Cultural Appropriation for Improved Knowledge Acquisition in Medical Education

Background

Culture is an essential component that governs all aspects of human behavior. Superstition is an irrational belief observed in almost all cultures. It is linked to one or more factors like supernatural powers, good luck, bad omen, fiction, illegitimate activity, absurd narration, folk tales, or practice without any rational basis.

Methods

A cross-sectional social experiment was conducted to evaluate the effect of cultural appropriation as a tool to enhance medical knowledge acquisition and attitudinal development in medical education. The experiment was designed to target a non-medical population. Four superstition-oriented videos were developed with 20 scientific pieces of information related to forensic medicine. A data collection sheet was developed on Microsoft form with 16 questions was distributed on the participants.

Results

Out of the 986 participants, 763 (77.5%) watched the whole set of videos. About 55-95% of responders demonstrated knowledge acquisition of all the questions. There was a statistically significant difference between those who watched the videos and those who did not. When participants were asked about the most important information they remember from the videos, their answers fell into two main categories; information related to core scientific knowledge (80% of participants) and information not related to the core knowledge (16% of respondents). The top three areas for the reasons why people wanted to watch the videos were curiosity, knowledge, and career. A change in attitudes was reported among the participants where 80% of responders demonstrated curiosity to know more about this world, 46% responders reported developing more respect for the forensic physician and 43% revealed their ignorance about this great hidden world.

Conclusion

Cultural appropriation could be a needed strategy to accommodate for upscale in education. Learners might validate that learning happens through a door that adopts not only honours their culture and adapts to it.

Part 1: The Beginning of Carla's Treatment

We propose to critically evaluate and strengthen the level of clinical evidence in psychoanalysis, using a strategy of triangulating clinical phenomena from different perspectives and increasing contextual knowledge. Insufficient discussion of alternative hypotheses and limited contextual information are two Achilles heels of psychoanalytic case presentations. We examine the concept and quality standards of clinical evidence in psychoanalysis and related disciplines, with particular attention to the contribution of the three-level model (3-LM). We analyze the case of a patient treated with transference-focused psychotherapy (TFP), making explicit the theoretical-clinical agreements and disagreements of the authors. We discuss the strengths and limitations of triangulation and contextualization, concluding that they make clinical work and psychoanalytic writing more reliable, transparent, auditable, and replicable.

Operationalizing competency-based assessment: Contextualizing for cultural and gender divides

Following current trends, educational institutions often decide to use a competency framework as an overarching structure in their assessment system. Despite the presence of a common understanding of how different examinations can contribute to the decision on attaining a particular competency, a detailed mapping of the data points appears to be a challenging area that remains to be explored. Faced with the newly emerged task of introducing the assessment of the attainment of UAE medical students against the EmiratesMEDs competency framework, Dubai Medical College for Girls (DMCG) attempted to operationalise the designed concept in the assessment system considering the cultural and gender divide. We believe that health professionals who attempt to implement contextualized competency-based assessment could benefit from being acquainted with our experience. The article offers a step-by-step guide on contextualized competency assessment operationalization, describing building the team, working with consultants and faculty development, estimating institutional assessment capacity, mapping and operationalizing the maps by using both human recourses and the software. We also offer the readers the list of enabling factors and introduce the scope of limitations in the process of developing the competency-based assessment system. We believe that following the present guide can allow educators to operationalize competency-based assessment in any context with respect to local culture and traditions.

Appraising Unmet Needs and Misinformation Spread About Polycystic Ovary Syndrome in 85,872 YouTube Comments Over 12 Years: Big Data Infodemiology Study

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women, resulting in substantial burden related to metabolic, reproductive, and psychological complications. While attempts have been made to understand the themes and sentiments of the public regarding PCOS at the local and regional levels, no study has explored worldwide views, mainly due to financial and logistical limitations. YouTube is one of the largest sources of health-related information, where many visitors share their views as questions or comments. These can be used as a surrogate to understand the public's perceptions.

OBJECTIVE

We analyzed the comments of all videos related to PCOS published on YouTube from May 2011 to April 2023 and identified trends over time in the comments, their context, associated themes, gender-based differences, and underlying sentiments.

METHODS

After extracting all the comments using the YouTube application programming interface, we contextually studied the keywords and analyzed gender differences using the Benjamini-Hochberg procedure. We applied a multidimensional approach to analyzing the content via association mining using Mozdeh. We performed network analysis to study associated themes using the Fruchterman-Reingold algorithm and then manually screened the comments for content analysis. The sentiments associated with YouTube comments were analyzed using SentiStrength.

RESULTS

A total of 85,872 comments from 940 PCOS videos on YouTube were extracted. We identified a specific gender for 13,106 comments. Of these, 1506 were matched to male users (11.5%), and 11,601 comments to female users (88.5%). Keywords including diagnosing PCOS, symptoms of PCOS, pills for PCOS (medication), and pregnancy were significantly associated with female users. Keywords such as herbal treatment, natural treatment, curing PCOS, and online searches were significantly associated with male users. The key themes associated with female users were symptoms of PCOS, positive personal experiences (themes such as helpful and love), negative personal experiences (fatigue and pain), motherhood (infertility and trying to conceive), self-diagnosis, and use of professional terminology detailing their journey. The key themes associated with male users were misinformation regarding the "cure" for PCOS, using natural and herbal remedies to cure PCOS, fake testimonies from spammers selling their courses and consultations, finding treatment for PCOS, and sharing perspectives of female family members. The overall average positive sentiment was 1.6651 (95% CI 1.6593-1.6709), and the average negative sentiment was 1.4742 (95% CI 1.4683-1.4802) with a net positive difference of 0.1909.

CONCLUSIONS

There may be a disparity in views on PCOS between women and men, with the latter associated with non-evidence-based approaches and misinformation. The improving sentiment noticed with YouTube comments may reflect better health care services. Prioritizing and promoting evidence-based care and disseminating pragmatic online coverage is warranted to improve public sentiment and limit misinformation spread.

Single-arm trials supporting the approval of anticancer medicinal products in the European Union: contextualization of trial results and observed clinical benefit

BACKGROUND

Single-arm trials (SATs) can sometimes be used to support marketing authorization of anticancer medicinal products in the European Union. The level and durability of antitumor activity of the product as well as context are important aspects to determine the relevance of trial results. The aim of this study is to provide details on the contextualization of trial results and to evaluate the magnitude of benefit of medicinal products approved based on SATs.

MATERIALS AND METHODS

We focused on anticancer medicinal products for solid tumors approved on the basis of SAT results (2012-2021). Data were retrieved from European public assessment reports and/or published literature. The benefit of these medicinal products was evaluated via the European Society for Medical Oncology (ESMO)-Magnitude of Clinical Benefit Scale (MCBS).

RESULTS

Eighteen medicinal products were approved based on 21 SATs-few medicinal products were supported by >1 SAT. For the majority of clinical trials, a clinically relevant treatment effect was (pre)specified (71.4%) and most often an accompanying sample size calculation was provided. For 10 studies, each testing a different medicinal product, a justification for the threshold for a clinically relevant treatment effect could be identified. At least 12 out of 18 applications included information to facilitate the contextualization of trial results, including six supportive studies. Of the pivotal SATs analyzed (n = 21), three were assigned an ESMO-MCBS score of 4, which corresponds to 'substantial' benefit.

CONCLUSIONS

The clinical relevance of the treatment effects shown by medicinal products for solid tumors tested in SATs is dependent on the effect size and context. To better facilitate regulatory decision making, prespecifying and motivating a clinically relevant effect and aligning the sample size to that effect is important. External controls may facilitate in the contextualization process, but the associated limitations must be addressed.

Acquiring religious words: dialogical and individual construction of a word's meaning

By the age of eight, there is a significant increase in abstract words in the child's lexicon. A crucial contribution can be seen in the linguistic input, i.e. the way how abstract words are presented by caregivers by means of linguistic perspectivation and emotionalization. Following an interactionist way, we were interested in how the semantics of abstract words is constructed by child and caregiver in duet. We focused on a subset of abstract words and studied the acquisition of meaning of the religious concept mercy. We expected religious words to be emotionally anchored and presented with perspectivation, both contributing to learning. Exploring the dialogic constructions, we investigated eight 7- to 8-year olds and their parents during dialogic reading and studied their strategies focusing on the linguistic means of emotionalization and perspectivation in contextualizing the word. In a subsequent test, we analysed these means used by the children and assessed their individual understanding of mercy. Our analyses indicate that during reading, the enrichment of semantics by emotionalization was related between child and caregiver, whereas cross-situationally, a simultaneous enrichment of emotionalization and perspectivation was present. Moreover, the children demonstrated a conceptual understanding of mercy in religious contexts, but not in secular contexts. This article is part of the theme issue 'Concepts in interaction: social engagement and inner experiences'.

Of Blickets, Butterflies, and Baby Dinosaurs: Children's Diagnostic Reasoning Across Domains

The three studies presented here examine children’s ability to make diagnostic inferences about an interactive causal structure across different domains. Previous work has shown that children’s abilities to make diagnostic inferences about a physical system develops between the ages of 5 and 8. Experiments 1 (N = 242) and 2 (N = 112) replicate this work with 4- to 10-year-olds and demonstrate that this developmental trajectory is preserved when children reason about a closely matched biological system. Unlike Experiments 1 and 2, Experiment 3 (N = 110) demonstrates that children struggle to make similar inferences when presented with a parallel task about category membership in biology. These results suggest that children might have the basic capacity for diagnostic inference at relatively early ages, but that the content of the inference task might interfere with their ability to demonstrate such capacities.

Contextualization and psychometrics of interprofessional collaboration checklist in Iranian community health-care setting

INTRODUCTION

Assessment interprofessional collaboration (IPC), in community health-care setting usually has been neglected due to the lack of standard tools and assessors. In the present study, the IPC checklist extracted from CANMEDS collaborator toolkit for teaching and assessing the collaborator role is contextualized in Iranian community healthcare.

MATERIALS AND METHODS

According to CANMEDS Toolkit, an instrument extracted for IPC assessment. Using Chavez' toolkit, face and content validity were studied through two rounds of Delphi by 12 experts of TUMS. Qualitative content validity including content validity index (CVI), and content validity ratio (CVR) were assessed following watching a standard video about IPC by them. Construct validity was studied by confirmatory factor analysis through LISREL software. To check reliability, Cronbach's alpha was calculated, and the other 12 experts completed checklists in test-retest process with a 2-week interval.

RESULTS

Face and qualitative content validity were confirmed using the Delphi method. CVI and CVR were calculated as 0.61 and 0.86. In factor analysis, x2/df and RMSEA were calculated as 1.363 and 0.036; CFI, IFI, GFI, and AGFI were >0.7, and hence, the construct validity was confirmed. Cronbach's alpha was 0.953 for internal consistency. Test-retest was also calculated as 0.918 indicated to confirm reliability.

CONCLUSION

CANMEDS framework as an assessment tool for evaluating IPC in community health setting is not only valid and reliable in the Iranian context but also it is easy to use for respondents resulted from the rational number of items in community.

A Framework Model for a Contextualized and Integrated Warfarin Therapy Case in a Master of Pharmacy Program

Objective. To develop and integrate a case study on warfarin into a clinical pharmacy workshop. Methods. A framework model was designed and used to create a case study on warfarin therapy. The case study was implemented in a third-year Master of Pharmacy course. Student feedback was obtained using an online questionnaire and two focus groups. Results. All students agreed that the case study successfully integrated the science of warfarin and concepts of pharmacy practice. The majority of students (94%) agreed that this approach helped them to understand the science of warfarin more than a traditional lecture would have. Students felt the time allocated to the workshop was too short. Conclusion. An integrated case study provides a learning environment that emphasizes the contextualization of chemistry and pharmacology into a clinical pharmacy setting.

Some thoughts about the terms "centre" and "inside," in relation to the concept of person-centredness

BACKGROUND

In everyday practice, we do not pay much attention to the words we use. So we do not usually become aware of an ontological difference between the levels of so-called objects focused upon and person-centredness. To elucidate this fundamental difference, we contrast here person-centred medicine (PCM) and a corresponding use of a polycentric grid approach (PCG approach) with the conventional impersonal, objectifying approach. The latter is typically depicted in orthogonal grids, such as charts and lists. This conventional way may be called the Cartesian orthogonal grid approach, or simply Cartesian approach.

RESULTS

A conceptual framework corresponding to PCM is proposed. The PCG approach issues centricity in a formal way and provides a polycentric arrangement of interacting centres. The topic of polycentricity is discussed by the later Nobel Prize-winner Elinor Ostrom and her husband Victor, concerning management of common goods. The corresponding concept and use of a polycentric grid allow depicting uniqueness and relatedness of interacting centres better than the conventional Cartesian orthogonal grids. The PCG approach outlined here corresponds to the use of different graphic and cartographic procedures, such as the glyph plot. This unconventional form of representation is seen as beneficial in PCM. Practical exercises are developed to enhance awareness of centricity in everyday health care settings. The steps suggested are based on imagination of common tools, such as used in playing darts. Following the practical application, the theoretical background is outlined. It has been published in an extended form and hence can be discussed in a more focused way.

CONCLUSIONS

Use of the PCG approach enhances experience and enactment of personhood. It supports PCM in everyday practice. On a theoretical level, the PCG approach has ontological primacy compared with the conventional Cartesian approach. To refer to physical empiric, the decontextualized Cartesian concept needs to be embedded in the empiric polycentric one.

Bridging the Gap Between the Social and the Technical: The Enrolment of Socio-Technical Information Architects to Cope with the Two-Level Model of EPR Systems

This is a project proposal derived from an urge to re-define the governance of ICT in healthcare towards regional and national standardization of the patient pathways. The focus is on a two-levelled approach for governing EPR systems where the clinicians' model structured variables and patient pathways. The overall goal is a patient centric EPR portfolio. This paper define and enlighten the need for establishing the socio- technical architect role necessary to obtain the capabilities of a modern structured EPR system. Clinicians are not capable to moderate between the technical and the clinical.

From adverse drug event detection to prevention. A novel clinical decision support framework for medication safety

BACKGROUND

Errors related to medication seriously affect patient safety and the quality of healthcare. It has been widely argued that various types of such errors may be prevented by introducing Clinical Decision Support Systems (CDSSs) at the point of care.

OBJECTIVES

Although significant research has been conducted in the field, still medication safety is a crucial issue, while few research outcomes are mature enough to be considered for use in actual clinical settings. In this paper, we present a clinical decision support framework targeting medication safety with major focus on adverse drug event (ADE) prevention.

METHODS

The novelty of the framework lies in its design that approaches the problem holistically, i.e., starting from knowledge discovery to provide reliable numbers about ADEs per hospital or medical unit to describe their consequences and probable causes, and next employing the acquired knowledge for decision support services development and deployment. Major design features of the framework's services are: a) their adaptation to the context of care (i.e. patient characteristics, place of care, and significance of ADEs), and b) their straightforward integration in the healthcare information technologies (IT) infrastructure thanks to the adoption of a service-oriented architecture (SOA) and relevant standards.

RESULTS

Our results illustrate the successful interoperability of the framework with two commercially available IT products, i.e., a Computerized Physician Order Entry (CPOE) and an Electronic Health Record (EHR) system, respectively, along with a Web prototype that is independent of existing healthcare IT products. The conducted clinical validation with domain experts and test cases illustrates that the impact of the framework is expected to be major, with respect to patient safety, and towards introducing the CDSS functionality in practical use.

CONCLUSIONS

This study illustrates an important potential for the applicability of the presented framework in delivering contextualized decision support services at the point of care and for making a substantial contribution towards ADE prevention. Nonetheless, further research is required in order to quantitatively and thoroughly assess its impact in medication safety.

Moving life science ethics debates beyond national borders: some empirical observations

The life sciences are increasingly being called on to produce "socially robust" knowledge that honors the social contract between science and society. This has resulted in the emergence of a number of "broad social issues" that reflect the ethical tensions in these social contracts. These issues are framed in a variety of ways around the world, evidenced by differences in regulations addressing them. It is important to question whether these variations are simply regulatory variations or in fact reflect a contextual approach to ethics that brings into question the existence of a system of "global scientific ethics". Nonetheless, within ethics education for scientists these broad social issues are often presented using this scheme of global ethics due to legacies of science ethics pedagogy. This paper suggests this may present barriers to fostering international discourse between communities of scientists, and may cause difficulties in harmonizing (and transporting) national regulations for the governance of these issues. Reinterpreting these variations according to how the content of ethical principles is attributed by communities is proposed as crucial for developing a robust international discourse. To illustrate this, the paper offers some empirical fieldwork data that considers how the concept of dual-use (as a broad social issue) was discussed within African and UK laboratories. Demonstrating that African scientists reshaped the concept of dual-use according to their own research environmental pressures and ascribed alternative content to the principles that underpin it, suggests that the limitations of a "global scientific ethics" system for these issues cannot be ignored.

The Pharmville community: a curriculum resource platform integrating context and theory

OBJECTIVE

To develop and implement a resource platform consisting of a fictional community of people to augment learning in an undergraduate pharmacy program and to refine patient contact skills.

DESIGN

Pharmville, a virtual community comprised of 29 fictional characters in 7 families, was developed that included high-quality video vignettes, photographs, drug structures, documented health profiles, and medical and social histories representative of an Australian metropolitan suburb. Over the next 4 years, Pharmville resources and themes were incorporated into the Bachelor of Pharmacy (BPharm) degree program orientation, and implemented in lectures and tutorials, assessments, independent study resources, and in a variety of contact activities throughout the curriculum.

ASSESSMENT

A 2010 comprehensive evaluation found that 21 of the 29 Pharmville characters had been incorporated into teaching materials in about 40% of instructional units in the first 3 years of the BPharm program, that all of the types of resources available were being used, and that use was almost equal between pharmacy practice and science units. A student evaluation of Pharmville showed a positive response to its use, with students able to identify with various characters within the community.

CONCLUSION

Pharmville is an instructional resource that links professionalism and academic study, and provides context for student learning.

Physicians' perceptions on the usefulness of contextual information for prioritizing and presenting alerts in Computerized Physician Order Entry systems

BACKGROUND

One possible approach towards avoiding alert overload and alert fatigue in Computerized Physician Order Entry (CPOE) systems is to tailor their drug safety alerts to the context of the clinical situation. Our objective was to identify the perceptions of physicians on the usefulness of clinical context information for prioritizing and presenting drug safety alerts.

METHODS

We performed a questionnaire survey, inquiring CPOE-using physicians from four hospitals in four European countries to estimate the usefulness of 20 possible context factors.

RESULTS

The 223 participants identified the 'severity of the effect' and the 'clinical status of the patient' as the most useful context factors. Further important factors are the 'complexity of the case' and the 'risk factors of the patient'.

CONCLUSIONS

Our findings confirm the results of a prior, comparable survey inquiring CPOE researchers. Further research should focus on implementing these context factors in CPOE systems and on subsequently evaluating their impact.