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Heitmann H, Wagner P, Fischer E, Gartmeier M, Schmidt-Graf F. Effectiveness of non-bedside teaching during the COVID-19 pandemic: a quasi-experimental study. BMC MEDICAL EDUCATION 2022; 22:73. [PMID: 35101016 PMCID: PMC8801559 DOI: 10.1186/s12909-022-03141-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/27/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic poses a huge challenge for clinical teaching due to contact restrictions and social distancing. Medical teachers have to balance potential risks and benefits of bedside teaching, especially in course formats intended to foster practical clinical skills. In this context, we aimed to address the question, whether presence-based teaching formats without patient involvement are suitable to teach practical skills. METHODS In this quasi-experimental study, presence-based teaching formats with and without patient contact were retrospectively compared regarding their effects on medical students' theoretical knowledge and practical skills, i.e. the performance and clinical interpretation of the neurological exam. To this end, evaluations from 102 students and their lecturers participating in a neurological bedside teaching course at a German university hospital between October 2020 and April 2021 were obtained. Students were initially randomly assigned to course dates. However, 53 students assigned to courses in November and December 2020, were not able to go bedside due to contact restrictions. These students formed the interventional group and the remaining 49 students the control group. The primary outcome measures were students' overall grading of the course (school grades, 1-6) as well as ratings of knowledge and skills provided by the students themselves and their lecturers on a numerical rating scale (0-10). Comparison between groups was performed using frequentist and Bayesian t-statistics. RESULTS The teaching format without patient contact received a significantly poorer overall grade by the students (p = 0.018). However, improvements in the students' self-ratings of knowledge and skills did not differ between the two formats (all p > 0.05, BF10max = 0.42). Moreover, especially practical skills were even rated significantly better in the group without patient contact by the lecturers (p < 0.001). CONCLUSIONS Teaching formats without patient contact are less well-received by the students. However, they are able to teach practical skills regarding the performance and clinical interpretation of examination techniques. Still, the evaluations obtained might not adequately capture the importance of bedside teaching in preparing future physicians for their practice. Perspectively, hybrid teaching approaches including flipped-classroom concepts hold considerable potential to enhance effectiveness of bedside teaching in the present pandemic situation and in the future.
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Affiliation(s)
- Henrik Heitmann
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.
| | - Philipp Wagner
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Elisabeth Fischer
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Martin Gartmeier
- TUM Medical Education Center, School of Medicine, TUM, Munich, Germany
| | - Friederike Schmidt-Graf
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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Hascalovici J, Kohan L, Spektor B, Sobey C, Meroney M, Anitescu M, Barad M, Steinmann A, Vydyanathan A, Wahezi S. The Pain Medicine Fellowship Telehealth Education Collaborative. PAIN MEDICINE 2021; 22:2779-2805. [PMID: 34402913 DOI: 10.1093/pm/pnab251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/10/2021] [Accepted: 08/04/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Jacob Hascalovici
- Multidisciplinary Pain Program.,Saul R. Korey Department of Neurology.,The Arthur S. Abramson Department of Physical Medicine and Rehabilitation.,Department of Anesthesiology.,Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Lynn Kohan
- University of Virginia Department of Anesthesiology
| | - Boris Spektor
- Department of Anesthesiology Emory University School of Medicine
| | | | | | | | | | | | - Amaresh Vydyanathan
- Multidisciplinary Pain Program.,The Arthur S. Abramson Department of Physical Medicine and Rehabilitation.,Department of Anesthesiology.,Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Sayed Wahezi
- Multidisciplinary Pain Program.,The Arthur S. Abramson Department of Physical Medicine and Rehabilitation.,Department of Anesthesiology.,Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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Maggio LA, Larsen K, Thomas A, Costello JA, Artino AR. Scoping reviews in medical education: A scoping review. MEDICAL EDUCATION 2021; 55:689-700. [PMID: 33300124 PMCID: PMC8247025 DOI: 10.1111/medu.14431] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities. METHOD The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review. RESULTS One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal. CONCLUSIONS Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.
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Affiliation(s)
- Lauren A. Maggio
- Department of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
| | - Kelsey Larsen
- Department of Politics, Security, and International AffairsUniversity of Central FloridaOrlandoFLUSA
| | - Aliki Thomas
- School of Physical and Occupational TherapyInstitute of Health Sciences EducationFaculty of MedicineMcGill UniversityMontrealQCCanada
| | | | - Anthony R. Artino
- Department of Health, Human Function, and Rehabilitation SciencesThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
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The provision of ENT teaching in the undergraduate medical curriculum: a review and recommendations. The Journal of Laryngology & Otology 2021; 135:610-615. [PMID: 34030747 DOI: 10.1017/s0022215121001389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The existing provision of ENT teaching in the undergraduate curriculum is deemed inadequate by medical students, general practitioners and ENT surgeons alike. This study aims to explore the perceptions of a variety of stakeholders on how undergraduate ENT provision can be optimised. METHODS This study involved semi-structured interviews with seven participants (two medical students, two general practitioners, two ENT surgeons and a curriculum developer). Inductive thematic analysis was used to identify key themes that emerged from the interviews. RESULTS The four emergent themes were evaluation of current ENT provision, barriers to learning and teaching, alternate means of delivery of ENT education, and professional identity development. A number of barriers to learning and teaching in the clinical environment were identified including student-related, teacher-related and environmental factors. CONCLUSION The existing ENT provision should be re-considered to help students achieve a basic level of competence in managing common ENT conditions. This can be achieved by ENT teaching in additional contexts including general practice, e-learning and simulation workshops.
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Barry AR, Turgeon RD, Ellis UM. Physical assessment educational programs for pharmacists and pharmacy students: A systematic review. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Arden R. Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia Vancouver British Columbia Canada
- Chilliwack General Hospital, Lower Mainland Pharmacy Services Chilliwack British Columbia Canada
| | - Ricky D. Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia Vancouver British Columbia Canada
- St. Paul's Hospital, Lower Mainland Pharmacy Services Vancouver British Columbia Canada
| | - Ursula M. Ellis
- Woodward Library, University of British Columbia Vancouver British Columbia Canada
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Graf J, Loda T, Zipfel S, Wosnik A, Mohr D, Herrmann-Werner A. Communication skills of medical students: survey of self- and external perception in a longitudinally based trend study. BMC MEDICAL EDUCATION 2020; 20:149. [PMID: 32393242 PMCID: PMC7216673 DOI: 10.1186/s12909-020-02049-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/21/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND As good communication skills are crucial for doctor-patient interactions, it is recommended to incorporate them in medical school programs from the very beginning. On this basis medical schools in Germany introduced the OSCE (objective structured clinical examination) to examine and by this foster learning of communication skills as assessment drives learning. The aim of the study was to examine the development of the communication skills of medical students during an OSCE to investigate how communication competence has developed between different student cohorts. METHODS This study is a longitudinal trend study based on seven semester-cohorts, examining the communication skills of medical students in the OSCE both from the perspective of students and from the viewpoint of standardized patients (SP). Altogether, 1027 students from seven semester cohorts were asked to rate their own communication skills (self-perception) before the OSCE exam started. Here, sub-analyses were performed to outline a potential influence of previous history-taking group participation. The SP evaluated the students' communication skills in external perception during the OSCE exam at each station with history-taking or physical examinations. The communication skills in both groups were ascertained in the dimensions of empathy, content structure, verbal expression, and non-verbal expression. RESULTS Only in the dimension of non-verbal expression could a statistically significant change be found in students' self-perception over the years. Notably, the rating of communication skills as self-rated by the students has risen constantly, whereas they deteriorated from the perspective of standardized patients (SP). It has also been found that previous history-taking courses have a positive influence on the structural dimension of communication skills in particular. CONCLUSIONS The results of this study support conclusions of other studies which also suggest differences between self- and external perception of medical students' communication skills. Nevertheless, students showed good overall communication skills in the four dimensions of empathy, content structure, verbal expression, and non-verbal expression, as demonstrated in a longitudinal trend study over seven semesters. However, we noted that externally rated empathy levels declined over the semester cohorts, suggesting the need for new priorities to be set in student teaching.
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Affiliation(s)
- Joachim Graf
- University Hospital Tuebingen, Institute for Health Sciences, Section of Midwifery Science, Hoppe-Seyler-Strasse 9, 72076 Tuebingen, Germany
| | - Teresa Loda
- Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstrasse 5, 72076 Tuebingen, Germany
| | - Stephan Zipfel
- Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstrasse 5, 72076 Tuebingen, Germany
- Medical Faculty Tuebingen, Dean’s Office for Students’ Affairs, Geissweg 5, 72076 Tuebingen, Germany
| | - Annette Wosnik
- Medical Faculty Tuebingen, Dean’s Office for Students’ Affairs, Geissweg 5, 72076 Tuebingen, Germany
| | - Daniela Mohr
- Medical Faculty Tuebingen, Dean’s Office for Students’ Affairs, Geissweg 5, 72076 Tuebingen, Germany
| | - Anne Herrmann-Werner
- Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstrasse 5, 72076 Tuebingen, Germany
- Medical Faculty Tuebingen, Interdisciplinary Training Centre DocLab, Elfriede-Aulhorn-Strasse 10, 72076 Tuebingen, Germany
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Sharma D, Sohn JK, Zillioux JM, Herndon CDA, Corbett ST, Kern NG. Identifying and addressing training deficiencies in the examination of cryptorchidism-a quality improvement study. J Pediatr Urol 2020; 16:61.e1-61.e8. [PMID: 31848108 DOI: 10.1016/j.jpurol.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Accurate and timely diagnosis of cryptorchidism by primary care providers (PCPs) is critical to oncologic and fertility outcomes. Physical exam is the mainstay of diagnosis, but little is known about PCPs' skills in examining cryptorchid patients. Patients referred to surgeons for cryptorchidism often have normal or retractile testes on exam, and delayed or missed diagnosis of cryptorchidism may contribute to advanced age at surgical intervention. Previous studies on cryptorchidism have not investigated the baseline training, confidence, and/or exam skills of providers. OBJECTIVE The authors aimed to define baseline training and provider confidence in the exam of cryptorchid patients and to improve examiner confidence using bedside teaching with a pediatric urologist. Secondarily, baseline training and confidence were correlated to skill. STUDY DESIGN Medical students, family medicine, pediatrics, and urology residents, and pediatric attendings completed surveys on baseline training and self-reported confidence in the examination of cryptorchid patients at an academic institution from 2017 to 2018. N.G.K. (pediatric urologist) proctored examinations of cryptorchid patients and provided standardized grades and individualized feedback. Surveys were readministered after 3 months. Non-parametric comparison tests were performed to determine intervention effect and compare subgroups. RESULTS Ninety-two respondents participated. 62% reported little to no formal training on the scrotal exam, 50% were self-taught, and 20% defined undescended testis incorrectly. Confidence increased with level of training, comparing attendings to residents to students (P < 0.001). Those who learned from a mentor had higher baseline confidence than those who did not (P < 0.01). Baseline confidence and amount of formal training positively correlated with exam skill as graded during proctored sessions (n = 59, P < 0.01). Provider confidence was higher after proctored exams (Fig. 2, n = 32, P < 0.0001). DISCUSSION Significant training deficiencies exist in the examination of cryptorchid patients. A single proctored exam with a pediatric urologist can improve provider confidence and may improve exam skills. A rotation with pediatric urology, including proctored exams of cryptorchid patients, has become standard practice for pediatric trainees at the authors institution as a result of this study. CONCLUSIONS While further studies are required to assess the effectiveness of bedside teaching and its impact on accurate and timely diagnosis of cryptorchidism, implementation of the authors quality improvement recommendations at other teaching institutions would help address training deficiencies in the examination of cryptorchid patients.
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Affiliation(s)
- Devang Sharma
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA
| | - Julia K Sohn
- University of Virginia School of Medicine, Department of Pediatrics, PO Box 801355, Charlottesville, VA, 22908, USA
| | - Jacqueline M Zillioux
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA
| | - C D Anthony Herndon
- Children's Hospital of Richmond at Virginia Commonwealth University, Department of Urology, 8700 Stony Point Parkway, Richmond, VA, 23235, USA
| | - Sean T Corbett
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA
| | - Nora G Kern
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA.
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Danielson AR, Venugopal S, Mefford JM, Clarke SO. How do novices learn physical examination skills? A systematic review of the literature. MEDICAL EDUCATION ONLINE 2019; 24:1608142. [PMID: 31032719 PMCID: PMC6495115 DOI: 10.1080/10872981.2019.1608142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 05/23/2023]
Abstract
BACKGROUND Physical Examination (PE) skills are vital for patient care, and many medical students receive their first introduction to them in their pre-clinical years. A substantial amount of curriculum time is devoted to teaching these skills in most schools. Little is known about the best way to introduce PE skills to novice learners. OBJECTIVE Our objective was to conduct a systematic review of how medical students are first taught PE skills and the evidence supporting these strategies. DESIGN We searched ERIC, SCOPUS, MEDLINE, PubMed and EMBASE for descriptions of complete PE curricula for novice learners. Inclusion criteria were: (1) English language; (2) subjects were enrolled in medical school and were in the preclinical portion of their training; (3) description of a method to teach physical examination skills for the first time; (4) description of the study population; (5) Description of a complete PE curriculum. We used the Medical Education Research Study Quality Instrument (MERSQI) score to evaluate the quality of evidence provided. RESULTS Our search returned 5,418 articles; 32 articles met our inclusion criteria. Two main types of curricula were reported: comprehensive 'head-to-toe' PE curricula (18%) and organ system-based curricula (41%). No studies compared these directly, and only two evaluated trainees' clinical performance. The rest of the articles described interventions used across curricula (41%). Median MERSQI score was 10.1 Interquartile range 8.1-12.4. We found evidence for the use of non-faculty teaching associates, technology-enhanced PE education, and the addition of clinical exposure to formal PE teaching. CONCLUSIONS The current literature on teaching PE is focused on describing innovations to head-to-toe and organ system-based curricula rather than their relative effectiveness, and is further limited by its reliance on short-term outcomes. The optimal strategy for novice PE instruction remains unknown.
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Affiliation(s)
- Aaron R. Danielson
- Department of Emergency Medicine, University of California at Davis, Sacramento, CA, USA
| | - Sandhya Venugopal
- Division of Cardiovascular Medicine, University of California at Davis, Sacramento, CA, USA
| | - Jason M. Mefford
- Department of Emergency Medicine, Kaiser Permanente, Santa Clara, CA, USA
| | - Samuel O. Clarke
- Department of Emergency Medicine, University of California at Davis, Sacramento, CA, USA
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Tseng FY, Chang YT, Yu CJ, Chang SC. Advanced physical examination training course improves medical students' confidence in physical examination. J Formos Med Assoc 2019; 118:1416-1422. [PMID: 30612884 DOI: 10.1016/j.jfma.2018.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/12/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Physical examination (PE) is a basic diagnostic tool in clinical settings. It is important to enhance medical students' skills and confidence in PE. SUBJECTS AND METHODS Our medical students begin learning PE in the fourth medical year (M4). They undergo hands-on clinical training in the fifth medical year (M5). To improve the teaching of PE, we implemented an advanced PE training course (APETC) for M5 students. In APETC, PE skills for chest (CH), cardiovascular system (CV), and abdomen (GI) domains were demonstrated by senior specialists. Under tutors' supervision, students performed PE on selected patients with positive signs. To evaluate the effect of this training course, we designed a checklist to evaluate students' confidence level in PE before and after APETC. Average confidence scores of PE in CH, CV, and GI domains among different years and genders were compared using ANOVA tests. RESULTS M5 students' confidence in PE for individual items on the CH, CV, and GI checklists increased significantly after the APETC, in both 2014 and 2015 (all p < 0.0001).The average post-course confidence scores of all items in CH, CV, and GI domains increased significantly over average pre-course confidence scores. The average post-course confidence score in PE was higher in the year 2015 than that in the year 2014. Male students tended to have higher confidence scores in PE than female students. CONCLUSION APETC enhanced medical students' confidence in PE. Long-term effects of the training course and the impact of students' gender on learning outcomes remain to be investigated.
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Affiliation(s)
- Fen-Yu Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Chang
- Department of Internal Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan.
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