Factors Affecting the Level of Reflective Thinking and Clinical Decision-Making Skills in Medical Faculty Students

Objectives

The aim of this study is to evaluate the reflection skills of students at the Faculty of Medicine and the factors influencing these skills, as well as to measure the impact of students' reflection skills on their clinical decision-making.

Methods

This study is an educational research project conducted on fifth-year Ear Nose Throat (ENT) interns at Vakif University's Faculty of Medicine. The "Reflective Thinking Level Determination Scale" and the "Clinical Decision-Making Scale," which are valid and reliable, were used to assess the reflection skills and clinical decision-making abilities of the 125 students participating in the study.

Results

In our study, the mean score of the sub-dimensions of the Groningen Reflection Skills Scale was 77.04±5.14 for the fifth-year student population surveyed. Scores from the "Self-Reflection" and "Reflective Communication" sub-dimensions of the Groningen Reflection Skills Scale were compared based on gender, participation in summer internships, receipt of scholarships, membership in social sciences clubs, place of residence, school attended, diary-keeping habits, study styles, and cities of residence. Although there were some differences between the groups, these differences were not statistically significant. The total scores of the students on the Clinical Decision-Making Scale sub-dimensions ranged from 98 to 169, with a mean score of 146.18±10.97. A statistically positive and moderate correlation was found between the total scores of the participants on the Groningen Reflection Skills Scale and the total scores they obtained on the Clinical Decision-Making Scale (r=0.403; p=0.001).

Conclusion

Consequently, an increase in the reflection skills of participants is associated with higher clinical decision-making scores. Reflection is the primary means of transitioning students from novices to experts, enhancing both comprehensive learning and learning experiences. Therefore, every medical school should develop a training program for student reflection, along with a feedback and assessment system integrated into the curriculum.

RE-AIMing COVID-19 online learning for medical students: a massive open online course evaluation

BACKGROUND

Clinical training during the COVID-19 pandemic is high risk for medical students. Medical schools in low- and middle-income countries (LMIC) have limited capacity to develop resources in the face of rapidly developing health emergencies. Here, a free Massive Open Online Course (MOOC) was developed as a COVID-19 resource for medical students working in these settings, and its effectiveness was evaluated.

METHODS

The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was utilized to evaluate the effectiveness of MOOC in teaching medical students about COVID-19. The data sources included the student registration forms, metrics quantifying their interactions within the modules, students' course feedback, and free-text responses. The data were collected from the Moodle learning management system and Google analytics from May 9 to September 15, 2020. The research team analyzed the quantitative data descriptively and the qualitative data thematically.

RESULTS

Among the 16,237 unique visitors who accessed the course, only 6031 medical students from 71 medical schools registered, and about 4993 (83% of registrants) completed the course, indicating high levels of satisfaction (M = 8.17, SD = 1.49) on a 10-point scale. The mean scores of each assessment modules were > 90%. The free-text responses from 987 unique students revealed a total of 17 themes (e.g., knowing the general information on COVID-19, process management of the pandemic in public health, online platform use, and instructional design) across the elements of the RE-AIM framework. Mainly, the students characterized the MOOC as well-organized and effective.

CONCLUSIONS

Medical students learned about COVID-19 using a self-paced and unmonitored MOOC. MOOCs could play a vital role in the dissemination of accurate information to medical students in LMIC in future public health emergencies. The students were interested in using similar MOOCs in the future.

Students meeting with caregivers of cancer patient: results of an experience-based learning project

The communication between medical students and cancer caregivers, and the problems they have experienced as well as the outcomes for their professional development before starting clinical practice was assessed in the context of a student research project. Data were collected by questionnaires or by 20 to 40-min long interviews with cancer caregivers. Their communications with physicians, hearing the bad news, and health service satisfaction were questioned. Therefore, the caregivers trusted the professional approach of their physician. However, they expected more empathic communication in the process of diagnosis and therapy. Development of empathy and trust-based communication between patients and physicians and enhancement of the quality of devoted time to cancer patients and caregivers may have an effect on the course of disease. Interviewer students mentioned that they developed communication skills about difficult clinical tasks and in delivering bad news face to face to cancer caregivers before starting their clinical education.

[Immigrations to Anatolia, related public health problems and healthcare services in the beginning of the Twentieth Century]

Anatolia, one of the most important crossroads between two continents, has witnessed so many immigrations throughout the history. It is a place where different civilizations and cultures met and transformed each other by interaction. History of important immigrations to Anatolia during the reign of the Ottoman Empire goes back to 1683. Also, the period between the end of 19th century and the beginning of 20th century was the time of wars, immigrations, and death and birth of nations. The Ottoman Empire had joined the several wars as well, and the new Republic of Turkey was established after it collapsed. In this study, we investigated the two large scale immigrations to Anatolia between Balkan Wars and the first years of Republic, and tried to compile our knowledge about the public health problems and the healthcare services provided.

The impact of a faculty development program: evaluation based on the self-assessment of medical educators from preclinical and clinical disciplines

Self-assessment tools have previously been used to assess the impact of a faculty development program on the teaching skills of medical educators. In this study, we aimed to assess the impact of a faculty development program on the teaching performances of faculty members in relation to their medical disciplines and academic positions. A faculty-training program consisted of "training skills" and "student assessment instruments" courses. The impact of the program was evaluated by self-reporting of faculty members (a total of 225 reports) 1-2 yr after the program. Both courses were found to be beneficial by nearly all of the attendants. Clinicians benefited more from some topics in the student assessment course and could apply the structured learning and assessment guides, structured oral examination, and objective structured clinical examination more efficiently than their peers from preclinical departments. In conclusion, the results demonstrated that the participants of the faculty development program modified their teaching activities according to the demands of their clinical practice. The correlations between the benefits and behavioral changes were statistically significant.

Exposure of medical students to pharmaceutical marketing in primary care settings: frequent and influential

It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician-pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised.

Determination of chlorophyll-a amount in Golden Horn, Istanbul, Turkey using IKONOS and in situ data

The objective of this research was to explore an accurate and fast way of estimating chlorophyll-a amount, a water quality parameter (WQP), using IKONOS satellite sensor image and in situ measurements. Since the in situ data of WQPs are limited with the number of sampling locations, deriving a correlation between these measurements and remotely sensed image allows synoptic estimates of the related parameter over large areas even if the areas are in remote and inaccessible locations. In this study, simultaneously collected satellite image data and in situ measurements of chlorophyll-a were correlated using multivariate regression model. Different experiments were designed by changing the numbers and distributions of in situ measurements. Regression coefficients of each design and differences between model-derived data and in situ measurements were calculated to find out the optimum design to produce chlorophyll-a map of study region. Results illustrated that both the number and distribution of in situ measurements have impact on regression analysis, therefore should be selected attentively. Also, it is found that IKONOS imagery is an efficient and effective source to derive chlorophyll-a map of the large areas using limited number of ground measurements.

[Medical ethics in residency training]

Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be's and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician's working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed.

Exposing Nursing Students To the Marketing Methods of Pharmaceutical Companies

There is a strong association between reliance on the promotional activities of pharmaceutical companies and a generally less appropriate use of prescription drugs. Pharmaceutical companies direct some of their promotion towards health workers who do not have the authority to prescribe medicines, such as nurses in certain countries. The aim of this study was to determine the impact that exposure to the marketing methods of pharmaceutical companies has on judgments made by nursing students about health worker—pharmaceutical company relationships. A cross-sectional survey was carried out with 442 nursing students in Istanbul, Turkey. The exposure of students to the marketing methods of pharmaceutical companies, whether it be indirectly through observation or directly by first-hand experience, increases the probability that students will adopt rationales that underlie affirmative judgments of health worker—pharmaceutical company relationships. Based on the pervasiveness and ability of drug promotion to influence the perceptions of students, it is imperative that attempts be made to reduce its negative impact.

Avian influenza outbreak in Turkey through health personnel's views: a qualitative study

Background

Avian influenza threatens public health worldwide because it is usually associated with severe illness and, consequently, a higher risk of death. During the first months of 2006, Turkey experienced its first human avian influenza epidemic. A total of 21 human cases were identified, 12 of which were confirmed by the National Institute for Medical Research. Nine of the cases, including the four fatal ones, were from the Dogubeyazit-Van region. This study aims to evaluate the efforts at the avian influenza outbreak control in the Van-Dogubeyazit region in 2006 through the experiences of health personnel.

Methods

We conducted in-depth interviews with seventeen key informants who took active roles during the avian influenza outbreak in East Turkey during the first months of 2006. We gathered information about the initial responses, the progress and management of the outbreak control, and the reactions of the health professionals and the public. The findings of the study are reported according to the topics that appeared through thematic analysis of the interview transcripts.

Results

Following the first suspected avian influenza cases, a Van Crisis Coordination Committee was formed as the coordinating and decision-making body and played an important role in the appropriate timing of decisions. The health and agriculture services could not be well coordinated owing to the lack of integrated planning in preparation for outbreak and of integrated surveillance programs. Traditional poultry practice together with the low socio-economic status of the people and the lack of health care access in the region seemed to be a major risk for animal to animal and animal to human transmission. The strengths and weaknesses of the present health system – primary health care services, national surveillance and notification systems, human resource and management – affected the inter organizational coordination during the outbreak. Open communication between the government and the public played an important part in overcoming difficulties.

Conclusion

Although there were problems during the avian influenza outbreak in Turkey, the rapid responses of the central and regional health authorities and the performance of the health workers were the key points in controlling the epidemic. The lessons from this outbreak should provide an opportunity for integrating the preparation plans of the health and agricultural organizations, and for revising the surveillance system and enhancing the role of the primary health care services in controlling epidemic disease. Developing successful strategies based on knowledge and experience may play a valuable role in delaying an avian influenza pandemic.

The anxieties of medical students related to clinical training

High levels of anxiety and stress during medical education may have negative effects on students' learning and may also influence students' performance, decision-making and caring capabilities. This study aims to compare the anxieties of clerkships of two medical schools that apply two different preclinical curricula; one is problem-based and the other is integrated. Dokuz Eylul University School of Medicine (DEUSM) has the basic clinical and communication skills education by the first year of medical education. However, the students of Marmara University School of Medicine (MUSM) had not any preclinical training about these issues at the time we performed this study. In order to evaluate the perceived anxiety, we used a questionnaire which comprises 39 issues presented as 4-point Likert-type scales. Eighty-six clerkships from MUSM and 115 clerkships from DEUSM participated in the study. According to the students of both of the schools, fear of making mistakes that could harm the patients was at the top of the list of sources of anxiety. The students of MUSM have additional anxieties related to the core clinical skills such as suturing patients, taking blood from patients and giving injections. On the other hand, the students of DEUSM have anxieties mostly related to difficult issues in communication such as breaking bad news. The study has revealed that medical students might have anxiety related to the clinical practice in the beginning of their clerkships. It was also shown that sources of anxiety may vary among students exposed to different preclinical curricula and different educational environment. If basic clinical and communication skills courses are integrated in preclinical curriculum, the students would meet some clinical task in the early year and would be orientated through clinical period.

Minimizing missed opportunities: an approach to decrease the unmet need for family planning

OBJECTIVES

The aim of the study was to determine the participants with unmet need and to show that family planning consultancy given to women and men attending the first-level health facilities would increase contraceptive usage and reduce unmet need for family planning.

METHODS

All married women aged 15-49 years and men having wives of the same age group attending the health centers for any service other than family planning were included in the study. Among 2021 attendants, a total of 1701 participated in the study (84.2%). Participants were interviewed after they took the services for which they attended. At the end of the inquiries, all willing participants were referred to the family planning unit in the same building.

RESULTS

The unmet need (need for any or more effective contraceptive methods) was 43.1%. All participants with unmet need were referred to the family planning unit in the same building and willing participants were given family planning services. Of the participants, 23.9% attended the family planning unit and 17.8% took services immediately at the time of the attendance.

CONCLUSIONS

Linking family planning services with other health services can be a cheap and practical way to reduce the unmet need.

Integration of a problem-based multidisciplinary clinical cancer management course into undergraduate education

BACKGROUND

Undergraduate cancer education programs usually involve diagnosis and treatment of various organs and tissues of the body that are invaded by this disease. Teaching organ system-based oncology by different disciplines causes a fragmented structure of knowledge with difficulty on reuniting the knowledge for the real patient.

METHODS

Along with the reorganization process of the curriculum, an integrated, problem-based multidisciplinary clinical cancer management course has been introduced to fifth-year students. The course has consisted of group studies, panel discussions, site visits to departments involved in diagnosis and treatment of cancer, and lecture tutorials enriched with interactive learning methods.

RESULTS AND CONCLUSION

Overall assessment of the course has been encouraging in terms of a clinical approach for students to the cancer patient, and innovations for better learning have been implemented for the following year.

Attitudes of Turkish anatomists toward cadaver donation

There is an insufficient number of cadavers in anatomy education in Turkey. This is because of decreased number of unclaimed bodies and very few cadaver donations. Increasing the number of cadaver donation is one of the probable solutions. Although anatomists encourage people to donate bodies, the attitudes of anatomists toward donating their own bodies for dissection is not well known. In this study, the attitudes of Turkish anatomists toward cadaver donation were evaluated. The questionnaires were sent to the anatomists in Turkey by mail and E-mail. Eighty-three anatomists replied to the questionnaire. The main solutions proposed for cadaver insufficiency included increasing the supply of unclaimed bodies (77.1%) and increasing body donation (78.3%). Further, 51.8% of the respondents thought that increasing body donation was a long-term solution. The general belief (83.1%) was that a campaign would help to increase body donation and 47% of respondents were willing to participate in such a campaign. Of the 83 anatomists, 20.5% of the respondents donated their organs and 49.4% were planning to donate them. Further, 15.7% were planning to donate their bodies; however, 63.9% did not consider donating. The main reasons of the respondents to object the donation were: to be dissected by a colleague (15.7%), the unacceptability of donation by family (26.5%), psychological reasons (43.4%), the anxiety of disrespectful behavior to cadavers (26.5%), and religious beliefs (3.6%). Although the majority of the respondents objected to donating their bodies due to psychological reasons, body donation was proposed as the main solution of cadaver insufficiency.