"Give My Daughter the Shot!": A Content Analysis of the Depiction of Patients with Cancer Pain and Their Management in Hollywood Films

INTRODUCTION

Cinemeducation, the pedagogical use of films, has been used in a variety of clinical disciplines. To date, no studies have looked at the use of film depictions of cancer pain and its management in clinical education. We investigated how patients with cancer pain and their management are depicted in Hollywood films to determine whether there is content that would be amenable to use for cancer pain assessment and management education.

METHODS

A qualitative content analysis was performed. Films that contained characters with or references to cancer pain were searched for using the International Movie Database, the Literature Arts Medicine Database, the History of Medicine and Medical Humanities Database, and Medicine on Screen. After review, 4 films were identified for review and analysis.

RESULTS

Themes that emerged from the analysis concerned the films' depictions of characters with pain, their healthcare providers, the therapies used for pain management, and the setting in which pain management was provided.

CONCLUSIONS

This study demonstrates that patients with cancer pain are depicted in a compassionate manner. Pain management focused on the use of opioids. The settings in which patients received pain management was depicted as not being amenable to providing holistic care. This variety of topics related to pain management covered in the films make them amenable to use in cinemeducation. This study therefore forms the basis for future work developing film-based cancer education modules.

Emergency Medicine Residency Curricular Innovations: Creating a Virtual Emergency Medicine Didactic Conference

Currently, there is a pandemic forcing social distancing and, consequently, traditional in-person education must shift to a virtual curriculum to protect all parties and continue professional development. Recognizing that not all emergency medicine (EM) content can be taught through a virtual platform, we propose a model for nearly all EM resident didactic conference adaptation to a virtual format to meet the needs of the adult learner while protecting all participants from the current coronavirus pandemic.

Application of mini-clinical evaluation exercise for assessing the integrated-based learning during physical diagnostic course

Medical education paradigm has been questioned for the requirements of improving the quality and quantity of medical students. This study was to explore the efficiency of integrated-based learning (IBL) used mini-clinical evaluation exercise (mini-CEX) during physical diagnostics course. One hundred and eleven volunteered students were randomly divided into three groups: lecture-based learning (LBL), case-based learning (CBL), and IBL. Nephrotic syndrome was the teaching content. In the IBL group, students were provided the guideline and additional interpretation from the instructor about the basic knowledge related to disease as vertical integration curriculum. Their performance was evaluated by mini-CEX and theoretical examination, respectively. All subjects have completed the study. The difference of five factors (medical interview, physical examination, clinical judgment, organizational effectiveness, and competence) in mini-CEX between IBL, CBL, and LBL were statistically significant (p <0.05). Sample sizes of below, meets, and above the expectations of mini-CEX in different instructional groups were statistically significant (X² =17.842, p =0.001). The final exam scores in IBL group and the CBL group were significantly higher than that of LBL group (F =41.553, p =0.000). And the relationship of final exam score only in the IBL group was positive existed with medical interview (R =0.466, p =0.004), physical examination (R =0.328, p =0.048), professional attitude (R =0.366, p =0.026), and communication skill (R =0.412, p =0.011). Therefore, our study revealed the effect of IBL on the medical students' skills. It highlights IBL could improve the physical examination, organizational effectiveness, and competence and the application of basic knowledge. © 2018 International Union of Biochemistry and Molecular Biology, 46(5):417-423, 2018.

The status of radiation oncology teaching in Australian and New Zealand medical schools

INTRODUCTION

Radiation therapy is a core component of curative and palliative cancer treatment; however, its indications and benefits remain poorly understood across the medical profession.

METHODS

An electronic survey focussing on curriculum content, teaching and assessment in radiation oncology and plans for curriculum change was developed. The Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiology (RANZCR) distributed the survey to all 24 Australian and New Zealand medical schools. The survey was conducted from November 2017 to January 2018 following ethics approval.

RESULTS

Sixteen of the 24 (67%) medical Faculties in Australia and New Zealand responded. Ninety-four percent of Faculties had no formal radiation oncology curriculum. Most Faculties (87%) dedicated <15% of the total medical course to oncology, of which the majority (63%) dedicated <10% to radiation oncology. At least 50% of Faculties did not offer formal radiation oncology teaching to all students. When offered, students' exposure to radiation oncology was often <5 days over the entire course (44%). The majority of medical schools (73%) are planning curriculum changes in the next 5 years; however, most have no intention of changing radiation oncology teaching.

CONCLUSION

Radiation oncology continues to be underrepresented in medical curricula throughout Australia and New Zealand with no plans for improvement by Faculties. This study supports the need for formal advocacy for improving radiation oncology education in medical schools and will form the basis of new national recommendations for radiation oncology curriculum development.

Attitudes Towards Problem-Based Learning of Faculty Members at 12 U.S. Medical and Dental Schools: A Comparative Study

Problem-based learning (PBL) is a teaching method used in medical and dental education to promote students' problem-solving skills. It may also be a viable tool for interprofessional education in which medical and dental students learn together, collaborate, and learn about, from, and with each other. The aim of this study was to compare medical and dental faculty members' attitudes about and perceptions of PBL at 12 U.S. medical and dental schools known to use PBL. In 2015, 111 medical and 132 dental faculty members (combined n=243) from six medical and six dental schools completed a survey containing ten statements and an open comment section. The response rate was 42% of those who received the survey. In the results, the medical faculty participants showed significantly higher enthusiasm for and agreement with PBL benefits than did the dental faculty participants (p˂0.05). The two groups agreed that PBL should be used to supplement conventional teaching (p>0.05). There were no opposite attitudes or contrasts found between the two groups with regards to PBL. The strongest themes expressed by both groups were that PBL should not be used as the sole method of instruction and that students needed a solid foundation in the subject prior to engaging in PBL.

The Comparison between two Methods of Basic Life Support Instruction: Video Self-Instruction versus Traditional Method

Introduction

Medical education is changing and evolving. Teachers need to re-evaluate their medical teaching practice to enhance student learning. The data about the ideal training method of Basic Life Support (BLS) is lacking. The goal of this study was to analyse the use and performance of video self-instruction (VSI) method in BLS, in order to develop an efficient BLS training method.

Methods

Eighty-one undergraduate medical interns were enrolled in a prospective clinical study in 2011. They were divided into VSI group and traditional group. We provided the first group with a DVD containing a 20-minute training video while the second group took part in a 4-hour training class of BLS. Subjects participated in a pre-test and post-test based on 2010 American Heart Association Resuscitation guideline.

Results

The average scores of VSI group and the traditional group before training were 8.85±2.42 and 8.57±2.22 respectively (p=0.592). After training, the average scores of the VSI and the traditional group were 20.24±0.83 and 18.05±1.86 respectively. VSI group achieved slightly better scores compared with the traditional group (p<0.001).

Conclusions

Training through VSI achieves more satisfying results than the traditional lecture method. VSI method can be considered a useful technique in undergraduate educational programs. Developing VSI can increase significantly the access to the BLS training. (Hong Kong j.emerg.med. 2015;22:291-296)

Content analysis of chronic pain content at three undergraduate medical schools in Ontario

Background: It has been well documented that interdisciplinary, comprehensive pain education can foster positive pain beliefs among medical students, in addition to improving students' abilities to diagnose and treat pain. Though some work has been done to quantify the number of hours of pain education students receive, the content itself has received little attention. Aims: This study seeks to identify what medical students learn about chronic pain throughout an undergraduate medical degree program in Ontario. Methods: Three undergraduate medical schools in Ontario were selected on the basis of variety in curricular structure and instructional methods. Written documents comprising the formal curriculum were analyzed through qualitative and quantitative content analysis. These findings were compared with promising practices from the pain education literature. Results: The three curricula studied here dedicate the bulk of pain education to three topics: pain mechanisms, pain management, and opioids and addiction. The curricula vary considerably in organization of content and hours of pain training. All three curricula were found to contain negative pain beliefs that characterize pain patients as difficult, overwhelming, and unrewarding to work with. Two of the medical schools studied here do not have a pain curriculum. Conclusions: The results of this study indicate a need for medical schools to develop comprehensive, interdisciplinary pain curricula. Though increasing the number of hours of pain training is crucial, equally imperative is a consideration of what, and how, students learn about pain.

Simplifying the upper limb peripheral motor screen: Proposing the "K" sign

The well-recognized erosion of pathoanatomic correlations in basic medical training, combined with the increasing everyday pressures of time-efficacy in patient examination, continue to place strain on junior clinicians. Over the years, many refinements to tried-and-true basic physical examination techniques have been described, allowing improvement in diagnostic yield. A multitude of “screening” techniques are available for physical assessment; however, such approaches are often nonstandardized and inconsistently taught and applied in the clinical realm. Great interexaminer inconsistency in the documentation of many forms of screening techniques also substantively undermines their respective clinical value. The current work presents a novel refinement/combination of previously described examination approaches for the assessment of peripheral upper limb (UL) motor function — the “K” sign. Having been successfully applied in both the acute and ambulatory clinical settings for several years, we feel that the technique has a useful role as a rapid and specific screening technique that is easily taught, learnt, and applied. Arguably, its employment serves to improve time efficacy in the screening examination, and may even improve diagnostic yield through its reliable reproducibility and provision of direct bilateral comparison. Its inherent simplicity also lends itself well to high levels of uptake (and retention) by medical students and junior clinicians alike. On top of presenting the simple screening test itself, we offer a simple means of subsequent notation for the patient's case note record, again in the hope of standardization and endurance of clinical value beyond the time of patient examination.

"Men's health--a little in the shadow": a formative evaluation of medical curriculum enhancement with men's health teaching and learning

BACKGROUND

Enhancing a medical school curriculum with new men's health teaching and learning requires an understanding of the local capacity and the facilitators and barriers to implementing new content, and an approach that accommodates the systemic and cultural differences between medical schools.

METHODS

A formative evaluation was undertaken to determine the perspectives of key informants (academics, curriculum developers) from four Australian medical schools about the strategies needed to enhance their curriculum with men's health teaching and learning. Through semi-structured questioning with 17 key informants, interviewees also described the contextual barriers and facilitators to incorporating new topic areas into existing curriculum. Interviews were recorded with consent, transcribed verbatim, and analysed by two researchers to identify key themes.

RESULTS

Interviewees were enthusiastic about incorporating men's health content through a men's health curriculum framework but highlighted the need for systems to assist in identifying gaps in their current curriculum where the men's health topics could be integrated. The student experience was identified as a key driver for men's health teaching and learning. Furthermore, core men's health clinical outcomes needed to be defined and topic areas vertically integrated across the curricula. This would ensure that students were appropriately equipped with the skills and knowledge for subsequent clinical practice in a range of geographical settings. Interviewees consistently suggested that the best implementation strategy is to have someone 'on the ground' to work directly with medical school staff and champion the men's health discipline. Providing mechanisms for sharing knowledge and resources across medical schools was highlighted to facilitate implementation, particularly for those medical schools with limited men's health teaching resources.

CONCLUSIONS

Despite the unanimous support for men's health teaching and learning, the evaluation highlighted that the student experience must be recognised as paramount when integrating new topic areas into an already packed curriculum. A community of practice, where medical schools share relevant resources and knowledge, could help to ensure a commonality of student experience with respect to men's health learning in medical schools across different geographical settings and with different levels of resourcing. Such an approach could also be adapted to other areas of curriculum enhancement.

An argument-based approach to the validation of UHTRUST: can we measure how recent graduates can be trusted with unfamiliar tasks?

There is a need for valid methods to assess the readiness for clinical practice of medical graduates. This study evaluates the validity of Utrecht Hamburg Trainee Responsibility for Unfamiliar Situations Test (UHTRUST), an authentic simulation procedure to assess whether medical trainees are ready to be entrusted with unfamiliar clinical tasks near the highest level of Miller's pyramid. This assessment, in which candidates were judged by clinicians, nurses and standardized patients, addresses the question: can this trainee be trusted with unfamiliar clinical tasks? The aim of this paper is to provide a validity argument for this assessment procedure. We collected data from various sources during preparation and administration of a UHTRUST-assessment. In total, 60 candidates (30 from the Netherlands and 30 from Germany) participated. To provide a validity argument for the UHTRUST-assessment, we followed Kane's argument-based approach for validation. All available data were used to design a coherent and plausible argument. Considerable data was collected during the development of the assessment procedure. In addition, a generalizability study was conducted to evaluate the reliability of the scores given by assessors and to determine the proportion of variance accounted by candidates and assessors. It was found that most of Kane's validity assumptions were defendable with accurate and often parallel lines of backing. UHTRUST can be used to compare the readiness for clinical practice of medical graduates. Further exploration of the procedures for entrustment decisions is recommended.

Differential student attrition and differential exposure mask effects of problem-based learning in curriculum comparison studies

PURPOSE

Studies that compare the effects of problem-based and conventional medical curricula on student performance generally show no significant differences. However, curriculum comparison studies are at best quasi-experimental, so they are prone to forms of selection bias. The purpose of this study was to reanalyze data from such comparisons by controlling for two potential biases: differential student attrition and differential exposure.

METHOD

The authors reanalyzed 104 previously published comparisons involving a single, problem-based medical school in the Netherlands (Maastricht University's medical school), using student attrition and study duration data from this school and the schools with which it was compared. The authors removed bias by reequalizing the comparison groups in terms of attrition and study duration.

RESULTS

The uncorrected data showed no differences between problem-based and conventional curricula: Mean effect sizes as expressed by Cohen d were 0.02 for medical knowledge and 0.07 for diagnostic reasoning. However, the reanalysis demonstrated medium-level effect sizes favoring the problem-based curriculum. After corrections for attrition and study duration, the mean effect size for knowledge acquisition was 0.31 and for diagnostic reasoning was 0.51.

CONCLUSIONS

Effects of the Maastricht problem-based curriculum were masked by differential attrition and differential exposure in the original studies. Because this school has been involved in many studies included in influential literature reviews published in the past 20 years, the authors' findings have implications for the assessment of the value of problem-based learning put forward by these reviews.

Pain education in North American medical schools

Knowledgeable and compassionate care regarding pain is a core responsibility of health professionals associated with better medical outcomes, improved quality of life, and lower healthcare costs. Education is an essential part of training healthcare providers to deliver conscientious pain care but little is known about whether medical school curricula meet educational needs. Using a novel systematic approach to assess educational content, we examined the curricula of Liaison Committee on Medical Education-accredited medical schools between August 2009 and February 2010. Our intent was to establish important benchmark values regarding pain education of future physicians during primary professional training. External validation was performed. Inclusion criteria required evidence of substantive participation in the curriculum management database of the Association of American Medical Colleges. A total of 117 U.S. and Canadian medical schools were included in the study. Approximately 80% of U.S. medical schools require 1 or more pain sessions. Among Canadian medical schools, 92% require pain sessions. Pain sessions are typically presented as part of general required courses. Median hours of instruction on pain topics for Canadian schools was twice the U.S. median. Many topics included in the International Association for the Study of Pain core curriculum received little or no coverage. There were no correlations between the types of pain education offered and school characteristics (eg, private versus public). We conclude that pain education for North American medical students is limited, variable, and often fragmentary. There is a need for innovative approaches and better integration of pain topics into medical school curricula.

PERSPECTIVE

This study assessed the scope and scale of pain education programs in U.S. and Canadian medical schools. Significant gaps between recommended pain curricula and documented educational content were identified. In short, pain education was limited and fragmentary. Innovative and integrated pain education in primary medical education is needed.

Opportunity or threat: the ambiguity of the consequences of transitions in medical education

OBJECTIVES

The alleged medical education continuum is interrupted by a number of major transitions. After starting medical school, the first transition students encounter is that from non-clinical to clinical training. The second transition is that of graduated student to junior doctor or specialist trainee, and the third concerns the specialist trainee's transition to medical specialist. As a first step towards a better understanding of the effects of transitions, this paper provides a critical overview of how these transitions have been conceptualised in the medical education domain. The findings are complemented with perspectives from the fields of transitional psychology and organisational socialisation. The transition into medical school is not reviewed.

METHODS

Using the term 'transition', six leading medical education journals were searched for relevant articles. A snowballing technique on the reference lists of the 44 relevant articles yielded 29 additional publications. Studies were reviewed and categorised as representing objectifying, clarifying, or descriptive and/or justifying research.

RESULTS

When students enter clinical training, they need to relearn what they thought they knew and they must learn new things in a more self-directed way. As junior doctors or specialist trainees, their main challenges involve handling the many responsibilities that accompany the delivery of patient care while simultaneously learning from the process of providing that care. As medical specialists, new non-medical tasks and decisions on how to delegate responsibilities become issues.

CONCLUSIONS

Research on transitions has objectified the challenges students and doctors face. Clarifying studies often lack conceptual frameworks that could help us to gain deeper insight into the observed phenomena. Psychology offers valuable theoretical perspectives that are applicable to medical education transitions. To transform a transition from a threat to a learning opportunity, medical education should assist students and doctors in developing the coping skills they need to effectively deal with the challenges presented by new environments.