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Tefera AS, Melaku EE, Urgie BM, Hassen EM, Tamene TD, Gebeyaw ED. Barriers to implementing problem-based learning at the school of medicine of Debre Berhan University, Ethiopia. BMC MEDICAL EDUCATION 2024; 24:501. [PMID: 38711080 DOI: 10.1186/s12909-024-05252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 03/01/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Implementing PBL in teaching and learning can be challenging due to a variety of complex barriers. Studies on barriers to the implementation of problem-based learning in Ethiopia are scarce. This study aimed to explore the barriers to the implementation of problem-based learning at the Debre Berhan University Medical School. METHODS A qualitative study was conducted among faculty and medical students at the medical school. Purposive sampling was used to select participants. Semi-structured interviews were conducted with tutors and academic leaders, including the problem-based learning coordinator, the biomedical sciences coordinator, and the school dean. Data was also collected from students through focus group discussions. All interviews and discussions were recorded. The four steps of data analysis of Spradley, including domain analysis, taxonomic analysis, componential analysis, and theme analysis, were employed. RESULTS The study identified student-related, tutor-related, case scenario-related, and assessment-related barriers as the most significant obstacles to implementing problem-based learning. These barriers included work overload for both students and tutors, lack of training and experience among tutors, student reluctance, absence of standardized case scenarios, subjectivity of assessment methods, and on-the-spot assessment of students. CONCLUSIONS AND RECOMMENDATIONS Lack of both tutor and student commitment, lack of standardized cases, absence of a recognition of staff input, gap in communication skills, work overload, lack of continuous training, and at-spot evaluation of students were identified as the main barriers to the implementation of PBL.
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Affiliation(s)
- Aklile Semu Tefera
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia.
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Cahill EM, Ferreira G, Glendinning D. The Effectiveness of a Journal Club for Improving Evidence-Based Medicine Skills and Confidence in Pre-clerkship Medical Students. MEDICAL SCIENCE EDUCATOR 2023; 33:531-538. [PMID: 37251208 PMCID: PMC10061358 DOI: 10.1007/s40670-023-01779-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/31/2023]
Abstract
Introduction Evidence-based medicine (EBM) refers to medical practice that uses current best evidence to inform decision-making. This requires several skills including (1) creating an answerable question, (2) searching literature, (3) critically appraising evidence, and (4) applying results. Journal clubs are known to be effective in improving searching and critical appraisal skills in graduate medical education. In pre-clerkship medical education, journal clubs are used less often, and students often do not have the opportunity to engage in all of the steps above. Methods We developed a journal club for pre-clerkship students and measured its effectiveness using a pre-test, post-test design. Students attended 5 journal club sessions run by rotating student leaders and facilitated by faculty. Student groups developed searchable questions from clinical cases, searched the literature, located and critically appraised an article, and applied results to the case. We measured EBM skills and confidence using two validated questionnaires. Results Twenty-nine students (MS-1 and MS-2) completed the study. EBM confidence significantly improved at post-test with greatest improvements in the MS-1 student cohort. Confidence in developing a searchable question from a patient case significantly improved in both cohorts. There were no changes measured on the Test of EBM Knowledge and Skills. Discussion Participation in a faculty-mentored, student-led journal club improved confidence across all domains of EBM, primarily in MS-1 students. Journal clubs are positively received by pre-clerkship medical students and provide effective mechanisms to teach and promote all steps of EBM in pre-clerkship curricula. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01779-y.
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Affiliation(s)
- Ellen M. Cahill
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Gabriela Ferreira
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Diana Glendinning
- Department of Neuroscience & Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ USA
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Ma KSK, Chang HC, Krupat E. Teaching evidence-based medicine with electronic databases for preclinical education. ADVANCES IN PHYSIOLOGY EDUCATION 2021; 45:849-855. [PMID: 34705577 DOI: 10.1152/advan.00057.2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
To evaluate the efficacy of an educational module on evidence-based medicine (EBM) assisted with electronic medical databases (EMDs) for preclinical education, medical students (n = 111) were matriculated in a program consisted of 16 2-h sessions on EBM plus hands-on experience on EMDs in a problem-based learning-type format. Students were required to make an oral presentation on designated clinical scenarios before and after the sessions, without prior notice, as an indicator of performance. In addition, questionnaires focusing on behavioral changes, awareness, and confidence of mastering EBM were administered before and after the sessions to assess the attitudinal and behavioral impact of the intervention on the participants. We found evidence of better postprogram performance in utilizing EBM-relevant concepts and resources when the enrolled medical students were giving oral presentations. Moreover, the participants reported increased awareness of EBM and, behaviorally, increased utilization of EBM-relevant resources provided by libraries. Also, they reported improvement on appropriately using EBM-relevant resources, and 99% of the participants reported strong confidence in practicing EBM. In conclusion, modules on EBM implemented with EMDs benefitted medical students in scenario-oriented PBL tutorials. Improvements in awareness, behavior, confidence, and performance in mastering EBM were noted.
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Affiliation(s)
- Kevin Sheng-Kai Ma
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Dentistry, Chung Shan Medical University and Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Hui-Chin Chang
- Library, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Edward Krupat
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Center for Evaluation, Harvard Medical School, Harvard University, Boston, Massachusetts
- Dental Education Program, Harvard School of Dental Medicine, Boston, Massachusetts
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Mai DH, Taylor-Fishwick JS, Sherred-Smith W, Pang A, Yaworsky J, Whitty S, Lafever A, Mcilvain C, Schmitt M, Rogers-Johnson M, Pace A, Dobrian AD. Peer-Developed Modules on Basic Biostatistics and Evidence-Based Medicine Principles for Undergraduate Medical Education. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11026. [PMID: 33274291 PMCID: PMC7703476 DOI: 10.15766/mep_2374-8265.11026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/21/2020] [Indexed: 06/12/2023]
Abstract
Introduction Evidence-based medicine (EBM) is pivotal in shaping patient care, yet it is challenging to incorporate into undergraduate medical education (UME) due to a lack of dedicated resources within the preclinical curriculum. To address this challenge, we used a peer-led approach to explain difficult concepts through language that students can understand at their shared level of understanding. Methods Four second-year medical students trained in EBM over 18 months by facilitating monthly journal clubs, ultimately leading to their involvement as peer-instructors. With input from a faculty expert, peer-instructors designed integrative PowerPoint modules and interactive problem sets on basic biostatistics and EBM principles. Assessment included formative quizzes with multiple attempts to achieve at least 80% to demonstrate mastery of core learning objectives. Afterwards, students were invited to provide feedback using a 5-point Likert scale survey. Results Of second-year students who participated, all 151 demonstrated 80% competency on each quiz. Eighty-seven (58%) students completed the survey on which, 77% agreed/strongly agreed that their level of understanding of EBM improved after the peer-led sessions, 76% agreed/strongly agreed that the sessions were more conducive to learning compared to traditional lectures, and 94% agreed/strongly agreed that the material covered was relevant to the USMLE Step 1. Discussion This peer-led approach has been rated as effective by learners, improving their ability to critically appraise and apply clinical evidence. To promote integration of EBM into UME, we have prepared modules, problem sets, quizzes, and an outline of the problem-solving sessions for universal adoption.
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Affiliation(s)
- Daniel H. Mai
- Medical Student, School of Medicine, Eastern Virginia Medical School
| | | | | | - Anthony Pang
- Medical Student, School of Medicine, Eastern Virginia Medical School
| | - Justin Yaworsky
- Medical Student, School of Medicine, Eastern Virginia Medical School
| | - Sean Whitty
- Medical Student, School of Medicine, Eastern Virginia Medical School
| | - Alex Lafever
- Medical Student, School of Medicine, Eastern Virginia Medical School
| | - Cody Mcilvain
- Medical Student, School of Medicine, Eastern Virginia Medical School
| | - Mark Schmitt
- Medical Student, School of Medicine, Eastern Virginia Medical School
| | | | - April Pace
- Librarian, Eastern Virginia Medical School
| | - Anca D. Dobrian
- Professor, Department of Physiological Sciences, Eastern Virginia Medical School
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Tavarez MM, Kenkre TS, Zuckerbraun N. Evidence-Based Medicine Curriculum Improves Pediatric Emergency Fellows' Scores on In-Training Examinations. Pediatr Emerg Care 2020; 36:182-186. [PMID: 28562466 PMCID: PMC5709277 DOI: 10.1097/pec.0000000000001185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine if implementation of our evidence-based medicine (EBM) curriculum had an effect on pediatric emergency medicine fellows' scores on the relevant section of the in-training examination (ITE). METHODS We obtained deidentified subscores for 22 fellows over 6 academic years for the Core Knowledge in Scholarly Activities (SA) and, as a balance measure, Emergencies Treated Medically sections. We divided the subscores into the following 3 instruction periods: "baseline" for academic years before our current EBM curriculum, "transition" for academic years with use of a research method curriculum with some overlapping EBM content, and "EBM" for academic years with our current EBM curriculum. We analyzed data using the Kruskal-Wallis test, the Mann-Whitney U test, and multivariate mixed-effects linear models. RESULTS The SA subscore median was higher during the EBM period in comparison with the baseline and transition periods. In contrast, the Emergencies Treated Medically subscore median was similar across instruction periods. Multivariate modeling demonstrated that our EBM curriculum had the following independent effects on the fellows' SA subscore: (1) in comparison with the transition period, the fellows' SA subscore was 21 percentage points higher (P = 0.005); and (2) in comparison to the baseline period, the fellows' SA subscore was 28 percentage points higher during the EBM curriculum instruction period (P < 0.001). CONCLUSIONS Our EBM curriculum was associated with significantly higher scores on the SA section of the ITE. Pediatric emergency medicine educators could consider using fellows' scores on this section of the ITE to assess the effect of their EBM curricula.
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Affiliation(s)
- Melissa M. Tavarez
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
- University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Tanya S. Kenkre
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA
| | - Noel Zuckerbraun
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
- University of Pittsburgh, School of Medicine, Pittsburgh, PA
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Oh EG, Yang YL. Evidence-based nursing education for undergraduate students: A preliminary experimental study. Nurse Educ Pract 2019; 38:45-51. [PMID: 31176243 DOI: 10.1016/j.nepr.2019.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 03/25/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
With increasing needs for evidence-based practice, the well-designed EBP education is necessary to enhance the critical thinking and decision-making skills of nursing undergraduates. This study is to evaluate the effectiveness of an evidence-based practice education program with blended learning on undergraduate nursing students. In this preliminary experimental study, 45 senior nursing undergraduates were recruited from a university in Seoul, Korea. Self-selection was used to create two groups: an intervention group and a control group consisting of 21 and 24 students, respectively. The intensive 30-hours evidence-based practice education program was provided to the intervention group. Evidence-based practice knowledge, self-efficacy, and evidence utilization were evaluated as outcome variables at baseline and two months after the intervention. There were no significant differences between the intervention and control groups on the background characteristics and outcome variables (p > .05). There were significant increases in evidence-based practice knowledge (Z = -5.28), self-efficacy (t = -6.42), resource utilization (Z = -2.60), and databases utilization (t = -2.98) in the intervention group, when compared with the control group (p < .01). Further studies are recommended to develop the evidence-based practice train-the-trainer program for nursing educators and to maximize the effectiveness of utilizing blended learning in evidence-based practice education.
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Affiliation(s)
- Eui Geum Oh
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea.
| | - You Lee Yang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea.
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Slager SL, Weir CR, Kim H, Mostafa J, Del Fiol G. Physicians' perception of alternative displays of clinical research evidence for clinical decision support - A study with case vignettes. J Biomed Inform 2017; 71S:S53-S59. [PMID: 28089913 DOI: 10.1016/j.jbi.2017.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 09/12/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To design alternate information displays that present summaries of clinical trial results to clinicians to support decision-making; and to compare the displays according to efficacy and acceptability. METHODS A 6-between (information display presentation order) by 3-within (display type) factorial design. Two alternate displays were designed based on Information Foraging theory: a narrative summary that reduces the content to a few sentences; and a table format that structures the display according to the PICO (Population, Intervention, Comparison, Outcome) framework. The designs were compared with the summary display format available in PubMed. Physicians were asked to review five clinical studies retrieved for a case vignette; and were presented with the three display formats. Participants were asked to rate their experience with each of the information displays according to a Likert scale questionnaire. RESULTS Twenty physicians completed the study. Overall, participants rated the table display more highly than either the text summary or PubMed's summary format (5.9vs. 5.4vs. 3.9 on a scale between 1 [strongly disagree] and 7 [strongly agree]). Usefulness ratings of seven pieces of information, i.e. patient population, patient age range, sample size, study arm, primary outcome, results of primary outcome, and conclusion, were high (average across all items=4.71 on a 1 to 5 scale, with 1=not at all useful and 5=very useful). Study arm, primary outcome, and conclusion scored the highest (4.9, 4.85, and 4.85 respectively). Participants suggested additional details such as rate of adverse effects. CONCLUSION The table format reduced physicians' perceived cognitive effort when quickly reviewing clinical trial information and was more favorably received by physicians than the narrative summary or PubMed's summary format display.
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Affiliation(s)
- Stacey L Slager
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA; George E Whalen VA Medical Center, Salt Lake City, UT, USA
| | - Heejun Kim
- School of Information and Library Science, University of North Carolina, Chapel Hill, NC, USA
| | - Javed Mostafa
- School of Information and Library Science, University of North Carolina, Chapel Hill, NC, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
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Gosselin K, Norris JL, Ho MJ. Beyond homogenization discourse: Reconsidering the cultural consequences of globalized medical education. MEDICAL TEACHER 2016; 38:691-9. [PMID: 26571353 DOI: 10.3109/0142159x.2015.1105941] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Global medical education standards, largely designed in the West, have been promoted across national boundaries with limited regard for cultural differences. This review aims to identify discourses on cultural globalization in medical education literature from non-Western countries. METHODS To explore the diversity of discourses related to globalization and culture in the field of medical education, the authors conducted a critical review of medical education research from non-Western countries published in Academic Medicine, Medical Education and Medical Teacher from 2006 to 2014. Key discourses about globalization and culture emerged from a preliminary analysis of this body of literature. A secondary analysis identified inductive sub-themes. RESULTS Homogenization, polarization and hybridization emerged as key themes in the literature. These findings demonstrate the existence of discourses beyond Western-led homogenization and the co-existence of globalization discourses ranging from homogenization to syncretism to resistance. CONCLUSIONS This review calls attention to the existence of manifold discourses about globalization and culture in non-Western medical education contexts. In refocusing global medical education processes to avoid Western cultural imperialism, it will also be necessary to avoid the pitfalls of other globalization discourses. Moving beyond existing discourses, researchers and educators should work towards equitable, context-sensitive and locally-driven approaches to global medical education.
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Affiliation(s)
- K Gosselin
- a National Taiwan University College of Medicine , Taiwan
| | - J L Norris
- a National Taiwan University College of Medicine , Taiwan
| | - M-J Ho
- a National Taiwan University College of Medicine , Taiwan
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