Promoting physician-patient language concordance in undergraduate medical education: a peer assisted learning approach

Enhancing medical English proficiency: the current status and development potential of peer-assisted learning in medical education

This narrative review investigates the current implementation and future potential of Peer-Assisted Learning (PAL) in medical education, specifically emphasizing its role in enhancing medical English proficiency. The article analyzes the effectiveness of PAL across various medical education contexts, including primary medical courses, doctor-patient communication, and standardized residency training. The findings indicate that PAL positively impacts student learning outcomes and promotes professional development, highlighting the necessity of its application in medical English instruction. However, implementing PAL faces several obstacles, such as limitations in student cognition and a singular interaction model. This review presents several application prospects, including scenario simulation and the integration of PAL with pedagogical methods such as Problem-Based Learning (PBL), Case-Based Learning (CBL), and Team-Based Learning (TBL). Ultimately, this review underscores the importance of PAL in medical English teaching and recommends future research directions to develop effective teaching models that optimize its implementation.

Transforming Education: Case-Based Integrated Learning Development and Implementation - A Mixed Methods Study at a Private Medical College

Introduction

Case-based learning (CBL) is widely used in medical education to bridge theory and practice, but traditional methods often struggle to sustain student engagement and promote critical thinking. To address these challenges, Case-Based Integrated Learning (CBIL) was developed as a novel approach combining immersive and interactive learning techniques. This study aimed to evaluate the effectiveness of CBIL in enhancing engagement, critical thinking, and clinical reasoning among medical students, and explore faculty experiences regarding the pedagogy.

Methods

An explanatory-sequential mixed-methods study was conducted in a private medical college in Pakistan. Quantitative data were collected through faculty (n=35) and student (n=122) evaluation surveys, and analyzed using descriptive statistics (mean, standard deviation, frequencies, and percentages). Qualitative data from focused group discussions (FGD) with faculty were analyzed thematically. A committee of clinical faculty and medical educationists developed four CBIL prototypes. Faculty from various clinical specialties were trained on CBIL concepts and lesson planning, and the prototypes were used to develop engaging cases for subsequent sessions. Participants included faculty from diverse disciplines and students in their third and fourth years of medical school.

Results

The faculty considered the training very effective (overall satisfaction 5.17±0.89 out of 6), with a vast majority being very satisfied with its relevance (86%, n=30) and structure (91%, n=32). Among students, 95% (n=116) were satisfied with the developed cases. Most of them were also satisfied with the clarity (92%, n=112) and applicability of the cases (96%, n=117). In FGD, facilitators expressed satisfaction with CBIL formats as it provided opportunities for engagement, in-depth analyses, and discussions.

Conclusion

Interactive formats like CBIL can engage students by allowing opportunities for interaction, discussion, and peer-learning. This promotes improved understanding and critical thinking. Further exploration of the effectiveness and impacts on the learning of various interactive formats of case-based learning is essential.

Non-native English-speaking applicants and the likelihood of physician assistant program matriculation

PURPOSE

Effective communication is critical in patient care. Multilingual medical providers, including Physician Assistants (PAs) can contribute to improved health care among patients with limited English proficiency; however, this is contingent upon matriculating multilingual providers. In this study, the association between prospective applicants' self-reported English as second language (ESL) status and their likelihood of matriculation into a PA program was investigated.

METHODS

Participants included applicants to five admission cycles of the Centralized Application Service for Physician Assistant from 2012 to 2020. Logistic regression was utilized to investigate association between applicant ESL status and odds of program matriculation in both bivariate and multivariable regression models. Models were adjusted for citizenship status, undergraduate grade point average, gender, age, race/ethnicity, number of programs applied to, and patient care hours.

RESULTS

In unadjusted and adjusted models, ESL status was associated with a significantly lower odds of matriculation to a PA program across all study years. In adjusted multivariable models, associations were strongest for 2014-2015 where ESL status was associated with a 35% lower odds of matriculation (odds ratio 0.65, 95% confidence interval 0.56, 0.76) when controlling for demographics, citizenship status, patient care experience, and academic achievement. In sensitivity analyses restricting to (a) those with TOEFL scores ≥ 100, and (b) restricting to those ESL applicants without TOEFL scores, we did not observe important changes in our results.

CONCLUSIONS

Results indicated that non-native English-speaking applicants have lower odds of PA program matriculation. Decrements in matriculation odds were large magnitude, minimally impacted by adjustment for confounders and persistent across the years. These findings suggest that PA program admission processes may disadvantage non-native English-speaking applicants. While there are potential explanations for the observed findings, they are cause for concern. Matriculating and training PAs who have language concordance with underserved populations are important means of improving patient outcomes.

Does empathy decline in the clinical phase of medical education? A study of students at Leicester medical school

Objective

To examine whether medical student empathy changes throughout the five years of a UK medical school.

Methods

Students completed an online version of the Jefferson Scale of Empathy (JSE-S) during the 2022-2023 academic year. Comparisons of empathy scores were made using analysis of variance (ANOVA), and independent t-tests.

Results

Empathy scores varied across different years of medical school (P ≤ 0.001), with a small drop in empathy between the pre-clinical and clinical phases of medical school (Mean difference = 1.82, P = 0.025). Male students scored lower than female students and there was no statistically significant difference between the mean empathy score and speciality interest.

Conclusions

Students' empathy appeared declined slightly as they progressed through medical school. As a crucial component of good clinical care, interventions in medical education to enhance empathy should be prioritised.

Innovation

This is the first time following the COVID-19 pandemic that medical student empathy was measured across all five years of a medical school. Unlike many previous related studies, we identified the point at which empathy appears to decline, providing guidance for educators who can target empathy enhancing interventions where they are most needed.

Unraveling the link between language barriers and cancer risk

PURPOSE

Clear patient communication with the physician is an integral aspect of cancer treatment and successful health outcomes. Previous research has shown improved cancer screening in cases of patient navigator assistance to limited English proficient patients, but no research has analyzed the relationship between language isolation and cancer incidence rates in the United States.

METHODS

Using state-level data from the United States Census Bureau and the National Cancer Institute, we analyzed the correlations between language isolation and age-adjusted incidence rates across 19 different invasive cancers.

RESULTS

A complex relationship between language isolation and cancer incidence rates was found. States such as California, New York, Texas, and New Jersey show high language isolate prevalence and elevated cancer incidence rates. Cancer subtype incidence rates varied between states, indicating the multifactorial importance of lifestyle, genetics, and environment in cancer. California had the highest language isolation ranking of 8.5% and elevated rates of ovarian (10.4/100,000) and stomach (9.1/100,000) cancers. New York, with the second-highest language isolation ranking of 7.6%, manifests a pronounced prevalence of ovarian (11.3/100,000) and stomach (10.9/100,000) cancers. Overall, positive correlations were observed between language isolation and ovarian/stomach cancers, while negative correlations were found with lung, kidney, melanoma, and colorectal cancers.

CONCLUSION

This study emphasizes the need to address language barriers and other social determinants of health in cancer prevention/control. Targeted interventions, such as culturally appropriate education, increased access to linguistically and culturally appropriate cancer screening, and language lessons, are crucial in improving health outcomes in linguistically diverse communities.

Revisiting the conceptualisation and implications of medicine's 'hidden curriculum'

In medical training and practice, our professional attributes, attitudes, perceptions, character traits and identities are fundamentally shaped by our lived experiences and observations in clinical and para-clinical settings instead of being inculcated through formal curriculum or classroom teaching. For instance, clinical acumen, communication skills and bedside manners are learnt through role modelling and experiential learning in the course of clinical rotations. Likewise, one's attitudes, professional behaviours and inclinations are often also influenced by direct/indirect observations of the actions of others in the medical fraternity in various clinical and non-clinical settings. This is also what is often termed as the 'hidden curriculum' of medicine. In this article, we sought to provide a practical conceptualisation of the hidden curriculum in medical training, which we describe as lived experiences and personal observations of medical trainees and residents in clinical and para-clinical spaces, which shape their perceptions of the medical profession (vocational identity and purpose), patients (patient-physician relationship) and colleagues (intra- and inter-professional relationships), with downstream implications on physician well-being and clinical decision-making. Although this idea of a 'hidden curriculum' has conventionally carried predominantly negative connotations in medical literature, we suggest that it is an inevitable part of medical education and practice, which, through deliberate regulation, can potentially be shaped to create more positive and meaningful effects in the professional development of medical trainees.

Comparison of WhatsApp® and Face-to-Face case based learning in undergraduate dental students: A randomized controlled trial

Objective

The study compares two different interfaces of CBL (WhatsApp® and Face-to-Face) in undergraduate dental students and examines WhatsApp's effectiveness as a teaching tool.

Methods

A Randomized Controlled Trial (RCT) was conducted from May 2023 to October 2023 at Ayub College of Dentistry, Orthodontic Department, Abbottabad, involving 30 participants randomly assigned to control (Face-to-Face) Group-1 and experimental (WhatsApp®) Group-2. The six-week study utilized pre-validated questionnaires and Multiple-Choice Questions assessments, comparing post-test scores. Assessment of the intervention involved evaluating Kirkpatrick levels one and two, with responses being rated using a five-point Likert scale. Statistical analysis employed Students' t-tests for group comparisons and paired t-tests for MCQ results before and after the intervention for each group. A p-value less than 0.05 indicated statistical significance, with SPSS version 23 used for analysis.

Results

The study involved 30 participants with a mean age of 23.23±0.67 years, encompassing both males (53.3%) and females (46.7%). All survey participants (100%) used WhatsApp, highlighting its popularity. Everyone had internet access, with 73.3% using smartphones and 26.7% using laptops for mobile internet. Post-intervention, both control and experimental groups exhibited improved post-test scores (p<0.001), but the comparison between groups showed no statistically significant difference (p>0.50). Over 50% of students expressed satisfaction with WhatsApp as a teaching tool, resulting in a learning gain of 36.18%.

Conclusions

The study concluded that both WhatsApp® and Face-to-Face CBL effectively improved dental students' learning, with WhatsApp® yielding results comparable to traditional methods.

Nursing care experiences of people living with HIV/AIDS (PLWHA): A phenomenological study from the West of Iran

Introduction

Nursing care for people living with HIV/AIDS (PLWHA) can be challenging and is dependent on the context. However, there is a lack of information about nurses' experiences in caring for PLWHA in the western region of Iran. Therefore, this study aimed to describe the experiences of nurses in caring for PLWHA in Kermanshah, Iran.

Methods

In this qualitative descriptive phenomenological study, data were gathered via semi-structured, in-depth interviews. The sample comprised 15 nurses employed at hospitals affiliated with Kermanshah University of Medical Sciences, selected through purposive sampling. Colaizzi's seven-step method was employed to analyze the data, and MAXQDA 10 software was used for data management.

Results

In this study, we obtained 579 codes and four main themes of "caring with fear", "Care ethics", "protective precautions" and "duality of feeling ".

Conclusion

According to the results, nurses confront numerous difficulties, challenges, fears, and stress when dealing with PLWHA. Participants' perceptions and practical experiences of AIDS patients enable patients to receive appropriate and high-quality care and provide valuable insights for nursing managers to enhance the preparedness of HIV ward nurses. To gain a comprehensive understanding of HIV nursing care, nurses require further education and awareness on this subject.

The Relationship between Spiritual Intelligence and Fatigue and Moral Distress in Emergency Nurses: A Cross-Sectional Study

Background

Emergency nurses face various challenging conditions and many moral distress that may associated with fatigue from providing care. The spiritual intelligence of nurses has been found to have an impact on the quality of care. This study aimed to investigate the relationship between the spiritual intelligence of emergency nurses with fatigue from providing care and moral distress in emergency nurses.

Materials and Methods

This descriptive-analytical cross-sectional study was conducted on 200 nurses working in the emergency departments of hospitals in Semnan and Sabzevar, who were selected by stratified random method. They were asked to complete the spiritual intelligence, nurse fatigue scale, and moral distress questionnaire through self-reporting. The data were analyzed using SPSS 26 and Amos software, path analysis, and correlation tests.

Results

An increase in spiritual intelligence leads to a significant reduction in moral distress (p = 0.01) and fatigue from caregiving (p = 0.001). In contrast, an increase in moral distress leads to a considerable increase in fatigue from caregiving (p = 0.001).

Conclusions

The results showed that spiritual intelligence has an inverse relationship with moral distress and fatigue from providing care. Moral distress has a direct relationship with fatigue from providing care. Therefore, interventions in the field of increasing spiritual intelligence and reducing moral distress and fatigue from providing care are recommended.

Estimating Students' Academic Success in the Preclinical Stage of Undergraduate Medical Education Using the Admission Test Approach

Introduction

Medical schools face substantial challenges in objectively selecting the best applicants, and the admission process can impact medical students' academic performance. This study aimed to estimate the students' academic success in the preclinical stage of undergraduate medical education using admission tests.

Methods

This cross-sectional study was conducted on 1,193 students' records from the 2014 to 2019 cohorts. The students' admission data comprised the cohort, sex, admission track, psychological test, and academic tests. The academic success was based on the student's end-year academic evaluation. Data were analyzed using contingency and Kendall's tau b tests with IBM® SPSS® Statistics version 16.0 for Windows.

Results

Most of the 1,193 preclinical medical students' records included in the study were females (68.1%), from the regular admission track (78.5%), from the considered psychology test category (52.8%), and had an academic admission test of less than or equal to the median. (51.6%). Most students (89.7%) met all the academic requirements to pass the end-year evaluation. The bivariate analyses showed significant correlations between academic success and cohort (p<0.001), psychology test (p=0.005), and academic test (p<0.001). The analyses showed no significant correlation between academic success and sex (p=0.324), and admission track (p=0.128).

Conclusions

This study indicated that cohort and psychology tests could estimate the student's academic success at the preclinical stage of undergraduate medical education. The admission criteria related to the academic tests during the admission process should be re-evaluated, so that the academic tests could select the best students among the applicants.

Usage of social media and Covid 19 vaccine hesitancy among medical students in Kericho County

The recent Covid 19 pandemic revealed the global challenge posed by infectious diseases. Vaccines are a crucial tool in preventing pandemics, as evidenced by their success in controlling past outbreaks. The rise of information and communication technology has introduced social media platforms as potential game-changers in both preventing and managing future pandemics. However, these same platforms can also be a double-edged sword, hindering the uptake of essential vaccination services. This study investigated the association between social media use and vaccine hesitancy among medical students. The study was designed as an institution based cross sectional study of 423 medical students in Kenya Medical Training College and University of Kabianga in Kericho County. Stratified sampling was used to decide on the two institutions and systematic random sampling was used to select the study participants. Research administered questionnaires were used to collect data on the socio-demographic characteristics, use of social media platforms, social media campaigns, and uptake of Covid 19 vaccines. The collected data was analyzed using Statistical Package for Social Sciences version 25. Chi square was used to establish the association between the independent variables and uptake of Covid 19 vaccines. The variables that were significantly associated with hesitancy to Covid 19 vaccines were further analyzed using binary logistic regression. The confidence interval (CI) was set at 95% and statistical significance was considered at p < 0.05. The study found significant associations between vaccine hesitancy and several factors, including academic level, preferred social media platform, the influence of social media on attitudes towards vaccines, concerns about vaccine safety and efficacy, and confidence in vaccines. The findings present social media as a potential platform for promotion of vaccines utilization during pandemics when used well.

Self-regulated learning strategies adopted by successful Chinese nursing students in the process of learning Nursing English

As the number of foreign patients and the frequency of international academic exchanges increase, English proficiency has become increasingly essential for Chinese nurses in the treatment and nursing processes, clinical academic exchanges, and ongoing education. However, the overall English proficiency of Chinese nurses is generally inadequate, greatly depending on the English that they acquire during their nursing education. This study aims to explore the challenges encountered by Chinese EFL (English as a Foreign Language) nursing students in the process of learning Nursing English, along with the effective self-regulated learning strategies they adopt to overcome these challenges. Data were collected from nine Chinese EFL nursing students through their reflective journals and thematic analysis was applied. Data analysis revealed the variety of challenges EFL nursing students encountered, including language-related challenges, which are linguistic difficulties that relate to Nursing English learning itself, such as Nursing English vocabulary and terminology, English-to-English translation, limited listening comprehension, and the gap between textbook knowledge and its practical application; learner-related challenges, which are difficulties that affect students' emotional, affective, and mental state, primarily caused by uncertainty about the significance of Nursing English, the unexpected difficulty of Nursing English, and failing quizzes; and context-related challenges, which are difficulties relate to social, cultural, and educational context, such as insufficient learning resources, a lack of language environment, and peer pressure. To surmount these challenges, the participants adopted diverse self-regulated learning strategies, including setting goals, previewing in advance and reviewing in time, utilizing word roots, prefixes, and suffixes to facilitate vocabulary learning, repeating, practicing with sounds and writing systems, translating, highlighting and using imagery to overcome language-related challenges; believing in the usefulness and significance of Nursing English, keeping a growth mindset, enjoying Nursing English learning and teacher support and maintaining grit in learning Nursing English to overcome learner-related challenges; and integrating resources, creating supportive language environments and seeking assistance from teachers and cooperating with peers to overcome context-related challenges. Based on these findings, implications are drawn for Nursing English teachers, material designers, curriculum developers, and program designers. We suggest incorporating explicit strategy instruction into regular Nursing English education to enhance nursing students' self-regulated learning.

A four-Axis-Method to Evaluate a Part of an Undergraduate Medical Students' Curriculum

Introduction

The evaluation of programs in faculties of medicine enables them to adequately reach their mission objectives, and social responsibilities and to correct their potential lacune. Few publications have described the process of internal evaluation of a program performed by the organizational members. The authors aimed to describe a practical method called the four-axis method to assess curriculum using a practical example.

Methods

The authors performed a descriptive study, highlighting the application of a particular method of evaluation of a program called the four-axis method. It consisted of the assessment of the pedagogical alignment [1], teaching techniques and evaluation tests [2], students' viewpoints and needs [3], and the teachers' opinions and needs [4]. To contextualize this method, the authors described a practical experience of the assessment of a multidisciplinary theme (theme 16), which is taught during the second year of medical education. Was performed the evaluation from January 2020 to January 2021. The population studied consisted of the tutors implicated in the teaching of the theme and the students in the second year of medical education who accepted to answer the satisfaction questionnaires. The students and tutors who did not fill out the questionnaires were excluded. No statistical tests were needed because of the descriptive nature of the study.

Results

The most relevant results highlighted that 48.4% of the teachers did not systematically use bioclinical cases involving interactions between students; also, 42.4% of the students believed that the teaching sessions didn't introduce practical examples giving rise to interactions between them. Therefore, the 4-axis-based analysis indicated that weaknesses were mostly attributed to the lack of homogeneity in the teaching methods and techniques which showed the teachers' difficulties in integrating clinical data into their teaching so that they can help the students to assimilate the fundamental data.

Conclusion

The authors' used a particular approach since it focused both on an objective evaluation of the teaching methods and the evaluation tests and the students' and teachers' viewpoints and needs. The major limitation of this approach was the fact that it could not integrate the educational environment that could impact the students' performances.

Fear of Cancer Recurrence in Differentiated Thyroid Cancer Survivors: A Systematic Review

Background: Despite excellent survival rates, health-related quality of life detriments are common in differentiated thyroid cancer survivors and can be driven by fear of cancer recurrence (FCR). This review aims to report the incidence of FCR in thyroid cancer survivors and synthesize evidence regarding contributing factors. An overview and appraisal of the range of tools used to measure FCR is presented. Methods: A systematic review of the English literature was performed. The search across six electronic databases generated 3414 studies. Two reviewers independently screened the citations and full-text articles, of which 31 were included. The data were extracted independently by two reviewers. Results: The incidence of FCR was reported in 27/31 studies and ranged from 15% to 91%. Direct comparisons regarding incidence and severity of FCR were not possible due to heterogeneity in cut-points used to define FCR. A total of eight validated tools were used to measure FCR across all studies, with five studies using self-developed nonvalidated items. There was minimal repetition of validated tools and no clear consensus as to a preferred survey tool. Factors influencing FCR were reported in 11 studies. There was minimal overlap of factors influencing FCR. Risk factors contributing to increased FCR reported in more than one study included young age and an upcoming clinical appointment. Male gender and higher education levels were reported in more than one article as protective. No literature evaluating interventions to address FCR in thyroid cancer survivors was found. Conclusion: FCR is common in thyroid cancer survivors, but significant heterogeneity in the current evidence base limits assessment of incidence, severity, or risk factors. There is a need to use validated tools to assess FCR in both research and clinical contexts. Reliable assessment of FCR may permit routine assessment of FCR in clinical practice and allow interventions to be prospectively evaluated to optimize the holistic well-being of thyroid cancer survivors.

WeChat mini program in laboratory biosafety education among medical students at Guangzhou Medical University: a mixed method study of feasibility and usability

BACKGROUND

Laboratory biosafety should be a priority in all healthcare institutions. In traditional laboratory safety teaching students typically receive knowledge passively from their teachers without active involvement. The combination of experiential learning and mobile learning may provide students with greater engagement, retention, and application of knowledge. To address this issue, we developed and conducted a convergent mixed methods study to assess the feasibility and usability of a WeChat mini program (WMP) named WeMed for laboratory biosafety education for medical laboratory students at Guangzhou Medical University (GMU).

METHODS

The study was conducted between November 2022 and October 2023 among second-year undergraduate students at GMU. It involved the concurrent collection, analysis, and interpretation of both qualitative and quantitative data to assess feasibility and usability. In the quantitative strand, two evaluations were conducted via online surveys from students (n = 67) after a four-week study period. The System Usability Scale (SUS) was used to evaluate usability, while self-developed questions were used to assess feasibility. Additionally, a knowledge test was administered 6 months after the program completion. In the qualitative strand, fourteen semi-structured interviews were conducted, whereby a reflexive thematic analysis was utilized to analyze the interview data.

RESULTS

The overall SUS score is adequate (M = 68.17, SD = 14.39). The acceptability of the WeMed program is in the marginal high range. Most students agreed that WeMed was useful for learning biosafety knowledge and skills (13/14, 93%), while 79% (11/14) agreed it was easy to use and they intended to continue using it. After 6 months, a significant difference in the knowledge test scores was observed between the WeMed group (n = 67; 2nd year students) and the traditional training group (n = 90; 3rd year students). However, the results should be interpreted cautiously due to the absence of a pretest.

CONCLUSION

The combination of experiential learning and mobile learning with WMP is a feasible tool for providing laboratory biosafety knowledge and skills. Ongoing improvements should be made in order to increase long-term acceptance.

Teaching Social Determinants of Health in Undergraduate Medical Education: A Longitudinal Curricular and Experiential Program in the United Arab Emirates

ABSTRACT

Social determinants of health (SDH) have a major impact on illness and wellness. However, research shows a lack of training on SDH in both undergraduate and postgraduate medical education, with studies confirming that the social needs of patients are not routinely identified or addressed by health care professionals in clinical practice. The medical education community is currently working to incorporate SDH into undergraduate training but has had limited guidance regarding educational topics, modes of teaching, and evaluation criteria in this domain. This article describes the evolution, process, and structure, along with student perceptions, lessons learned, and future directions, of an SDH educational program in the United Arab Emirates. Using the Institute of Medicine's behavioral and social science knowledge domains as a framework, the program includes a didactic component with workshops, reflective practice training, and an experiential component that integrates home visits with social activities in collaboration with community partners. The program began in 2019. To date, 114 students have completed the didactic sessions and at least 1 year of the experiential component. Student surveys and reflective narratives reveal positive perceptions of the program and improved SDH knowledge, skills, and attitudes.