Overcrowded curriculum is an impediment to change (Part A)

Exploration of the integration of microbiology and immunology emerging topics into undergraduate medical education

PURPOSE

Medical school educators face challenges determining which new and emerging topics to incorporate into medical school curricula, and how to do so. A study was conducted to gain a better understanding of the integration of emerging topics related to microbiology and immunology in the undergraduate medical curriculum (UME).

METHODS

An anonymous survey with 17 questions was emailed to medical school faculty who teach immunology and/or microbiology through the DR-Ed listserv, the American Society for Microbiology (ASM) Connect listserv, and attendees of the Association of Medical School Microbiology and Immunology Chairs (AMSMIC) Educational Strategies Workshop. Participants were asked about experiences, perceptions, and the decision-making process regarding integrating emerging topics into UME.

RESULTS

The top emerging topics that were added to the curriculum or considered for addition in the last 10 years included COVID-19, Zika virus, mRNA vaccines, and Mpox (formerly known as monkeypox). Most respondents reported lectures and active learning as the major methods for topic delivery, with most faculty indicating that formative assessment was the best way to assess emerging topics. Content experts and course directors were the most cited individuals making these decisions. Top reasons for incorporating emerging topics into curricula included preparing students for clinical treatment of cases, followed by demonstrating the importance of basic science, and opportunities to integrate basic science into other disciplines. Challenges for incorporating these topics included making room in an already crowded curriculum, followed by content overload for students.

CONCLUSIONS

This study describes the rationale for integrating emerging topics related to microbiology and immunology into UME, and identifies the current new and emerging topics, as well as the main methods of integration and assessment. These results may be used by medical educators to inform curricular decisions at their institutions. Future studies will include developing innovative learning modules that overcome barriers to integration.

Health advocacy: A gulf between instruction and practice

BACKGROUND

Systematic ways to teach health advocacy, an educational outcome for pharmacy graduates, is lacking. We developed a workshop to facilitate understanding and application of a novel structured framework for health advocacy and explored how pharmacy students enacted opportunities for health advocacy during subsequent outpatient experiential training.

EDUCATIONAL ACTIVITY AND SETTING

A two-hour workshop was introduced for year 2 students in 2019. Its content was organized around a health advocacy framework. With patient and faculty facilitators, students worked through examples characterized into the framework's four quadrants: 1) shared advocacy "with patients" at the individual- or 2) systems-level and 3) directed advocacy "for patients" at the individual-or 4) systems-level. We then conducted a longitudinal diary study asking pharmacy students (N = 23) to reflect on opportunities to practice health advocacy skills in community pharmacy practice. A systematic, multi-coder reflexive thematic analysis of diary entries was employed.

FINDINGS

Pharmacy students did not express a fulsome view of patient health advocacy and mischaracterized self-reported practice examples into inappropriate categories of the health advocacy framework. Most overemphasized usual pharmacist care as acts of health advocacy. No systems-level activities were undertaken, although isolated episodes of shared advocacy with patients were identified.

SUMMARY

Lasting impacts of a health advocacy workshop in our pharmacy curriculum were not widely apparent. While longer training periods in community pharmacy practice may yield more opportunities to develop and enact this role, gaps in student conceptualization of health advocacy and inabilities to practically observe and exercise system-level advocacy are ultimately problematic for patient care.

Teaching Provider Wellness and Physician Assistant Student Well-Being

PURPOSE

The purpose of this novel study was to determine whether any association exists between student well-being and physician assistant (PA) program approaches to teaching provider health and well-being (provider wellness).

METHODS

Data were sourced from 3 PA Education Association surveys. Data from the 2019 Matriculating Student and End of Program Surveys (EOPS) were analyzed to compare student-reported well-being across 6 measures. Next, data from the 2019 Didactic Curriculum Survey were assessed and matched to the 2019 EOPS data. Finally, generalized estimating equation models were used to assess the independent effects of course structure, mode of instruction, and contact hours on well-being scores among end-of-program students (within one month of graduation).

RESULTS

While levels of well-being were generally favorable, except for "level of social activity" ( P = .20), across measures, graduating student levels of well-being ( P < .05) were statistically significantly lower than matriculating student levels of well-being. No associations were found between levels of student well-being and whether programs reported teaching or not teaching provider wellness. Some aspects of instruction (eg, contact hours) were inconsistently associated with various well-being measures.

CONCLUSION

In this study, no consistent associations between approaches to teaching provider wellness and various measures of student well-being were identified. Further research is needed to determine what approaches to promoting wellness are effective.

Revolutionizing Medical Education: Can ChatGPT Boost Subjective Learning and Expression?

ChatGPT is an AI tool that can be used to enhance medical education by helping students develop subjective learning and expression skills. These skills are critical in clinical practice, but the current medical education system is heavily focused on objective assessments, such as Multiple Choice Questions (MCQs). Students from non-English speaking backgrounds can particularly struggle with expressing themselves in English, which is the primary language of instruction in many medical schools worldwide. ChatGPT can provide additional language support for these students to help them develop their language skills and communicate effectively. ChatGPT can be used in small group assessments to serve as a benchmark for students to strive for in their medical education. By comparing their answers to ChatGPT's responses, students can identify gaps in their knowledge and work to fill them. ChatGPT can also provide students with feedback on their writing style and language usage, helping them to improve their subjective expression of medical knowledge. Furthermore, ChatGPT can be used to simulate patient encounters for medical students. By interacting with ChatGPT, students can practice taking medical histories and documenting symptoms accurately. In continuing medical education (CME) programs, physicians can also benefit from ChatGPT's capabilities. By using ChatGPT to search for the latest research articles, clinical trials, and treatment guidelines, physicians can stay informed and provide the best care possible to their patients. Overall, ChatGPT has the potential to be a valuable tool in medical education by helping students and physicians develop the essential skills required for clinical practice, such as communication, problem-solving, and critical thinking.

Survey results on training in developmental disabilities in Canadian psychiatry residency programs

Objective

Mental health problems in children, adolescents, and adults with developmental disabilities (DD) are an underserviced clinical area. Although the Royal College of Physicians and Surgeons of Canada requires that experiences with patients with DD must be included during psychiatry residency training, the type and extent of this experience is not specified. The purpose of this study was to examine the current educational opportunities regarding DD in Canadian psychiatry residency programs.

Methods

A survey asking about training in DD was sent to psychiatry residency directors at all 17 medical schools in Canada. The survey consisted of three sections focused on didactic teaching and clinical rotations (required and elective) in DD for residents.

Results

Program directors of all psychiatry residency programs noted that their program included didactic teaching specific to DD, although the time dedicated to this differed greatly, ranging from 2 to 20 hours. Although 13 programs offered electives in DD, only five programs required residents to complete a clinical rotation specific to DD. Two programs did not have required or elective rotations in DD.

Conclusion

These results suggest that training specific to DD is probably inadequate for most residents. This is likely to result in limitations in knowledge and skills required to assess and treat people with DD, decreased comfort working with them, and ultimately reduced quality and availability of psychiatric care for this underserved population. More specific and comprehensive training requirements and opportunities are needed to ensure that residents receive appropriate training in this area.

Five ways to counter ableist messaging in medical education in the context of promoting healthy movement behaviours

One in five Canadians have a disability and there are well-documented gaps in care for this equity-deserving group that have roots in medical education. In this paper, we highlight the unintended consequences of ableist messaging for persons living with disabilities, particularly in the context of promoting healthy movement behaviours. With its broad reach and public trust, the medical community has a responsibility to acknowledge the reality of ableism and take meaningful action. We propose five strategies to counter ableist messaging in medical education: (1) increase knowledge and confidence among physicians and trainees to optimize movement behaviours in persons living with disabilities, (2) perform personal and institutional language audits to ensure terminology related to disability is inclusive and avoids causing unintended harm, (3) challenge ableist messages effectively, (4) address the unmet healthcare needs of persons living with disabilities, and (5) engage in efforts to reform medical curricula so that persons living with disabilities are represented and treated equitably. Physicians and trainees are well-positioned to deliver competent and inclusive care, making medical education an opportune setting to address health inequities related to disability.

Moving toward co-production: five ways to get a grip on collaborative implementation of Movement Behaviour curricula in undergraduate medical education

Several "calls to action" have imposed upon medical schools to include physical activity content in their overextended curricula. These efforts have often neither considered medical education stakeholders' views nor the full complexity of medical education, such as competency-based learning and educational inflation. With this external pressure for change, few medical schools have implemented physical activity curricula. Moreover, Canada's new 24-Hour Movement Guidelines focus on the continuum of movement behaviours (physical activity, sedentary behaviour, and sleep). Thus, a more integrated process to overcome the "black ice" of targeting all movement behaviours, medical education stakeholder engagement, and the overextended curriculum is needed. We argue for co-production in curriculum change and offer five strategies to integrate movement behaviour curricula that acknowledge the complexity of the medical education context, helping to overcome our "black ice." Our objectives were to investigate 24-Hour Movement Guideline content in the medical curriculum and develop an integrated process for competency-based curriculum renewal. Stakeholders were equal collaborators in a two-phased environmental scan of 24-Hour Movement Guideline content in the Queen's University School of Medicine. Findings and a working curriculum map highlight how new, competency-based content may be embedded in an effort to guide more relevant and feasible curriculum changes.