Free comments from participants indicated that this was due to a lack of clinical experience. Approximately, 80% of participants ranked education in endodontics at Cardiff University as ≤5 on a Likert scale (1 = inadequate to 10 = good), indicating that improvement was required. Improvements that were suggested by the students included the provision of further information within lectures, a broader range of lecturers, an increased number of shorter, more organised practical sessions, additional training equipment, greater supervision and online reference guides to root canal treatment.

CONCLUSION

Enhancing undergraduate education in endodontics is necessary to increase students' perception of their confidence and competence when performing root canal treatment.

Evidence for curricular and instructional design approaches in undergraduate medical education: An umbrella review

INTRODUCTION

An umbrella review compiles evidence from multiple reviews into a single accessible document. This umbrella review synthesizes evidence from systematic reviews on curricular and instructional design approaches in undergraduate medical education, focusing on learning outcomes.

METHODS

We conducted bibliographic database searches in Medline, EMBASE and ERIC from database inception to May 2013 inclusive, and digital keyword searches of leading medical education journals. We identified 18,470 abstracts; 467 underwent duplicate full-text scrutiny.

RESULTS

Thirty-six articles met all eligibility criteria. Articles were abstracted independently by three authors, using a modified Kirkpatrick model for evaluating learning outcomes. Evidence for the effectiveness of diverse educational approaches is reported.

DISCUSSION

This review maps out empirical knowledge on the efficacy of a broad range of educational approaches in medical education. Critical knowledge gaps, and lapses in methodological rigour, are discussed, providing valuable insight for future research. The findings call attention to the need for adopting evaluative strategies that explore how contextual variabilities and individual (teacher/learner) differences influence efficacy of educational interventions. Additionally, the results underscore that extant empirical evidence does not always provide unequivocal answers about what approaches are most effective. Educators should incorporate best available empirical knowledge with experiential and contextual knowledge.

A case-based, problem-based learning approach to prepare master of public health candidates for the complexities of global health

Global health is a dynamic, emerging, and interdisciplinary field. To address current and emerging global health challenges, we need a public health workforce with adaptable and collaborative problem-solving skills. In the 2013-2014 academic year, the Hubert Department of Global Health at the Rollins School of Public Health-Emory University launched an innovative required core course for its first-year Master of Public Health students in the global health track. The course uses a case-based, problem-based learning approach to develop global health competencies. Small teams of students propose solutions to these problems by identifying learning issues and critically analyzing and synthesizing new information. We describe the course structure and logistics used to apply this approach in the context of a large class and share lessons learned.

How was the intern year?: self and clinical assessment of four cohorts, from two medical curricula

BACKGROUND

Problem-based curricula have provoked controversy amongst educators and students regarding outcome in medical graduates, supporting the need for longitudinal evaluation of curriculum change. As part of a longitudinal evaluation program at the University of Adelaide, a mixed method approach was used to compare the graduate outcomes of two curriculum cohorts: traditional lecture-based 'old' and problem-based 'new' learning.

METHODS

Graduates were asked to self-assess preparedness for hospital practice and consent to a comparative analysis of their work-place based assessments from their intern year. Comparative data were extracted from 692 work-place based assessments for 124 doctors who graduated from the University of Adelaide Medical School between 2003 and 2006.

RESULTS

Self-assessment: Overall, graduates of the lecture-based curriculum rated the medical program significantly higher than graduates of the problem-based curriculum. However, there was no significant difference between the two curriculum cohorts with respect to their preparedness in 13 clinical skills. There were however, two areas where the cohorts rated their preparedness in the 13 broad practitioner competencies as significantly different: problem-based graduates rated themselves as better prepared in their 'awareness of legal and ethical issues' and the lecture-based graduates rated themselves better prepared in their 'understanding of disease processes'.Work-place based assessment: There were no significant differences between the two curriculum cohorts for 'Appropriate Level of Competence' and 'Overall Appraisal'. Of the 14 work-place based assessment skills assessed for competence, no significant difference was found between the cohorts.

CONCLUSIONS

The differences in the perceived preparedness for hospital practice of two curriculum cohorts do not reflect the work-place based assessments of their competence as interns. No significant difference was found between the two cohorts in relation to their knowledge and clinical skills. However results suggest a trend in 'communication with peers and colleagues in other disciplines' (χ2 (3, N = 596) =13.10, p = 0.056) that requires further exploration. In addition we have learned that student confidence in a new curriculum may impact on their self-perception of preparedness, while not affecting their actual competence.

Performance of speech-language pathology students in problem-based learning tutorials and in clinical practice

The purpose of the study was to identify if performance of speech-language pathology students in problem-based learning (PBL) tutorials could predict subsequent clinical performance evaluated through (a) a non-standardized, custom clinical evaluation form (HKU form) and (b) a standardized competency assessment for speech pathology developed in Australia (COMPASS®). Students' scores from PBL tutorial performance were correlated with scores in clinical placement on both the HKU form and the COMPASS. Significant correlations were found between students' PBL tutorial performance (reflective journals and participation in the tutorial process) and their clinical performance (treatment and interpersonal skills) on the HKU clinical evaluation form. Significant correlations were also found between (a) PBL tutorial performance (participation in the tutorial process) and their clinical performance (all generic and occupational competencies, and the overall score) on the COMPASS, (b) PBL tutorial performance (reading forms) and two occupational competencies on the COMPASS, (c) PBL tutorial performance (reflective journals) and four occupational competencies and the overall score on the COMPASS. The results highlighted the need for validating the assessment for the learning process in PBL tutorials with empirical evidence and the advantage of assessing clinical performance through COMPASS in Hong Kong. Tutors, clinical supervisors and students should be given clear behavioral descriptors for expected performance in PBL tutorials and clinical practice at different year levels.

Integrating a primary oral health care approach in the dental curriculum: a Tanzanian experience

This paper is based on a conference presentation made during the inauguration of the Faculty of Dentistry, Kuwait University, as a World Health Organization Collaborating Centre for Primary Oral Health Care (POHC) on November 27-28, 2012. The aim of this paper is to review how the POHC approach has been integrated into the dental curriculum, sharing the Tanzanian experience as a case presentation from a developing country. The burden of oral diseases worldwide is high, and the current oral health workforce is inadequate to meet the challenges. Curative oral health care is very costly and not accessible to the poor and minorities. To tackle the problem, the POHC approach rooted in primary health care that emphasizes equity, community involvement, prevention, appropriate technology and a multi-sectorial approach was developed and has been operating for more than 3 decades now. Execution of a comprehensive POHC requires a trained oral health workforce mix with essential competencies. For this case study, a literature search was done using the search engines subscribed to by the library of Muhimbili University of Health and Allied Sciences, including PubMed, Cochrane, ScienceDirect and Scopus, Wiley-Blackwell Interscience, Sage and the Health InterNetwork Access to Research Initiative (HINARI) that gives access to Scirus and Google Scholar. Challenges are discussed with an emphasis more on addressing the common risk factors and determinants of oral health. Integration of the POHC approach in the dental curriculum for training a competent workforce is crucial in attaining better oral health. Resources are still a major challenge, and the impact of the POHC approach in the curriculum is yet to be evaluated.

FACTORS INFLUENCING VICARIOUS LEARNING MECHANISM EFFECTIVENESS WITHIN ORGANIZATIONS

As organizations become larger it becomes increasingly difficult to share lessons-learned across their disconnected units allowing individuals to learn vicariously from each other's experiences. This lesson-learned information is often unsolicited by the recipient group or individual and required an individual or group to react to the information to yield benefits for the organization. Data was collected using 39 interviews and 582 survey responses that proved the effects of information usefulness, related human intermediary activities, and an individual's perceived discretion have on the review and subsequent adoption of unsolicited lessons-learned information.

Comparison of chiropractic student scores before and after utilizing active learning techniques in a classroom setting

Objective : We report the differences in final examination scores achieved by students at the culmination of two different teaching strategies in an introductory skills course. Methods : Multiple choice examination scores from six consecutive academic calendar sessions over 18 months (n = 503) were compared. Two groups were used: Cohort A (n = 290) represented students who were enrolled in the course 3 consecutive academic sessions before an instructional change and Cohort B (n = 213) included students who were enrolled in 3 consecutive academic sessions following the instructional change, which included a more active learning format. Statistical analyses used were 2-tailed independent t-test, one-way ANOVA, Tukey's honestly significant difference (HSD), and effect size. Results : The 2-tailed independent t-test revealed a significant difference between the two groups (t = -3.71, p < .001; 95% confidence interval [CI] 1.29-4.20). Significant difference was found in the highest performing subgroup compared to the lowest performing subgroup in Cohort A (F = 3.343, p = .037). For Cohort A subgroups 1 and 2, Tukey's HSD was p < .028. In Cohort B, no difference was found among subgroups (F = 1.912, p = .150, HSD p > .105). Conclusion : Compared to previous versions of the same course taught by the same instructor, the students in the new course design performed better, suggesting that using active learning techniques helps improve student achievement.

Teaching at primary healthcare services within the Brazilian national health system (SUS) in Brazilian healthcare professionals' training

The aim of this study was to analyze the role of teaching at primary healthcare services within the Brazilian National Health System (SUS) in dentists' training, at a public university in the south of Brazil. A qualitative methodological approach (case study) was used. Interviews were conducted with 12 dentistry students, six dentists who were preceptors working in public primary healthcare services and three teachers connected with this curricular training. Our findings showed that the curricular training in SUS primary healthcare services had an impact on the dentists' education through establishment of bonds, autonomy in problem-solving and multiprofessional teamwork. It was seen that they learned about how healthcare services function, about healthcare and about development of cultural competence. There is a need to maintain constant questioning regarding these practices, and to ensure the presence of infrastructure and qualified professionals for teaching at these services.

Comparing the long-term retention of a physiology course for medical students with the traditional and problem-based learning

The rapid improvements in medical sciences and the ever-increasing related data, however, require novel methods of instruction. One such method, which has been given less than due attention in Iran, is problem-based learning (PBL). In this study, we aimed to evaluate the impact of study skills and the PBL methods on short and long-term retention of information provided for medical students in the course of respiratory physiology and compare it with traditional learning method. In this study, 39 medical students from Medical School of Kerman University of Medical Sciences, Kerman, Iran (2006-2010) were enrolled in the study and allocated randomly in three equal groups (13 in each group). All groups underwent a pre-test to be assessed for their basic information regarding respiratory physiology. Two groups were instructed using the traditional method, and one group used PBL. Among the two groups of the traditional method, one was instructed about study skills and the other was not. Once the PBL group took the study skill workshop, they were aided by tutors for their education. In the final term test, those students who had learned study skills and were instructed with the traditional method scored higher compared to other groups (p < 0.05). However, in the 1 year (p < 0.05) and 4 year (p < 0.01) interval examinations, the PBL group achieved significantly higher scores. Despite the fact that PBL had no positive effect on the final term exam of our students, it yielded a more profound and retained understanding of the subject course. Moreover, considering the positive effect of study skills on long-term student scores, we recommend students to receive instructions regarding the appropriate study skills when initiated into universities.

How much structuring is beneficial with regard to examination scores? A prospective study of three forms of active learning

Many studies have demonstrated a superiority of active learning forms compared with traditional lecture. However, there is still debate as to what degree structuring is necessary with regard to high exam outcomes. Seventy-five students from a premedical school were randomly attributed to an active lecture group, a cooperative group, or a collaborative learning group. The active lecture group received lectures with questions to resolve at the end of the lecture. At the same time, the cooperative group and the collaborative group had to work on a problem and prepare presentations for their answers. The collaborative group worked in a mostly self-directed manner; the cooperative group had to follow a time schedule. For the additional work of preparing the poster presentation, the collaborative and cooperative groups were allowed 50% more working time. In part 1, all groups worked on the citric acid cycle, and in part 2, all groups worked on molecular genetics. Collaborative groups had to work on tasks and prepare presentations for their answers. At the end of each part, all three groups were subjected to the same exam. Additionally, in the collaborative and cooperative groups, the presentations were marked. All evaluations were performed by two independent examiners. Exam results of the active lecture groups were highest. Results of the cooperative group were nonsignificantly lower than the active lecture group and significantly higher than the collaborative group. The presentation quality was nonsignificantly higher in the collaborative group compared with the cooperative group. This study shows that active lecturing produced the highest exam results, which significantly differed from collaborative learning results. The additional elaboration in the cooperative and collaborative learning setting yielded the high presentation quality but apparently could not contribute further to exam scores. Cooperative learning seems to be a good compromise if high exam and presentation scores are expected.

Dynamic Systems (Complexity) theory as a new conceptual model for researching PBL in dental education

Although problem-based learning (PBL) was introduced into dental education some 20 years ago, there have been relatively few well-designed studies carried out to clarify whether, how or why it works in a dental context. This paper introduces the Dynamic Systems (Complexity) theory as a new and potentially productive theoretical framework for researching PBL in dental education. This framework emphasises the importance of emergent self-organisation, perception and brain plasticity in learning. In this paper, a brief overview of the history of PBL in dentistry is presented and then the fundamentals of a Dynamic Systems Approach (DSA) are explained, drawing on two recently published papers advocating the DSA in medical education and teacher education. We focus on three key points related to this new approach: emergent self-organisation rather than simple construction of knowledge; the notion that perception drives the learning process; and the brain as the substrate of all learning. The paper also suggests how the DSA can help us move forward, both in terms of the future application of PBL in dental education and also in relation to posing new types of research questions.

Is the Sun Setting on Lecture-based Education?

Lecture-based instructional models have been the mainstay of education for centuries. They excel primarily at delivering information from the one to the many. Educators refer to this model as “the sage on the stage”. Clearly there are educators who relish this role and are strongly opposed to moving away from it. Yet, educational research and new innovative technologies are suggesting that lecture-based classes may no longer be the most effective teaching method for many situations, especially clinical practice.

Transfer of take-home messages in graduate ICU education

PURPOSE

Teaching by lecture (lecture format) is widely used at congresses and in medical educational programmes. The process involves the transfer of take-home messages. The aim of this study was to assess the number of take-home messages identified by postgraduate critical care junior doctors (juniors) during lectures.

METHODS

This was a prospective observational study of 13 lectures. Lecturers were not informed in advance of the study. At the end of the lecture (30 or 50 min), the lecturer (senior doctor) and juniors listed the three main take-home messages on a form. Subjective elements of the juniors' appraisal (quality of the presentation, explanation of the topic's relevance, enthusiasm of the lecturer, background, case-based, delivery and personality, comprehensibility, practical applicability of information given, prioritization, presence of raw data, references, overall satisfaction) and objective elements (length of lecture, number of take-home messages written on the slides) of the lectures were recorded. Successful knowledge transfer was assessed by matching lecturers' and juniors' take-home messages.

RESULTS

In total, 367 forms completed by 367 juniors were analysed. A match equal to 3 (highest match), 2, 1 or 0 was observed in 3.8, 26.7, 48.2 and 21.2% of the forms, respectively. No single subjective or objective element of the lecture was associated with the number of identified take-home messages.

CONCLUSIONS

Two-thirds of critical care junior doctors identified at best only one of the three main take-home messages of a lecture, suggesting that knowledge transfer is poor during passive format learning. These results suggest that there is a need to develop strategies to improve the performance of lecture-based learning.