Medical education today: all that glitters is not gold

The prevalence of sleep disturbance and its possible associated factors among iranian medical students: A cross-sectional study with a national meta-analysis

Background

The aim of this cross-sectional study was to investigate the prevalence of sleep disturbance and its possible associated factors among Iranian medical students. Additionally, a national meta-analysis was conducted to provide a comprehensive overview of sleep disturbance in this population.

Methods

A sample of medical students from Guilan University of Medical Sciences, Iran was included in the study. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep disturbance. Demographic and lifestyle factors, as well as academic performance, were collected through a self-administered questionnaire. The data collected from this study were combined with existing studies through a meta-analysis to estimate the overall prevalence of sleep disturbance among Iranian medical students using the random effects model.

Results

A total of 249 medical students participated in the study. The prevalence of sleep disturbance among Guilan University of Medical Sciences medical students was found to be 71.1%. A significant difference was observed in total PSQI means regarding medical students' residency (p < 0.001) and their duration of sleep in the last 24 h (p = 0.006). The national prevalence of sleep disturbances was 59% (95% CI: [51%-66%], I2 = 97%).

Conclusion

Sleep disturbance is highly prevalent among Iranian medical students, with various factors contributing to its occurrence. The findings of this study highlight the need for interventions and strategies to improve sleep quality and overall well-being among this population. The national meta-analysis provides valuable insights into the overall burden of sleep disturbance among Iranian medical students and can serve as a reference for future studies and public health initiatives targeting this issue.

Comparative analysis of factors and barriers intervening in research participation among romanian and international medical graduates from one romanian medical faculty across three generations

OBJECTIVES

This study focuses on the factors that encouraged engagement in research activities, as well as the barriers that restricted their involvement, until the final year of study at Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Faculty of Medicine. The main objectives of this study are to investigate potential disparities in research culture and student engagement in various research opportunities between Romanian and international medical graduates, as well as to conduct an examination of the observed patterns across various graduating years (2021-2023).

MATERIALS AND METHODS

A cross-sectional investigation was conducted among graduate students of the Faculty of Medicine at the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. From 2021 to 2023, all graduate students from the Romanian and international programs of the faculty were asked to participate in the study by filling out an anonymous online questionnaire. The final sample included 572 participants, of whom 392 were students from the Romanian section and 180 were students from international programs.

RESULTS

Motivation and personal interest drive research engagement, according to over half of graduates. For over one-third of graduates, institutional elements like financial support and education also play a major role, as does the desire to enhance their curriculum vitae. More than 25% of graduates value community influence, 70% of graduates attended medical congresses, 12-15% presented papers at medical conferences, 23% wrote medical articles, 10-15% published at least one scientific paper in medical journals, and 20% participated in medical school research projects. Comparative analysis showed that Romanian students start research earlier, attend more medical conferences, present posters, collect data for studies, and are more interested in publishing graduation thesis data in scientific journals. To encourage international students to participate in research, the study found that colleagues' examples were more important, and both time and funds were key barriers. The research also shows that 2022 and 2023 graduates will organize more scientific conferences. According to the study, 2022 graduates began their research earlier than others.

CONCLUSIONS

To increase student engagement in research activities, medical schools should prioritize the promotion of positive factors, minimize common barriers, offer customized support and resources, encourage collaborative research activities, and facilitate cross-cultural learning.

A systematic review of medical practitioners' retention and application of basic sciences to clinical practice

BACKGROUND

Medical education offers the foundational base for future healthcare professionals, with basic sciences playing a pivotal role in providing essential knowledge and skills for clinical practice. However, the long-term retention and application of this knowledge in clinical practice remain a significant challenge. This systematic review synthesised global evidence from diverse studies on the short / long-term retention and clinical application of basic sciences among medical doctors.

METHODS

A comprehensive search was conducted across six databases, including Web of Science, Scopus, Medline, CINAHL, Emcare, and Informit. The review included studies that encompassed a variety of study designs, participant groups, and educational interventions. The Quality Assessment with Diverse Studies (QuADS) tool was utilised to assess the quality of the reviewed studies.

RESULTS

A total of 10 studies were included in the review. The findings revealed that rehearsals significantly optimise the retention of basic science knowledge among medical practitioners. Retention varied by discipline, with medical practitioners retaining more knowledge in anatomy (mean scores ranging from 45.0 to 82.9%), while microbiology had the lowest retention score (39.1%). Factors influencing retention included age, gender, and curriculum type. Educational interventions such as targeted courses, integration of basic sciences with clinical skills, generative retrieval and continuous quality improvement in the curriculum were found to enhance both knowledge retention and clinical reasoning. The concept of 'encapsulated knowledge' demonstrates that integrated basic science knowledge helps in synthesising clinical presentations, reducing the need for detailed recall as clinical experience increases. The reviewed studies primarily involved interns and surgeons, leaving a significant gap in research for specialties like internal medicine and primary care/ general practice.

CONCLUSION

Detailed retention of basic science knowledge may diminish over time; however, the conceptual framework remains essential for ongoing learning and clinical reasoning. This review's findings highlight the need for specialised educational interventions to improve long-term retention. Continuous professional development and targeted educational techniques are vital for maintaining clinical competence and applying basic science knowledge effectively throughout a medical career. Further research is needed to address gaps in specialty-specific knowledge application and the impact of different instructional methods.

Enhancing the physician-scientist workforce: evaluating a mentored research program for medical students' research competencies and intentions

Background

The growing recognition of the need to incorporate scientific discoveries into healthcare decisions underscores an urgency for a robust physician-scientist workforce to advance translational research. Despite the correlation between medical students' research engagement and their academic productivity and success, significant gaps remain in the scientific workforce exacerbated by the "leaky pipeline" phenomenon from medical school to academic medicine, where potential physician-scientists veer away from research careers.The purpose of this study was to assess the effectiveness of a structured mentored research program for enhancing medical students' research competencies and sustaining their interest in research careers, thereby potentially enhancing the physician-scientist workforce.

Methods

The Medical Student Research Program (MSRP) implemented at the University of California, Irvine (UCI) was designed to provide comprehensive research training and support to medical students through a series of structured lectures, mentorship by dedicated faculty, and administrative support for research activities. Students were surveyed upon enrollment and one year later to assess the change in research competencies from baseline to follow-up (paired samples t-test), students' intent to use research in clinical practice (paired samples t-test), and their intent to conduct research in the future (McNemar's test and McNemar Bowker test).

Results

Preliminary evaluations indicated that the MSRP enhanced students' research competencies and has the potential to enhance medical students' research skills. However, similar to national trends, there was a decrease in students' intentions to engage with research in their future clinical career.

Conclusions

Our preliminary findings demonstrate MSRP students' enhanced research competencies during the first year of the program. However, the decline in students' intentions to engage in future research highlights the need for continued innovation in research training programs to sustain future intent to conduct research, in turn helping to address the "leaky pipeline" in the physician-scientist workforce. Future studies should focus on mid and long-term outcomes to fully assess research program impact on the physician-scientist pipeline and on integrating such programs more broadly into medical education.

Interactive Journal Club: A Learning Method to Enhance Collaboration and Participation among Medical Students

Objectives

This quality improvement study aimed to explore the viability of a learning pedagogy for medical students, the interactive journal club (IJC), in stimulating active learning and engagement among learners. The study intends to explore the benefits provided by the IJC when compared to traditional learning methods (e.g., traditional journal clubs). It attempts to highlight the importance of didactics which focus on active learning and interactive engagement between learners.

Methods

The IJC was implemented as a course requirement in HI 201: Health Informatics, a midyear elective course at the College of Medicine, University of the Philippines Manila. A class of MD-PhD (Molecular Medicine) students was divided into two separate groups: the designated leaders who presented the article and moderated the discussion, and the audience who did not read the article beforehand yet were involved in its critical analysis. The IJC was conducted twice in two different sections of MD-PhD (Molecular Medicine) students, across two different midyear terms, Midyear Term 2021, and Midyear Term 2022. Reflection papers were collected and the responses through this requirement were collated before the primary takeaways were extrapolated. A survey was also sent out to the students of each class to itemize the consolidated feedback of students on the proposed didactic.

Results

The overall process of IJC was deemed both exciting and stimulating. The learning pedagogy provided an alternative platform for active learning, fostering a student-centered approach that placed a heavy emphasis on critical thinking. One major challenge identified in the implementation of the educational design was the heavy reliance on student participation which was identified to, at times, be a difficult factor to overcome. In order to improve its implementation, expectations may be set at the beginning and assessed at the end of the session. In addition, a pre- and post-questionnaire may be given to assess the perceived usefulness of this new method for qualitative comparison.

Conclusion

Interactive and student-centered modes of learning are empirical for the improvement of literature appraisal, journal presentation, and evidence-based critical thinking among medical students. IJCs may be utilized as an alternative and effective learning strategy in teaching pertinent skills expected of a proper physician. When compared to traditional pedagogies, IJCs provide a platform for deeper learning and enable the achievement of learning outcomes, with learner engagement as the focal point. Future attempts at executing IJCs may consider the implementation of learning outcomes setting, and the use of pre- and post- IJC surveys to assess the effectiveness of the modality.

Knowledge, attitude, and practice of non-ophthalmic medical staff toward myopia-related fundus lesions

This study assessed the knowledge, attitude, and practice (KAP) of non-ophthalmic medical staff towards myopia-related fundus lesions. This multicenter, cross-sectional study enrolled non-ophthalmic medical staff of Suining City between January and May 2023 using a self-designed questionnaire. A total of 505 (93.19%) valid questionnaires were included. Their mean KAP scores were 8.10 ± 2.32 (range: 0-12), 20.27 ± 2.68 (range: 0-24), and 17.77 ± 5.04 (range: 0-28), respectively. Structural equation modeling indicated that knowledge has a positive effect on attitude (β = 0.307, P < 0.001), and attitude has a positive effect on practice (β = 0.604, P < 0.001). Moreover, a higher degree of myopia exhibited a positive effect on knowledge (β = 0.510, P < 0.001). Nurses and other medical staff showed a negative effect on knowledge (β = - 0.706, P < 0.001) compared to doctors. Working in secondary and tertiary public hospitals, as well as private hospitals, demonstrated a negative effect on practice (β = - 1.963, P < 0.001) compared to those working in primary hospitals. Non-ophthalmic medical staff exhibited moderate knowledge, positive attitudes, and moderate practices toward myopia-related fundus lesions. The degree of myopia, doctors vs. other medical staff, and the hospital level influence the KAP of non-ophthalmic medical staff.

Laboratory animal ethics education improves medical students' awareness of laboratory animal ethics

OBJECTIVE

In this study, we added laboratory animal ethics education into both didactic sessions and practical sessions the general surgery laboratory course, with the didactic sessions focus on teaching the fundamental principles of laboratory animal ethics, while the practical sessions emphasize the application of these principles in laboratory classes and have assessed the changes in medical students' perception of laboratory animal ethics following medical students exposure to such education.

METHODS

One hundred and eighty-nine third-year medical students from Wuhan University's Second Clinical College completed a laboratory animal ethics awareness questionnaire and a laboratory animal ethics written examination before and after laboratory animal ethics education.

RESULTS

After receiving laboratory animal ethics education, the percentage of students who supported euthanasia for the execution of animals and humane treatment of laboratory animals were 95.2% and 98.8%, respectively, which did not differ from the 94.9% and 96.4% observed before the education. Moreover, there was a notable increase in the proportion of students who knew about regulations related to laboratory animals (from 39.9% to 57.1%), welfare issues (from 31.9% to 50.0%), and the 3R principle (from 30.4% to 58.9%) post-education, all statistically significant at P < 0.05. Test scores also showed improvement, with students scoring (93.02 ± 11.65) after education compared to (67.83 ± 8.08) before, a statistically significant difference.

CONCLUSIONS

This research helps to provide information for the good practices of laboratory animal ethics education. After receiving laboratory animal ethics education, students are better able to treat laboratory animals in a correct animal ethical manner. Laboratory animal ethics education helps improve students' knowledge of laboratory animal ethics. Students' perception towards how the laboratory animal ethics course should be delivered may vary. Still, new courses or better organized courses on laboratory animal ethics education are required in order to provide students an in-depth understanding.

Undergraduate Medical Education Curriculum Reforms in Pakistan: A Mixed Methods Study of Academic Leadership Perspectives

PURPOSE

Periodic revision of undergraduate medical education (UGME) curricula is an essential part of evidence-based educational practices. Pakistan's national UGME curriculum, last updated in 2005, was reviewed, and recommended updates were made in 2022. The authors explore academic medical school leaders' perspectives about the proposed reforms, gaps within the existing curriculum, and how to ensure the reform implementation is effective, collaborative, and feedback-driven.

METHOD

Using a mixed methods approach, data were collected from April to July 2022. Academic leadership (principals, who could designate vice principals or medical educators) at all medical schools across Pakistan (n = 117) were invited. Agreement with each of 20 proposed reforms was measured via a survey employing a Likert scale. A semistructured interview guide expanded on the survey questions with probes.

RESULTS

Eighty-eight survey responses, from private (59; 67.0%) and public (29; 33.0%) institutions, were obtained (75.2% response rate). Participants recommended most of the proposed reforms. The 3 reforms that received the highest agreement were teaching professionalism as an integral part of the curriculum (83; 94.3%), mandating bedside procedural skills training (80; 90.9%), and including patient safety in the UGME curriculum (79; 89.8%). Including multidisciplinary tumor boards and surgical oncology had the lowest agreement (26; 29.5%). Fifteen interviews were conducted, which revealed 3 major themes: perceptions about changes to the curricular content, limitation of human and financial resources as barriers to reform implementation, and recommendations for effective implementation of an updated curriculum.

CONCLUSIONS

The findings reflect an overall positive attitude of academic medical school leadership toward the 20 proposed UGME curriculum reforms, which could aid with on-the-ground implementation. However, major limitations, such as a lack of trained faculty and financial resources, must be addressed. The authors propose future research on the resources required for implementing UGME reforms and the reforms' impact after national implementation.

Clinician Educator Milestones: Assessing and Improving Educators' Skills

ABSTRACT

The importance of the clinician educator (CE) role in delivery of competency-based medical education is well recognized. There is, however, no formal mechanism to identify when faculty have the knowledge, skills, and attitudes to be successful CEs. In 2020, the Accreditation Council for Graduate Medical Education, Accreditation Council for Continuing Medical Education, Association of American Medical Colleges, and American Association of Colleges of Osteopathic Medicine convened a workgroup of 18 individuals representing multiple medical specialties and diverse institutions in the United States, including nonphysician educators, a medical student, and a resident, to develop a set of competencies, subcompetencies, and milestones for CEs.A 5-step process was used to create the Clinician Educator Milestones (CEMs). In step 1, the workgroup developed an initial CEM draft. Through brainstorming, 141 potential education-related CE tasks were identified. Descriptive statements for each competency and developmental trajectories for each subcompetency were developed and confirmed by consensus. The workgroup then created a supplemental guide, assessment tools, and additional resources. In step 2, a diverse group of CEs were surveyed in 2021 and provided feedback on the CEMs. In step 3, this feedback was used by the workgroup to refine the CEMs. In step 4, the second draft of the CEMs was submitted for public comment, and the CEMs were finalized. In step 5, final CEMs were released for public use in 2022.The CEMs consist of 1 foundational domain that focuses on commitment to lifelong learning, 4 additional domains of competence for CEs in the learning environment, and 20 subcompetencies. These milestones have many potential uses for CEs, including self-assessment, constructing learning and improvement plans, and designing systematic faculty development efforts. The CEMs will continue to evolve as they are applied in practice and as the role of CEs continues to grow and develop.

Using machine learning to identify key subject categories predicting the pre-clerkship and clerkship performance: 8-year cohort study

BACKGROUND

Medical students need to build a solid foundation of knowledge to become physicians. Clerkship is often considered the first transition point, and clerkship performance is essential for their development. We hope to identify subjects that could predict the clerkship performance, thus helping medical students learn more efficiently to achieve high clerkship performance.

METHODS

This cohort study collected background and academic data from medical students who graduated between 2011 and 2019. Prediction models were developed by machine learning techniques to identify the affecting features in predicting the pre-clerkship performance and clerkship performance. Following serial processes of data collection, data preprocessing before machine learning, and techniques and performance of machine learning, different machine learning models were trained and validated using the 10-fold cross-validation method.

RESULTS

Thirteen subjects from the pre-med stage and 10 subjects from the basic medical science stage with an area under the ROC curve (AUC) >0.7 for either pre-clerkship performance or clerkship performance were found. In each subject category, medical humanities and sociology in social science, chemistry, and physician scientist-related training in basic science, and pharmacology, immunology-microbiology, and histology in basic medical science have predictive abilities for clerkship performance above the top tertile. Using a machine learning technique based on random forest, the prediction model predicted clerkship performance with 95% accuracy and 88% AUC.

CONCLUSION

Clerkship performance was predicted by selected subjects or combination of different subject categories in the pre-med and basic medical science stages. The demonstrated predictive ability of subjects or categories in the medical program may facilitate students' understanding of how these subjects or categories of the medical program relate to their performance in the clerkship to enhance their preparedness for the clerkship.

Practice Standards in International Medical Departments of Public Academic Hospitals in China: Cross-Sectional Study

BACKGROUND

Improving health care in cities with a diverse, international population is crucial for ensuring health equity, particularly for foreigners facing challenges due to cultural and language barriers. This situation is especially relevant in China, a major destination for expatriates and travelers, where optimizing health care services and incorporating international standards in the public sector are vital. Achieving this involves understanding the operational details, cultural and linguistic nuances, and advancing medical digitalization. A strategic approach focusing on cultural competence and awareness of health care systems is essential for effectively navigating health care for foreigners and expatriates in China.

OBJECTIVE

The aim of this study was to perform an in-depth analysis of the subjective and objective experiences of local and international patients in public hospitals in China to provide a basis for enhancing the medical experience of all patients.

METHODS

A structured questionnaire was provided to patients at an international outpatient service of a top-tier university hospital in China. Qualitative analysis of the survey responses was performed to methodically categorize and analyze medical treatment, focusing on patient demand and satisfaction across four main category elements ("high demand, high satisfaction"; "high demand, low satisfaction"; "low demand, high satisfaction"; and "low demand, low satisfaction"), enabling a detailed cross-sectional analysis to identify areas for improvement.

RESULTS

Elements falling under "high demand, high satisfaction" for both Chinese and international patients were primarily in the realms of medical quality and treatment processes. In contrast, elements identified as "high demand, low satisfaction" were significantly different between the two patient groups.

CONCLUSIONS

The findings highlight the importance of systematic, objective research in advancing the quality of international health care services within China's leading academic medical centers. Key to this improvement is rigorous quality control involving both patients and providers. This study highlights the necessity of certifying such centers and emphasizes the role of digital platforms in disseminating information about medical services. This strategy is expected to cater to diverse patient needs, enhancing the overall patient experience. Furthermore, by developing comprehensive diagnosis and treatment services and highlighting the superior quality and costs associated with international health care, these efforts aim to foster a sense of belonging among international patients and increase the attractiveness of China's medical services for this demographic.

The protective role of sense of coherence in resident physicians facing secondary trauma due to patient death in intensive care-A qualitative inquiry

The salutogenic paradigm is increasingly used in research and practice but remains to be investigated in secondary trauma of health professionals. This qualitative study explored the main anchor of salutogenics, the sense-of-coherence, as a coping mechanism among resident physicians facing secondary trauma due to continuous exposure to patient suffering and deaths. Participants were sixteen resident physicians from intensive care units at emergency departments of two Israeli public tertiary hospitals. Data analysis employed reflexive thematic analysis. Findings suggest that while all residents described having comprehensibility, manageability and meaningfulness differed among residents. Some residents thrived, coped well with secondary trauma, centered on patient emotional needs, and drew meaningfulness from the challenges. Other residents suffered while providing care, reported poor well-being, were too overwhelmed to center patients, and doubted their career choices. Salutogenic-based interventions to cultivate the resilience of resident physicians experiencing secondary trauma are proposed.

Employing Escape Rooms in Medical Education to Deliver Engaging and Immersive Learning: Brief Review

The conventional mode of medical education is delivered using didactic lectures, wherein teachers disseminate the desired information to a large number of students in a structured manner. The purpose of the current review is to explore the scope and need of escape rooms in medical education and identify the potential considerations to be acknowledged while designing an escape room in a medical college for training undergraduate medical students. Escape rooms in principle refer to the learning environments that are interactive and immersive, in the sense that students who are part of these rooms are posed with a puzzle or a challenge or a task that must be solved by them within a defined period of timeframe to eventually escape from the room, which is the ultimate goal of such sessions. The success of escape rooms is determined depending by the way it has been designed, in terms of their ability to engage the involved participants and promote collaboration. In conclusion, the employment of escape rooms in medical education is an innovative teaching-learning method to overcome the limitations of conventional strategies. Acknowledging the merits of escape rooms in the development of critical thinking and teamwork skills, it is the need of the hour that every medical institution must explore the possibility and introduce it within their settings to ensure experiential and long-term learning among medical students.

Empowering Healthcare through Comprehensive Informatics Education: The Status and Future of Biomedical and Health Informatics Education

OBJECTIVES

Education in biomedical and health informatics is essential for managing complex healthcare systems, bridging the gap between healthcare and information technology, and adapting to the digital requirements of the healthcare industry. This review presents the current status of biomedical and health informatics education domestically and internationally and proposes recommendations for future development.

METHODS

We analyzed evidence from reports and papers to explore global trends and international and domestic examples of education. The challenges and future strategies in Korea were also discussed based on the experts' opinions.

RESULTS

This review presents international recommendations for establishing education in biomedical and health informatics, as well as global examples at the undergraduate and graduate levels in medical and nursing education. It provides a thorough examination of the best practices, strategies, and competencies in informatics education. The review also assesses the current state of medical informatics and nursing informatics education in Korea. We highlight the challenges faced by academic institutions and conclude with a call to action for educators to enhance the preparation of professionals to effectively utilize technology in any healthcare setting.

CONCLUSIONS

To adapt to the digitalization of healthcare, systematic and continuous workforce development is essential. Future education should prioritize curriculum innovations and the establishment of integrated education programs, focusing not only on students but also on educators and all healthcare personnel in the field. Addressing these challenges requires collaboration among educational institutions, academic societies, government agencies, and international bodies dedicated to systematic and continuous workforce development.

Integrating basic, clinical, and health system science in a medical neuroscience course of an integrated pre-clerkship curriculum

Basic science, clinical science, and health system science (HSS) have become three pillars of integration upon which modern, post-Flexner, medical education is now based. Because of this new approach to curricular integration in a clinical presentation curruculum, medical training is now placed in the context of healthcare delivery. This study described the design, implementation, and assessment of an integrated teaching strategy, including the effect on students' performance in a medical neuroscience course's summative and formative examinations of an integrated clinical presentation curriculum. The integrated teaching of basic science content, clinical case discussion, and HSS was performed in the first year of an allopathic integrated pre-clerkship curriculum. The two cohorts were from two different years, spring 2018 and 2019. The acceptance of the integrated teaching strategy by medical students was above 80% in all categories that were assessed, including enhancing the integrated experience in learning basic and clinical science materials in the context of HSS; understanding of the learning lessons; facilitation of self-directed learning; provision of a better learning environment; and a holistic understanding of materials including the relevance of HSS issues in the discussion of neurological cases in the medical career of the students. More than 90% of the students scored ≥70% in summative questions mapped to the four learning objectives of the integrated teaching session. The objectives are the correlation of structure to specific functions (94.0 ± 0.21), clinical anatomical features of the nervous system (95.0 ± 0.27), cross-sectional features of the nervous system (96.0 ± 0.31), and the effect of lesions on the structure and functional pathways of the nervous system (97.0 ± 0.34). This result was significantly higher when compared to students' performance in the non-integrated teaching cohort (p < 0.05). Formative assessments (F(7,159) = 92.52, p < 0.001) were significantly different between the two groups. When medical students were evaluated using the same questions for formative assessment, they performed better in the integrated teaching cohort (*p < 0.05) compared to the non-integrated teaching cohort (**p < 0.05).

Eye on the Prize: Patient Outcomes Research in Medical Education

The overarching goal of medical education is to train clinicians who achieve and maintain competence in patient care. Although the field of medical education research has acknowledged the importance of education on clinical practices and outcomes, most research endeavors continue to focus on learner-centered outcomes, such as knowledge and attitudes. The absence of clinical and patient-centered outcomes in pulmonary and critical care medicine medical education research has been attributed to barriers at multiple levels, including financial, methodological, and practical considerations. This Perspective explores clinical outcomes relevant to pulmonary and critical care medicine educational research and offers strategies and solutions that educators can use to accomplish what many consider the "prize" of medical education research: an understanding of how our educational initiatives impact the health of patients.

Innovative Self-directed, Problem-oriented, Lifelong learning, Integrated Clinical case Exercise (SPLICE) modules promote critical thinking skills, early clinical exposure, and contextual learning among first professional-year medical students

Medical education is undergoing various transformations to promote a more personalized and contextual way of learning. In light of this, the innovative "Self-directed, Problem-oriented, Lifelong learning, Integrated Clinical case Exercise" (SPLICE) modules were designed, implemented, and evaluated for medical students in the first professional year as a strategy for early clinical exposure in a collaborative and self-directed way of learning. This is a mixed methods study involving first-year medical students. Students were divided randomly into the control and the intervention groups. Six SPLICE modules were administered to the intervention while the control group followed the traditional curricula. The educational outcome was compared using an end-of-module assessment. In addition, 13-item and 8-item questionnaires were administered to students to evaluate the SPLICE and plenary sessions on a 5-point Likert scale. Furthermore, students' feedback was obtained on a 10-point rating scale and in in-depth small-group interviews. The majority of students perceived that the SPLICE module improved their communication and encouraged meaningful, active learning. Students found the plenary sessions to be well organized, with sufficient interaction with professionals. Students also gave excellent scores for feedback on SPLICE modules, demonstrating the effectiveness of the innovation. In terms of test scores used in assessing learning outcomes, the intervention group outperformed the control group (P < 0.0001). The innovative SPLICE curriculum facilitated early clinical exposure and active self-directed learning. Students perceived SPLICE modules to be highly helpful in terms of promoting meaningful learning and the future application of knowledge.NEW & NOTEWORTHY The very essence of this innovative "Self-directed, Problem-oriented, Lifelong learning, Integrated Clinical case Exercise" (SPLICE) curriculum is the team-based learning of integrated pre-, para-, and clinical learning objectives right from the first professional year of study serving as an early clinical exposure. This unique way of learning creates a holistic educational environment by combining both academic and professional development thereby empowering the next generation of physician leaders to take autonomy of their own learning strategies and emerge as competent lifelong learners.

The impact of online education during the Covid-19 pandemic on the professional identity formation of medical students: A systematic scoping review

Evolving individual, contextual, organizational, interactional and sociocultural factors have complicated efforts to shape the professional identity formation (PIF) of medical students or how they feel, act and think as professionals. However, an almost exclusive reliance on online learning during the COVID-19 pandemic offers a unique opportunity to study the elemental structures that shape PIF and the environmental factors nurturing it. We propose two independent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA)s to map accounts of online learning environment and netiquette that structure online programs. The data accrued was analysed using the clinically evidenced Krishna-Pisupati Model of Professional Identity Formation (KPM) to study the evolving concepts of professional identity. The results of each SSR in SEBA were evaluated separately with the themes and categories identified in the Split Approach combined to create richer and deeper 'themes/categories' using the Jigsaw Perspective. The 'themes/categories' from each review were combined using the Funnelling Process to create domains that guide the discussion. The 'themes/categories' identified from the 141 included full-text articles in the SSR in SEBA of online programs were the content and effects of online programs. The themes/categories identified from the 26 included articles in the SSR in SEBA of netiquette were guidelines, contributing factors, and implications. The Funnelling Process identified online programs (encapsulating the content, approach, structures and the support mechanisms); their effects; and PIF development that framed the domains guiding the discussion. This SSR in SEBA identifies the fundamental elements behind developing PIF including a structured program within a nurturing environment confined with netiquette-guided boundaries akin to a Community of Practice and the elemental aspect of a socialisation process within online programs. These findings ought to be applicable beyond online training and guide the design, support and assessment of efforts to nurture PIF.

Employment of Small-Group Discussions to Ensure the Effective Delivery of Medical Education

The changing landscape of medical education has made small-group discussions crucial components. These sessions, including problem-based learning (PBL), case-based learning (CBL), and team-based learning (TBL), revolutionize learning by fostering active participation, critical thinking, and practical skills application. They bridge theory with practice, preparing future healthcare professionals for the dynamic challenges of modern healthcare. Despite their transformative potential, there are challenges in faculty preparation, resource allocation, and effective evaluation. The best practices include aligning discussions with curriculum goals, skilled facilitation, promoting active participation, and robust assessment strategies. Looking ahead, adapting to emerging health trends, ongoing research, and evolving healthcare demands will ensure the continued relevance and effectiveness of small-group discussions, shaping competent and adaptable healthcare providers equipped for the ever-evolving healthcare landscape.

Are We Where We Want to Be in Undergraduate Pathology Education?

OBJECTIVE

This review which aims to examine the recent and current status of pathology education in medical schools, and covers the publications related to undergraduate pathology education published between 2010 January and June 2023.

MATERIAL AND METHOD

A search was performed through PubMed, Google Scholar, Semantic Scholar, and Ulakbim search engines for the Science Citation Index, Science Citation Index Expanded, Emerging Sources Citation Index, Directory of Open Access Journals, Scopus, PubMed as well as TR Dizin indexed articles. The findings are categorized into two periods as 2010 January - 2020 April (pre-COVID-19 pandemic) and May 2020 - 2023 June. A total of 24 reviews/editorials/letters to the editor and 63 research articles in the pre-pandemic period and 11 reviews/ editorials/ letters to the editor and 35 research articles between 2020 May and 2023 June are included in the analysis.

RESULTS

Currently, medical education generally depends on core education programs with defined learning objectives and outcomes. Moreover, problem-based, case-based, and team-based interactive learning are being used along with traditional didactic courses. Additionally, digital/ web-based/remote education methods have gained prominence after the COVID-19 pandemic. The virtual or augmented reality and 3D drawing applications are offered as a solution for the autopsy and macroscopy courses. A scarce number of publications are found on measuring and evaluating the effectiveness of learning.

CONCLUSION

Artificial intelligence in pathology education is a topic that looks likely to become important in the near future. National and international comprehensive standardization is a necessity. A joint effort and collective intelligence are needed to achieve the desired goals in undergraduate pathology education.

Planning and implementation of participant-centric group activity on research methodology: perceptions of postgraduate medical students in physiology

Knowledge about the key steps in "research methodology" is necessary for all postgraduate students who are enrolled in the medical profession. The objective of the present study was to plan, design, and implement a participant-centric postgraduate skill development activity to inculcate the key principles and components of research methodology. It included 3 goal-oriented component group exercises, namely, 1) framing a research question, 2) critiquing a research article, and 3) writing a research protocol. Out of 25 eligible postgraduate students of our department, 20 participated in all three component group exercises, and they were included in the study. Feedback was obtained from them on a five-point Likert scale after the group exercises. In addition, students were also asked to provide open-ended comments for further improvement of the session. Data from participants' feedback suggested that the majority of the participants expressed satisfaction regarding the plan, conduct, and learning experience of the postgraduate activity. Therefore, participant-centric group activity could be an innovative approach in postgraduate medical education to inculcate the basics of research methodology. It can provide additional emphasis on the components of self-directed learning through individual exercises and unsupervised group dynamics. Supervised group dynamics can inculcate skills in critical thinking, acceptance, communication skills, and teamwork.NEW & NOTEWORTHY Postgraduate medical education is underpinned by supervised and unsupervised learning processes. The current study incorporates an innovative approach to inculcate the basic skills of "research methodology" through three goal-oriented participant-centric group exercises, namely, 1) framing a research question, 2) critiquing a research article, and 3) writing a research protocol. The activities encompass components of self-directed learning through unsupervised group dynamics. They focus on critical thinking, acceptance, communication skills, and teamwork during supervised group dynamics.

ChatGPT Interactive Medical Simulations for Early Clinical Education: Case Study

BACKGROUND

The transition to clinical clerkships can be difficult for medical students, as it requires the synthesis and application of preclinical information into diagnostic and therapeutic decisions. ChatGPT-a generative language model with many medical applications due to its creativity, memory, and accuracy-can help students in this transition.

OBJECTIVE

This paper models ChatGPT 3.5's ability to perform interactive clinical simulations and shows this tool's benefit to medical education.

METHODS

Simulation starting prompts were refined using ChatGPT 3.5 in Google Chrome. Starting prompts were selected based on assessment format, stepwise progression of simulation events and questions, free-response question type, responsiveness to user inputs, postscenario feedback, and medical accuracy of the feedback. The chosen scenarios were advanced cardiac life support and medical intensive care (for sepsis and pneumonia).

RESULTS

Two starting prompts were chosen. Prompt 1 was developed through 3 test simulations and used successfully in 2 simulations. Prompt 2 was developed through 10 additional test simulations and used successfully in 1 simulation.

CONCLUSIONS

ChatGPT is capable of creating simulations for early clinical education. These simulations let students practice novel parts of the clinical curriculum, such as forming independent diagnostic and therapeutic impressions over an entire patient encounter. Furthermore, the simulations can adapt to user inputs in a way that replicates real life more accurately than premade question bank clinical vignettes. Finally, ChatGPT can create potentially unlimited free simulations with specific feedback, which increases access for medical students with lower socioeconomic status and underresourced medical schools. However, no tool is perfect, and ChatGPT is no exception; there are concerns about simulation accuracy and replicability that need to be addressed to further optimize ChatGPT's performance as an educational resource.

A palpable change in medical education post-COVID-19 pandemic

COVID-19 has brought with it a global crisis, but it also highlighted many important take-home messages to educators that are worth considering and implementing for better future medical education. We highlight 5 of these messages; (1) redefining of what considered being a core in training, (2) better to be prepared for the future challenges of online learning, (3) re-envision faculty development practices, (4) attention shift from stethoscope to microscope, (5) extra-curricular scientific activities should not lag.

Exploring basic science knowledge retention within a cohort of undergraduate medical students in the United Kingdom: A longitudinal study

BACKGROUND

Clinical reasoning is reliant on students having acquired a strong foundation in the basic sciences. However, there remains uncertainty regarding whether medical students are maintaining this knowledge over the span of their degrees. Therefore, this project aimed to assess long-term retention of basic science knowledge within a cohort of students from an undergraduate medical school in the United Kingdom (UK).

METHODS

This longitudinal study followed a cohort of students, from their first to final year. In their final year, participants sat a bespoke formative basic science knowledge assessment that utilised 46 single-best-answer questions. To examine for long-term attainment differences, these scores were compared with those achieved in first-year assessments.

RESULTS

Of the eligible students, 40% partook in the study (n = 22). Comparing assessment scores highlighted an enhancement in overall basic science knowledge between first and final year (p < 0.01). Although most basic science domains remained unchanged between both time points, anatomy and physiology scores increased (p = 0.03 and p = 0.02, respectively), whereas biochemistry scores were the only ones to decrease (p = 0.02).

DISCUSSION

This project provides insight into how well students are retaining the basic sciences during their studies. Underperforming science domains were identified, alongside pedagogical explanations for their individual shortcomings; for instance, students' perceived relevance of a domain is seen as a driver for its retention. Subsequently, a group of recommendations were derived to reinforce the most affected domains. The inclusion of more questions on the underperforming sciences, in clinically focussed assessments, is one such suggestion.

What Attributes Matter Most in Physicians? Exploratory Findings from a Single-Centre Survey of Stakeholder Priorities in Cancer Care at a Canadian Academic Cancer Centre

BACKGROUND

Limited research exists regarding how healthcare stakeholders prioritize the importance of differing physician attributes in oncologists. Identifying these priorities can help ensure that Canadian cancer care continues to meet the needs of its patients. In our previous research, compassion and empathy were identified as important physician attributes, with answers like knowledge, professionalism or communication less common. We hypothesized that respondents may have been assuming other, underlying qualities in their oncologists when they prioritized "compassion" and "empathy". To test this, the current study asks respondents to rank important physician attributes.

METHODS

With ethics approval, we asked healthcare stakeholders (physicians, nurses, patients, caregivers, medical students, and allied healthcare providers) to rank the eight most popular qualities or attributes. We identified differences between which characteristics each group valued most in physicians.

RESULTS

375 respondents participated in the survey. "Knowledge" and "competence" were the most popular answers in the current study among all groups except medical students.

CONCLUSION

Previously, we identified compassion as a highly valued attribute; however, this survey suggests that this may be with the assumption that a physician is knowledgeable and competent. Future research will use semi-structured interviews to investigate respondents' rationales for making their choices and help interpret our findings in this study.

Measuring deliberate reflection in residents: validation and psychometric properties of a measurement tool

PURPOSE

Reflective capacity is "the ability to understand critical analysis of knowledge and experience to achieve deeper meaning." In medicine, there is little provision for post-graduate medical education to teach deliberate reflection. The feasibility, scoring characteristics, reliability, validation, and adaptability of a modified previously validated instrument was examined for its usefulness assessing reflective capacity in residents as a step toward developing interventions for improvement.

METHODS

Third-year residents and fellows from four anesthesia training programs were administered a slightly modified version of the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) in a prospective, observational study at the end of the 2019 academic year. Six written vignettes of imperfect anesthesia situations were created. Subjects recorded their perspectives on two randomly assigned vignettes. Responses were scored using a 5-element rubric; average scores were analyzed for psychometric properties. An independent self-report assessment method, the Cognitive Behavior Survey: Residency Level (rCBS) was used to examine construct validity. Internal consistency (ICR, Cronbach's alpha) and interrater reliability (weighted kappa) were examined. Pearson correlations were used between the two measures of reflective capacity.

RESULTS

46/136 invited subjects completed 2/6 randomly assigned vignettes. Interrater agreement was high (k = 0.85). The overall average REFLECT score was 1.8 (1-4 scale) with good distribution across the range of scores. ICR for both the REFLECT score (mean 1.8, sd 0.5; α = 0.92) and the reflection scale of the rCBS (mean 4.5, sd 1.1; α = 0.94) were excellent. There was a significant correlation between REFLECT score and the rCBS reflection scale (r = .44, p < 0.01).

CONCLUSIONS

This study demonstrates feasibility, reliability, and sufficiently robust psychometric properties of a modified REFLECT rubric to assess graduate medical trainees' reflective capacity and established construct/convergent validity to an independent measure. The instrument has the potential to assess the effectiveness of interventions intended to improve reflective capacity.

Exploring the Educational Value of Popular Culture in Web-Based Medical Education: Pre-Post Study on Teaching Jaundice Using "The Simpsons"

BACKGROUND

The potential of popular culture as a tool for knowledge delivery and enhancing engagement in education is promising but not extensively studied. Furthermore, concerns exist regarding learning fatigue due to increased reliance on videoconferencing platforms following the COVID-19 pandemic. To ensure effective web-based teaching sessions that maintain attention spans and enhance understanding, innovative solutions are necessary.

OBJECTIVE

This study aims to evaluate the use of specific popular culture case studies to enhance student engagement in a web-based near-peer teaching session.

METHODS

We delivered a web-based teaching session to undergraduate medical students in the United Kingdom. The session included clinical vignettes and single-best-answer questions using characters from "The Simpsons" television show as patient analogies for various causes of jaundice. A pre-post survey, employing a 7-point Likert scale, was distributed to gather data from participants.

RESULTS

A total of 53 survey responses were collected. Participants reported significantly improved understanding of jaundice after the session compared to before the session (median 6, IQR 5-6 vs median 4, IQR 3-4.5; P<.001). The majority of participants agreed that the inclusion of "The Simpsons" characters enhanced their knowledge and made the teaching session more memorable and engaging (memorability: median 6, IQR 5-7; engagement: median 6, IQR 5-7).

CONCLUSIONS

When appropriately integrated, popular culture can effectively engage students and improve self-perceived knowledge retention. "The Simpsons" characters can be used pedagogically and professionally as patient analogies to deliver teaching on the topic of jaundice.

Designing a Shortened Preclinical Basic Science Curriculum: Expert-Derived Recommendations

PURPOSE

To generate an expert-derived list of recommendations for how medical schools should approach decisions about the placement of basic science topics within shortened preclinical curricula, which allow for early clinical immersion.

METHOD

A modified Delphi process was used to develop consensus on recommendations (March-November 2021). The authors performed semistructured interviews with national undergraduate medical education (UME) experts from institutions that previously underwent curricular reforms involving shortened preclinical curricula to elicit perspectives on how decisions were made at their institutions. The authors condensed the findings into a preliminary list of recommendations and distributed this list in 2 survey rounds to a larger group of national UME experts (from institutions that previously underwent curricular reforms or held positions of authority within national UME organizations) to gauge their level of agreement with each recommendation. Recommendations were revised based on participant comments, and those with at least 70% somewhat or strong agreement after the second survey were included in the final comprehensive list of recommendations.

RESULTS

Interviews were conducted with 9 participants and resulted in 31 preliminary recommendations that were then sent via survey to the 40 recruited participants. Seventeen/40 (42.5%) participants completed the first survey, after which 3 recommendations were removed, 5 were added, and 5 were revised based on comments-resulting in 33 recommendations. Twenty-two/38 (57.9%) participants responded to the second survey, after which all 33 recommendations met inclusion criteria. The authors removed 3 recommendations that did not directly address the curriculum reform process and consolidated the final 30 recommendations into 5 succinct, actionable takeaways.

CONCLUSIONS

This study generated 30 recommendations (summarized by the authors in 5 succinct takeaways) for medical schools designing a shortened preclinical basic science curriculum. These recommendations reinforce the importance of vertically integrating basic science instruction with explicit clinical relevance into all curricular phases.

Flexner has fallen: Transitions in medical education system across time, a gradual return to pre-Flexnerian state (de-Flexnerization)

The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.

Are Ethiopian schools of medicine producing competent medical graduates for providing quality health care in the era of COVID-19 pandemic?

BACKGROUND

Competent health workforce, including medical doctors, is the heart of health systems. Cognizant of this, Ethiopia is implementing licensure exam as a strategy to produce competent health workforce, including medical doctors and beyond, for the provision of high quality health care, among others. However, there is a dearth of evidence on medical graduates' competence in Ethiopia in the era of Covid-19 pandemic. Hence, this study aimed to assess the competence of medical graduates-based on licensure exam results in Ethiopia.

METHODS

A multi -center institution-based cross-sectional study was conducted among 1051 medical graduates (selected through cluster sampling method) from May - July 2022 in Medical Schools found in Amhara region, Northwest Ethiopia. Data were collected from secondary sources at the Ministry of Health and Medical Schools using a structured checklist. Data analysis was performed using SPSS Version 23 software. A binary logistic regression analysis was performed to identify factors associated with graduates' competence.

RESULTS

Nine hundred sixty-one (91.4%) medical graduates were competent. The study revealed that those graduates with older age (AOR: 0.63; 95% CI: 0.52, 0.76), being female graduates (AOR: 0.39; 95% CI: 0.22, 0.69), graduated in 2021 (AOR: 0.31; 95%; CI: 0.17, 0.60) and attending education in junior medical schools (AOR: 0.06; 95% CI : 0.01, 0.40) have lower competence as compared with that of their counterparts. Whereas, graduates with no repeating internship attachment (AOR: 2.41; 95% CI: 1.40, 4.17) and graduates with repeating academic year (AOR: 2.01; 95% CI: 1.14, 3.56) have better competence than that of their counterparts.

CONCLUSION

The proportion of competent medical graduates was relatively low as per the national strategic plan which aspires that all medical graduates to be competent. Medical graduate's competence was affected by age, gender, curriculum being implemented, and having academic as well as internship repeats. As result, policymakers should scale up competency based education in Medical Schools.

A Pilot Study Assessment of Medical Student Knowledge and System Citizenship Attitudes Pertaining to Health Systems Science

Background and Purpose

Health system science (HSS) has been described as the third pillar of medical education. We introduced a new health system science and interprofessional practice (HSSIP) curriculum, and measured students' HSS knowledge and attitudes concerning health system citizenship.

Methods

This pilot study involved first-year (M1) and fourth-year (M4) medical students in two cohorts across 2 years. Only M1 students in the second cohort participated in the new HSSIP curriculum. We compared student performance on a new National Board of Medical Examiners (NBME) HSS subject exam, and student attitudes toward system citizenship via a new attitudinal survey.

Results

Fifty-six eligible fourth-year students (68%) and 70 (76%) study eligible first-year students participated in the study. NBME HSS exam performance by M4 students was statistically significantly higher than M1 students for both cohorts, with moderate to large effect sizes. Exam performance for M1 students not experiencing the HSS curriculum was higher than for M1 students who received HSS curricular content. Attitudes toward HSS by M4 versus M1 students were statistically significantly different on several survey items with moderate effect sizes. Scale internal consistency for the HSS attitude survey was strong (0.83 or higher).

Discussion

There were differences among M4 and M1 medical students concerning knowledge of and attitudes toward HSS, with performance on the NBME subject exam similar to a national sample. Exam performance by M1 students was likely impacted by class size and other factors. Our results support the need for increased attention to HSS during medical education. Our health system citizenship survey has potential for further development and cross-institutional collaboration.

Early clinical exposure as a highly interesting educational program for undergraduate medical students: an interventional study

BACKGROUND

Training professional medical experts is so much dependent on the efficacy of the medical curriculum. Bearing this in mind, we aimed to evaluate the attitude of the undergraduate medical students toward the Early clinical exposure (ECE) program as a facilitator transition to the clinical phase.

METHODS

This quasi-experimental study was conducted on undergraduate medical students at the Mashhad University of Medical Sciences, Mashhad, Iran who were transferring from the pre-clinical course to the externship course from 2021 to 2022 by census method (i.e. all eligible students were included and no sampling was performed). An eight-session ECE intervention was performed on the participants by two professors of the Internal medicine department of Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. The participants' attitude toward the program and the program quality was assessed with the valid and reliable scale developed by Mirzazadeh et al. (Cronbach's alpha = 0.72). Statistical analyses were performed by SPSS software (version.16) with a statistically significant level of less than 0.05.

RESULTS

A total of 118 undergraduate medical students were enrolled in the study. Our results revealed that this program could familiarize (n = 95,81.2%)the students with the role of basic sciences knowledge in clinical settings, and 104(88.9%) participants believed that this intervention could motivate them toward learning more. The data revealed that this program was highly interesting for international students. There was a significant differentiation between Iranian and international students in familiarity with doctoring skills in medicine(P < 0.001), familiarity with the roles and responsibilities of clinical students(P < 0.001), and utility of early clinical exposure and providing more experiences(P < 0.001). According to the students' reports, the major strengths of the program were familiarizing themselves with the clinical fields, having excellent instructors, and performing admirable training. On the other hand, the major weakness of the program was the short duration and the high population of participants in each group.

CONCLUSIONS

The ECE program had a positive impact on the students' satisfaction with medical education, and it also enhanced their understanding of the role they will play as future physicians. Therefore, we recommend that this program be implemented as a part of the medical education curriculum in medical universities.

Generational situatedness: Challenging generational stereotypes in health professions education

PURPOSE

Use of generation theory is pervasive within health professions education (HPE) literature, yet its application perpetuates unfounded generalizations that disadvantage learners. The objectives of this thematic analysis are first, to understand how generation theory is applied to 'Generation Z' HPE students and second, to propose a more productive framework for approaching evolutions within HPE.

METHODS

A literature search was conducted to identify HPE publications pertaining to Gen Z learners. A thematic analysis was undertaken to identify a priori themes and uncover new themes.

RESULTS

Qualitative analysis revealed evidence of three a priori themes as well as four newly identified themes across our sample.

CONCLUSION

The near ubiquity of essentialism and generational othering across our sample illustrates the ongoing challenges posed by generationalism in HPE discourse. While traces of generational humility and generational situatedness suggest a more holistic response to evolving student populations, we nevertheless discourage the continued use of generation theory to guide HPE pedagogy and instead urge educators to resist essentializing generalizations by thinking comprehensively about what evolutions in HPE must occur if we are to best prepare our students to practice in present and future healthcare settings.[Box: see text].

Professional Coaching as a Continuing Professional Development Intervention to Address the Physician Distress Epidemic

ABSTRACT

Physician distress and burnout are reaching epidemic proportions, threatening physicians' capacities to develop and maintain competencies in the face of the increasingly demanding and complex realities of medical practice in today's world. In this article, we suggest that coaching should be considered both a continuing professional development intervention as well as an integral part of a balanced and proactive solution to physician distress and burnout. Unlike other interventions, coaching is intended to help individuals gain clarity in their life, rather than to treat a mental health condition or to provide advice, support, guidance, or knowledge/skills. Certified coaches are trained to help individuals discover solutions to complex problems and facilitate decision-making about what is needed to build and maintain capacity and take action. Across many sectors, coaching has been shown to enhance performance and reduce vulnerability to distress and burnout, but it has yet to be systematically implemented in medicine. By empowering physicians to discover and implement solutions to challenges, regain control over their lives, and act according to their own values, coaching can position physicians to become leaders and advocates for system-level change, while simultaneously prioritizing their own well-being.

A scoping review of patient-led teaching of health professions students

Patients with chronic health conditions may become experts in their own conditions. Thus, utilising patients as teachers, with autonomy over taught content, may better prepare students to deliver patient-centred care. A scoping review following Arksey and O'Malley and Joanna Briggs Institute framework was performed. A total of 2162 articles were identified and 28 unique studies were included. Patient teacher programmes range from single, short 1- to 2-h tutorials to longitudinal community-based programmes. These programmes are mutually beneficial for students, improving awareness of all patient-centred domains, and patients feel empowered by their roles in education.

Social Media and Vaccine Hesitancy: Help Us Move the Needle

With more than 75% of parents and pediatric caregivers getting their health-related information online, reaching families on social media is a powerful way to leverage the trust built in the examination room to address vaccine hesitancy. This article first reviews the ways the antivaccine movement has leveraged social media to expand its considerable influence, and why social media companies have failed to reduce antivaccine misinformation and disinformation. Next, it reviews the barriers to adoption of social media-based communication by pediatric health-care providers and concludes with action-oriented items to increase the adoption of this powerful tool.

A qualitative assessment of medical students' readiness for virtual clerkships at a Qatari university during the COVID-19 pandemic

BACKGROUND

This study aims to qualitatively examine the readiness of medical students to change to virtual clerkship (VC) during the pandemic, from both the faculty and students' perspectives.

METHODS

A qualitative study was conducted based on the framework of readiness to change. Focus group discussions with students, and semi-structured interviews with clinical faculty members were done using appropriate online platforms. Transcripts were then analyzed using inductive-deductive approach.

RESULTS

Twelve themes emerged which are (1) Perceptions about the university's decision and its communication to students, (2) A Perceived lack of clinical experience, (3) Students' role as members of the medical team facing the pandemic, (4) Student safety, (5) Quality and design of VC and the skills it offered, (6) Belief in own ability to succeed in the VC, (7) Confidence that VC would reach its goals, (8) New enhanced learning approaches, (9) Preparing students for new types of practice in the future (10) Acquired skills, 11) Academic support and communication with faculty and college, and 12) Psychological support. Medical students showed limited readiness to undertake a virtual clerkship and not play their role as healthcare professionals during the pandemic. They perceived a huge gap in gaining clinical skills virtually and asked for a quick return to training sites.

CONCLUSION

Medical students were not ready for virtual clerkships. There will be a need to integrate novel learning modalities such as patient simulations and case-based learning in order to meet future demands of the medical profession and enhance the efficiency of virtual clerkships.

Competency-Based Medical Education (CBME): an Overview and Relevance to the Education of Future Surgical Oncologists

In the next two decades, the global cancer burden is expected to rise by 47%, and the demand for global cancer surgery will increase by 52%. At present, only 25% of the estimated 80% of patients needing surgical intervention have access to timely surgical care. The shortage of a trained workforce of surgical oncologists is one of the main barriers to providing the optimal surgical intervention needed for cancer patients. Some of the contributing factors to the shortage of trained surgical oncologists are variations in the current global educational platforms, long training programs, and physician burnout. Therefore, the availability of a credible training framework and a sustainable certification pipeline for future surgical oncologists is critical to meet the global demand for an adequate healthcare workforce. The current surgical oncology educational program is a time-based construct that trains surgeons to function seamlessly in the multidisciplinary care of cancer patients. However, there is a lack of flexibility in the training framework and timeline despite differences in trainees' abilities. Developing a globally acceptable standard curriculum for surgical oncology training based on the competency-based medical education (CBME) framework and tailoring it to local needs can increase the surgical oncology workforce ready to tackle the rising cancer burden. However, successful implementation of the global CBME-based surgical oncology training curriculum requires an innovative approach to ensure that this framework produces a competent surgical oncologist that meets the local needs.

Radical reform of the undergraduate medical education program in a developing country: the Egyptian experience

Medical educators are in a continuous quest to close the gap between the needs of medical practice and the rising expectations of the communities in their countries. During the past two decades, competency-based medical education has been evolving as an appealing strategy to close this gap. In 2017, the Egyptian medical education authorities mandated all medical schools to change their curricula to comply with revised national academic reference standards, which changed from outcome-based to competency-based. In parallel, they also changed the timeline of all medical programs for six years of studentship and one-year internship to five years and two years, respectively. This substantial reform involved the assessment of the existing situation, an awareness campaign for the proposed changes and an extensive national faculty development program. Monitoring the implementation of this substantial reform was performed through surveys, field visits and meetings with students, teaching staff and program directors. In addition to the expected challenges, the COVID-19-associated restrictions presented a significant further challenge during the implementation of this reform. This article presents the rationale for and steps of this reform, the challenges faced and how they were addressed.

"Preparing them for the profession": An interpretative phenomenological analysis of anatomy educators coping with complexity in the United Kingdom curriculum

Efforts to integrate the basic sciences into the ever-changing curriculum are a trending area of research in health professions education. Low-stakes, high-frequency assessment methods such as the progress test are now widely implemented in the United Kingdom and Northern Ireland as a means of furthering curricular integration toward contemporary goals of competency and professional identity formation. The anatomy educator's experience vis-à-vis these curricular changes is not well understood. This study aimed to explore how anatomy educators make sense of the shifting demands of their role. The interviews were semi-structured, particularly concerned with the phenomenon of teachers adapting to the complexity of their learning environment. The study used interpretative phenomenological analysis (IPA) to focus on the lived experiences of participants coping with the phenomena in question: how do anatomy educators make sense of the learning environment in the United Kingdom? Interviews were transcribed verbatim and interpreted inductively, identifying four key themes: confidence through connectedness, variations in appraisals of curricular integration, managing expectations to perform in paradoxical situations, and the emergence of innovative teaching. Results point to the learning environment as a complex system and highlight the importance of feeling support from and connection to colleagues, enabling individual educators to develop confidence, meet the top-down demands of changing curricula, and experience personal identity development and uncertainty tolerance within their role. This IPA study offers insight into the lived experiences of anatomy educators whose experiential interpretations of a complex and changing curriculum can uniquely inform stakeholders in health professions education.

The use of facial expressions in measuring students' interaction with distance learning environments during the COVID-19 crisis

Digital learning is becoming increasingly important in the crisis COVID-19 and is widespread in most countries. The proliferation of smart devices and 5G telecommunications systems are contributing to the development of digital learning systems as an alternative to traditional learning systems. Digital learning includes blended learning, online learning, and personalized learning which mainly depends on the use of new technologies and strategies, so digital learning is widely developed to improve education and combat emerging disasters such as COVID-19 diseases. Despite the tremendous benefits of digital learning, there are many obstacles related to the lack of digitized curriculum and collaboration between teachers and students. Therefore, many attempts have been made to improve the learning outcomes through the following strategies: collaboration, teacher convenience, personalized learning, cost and time savings through professional development, and modeling. In this study, facial expressions and heart rate are used to measure the effectiveness of digital learning systems and the level of learners' engagement in learning environments. The results showed that the proposed approach outperformed the known related works in terms of learning effectiveness. The results of this research can be used to develop a digital learning environment.

Underrepresented in medicine students' perspectives on impactful medical education

BACKGROUND

Exploring the perceptions of underrepresented in medicine (URiM) students about the medical education curriculum and learning environment could optimize their education outcomes. The current study delineated perceptions of URiM medical students about the unique elements and characteristics of an impactful medical education program that create a positive, supportive learning environment culture.

METHODS

We conducted in-depth interviews with 15 URiM students between January 2018 and April 2018. Interviewees were recruited from an accredited medical education program in Historically Black Colleges and Universities (HBCUs). The University is also a member of the Hispanic Association of Colleges and Universities in the U.S. The main question that guided the study was, "What do URiM students at a Historically Black Colleges and Universities (HBCU) medical school believe would make a medical education program (MEP) impactful?" We used the grounded theory analytical approach and performed content analysis via qualitative thematic evaluation.

RESULTS

Of 112 enrolled medical students (MS), 15 verbally consented to participation. We identified four general themes and several subthemes. The themes include 1) Grounding learning in the community; 2) Progressive system-based practice competency; 3) Social justice competency and 4) Trauma-informed medical education delivery. Theme 1 included the following subthemes (a) community engagement, and (b) student-run clinic, mobile clinic, and homeless clinic rotations. Theme 2 includes (a) interprofessional learning and (b) multidisciplinary medicine for cultivating a 'just' healthcare system. Theme 3 includes (a) longitudinal social justice curriculum, (b) advocacy, and (c) health disparity research. Theme 4 had the following subdomains (a) early and ongoing mentoring and (b) provision of supportive policies, services and practices to maximize learning and mental health.

CONCLUSION

Our learners found that social justice, trauma-informed, community-based curricula are impactful for URiM learners. These findings highlight the need for further research to assess the impact of permeating the championship culture, community cultural wealth, and transformational education in all aspects of the MEP in providing a supporting and positive learning environment for URiM students.

Research engagement by British early-career practitioners in nephrology: a multidisciplinary survey

OBJECTIVES

To establish barriers and motivators underlying research engagement among early-career practitioners in nephrology across the UK, in order to guide potential interventions to enhance research involvement in renal units.

DESIGN

Cross-sectional online survey employing a range of free-text, Likert scale and binomial/multiple-choice responses, distributed via mailing lists and social media. Topics covered research experience, research involvement and barriers, impact of COVID-19 and strategies to improve research engagement. Thematic analysis was used to assess free-text responses.

SETTING

Renal units throughout the UK.

PARTICIPANTS

Non-consultant healthcare staff self-identifying as working in nephrology were included (n=211), with responses from non-UK respondents or consultant nephrologists excluded (n=12).

RESULTS

Responses were received from across the multidisciplinary team (physicians (n=83) and nurses (n=83)) and other allied health professionals (n=45). Most were aware of ongoing local research, but under half of them were actively involved. Multivariate analysis indicated employment as a physician, protected time for research activity and provision of appropriate training were associated with greater research experience and output. There was general enthusiasm to undertake research, but perceived barriers included insufficient staffing, lack of time, funding and encouragement. COVID-19 was felt to have further impacted negatively upon opportunities. Among the suggested strategies to promote engagement, mentorship and an online research resource were felt to be of most interest.

CONCLUSIONS

In the first survey of this type in nephrology, we demonstrate differences across the multidisciplinary spectrum in perceived research experience and accessibility, which have been worsened by COVID-19. Our findings will guide strategies to broaden engagement in early-career practitioners and serve as a baseline to assess the impact of these interventions.

Does developing multiple-choice Questions Improve Medical Students' Learning? A Systematic Review

Practicing Multiple-choice questions is a popular learning method among medical students. While MCQs are commonly used in exams, creating them might provide another opportunity for students to boost their learning. Yet, the effectiveness of student-generated multiple-choice questions in medical education has been questioned. This study aims to verify the effects of student-generated MCQs on medical learning either in terms of students' perceptions or their performance and behavior, as well as define the circumstances that would make this activity more useful to the students. Articles were identified by searching four databases MEDLINE, SCOPUS, Web of Science, and ERIC, as well as scanning references. The titles and abstracts were selected based on a pre-established eligibility criterion, and the methodological quality of articles included was assessed using the MERSQI scoring system. Eight hundred and eighty-four papers were identified. Eleven papers were retained after abstract and title screening, and 6 articles were recovered from cross-referencing, making it 17 articles in the end. The mean MERSQI score was 10.42. Most studies showed a positive impact of developing MCQs on medical students' learning in terms of both perception and performance. Few articles in the literature examined the influence of student-generated MCQs on medical students learning. Amid some concerns about time and needed effort, writing multiple-choice questions as a learning method appears to be a useful process for improving medical students' learning.

Computational pathology, new horizons and challenges for anatomical pathology

The emergence of digital pathology environments and the application of computer vision to the analysis of histological sections has given rise to a new area of Anatomical Pathology, termed Computational Pathology. Advances in Computational Pathology may substantially change the routine of Anatomical Pathology laboratories and the work profile of the pathologist.

Current Status of Immunology Education in U.S. Medical Schools

Immunology is an integral component of undergraduate medical education because of its critical role in many disease processes. Due to the complexity of the subject, the best practice of immunology education in the undergraduate medical curriculum has not been extensively discussed. This study intended to determine the current status of immunology education in U.S. medical schools with the hope of providing insight into curriculum design pertaining to this subject. Immunology curriculum information was collected from the curriculum Web pages of 199 U.S. medical schools, including multiple campuses. Data pertaining to the setting of immunology education such as subjects that are co-taught with immunology, timing of courses, credit hours, and integration level were recorded in Microsoft Excel for analysis. Of 199 U.S. medical schools studied, 174 posted curriculum information related to immunology online. For course settings, 59 (33.9%) offer immunology with microbiology, 42 (24.1%) offer immunology as part of a foundational sciences course, and 18 (10.3%) offer immunology as a stand-alone course. Ten programs (5.7%) have immunology fully integrated in system-based curriculum. Of 119 medical schools that provide information regarding timing, 94 (71.9%) provide immunology education in year 1 of the curriculum, 16 (9.2%) in year 2, and 9 (5.2%) in both years 1 and 2. Differences exist in allopathic versus osteopathic programs in the immunology curriculum setting. Credit hour data were not complete due to inconsistent availability. Our data suggest that immunology education in U.S. medical schools lacks consensus. Continued discussion on best practices of immunology education across U.S. medical schools is recommended.

How are Medical Institutions Supporting the Well-being of Undergraduate Students? A Scoping Review

INTRODUCTION

Medical students experience significant stress and impacts on mood due to multiple factors. Unmitigated stress impacts both physical and mental health while increasing the risk of unethical behavior. It is important for medical institutions to identify strategies that effectively reduce perceived stress and improve the well-being of their students.

METHODS

The authors undertook a scoping review of the literature to identify strategies implemented by medical educational programs to improve the well-being of medical students.

RESULTS

Of 1068 articles identified, 19 studies met the inclusion criteria. Interventions were categorized as mindfulness-based programs, reflection groups, curriculum changes, and 'miscellaneous.' All studies assessed outcomes of student stress/resilience, as well as additional domains including academic performance, mental health, and interpersonal skills. Some also assessed the acceptability of the intervention to students.

CONCLUSIONS

Despite the heterogeneity of interventions and outcome measures, a clear theme emerged that institutionally-provided strategies to promote student well-being tend to be effective when students opt into the program. It was noted that adding mandatory content or activities to a medical program without creating adequate space or support for it can have the opposite effect. Further high quality intervention studies involving randomization, blinding and rigorous controls are warranted.

Impact of Satisfactory/Unsatisfactory Grading on Student Motivation to Learn, Academic Performance, and Well-Being

Satisfactory/unsatisfactory (S/U) grading is often proposed to ameliorate stress by reducing the competitive nature of letter grading. Though explored considerably in human medical programs, minimal literature focuses on the veterinary school setting. The purpose of this study was to evaluate the impact of S/U grading on veterinary students' motivation to learn, academic performance, and well-being. Cornell University's COVID-19 pandemic response provided a unique opportunity to compare S/U and letter grading on the same population of students during a single pre-clinical foundation course, with the first half being graded S/U (spring semester 2020), returning to letter grades in the second half (fall semester 2020). Students were retroactively surveyed on the effect of S/U vs. letter grading on their overall educational experience and well-being, with 67.8% class participation. The majority of respondents (71.3%) stated that S/U grading had a positive impact on their overall learning experience. More than half (53.8%) perceived that they learned the same amount of information and had the same level of motivation (58.8%), even though most (61.3%) stated that they spent less time preparing for S/U assessments than letter grade assessments. Positive impact factor effects for S/U grading included decreased stress, more time for self-care, improved learning, and increased learning enjoyment. S/U grading did not negatively impact academic performance. In conclusion, this study demonstrates that, in our particular study population and setting, S/U grading conferred well-being and learning experience advantages to students without any reduction in motivation for learning or academic performance.

Performance effects of simulation training for medical students - a systematic review

OBJECTIVE

Simulation based medical education (SBME) is fast becoming embedded into undergraduate medical curricula with many publications now describing its various modes and student self-reported impacts. This systematic review synthesizes the available literature for evidence of performance effects of SBME as an adjunct within traditional teaching programmes.

METHODS

A narrative systematic review was conducted according to PRISMA guidelines using Ovid MEDLINE, EMBASE, and PubMed databases for studies, published in English, reporting on general medical and surgical undergraduate SBME between 2010 to 2020. Two reviewers independently assessed potential studies for inclusion. Methods and topics of simulation with their assessments were evaluated. Descriptive statistics were used to describe pooled student cohorts.

RESULTS

3074 articles were initially identified using the search criteria with 92 full-text articles then screened for eligibility. Nineteen articles, including nine randomised trials, concerning 2459 students (median 79/study), were selected for review. Cardiac scenarios were commonest (n=6) with three studies including surgical topics. Nine studies used mannequin simulators (median time/session 17.5minutes) versus standardised patients in seven (median time/session=82 minutes). Educational impact was measured by written (n=10), checklist (n=5) and OSCEs (n=3) assessment either alone or in combination (n=1, OSCE/written assessment). All articles reported a positive effect of SBME on knowledge including improved retention in three.

CONCLUSION

SBME, as an adjunct to existing curricula, improves knowledge-based performance of medical students at least in the short-term. Future studies should broaden its topics, assess longer term impacts and cost-effectiveness while also considering whether and what areas of traditional undergraduate learning it can replace.