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Choi JJ, Gribben J, Lin M, Abramson EL, Aizer J. Using an experiential learning model to teach clinical reasoning theory and cognitive bias: an evaluation of a first-year medical student curriculum. MEDICAL EDUCATION ONLINE 2023; 28:2153782. [PMID: 36454201 PMCID: PMC9718553 DOI: 10.1080/10872981.2022.2153782] [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: 04/28/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Most medical students entering clerkships have limited understanding of clinical reasoning concepts. The value of teaching theories of clinical reasoning and cognitive biases to first-year medical students is unknown. This study aimed to evaluate the value of explicitly teaching clinical reasoning theory and cognitive bias to first-year medical students. METHODS Using Kolb's experiential learning model, we introduced dual process theory, script theory, and cognitive biases in teaching clinical reasoning to first-year medical students at an academic medical center in New York City between January and June 2020. Due to the COVID-19 pandemic, instruction was transitioned to a distance learning format in March 2020. The curriculum included a series of written clinical reasoning examinations with facilitated small group discussions. Written self-assessments prompted each student to reflect on the experience, draw conclusions about their clinical reasoning, and plan for future encounters involving clinical reasoning. We evaluated the value of the curriculum using mixed-methods to analyze faculty assessments, student self-assessment questionnaires, and an end-of-curriculum anonymous questionnaire eliciting student feedback. RESULTS Among 318 total examinations of 106 students, 254 (80%) had a complete problem representation, while 199 (63%) of problem representations were considered concise. The most common cognitive biases described by students in their clinical reasoning were anchoring bias, availability bias, and premature closure. Four major themes emerged as valuable outcomes of the CREs as identified by students: (1) synthesis of medical knowledge; (2) enhanced ability to generate differential diagnoses; (3) development of self-efficacy related to clinical reasoning; (4) raised awareness of personal cognitive biases. CONCLUSIONS We found that explicitly teaching clinical reasoning theory and cognitive biases using an experiential learning model provides first-year medical students with valuable opportunities for developing knowledge, skills, and self-efficacy related to clinical reasoning.
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Affiliation(s)
- Justin J. Choi
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jeanie Gribben
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Myriam Lin
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Erika L. Abramson
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Juliet Aizer
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
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Chan JEZ, Hakendorf P, Thomas JS. Key aspects of teaching that affect perceived preparedness of medical students for transition to work: insights from the COVID-19 pandemic. Intern Med J 2023; 53:1321-1331. [PMID: 37255312 DOI: 10.1111/imj.16146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The self-perceived preparedness of medical students to transition into practising junior doctors has implications for patient safety, graduate well-being and development of professional identity. AIMS To examine the impact of changes to final-year education and placements and determine key elements that contribute to self-perceived preparedness for transition to work. METHODS An online survey among final-year medical students at one Australian medical school in 2020 (the cohort most affected by the coronarvirus disease 2019 [COVID-19] pandemic), exploring overall self-perceived preparedness and specific competencies, including questions in previous Australian Medical Council/Medical Board of Australia annual national surveys. Quantitative and qualitative content analyses were performed. RESULTS Thirty-three percent of eligible participants completed the survey. There was a significant decline in overall self-perceived preparedness among participants (mean preparedness, 3.55 ± 0.88) compared with 2019 graduates from the same medical school (mean preparedness, 4.28 ± 0.64, P < 0.001) and the national average (mean preparedness, 3.81 ± 0.93, P = 0.04). There was a decline in self-perceived preparedness for all specific competencies, with complex competencies more greatly affected. Qualitative content analysis of free text responses identified limitations of an online compared with a face-to-face formal education program and specific aspects of placements, which contribute to perceived preparedness. CONCLUSION The current study highlights key aspects of clinical placements and formal teaching programs that contribute to perceptions of preparedness for transition to clinical practice. Relevant experiential learning in the clinical setting, opportunities for deliberate practice of necessary skills (in simulation and the clinical setting) and reflective opportunities from formal teaching programs contribute to perceived preparedness and are important elements to be included in the final phase of any medical program.
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Affiliation(s)
- Joel Ern Zher Chan
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Paul Hakendorf
- Clinical Epidemiology Services, Flinders Medical Centre, Bedford Park, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Josephine Suzanne Thomas
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
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Bosch J, Ludwig C, Fluch-Niebuhr J, Stoevesandt D. Empowerment for the Digital Transformation: Results of a Structured Blended-Learning On-the-Job Training for Practicing Physicians in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12991. [PMID: 36293572 PMCID: PMC9603236 DOI: 10.3390/ijerph192012991] [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: 09/01/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Practicing physicians have not been in the focus of structured qualifications in basic digital competences so far. However, they are the current gatekeepers to implement digital technologies and need empowerment to proactively take part in the ongoing digital transformation process. The present study investigates if a structured blended-learning training for practicing physicians in Germany enhances both physicians' knowledge about central aspects of the digital transformation (including awareness of personal possibilities to act) and their attitudes towards a more digitally empowered mindset. (2) Methods: Participants (n = 32) self-assessed their knowledge (19 items, 10-point Likert-scale) and attitudes (6 items, 5-point Likert-scale) towards the digital transformation at the beginning and at the end of the training. MANCOVAs were conducted. (3) Results: Participants reported an increase in every knowledge domain, representing large effects (Hedges' g 1.06 to 2.82). Attitudes were partly shifted towards a more empowered mindset with decreased insecurity towards technological, legal, and ethical aspects of the digital transformation (Hedges' g -0.82 to -1.40). However, preparedness for the digital transformation remained low. (4) Conclusions: Generally, the hypotheses were confirmed. The presented on-the-job training had the desired effects on practicing physicians' knowledge and attitudes. Nevertheless, additional empowerment and support are essential.
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Affiliation(s)
- Josefin Bosch
- Dorothea Erxleben Learning Center, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Christiane Ludwig
- Dorothea Erxleben Learning Center, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
- Department for Internal Medicine, University Medicine Halle, 06120 Halle (Saale), Germany
| | | | - Dietrich Stoevesandt
- Dorothea Erxleben Learning Center, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
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Gottschalk M, Albert C, Werwick K, Spura A, Braun-Dullaeus RC, Stieger P. Students' perception and learning experience in the first medical clerkship. BMC MEDICAL EDUCATION 2022; 22:694. [PMID: 36167525 PMCID: PMC9513910 DOI: 10.1186/s12909-022-03754-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/07/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND The German clerkship ("Famulatur") is the first phase in medical education, in which students learn from a physician's perspective. According to the German Licensing Regulations for Physicians, students shall "familiarise" with providing care. However, specific learning objectives for the clerkship are not defined, although the acquisition of different competencies is implicitly demanded. Therefore, an additional understanding of the clerkship students' learning experience is needed. The goal of this study is to explore the student's learning perspective and experiences in the clerkship. METHODS Twelve guideline-based interviews were conducted with third year medical students. All participants completed their first clerkship. A qualitative content analysis was performed. The inductively identified categories were transferred into a quantitative questionnaire using a 5-point Likert-scale to explore their relevance in a validation cohort. The questionnaire was completed by 222 clinical students of the Otto-von-Guericke-Universität Magdeburg. RESULTS The qualitative analysis led to 26 individual items assigned to 4 main categories that describe the clerkship experience: 1) "coping with insecurities", 2) "the clerkship as a social arrangement", 3) "the clerkship as a learning opportunity" and 4) "the clerkship as a teaching opportunity". In the quantitative validation cohort, category one yielded a well-balanced result (median 3 = "neither agree nor disagree"; IQR 2-4), items addressed in categories 2-4 were generally supported by the students, predominantly selecting "strongly agree" or "agree" (Median 2; IQR 1-2 for each category). Students rated the role of the clinical team as especially important for their learning success and feared exclusion or negative reactions. CONCLUSIONS The medical clerkship provides an institutional, professional, and social framework, in which students are learning. Insecurities arose from curricular inconsistencies, a high dependency on the clinical team as well as the absence of specific learning objectives. Therefore, a better curricular integration regarding the semester structure and the learning objectives of the German clerkship is needed.
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Affiliation(s)
- Marc Gottschalk
- University Medicine Magdeburg, Center for Internal Medicine, University Clinic for Cardiology and Angiology, Leipziger Str. 44, D-, 39120 Magdeburg, Germany
| | - Christian Albert
- University Medicine Magdeburg, Center for Internal Medicine, University Clinic for Cardiology and Angiology, Leipziger Str. 44, D-, 39120 Magdeburg, Germany
- Diaverum Renal Services, MVZ, Potsdam, Germany
| | - Katrin Werwick
- Student Affairs, Medical Faculty, Magdeburg University, Magdeburg, Germany
| | - Anke Spura
- Federal Centre for Health Education, Cologne, Germany
| | - Ruediger C. Braun-Dullaeus
- University Medicine Magdeburg, Center for Internal Medicine, University Clinic for Cardiology and Angiology, Leipziger Str. 44, D-, 39120 Magdeburg, Germany
| | - Philipp Stieger
- University Medicine Magdeburg, Center for Internal Medicine, University Clinic for Cardiology and Angiology, Leipziger Str. 44, D-, 39120 Magdeburg, Germany
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Maria Francis Y, Sankaran PK, Kirthika CP, Karunakaran B, Sathish Kumar S, Karthikeyan D, Krishnan M, Babu S. Views on virtual education during the COVID-19 pandemic among medical and paramedical students in India. Bioinformation 2022; 18:518-524. [PMID: 37168794 PMCID: PMC10165041 DOI: 10.6026/97320630018518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
The COVID-19 pandemic has made the educational institutions to implement the mandatory virtual learning in medical education. It is undeniable that electronic gadget aided learning have a significant role to play during a pandemic. Both faculty and students are getting accustomed to this 'New Normalcy'. Therefore, it is of interest to determine the effectiveness and perception of virtual teaching and learning during the COVID 19 pandemic. A cross-sectional study was conducted in which 336 medical and 336 paramedical students of both the genders with age group of 17 - 21 years participated. The data obtained were analyzed using the SPSS software. The shift from class room teaching to virtual learning has led to many health issues among students such as eye strain, anxiety, depression, musculoskeletal problems and obesity. The students also had inadequate time to interact with faculties. Data shows that virtual learning an alternative mode to traditional method during a pandemic.
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Affiliation(s)
- Yuvaraj Maria Francis
- Department of Anatomy, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai- 602 105, India
| | - PK Sankaran
- Department of Anatomy, All India Institute of Medical Sciences, Mangalagiri -52008, Andhra Pradesh, India
| | - CP Kirthika
- Department of Anatomy, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai : 6000116, India
| | - Balaji Karunakaran
- Department of Anatomy, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai- 602 105, India
| | - S Sathish Kumar
- Department of Community Medicine, Vinayaka Missions Medical College and Hospital, Karaikal, Pondicherry, India
| | - D Karthikeyan
- Department of Microbiology, Vinayaka Missions Medical College and Hospital, Deemed university, Karaikal, Pondicherry, India
| | - Madhan Krishnan
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, chengalpattu- 603103 India
| | - Shyamaladevi Babu
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, chengalpattu- 603103 India
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O'Connor E, Doyle E. A Scoping Review of Assessment Methods Following Undergraduate Clinical Placements in Anesthesia and Intensive Care Medicine. Front Med (Lausanne) 2022; 9:871515. [PMID: 35449804 PMCID: PMC9016165 DOI: 10.3389/fmed.2022.871515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Anesthesia and intensive care medicine are relatively new undergraduate medical placements. Both present unique learning opportunities and educational challenges to trainers and medical students. In the context of ongoing advances in medical education assessment and the importance of robust assessment methods, our scoping review sought to describe current research around medical student assessment after anesthesia and intensive care placements. Methods Following Levac's 6 step scoping review guide, we searched PubMed, EMBASE, EBSCO, SCOPUS, and Web of Science from 1980 to August 2021, including English-language original articles describing assessment after undergraduate medical placements in anesthesia and intensive care medicine. Results were reported in accordance with PRISMA scoping review guidelines. Results Nineteen articles published between 1983 and 2021 were selected for detailed review, with a mean of 119 participants and a median placement duration of 4 weeks. The most common assessment tools used were multiple-choice questions (7 studies), written assessment (6 studies) and simulation (6 studies). Seven studies used more than one assessment tool. All pre-/post-test studies showed an improvement in learning outcomes following clinical placements. No studies used workplace-based assessments or entrustable professional activities. One study included an account of theoretical considerations in study design. Discussion A diverse range of evidence-based assessment tools have been used in undergraduate medical assessment after anesthesia and intensive care placements. There is little evidence that recent developments in workplace assessment, entrustable activities and programmatic assessment have translated to undergraduate anesthesia or intensive care practice. This represents an area for further research as well as for curricular and assessment developments.
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Affiliation(s)
- Enda O'Connor
- Department of Anesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College, Dublin, Ireland
| | - Evin Doyle
- Department of Anesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College, Dublin, Ireland
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Malau-Aduli BS, Jones K, Alele F, Adu MD, Drovandi A, Knott G, Young L, Jo C. Readiness to enter the workforce: perceptions of health professions students at a regional Australian university. BMC MEDICAL EDUCATION 2022; 22:89. [PMID: 35139831 PMCID: PMC8827198 DOI: 10.1186/s12909-022-03120-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Perceived readiness for practice can help mitigate the stress and uncertainty associated with transitioning from university into the workforce. This study aimed to identify factors influencing the readiness for clinical practice among final-year medical, dental, and pharmacy students at an Australian regional university. METHODS The study utilised a sequential explanatory mixed-methods approach with surveys administered for the quantitative phase and interviews/focus groups for the qualitative phase. Descriptive statistics and inductive thematic analysis were utilised for the quantitative and qualitative data, respectively. Triangulation of findings from both phases facilitated in-depth understanding of the factors that influenced participants' self-perceived readiness for clinical practice. RESULTS From the three disciplines, 132 students completed the survey and 14 participated in the focus groups and interviews. Students felt most prepared in their patient-centred capabilities, core skills, and advanced consultation skills, and least prepared in their system-related capabilities and clinical care skills. Themes identified as essential enablers and confidence builders in relation to workforce readiness in all three disciplines were: gained knowledge and skills, value of clinical placement experiences, support from peers, family and staff. However, students felt their work-readiness was impaired by heavy academic workloads and poor knowledge of health care systems, which affected skills development. Participants suggested additional support in health care system and clinical governance, mental healthcare, and induction to placement sites to further improve their work readiness. CONCLUSIONS The findings of this study suggest that improving work-readiness of healthcare students requires alignment of learning needs to real-world practice opportunities, ensuring support systems are appropriate, and early familiarisation with the healthcare system.
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Affiliation(s)
- Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, QLD 4811, Townsville, Queensland, Australia.
| | - Karina Jones
- College of Medicine and Dentistry, James Cook University, QLD 4811, Townsville, Queensland, Australia
| | - Faith Alele
- College of Medicine and Dentistry, James Cook University, QLD 4811, Townsville, Queensland, Australia
| | - Mary D Adu
- College of Medicine and Dentistry, James Cook University, QLD 4811, Townsville, Queensland, Australia
| | - Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, QLD 4811, Townsville, Queensland, Australia
| | - Gillian Knott
- College of Medicine and Dentistry, James Cook University, QLD 4811, Townsville, Queensland, Australia
| | - Louise Young
- College of Medicine and Dentistry, James Cook University, QLD 4811, Townsville, Queensland, Australia
| | - Clara Jo
- College of Medicine and Dentistry, James Cook University, QLD 4811, Townsville, Queensland, Australia
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Wilkinson C, Finn G, Crampton P. Responsibility with a Safety Net: Exploring the Medical Student to Junior Doctor Transition During COVID-19. MEDICAL SCIENCE EDUCATOR 2022; 32:121-129. [PMID: 34873496 PMCID: PMC8635475 DOI: 10.1007/s40670-021-01476-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The Foundation Interim Year-one (FiY1) Programme was part of a UK strategy to increase the medical workforce in response to the COVID-19 pandemic. However, the strategy was introduced urgently without evidence. We sought to explore the transition experience of medical student to FiY1 to foundation doctor, with a view to inform future undergraduate education. METHODS In this hermeneutic phenomenology study, semi-structured individual interviews were completed with nine foundation doctors who had experience of an FiY1 placement. A template analysis approach was taken, and themes reported. RESULTS Participants reported that FiY1 tended to offer a positive experience of transition as a stepping stone to becoming a foundation doctor. Having a degree of clinical responsibility including the right to prescribe medication with supervision was highly valued, as was feeling a core member of the healthcare team. Participants perceived that FiY1 made them more prepared for the foundation transition, and more resilient to the challenges they faced during their first foundation job. DISCUSSION The FiY1 fostered many opportunities for junior doctors to bridge the transition to foundation doctor. Aspects of the FiY1 programme, such as early licencing and increased team membership, should be considered for final-year students in the future.
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Affiliation(s)
- Chris Wilkinson
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, William Leech Building, Newcastle upon Tyne, NE2 4HH UK
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Gabrielle Finn
- Health Professions Education Unit, Hull York Medical School, York, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Paul Crampton
- Health Professions Education Unit, Hull York Medical School, York, UK
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Haque M, Godman B, Chowdhury K, Etando A, Kumar S, Lugova H, Shahwan M, Škrbic R, Jairoun A. The global impact of the COVID-19 pandemic on the education of healthcare professionals, especially in low- and middle-income countries. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_60_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Medical student perceptions of assessment systems, subjectivity, and variability on introductory dermatology clerkships. Int J Womens Dermatol 2021; 7:323-330. [PMID: 34222591 PMCID: PMC8243165 DOI: 10.1016/j.ijwd.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background Elective introductory clerkships in dermatology serve a critical function in providing formative experiences to medical students interested in the field. Although dermatology clerkships play a pivotal role in students’ career choices and residency preparation, the assessment systems used to evaluate students on these clerkships are widely different and likely affect student experiences. Objective This study aimed to explore the relationship between dermatology clerkship assessment systems and student experiences through interviews with students about their clerkship reflections and perceptions of assessment. Methods The authors contacted clerkship directors via the Association of Professors of Dermatology mailing list and invited them to provide a description of the assessment system at their institution. The authors, via contacted clerkship directors, then invited students who had completed an introductory dermatology clerkship in between 2018 and 2019 to provide a description of the assessment system at their institution and to participate in a qualitative interview about their experiences with assessment systems. The authors then iteratively synthesized interview transcripts using phenomenological analysis, in which a templated approach was used to achieve comprehensive thematic categorization. Results Prior to clerkship onset, students expressed a limited understanding of their clinical role and the assessment system. During the clerkship, students endorsed variable expectations across preceptors, limited feedback experiences, and pressures to perform for evaluators. After their clerkship, students continued to perceive assessment systems as nontransparent, subjective, and preordained. Conclusion Medical students perceived assessment systems on introductory dermatology clerkships to be unclear and arbitrary. Encouragingly, students also viewed these challenges in assessment as malleable, identifying several opportunities for educational reform in dermatology clerkships.
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Embedding Ethics Education in Clinical Clerkships by Identifying Clinical Ethics Competencies: The Vanderbilt Experience. HEC Forum 2020; 32:163-174. [PMID: 32307620 DOI: 10.1007/s10730-020-09410-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The clinical clerkships in medical school are the first formal opportunity for trainees to apply bioethics concepts to clinical encounters. These clerkships are also typically trainees' first sustained exposure to the "reality" of working in clinical teams and the full force of the challenges and ethical tensions of clinical care. We have developed a specialized, embedded ethics curriculum for Vanderbilt University medical students during their second (clerkship) year to address the unique experience of trainees' first exposure to clinical care. Our embedded curriculum is centered around core "ethics competencies" specific to the clerkship: for Medicine, advanced planning and end-of-life discussions; for Surgery, informed consent; for Pediatrics, the patient-family-provider triad; for Obstetrics and Gynecology, women's autonomy, unborn child's interests, and partner's rights; and for Neurology/Psychiatry, decision-making capacity. In this paper, we present the rationale for these competencies, how we integrated them into the clerkships, and how we assessed these competencies. We also review the additional ethical issues that have been identified by rotating students in each clerkship and discuss our strategies for continued evolution of our ethics curriculum.
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Holzhausen Y, Maaz A, Roa-Romero Y, Peters H. What can we expect from medical graduates? Empirical survey on the performance of Core EPAs in the first days of residency. BMC MEDICAL EDUCATION 2020; 20:452. [PMID: 33228704 PMCID: PMC7685603 DOI: 10.1186/s12909-020-02376-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/10/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Core Entrustable Professional Activities (EPAs) have been defined to specify the performance expectations for entering residents worldwide. The content of these EPAs was elaborated and validated primarily via medical expert consent approaches. The present study aims to collect empirical information on the actual task performance and supervision level of entering residents as a complementary methodological approach to enhance the content validity of a set of institutional EPAs. METHODS In the summers of 2017 and 2018, Charité medical graduates (n = 720) received a post-graduation survey by mail. The questionnaire covered the performance of Core EPAs, Core procedures and more advanced EPAs. Graduates were asked how frequently they had performed the respective EPAs since the start of residency and under what level of supervision. We expected the large majority of graduates (> 75%) to have performed the Core EPAs and procedures under at least indirect supervision. RESULTS In total, 215 graduates (30%) returned the questionnaire, and 131 (18%) surveys could be included in the data analysis. The majority of participants were female (63%) and worked in hospitals (50%) or in university medical centres (30%) across various medical disciplines. Among the Core EPAs, 10 out of 11 tasks had been performed by more than 75% of graduates since the start of residency, 9 under indirect supervision. Regarding the Core procedures, only 3 out of 13 procedures had been performed by the large majority of graduates under indirect supervision, and 10 procedures had not been carried out by at least one-third of participants. Among the 5 advanced EPAs, none of 5 had been performed by more than 75% of the participants since the start of residency, and 4 had been carried out by 50% under indirect supervision. CONCLUSIONS The results of this study largely and complementarily confirm the validity of the defined Core EPAs representing realistic expectations for entry into residence at our institution. The low actual performance rate of Core procedures serves to stimulate an institutional discussion on their adjustment to better match the workplace reality.
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Affiliation(s)
- Ylva Holzhausen
- Dieter Scheffner Centre for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Asja Maaz
- Dieter Scheffner Centre for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yadira Roa-Romero
- Department of Quality Management (QM) Teaching and Learning, Dean’s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Centre for Medical Education and Educational Research, Dean’s Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Hitzblech T, Maaz A, Rollinger T, Ludwig S, Dettmer S, Wurl W, Roa-Romero Y, Raspe R, Petzold M, Breckwoldt J, Peters H. The modular curriculum of medicine at the Charité Berlin - a project report based on an across-semester student evaluation. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc54. [PMID: 31815164 PMCID: PMC6883251 DOI: 10.3205/zma001262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/07/2019] [Accepted: 07/02/2019] [Indexed: 05/19/2023]
Abstract
Aim: The introduction of a reform clause into the German licensing laws for medical doctors has enabled German faculties to pilot alternative designs for medical degree programmes. The aim of this project report is to outline the curricular features of the modular curriculum of medicine (MCM) at the Charité and to assess the results of its implementation based on a student evaluation across semesters. Project outline: The MCM was planned and implemented in a competency- and outcome-based manner from 2010-2016 in a faculty-wide process. The curriculum is characterised by a modular structure, longitudinal teaching formats and the integration of basic and clinical science. In the winter semester 2017, evaluations by students in semesters 1-10 were carried out. The results were analysed descriptively, and the coverage of overarching learning outcomes was compared to the results of a survey carried out amongst students on the traditional regular curriculum of medicine track in 2016. Results: A total of 1,047 students participated in the across-semester evaluation (return rate 35%). A high percentage of the respondents positively rated the achieved curricular integration and longitudinal teaching formats. The majority of the respondents agreed with the relevance of the overarching learning outcomes. Students' evaluations of the coverage of learning outcomes showed a differentiated picture for the MCM. Compared to the regular curriculum track, the coverage in the MCM programme showed substantial improvements in all aspects. Students found themselves to be better prepared for the M2 state examination and the practical year. The students' overall satisfaction with their decisions to study in the MCM was high. Conclusions: The results of the student evaluation show that a significant improvement in medical education has been achieved at the Charité with the new integrated, outcome-oriented design and the implementation of the MCM. At the same time, ongoing weaknesses have been revealed that serve as a basis for the continued development of the curriculum. This report aims to contribute to the discussion of the future of undergraduate medical education in Germany.
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Affiliation(s)
- Tanja Hitzblech
- Charité – Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Dieter Scheffner Fachzentrum für medizinische Hochschullehre und Ausbildungsforschung, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Team Spezielle Lehrformate, Berlin, Germany
| | - Asja Maaz
- Charité – Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Dieter Scheffner Fachzentrum für medizinische Hochschullehre und Ausbildungsforschung, Berlin, Germany
| | - Torsten Rollinger
- Charité – Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Dieter Scheffner Fachzentrum für medizinische Hochschullehre und Ausbildungsforschung, Berlin, Germany
| | - Sabine Ludwig
- Charité – Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Team Qualitätssicherung und Evaluation, Berlin, Germany
| | - Susanne Dettmer
- Charité – Universitätsmedizin Berlin, Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Berlin, Germany
| | - Wiebke Wurl
- Charité – Universitätsmedizin Berlin, Fachschaftsinitiative Medizin, Berlin, Germany
| | - Yadira Roa-Romero
- Charité – Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Team Qualitätssicherung und Evaluation, Berlin, Germany
| | - Raphael Raspe
- Charité – Universitätsmedizin Berlin, Fachschaftsinitiative Medizin, Berlin, Germany
| | - Mandy Petzold
- Charité – Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Team Qualitätssicherung und Evaluation, Berlin, Germany
| | - Jan Breckwoldt
- Charité – Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Dieter Scheffner Fachzentrum für medizinische Hochschullehre und Ausbildungsforschung, Berlin, Germany
| | - Harm Peters
- Charité – Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Dieter Scheffner Fachzentrum für medizinische Hochschullehre und Ausbildungsforschung, Berlin, Germany
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Milles LS, Hitzblech T, Drees S, Wurl W, Arends P, Peters H. Student engagement in medical education: A mixed-method study on medical students as module co-directors in curriculum development. MEDICAL TEACHER 2019; 41:1143-1150. [PMID: 31203695 DOI: 10.1080/0142159x.2019.1623385] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Introduction: Beyond participation in evaluation of teaching, there is sparse research available on more active roles of medical students in curriculum development. We report on a model of student engagement where medical students function as module co-directors, and how this is experienced by faculty and student module directors. Methods: Student engage in co-development of their curriculum with a high level of autonomy in organizing their activities. We conducted a mixed-methods, convergent design study based on surveys with faculty and student module co-directors and a student co-director focus group. Quantitative data were analyzed descriptively. Qualitative analysis was performed inductively. Results: Quantitatively, the majority of both faculty and student module directors report that the curriculum benefits from the students' work (95 and 94%). Both groups see each other as equal partners (80 and 87%). Qualitatively, this is related to students' competencies such as "bringing in broad and unique knowledge of the curriculum", "giving the students' perspective a voice," and "contributing ideas for improvement". Key strategies and challenges of the student co-module directors are illuminated. Conclusions: Student module co-directors represent a well-accepted practice model for curriculum development. This report may stimulate other faculties to engage their students more actively in medical education.
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Affiliation(s)
- Lennart Steffen Milles
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Student Affairs, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Tanja Hitzblech
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Student Affairs, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Simon Drees
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Student Affairs, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Wiebke Wurl
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Student Affairs, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Peter Arends
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Student Affairs, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Student Affairs, Charité - Universitätsmedizin Berlin , Berlin , Germany
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Atherley A, Dolmans D, Hu W, Hegazi I, Alexander S, Teunissen PW. Beyond the struggles: a scoping review on the transition to undergraduate clinical training. MEDICAL EDUCATION 2019; 53:559-570. [PMID: 31012141 PMCID: PMC6593677 DOI: 10.1111/medu.13883] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/28/2019] [Accepted: 02/22/2019] [Indexed: 05/10/2023]
Abstract
CONTEXT The transition to clinical training within medical school is often seen as a struggle and students remain in distress despite numerous efforts to minimise threats. Efforts to change this may be misdirected if they are based on narrow conceptualisations of transitions. The authors conducted a scoping review to explore existing conceptual perspectives regarding the transition within medical school from pre-clinical training to clinical training to suggest a research agenda and practical implications. METHODS Between October 2017 and February 2018 the authors searched PubMed, MEDLINE, ERIC, PsycINFO, Web of Science and CINAHL for English language literature with no date limits and retrieved 1582 articles; 46 were included in this review. Two reviewers independently screened articles and extracted data. Data were then charted, analysed and discussed with the research team. RESULTS The transition to clinical training was often described negatively as 'difficult', 'a problem' and 'a struggle'. Our analysis found that researchers in medical education conducted studies on the transition to clinical training from three conceptual perspectives: educational; social, and developmental. Most research approached the transition to clinical training as a problem to be addressed from an educational perspective through transition to clerkship courses and curriculum innovations. Some research was conducted from a social perspective, focusing on building relationships. Regarding development, authors found a few articles highlighting opportunities for personal and professional development by nurturing transferrable learning strategies and reflection. CONCLUSIONS This review provides an empirical base on which future research can be built to better understand and support medical students' ability to navigate change. Finding new perspectives to approach the transition to clinical training could allow researchers to look beyond preparing students for struggles.
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Affiliation(s)
- Anique Atherley
- School of Health Professions Education (SHE)Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - Diana Dolmans
- School of Health Professions Education (SHE)Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - Wendy Hu
- School of MedicineUniversity of Western SydneyCampbelltownNew South WalesAustralia
| | - Iman Hegazi
- School of MedicineUniversity of Western SydneyCampbelltownNew South WalesAustralia
| | | | - Pim W Teunissen
- School of Health Professions Education (SHE)Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
- Department of Obstetrics and GynaecologyVU University Medical CentreAmsterdamthe Netherlands
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Luciani E, Consorti G, van Dun PLS, Merdy O, Lunghi C, Petracca M, Esteves JE, Cerritelli F. An overview of osteopathy graduates' perceived preparedness at transition from educational environment to clinic environment one year after graduation: a cross sectional study. BMC MEDICAL EDUCATION 2018; 18:319. [PMID: 30577828 PMCID: PMC6303955 DOI: 10.1186/s12909-018-1429-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND This study investigated perceived preparedness to practice, one year after graduation across osteopathic education institutions (OEIs) and explored possible differences between countries where osteopathy is regulated (Reg) and countries where it is not (Unreg). METHODS Two hundred forty-five graduates from 7 OEIs in 4 European countries, already assessed in a previous study, were contacted one year after their graduation to complete the survey. Survey tools included a questionnaire to assess perceived preparedness to practice: Association of American Medical Colleges (AAMC) questionnaire, and a questionnaire to collect socio-demographic information and practice characteristics. RESULTS One hundred sixty-eight graduates (68.6%) completed the survey. The AAMC mean score one year after the graduation (23.19; confidence interval 22.81-23.58) was significantly higher than in the previous study (17.58; 16.90-18.26) (p < 0.001). A difference was also found between Reg (23.49; 23.03-23.95) and Unreg (22.34; 21.74-22.94) (p = 0.004). Osteopaths with a previous healthcare degree scored significantly higher on AAMC score (25.53; 24.88-26.19) than osteopaths without a previous healthcare degree (22.33; 21.97-22.69) (p < 0.001). Regulation and a previous degree were the only significant independent variables in the most predictive multivariate linear model. The model had an r2 = 0.33. CONCLUSIONS Graduates from OEIs where osteopathy is regulated felt significantly better prepared to practice than Unreg. Systematic information searches about graduates' perception of preparedness to practice, may enable OEIs to strengthen their existing curricula to ensure their graduates are effectively prepared to practice.
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Affiliation(s)
- E. Luciani
- Clinical-based Human Research Department, Research Division, COME Collaboration, Pescara, Italy
- I.F.O.P. Chinesis, Rome, Italy
| | - G. Consorti
- Clinical-based Human Research Department, Research Division, COME Collaboration, Pescara, Italy
- Centre pour l’Etude, la Recherche et la Diffusion Osteopathiques (CERDO), Rome, Italy
- Società Italiana di Pedagogia Medica (SIPeM), Via Capitinzano 33, 00178 Rome, Italy
| | | | - O. Merdy
- Institut des Hautes Etudes Ostéopathiques (IdHEO), Saint-Herblain, France
| | - C. Lunghi
- Clinical-based Human Research Department, Research Division, COME Collaboration, Pescara, Italy
- Centro Ricerche Olistiche per la Medicina Osteopatica e Naturale (CROMON), Rome, Italy
| | - M. Petracca
- Clinical-based Human Research Department, Research Division, COME Collaboration, Pescara, Italy
- Centre pour l’Etude, la Recherche et la Diffusion Osteopathiques (CERDO), Rome, Italy
| | - J. E. Esteves
- Clinical-based Human Research Department, Research Division, COME Collaboration, Pescara, Italy
- British School of Osteopathy (BSO), London, UK
- Instituto Piaget, Lisbon, Portugal
| | - F. Cerritelli
- Clinical-based Human Research Department, Research Division, COME Collaboration, Pescara, Italy
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Andersen CY, Kristensen SG, Mamsen LS, Barratt CLR. Education, education, education-now more than ever? Mol Hum Reprod 2018; 24:426-429. [PMID: 29939362 DOI: 10.1093/molehr/gay028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/23/2018] [Indexed: 11/13/2022] Open
Abstract
The generation of scientists and physicians that took part in starting the whole era of modern-assisted reproduction is currently close to retirement or has already left research. A new generation is about to take over and the profession is facing a massive transgenerational transition. Since current treatments have reached a plateau in success rates and costs, new research and development is required to further advance the field. Today, multi-disciplinary platforms including numerous research areas, not previously integrated in our field, are fundamental to achieve new clinical approaches. Structured, broader and purposeful education of young researchers should be intensified and prioritized, and innovative educational initiatives are needed to facilitate 'thinkers' and advance developments in the field of assisted reproduction.
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Affiliation(s)
- Claus Yding Andersen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, Rigshospitalet, Copenhagen, Denmark
| | - Stine G Kristensen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, Rigshospitalet, Copenhagen, Denmark
| | - Linn Salto Mamsen
- Laboratory of Reproductive Biology, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, Rigshospitalet, Copenhagen, Denmark
| | - Christopher L R Barratt
- Reproductive and Developmental Biology, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Core neurological examination items for neurology clerks: A modified Delphi study with a grass-roots approach. PLoS One 2018; 13:e0197463. [PMID: 29771997 PMCID: PMC5957356 DOI: 10.1371/journal.pone.0197463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/02/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND With the evolution of treatments for neurological diseases, the contents of core neurological examinations (NEs) for medical students may need to be modified. We aimed to establish a consensus on the core NE items for neurology clerks and compare viewpoints between different groups of panelists. METHODS First, a pilot group proposed the core contents of NEs for neurology clerks. The proposed core NE items were then subject to a modified web-based Delphi process using the online software "SurveyMonkey". A total of 30 panelists from different backgrounds (tutors or learners, neurologists or non-neurologists, community hospitals or medical centers, and different academic positions) participated in the modified Delphi process. Each panelist was asked to agree or disagree on the inclusion of each item using a 9-point Likert scale and was encouraged to provide feedback. We also compared viewpoints between different groups of panelists using the Mann-Whitney U test. RESULTS Eighty-three items were used for the first round of the Delphi process. Of them, 18 without consensus of being a core NE item for the neurology clerks in the first round and another 14 items suggested by the panelists were further discussed in the second round. Finally, 75 items with different grades were included in the recommended NE items for neurology clerks. CONCLUSIONS Our findings provide a reference regarding the core NE items for milestone development for neurology clerkships. We hope that prioritizing the NE items in this order can help medical students to learn NE more efficiently.
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Abdalla ME, Shorbagi S. Challenges faced by medical students during their first clerkship training: A cross-sectional study from a medical school in the Middle East. J Taibah Univ Med Sci 2018; 13:390-394. [PMID: 31435352 PMCID: PMC6694914 DOI: 10.1016/j.jtumed.2018.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives The transition from preclinical to clinical training is characterized by several challenging experiences ranging from new roles, with their associated tasks, to unfamiliar settings. The aim of this study was to explore the difficulties faced by medical students during the transition from preclinical to clinical training in the Middle East region. Methods This cross-sectional study was conducted on fourth-year medical students at the end of their first clerkship. A self-administered questionnaire containing different aspects of students' perceived stress, preparation and clinical supervision was administered to the participants. Results Of the 89 students, 63 responded (response rate of 71%). Almost half of the students (59%) experienced stress at the beginning of their clinical training, while 33% thought that they were ready to begin their clerkship training. A majority of the students (81%) reported the need for more time to adjust to the new environment, and 84% indicated that a good introduction to the clerkship would make the transition easy for them. About half of the students (54%) reported receiving feedback during their clinical training. Conclusion This study highlighted the difficulties faced by medical students during their transition from preclinical to clinical training. There is a need to implement measures to ease this transition through a structured orientation about clerkship for both students and clinical faculty. In addition, it is recommended to organize faculty development workshops on feedback and supervision.
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Affiliation(s)
- Mohamed Elhassan Abdalla
- Medical Education Unit, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
- Corresponding address: Medical Education Unit, College of Medicine, University of Sharjah, Sharjah, PO Box 27272, United Arab Emirates.
| | - Sarra Shorbagi
- Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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