Medical student resilience and stressful clinical events during clinical training

BACKGROUND

Medical students face numerous stressors during their clinical years, including difficult clinical events. Fostering resilience is a promising way to mitigate negative effects of stressors, prevent burnout, and help students thrive after difficult experiences. However, little is known about medical student resilience.

OBJECTIVE

To characterize medical student resilience and responses to difficult clinical events during clinical training.

DESIGN

Sixty-two third-year (MS3) and 55 fourth-year (MS4) University of Chicago medical students completed surveys in 2016 assessing resilience (Connor Davidson Resilience Scale, CD-RISC 10), symptoms of burnout, need for resilience training, and responses to difficult clinical events.

RESULTS

Medical student mean resilience was lower than in a general population sample. Resilience was higher in males, MS4s, those without burnout symptoms, and students who felt able to cope with difficult clinical events. When students experienced difficult events in the clinical setting, the majority identified poor team dynamics among the most stressful, and agreed their wellbeing was affected by difficult clinical events. A majority also would prefer to discuss these events with their team later that day. Students discussed events with peers more than with attendings or residents. Students comfortable discussing stress and burnout with peers had higher resilience. Most students believed resilience training would be helpful and most beneficial during MS3 year.

CONCLUSIONS

Clinical medical student resilience was lower than in the general population but higher in MS4s and students reporting no burnout. Students had some insight into their resilience and most thought resilience training would be helpful. Students discussed difficult clinical events most often with peers. More curricula promoting medical student resilience are needed.

Does current provision of undergraduate education prepare UK medical students in ENT? A systematic literature review

OBJECTIVE

To systematically identify and analyse all published literature relating to the provision of undergraduate education for preparedness in ear, nose and throat (ENT) surgery, as perceived by medical students and clinicians in the UK.

DESIGN

Systematic literature review.

DATA SOURCES

5 major databases were searched: MEDLINE, EMBASE, ERIC, Cochrane and Web of Science. The literature search was conducted from February to April 2015.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary research or studies that report on the provision of undergraduate education for preparedness in ENT, from the perspective of medical students and clinicians in the UK. The timescale of searches was limited from 1999 onwards (ie, the past 15 years).

DATA EXTRACTION

The literature search was conducted by 2 independent reviewers. Search terms used involved the combination and variation of 5 key concepts, namely: medical student, clinician, ENT, undergraduate medical education and UK. A data extraction form was designed for and used in this study, based on guidelines provided by the UK National Health Service (NHS) Centre for Reviews and Dissemination. Textual narrative synthesis was used for data analysis.

RESULTS

A total of 7 studies were included in the final review. 4 main themes were identified: confidence in managing patients, teaching delivery, student assessment and duration of rotations. A consistent finding in this review was that the majority of final year medical students and junior doctors did not feel adequately prepared to practise ENT. Important factors influencing preparedness in ENT included the duration of clinical rotations, the opportunity for hands-on learning and formal assessment.

CONCLUSIONS

The findings of this review suggest the need for further development of the ENT undergraduate curricula across the UK. However, there is insufficient evidence from which to draw strong conclusions; this in itself is beneficial as it highlights a gap in the existing literature and supports the need for primary research.

Short-duration podcasts as a supplementary learning tool: perceptions of medical students and impact on assessment performance

BACKGROUND

Use of podcasts has several advantages in medical education. Podcasts can be of different types based on their length: short (1-5 min), moderate (6-15 min) and long (>15 min) duration. Short-duration podcasts are unique since they can deliver high-yield information in a short time. The perceptions of medical students towards short-duration podcasts are not well understood and this study aimed to analyze the same. An exploratory analysis of students' podcast usage and performance in summative assessments was also undertaken.

METHODS

First-year medical students (N = 94) participated in the study. Eight audiovisual podcasts, each ≤3 min duration (3-MinuTe Lessons; 3MTLs) were developed for two topics in biochemistry. The podcasts were made available for students after didactic lectures on the topics. Feedback was collected from students about their perceptions to 3MTLs using a self-reported questionnaire. The scores of students in summative assessments were compared based on their usage of 3MTLs.

RESULTS

Feedback revealed that 3MTLs were well received by students as a useful and convenient supplementary tool. Students used 3MTLs for topic review, to get an overview, as well as for quick revision and felt that 3MTLs were helpful in improving their understanding of the topic, clarify concepts and focus on important points and in turn, in preparation for assessments. A significant proportion (49%) felt that 3-min duration was optimal while, an equal proportion suggested an increase in the duration to 5 min with more information. The overall mean scores in assessments were not different between students based on 3MTLs usage. The pairwise comparisons revealed better scores amongst students who used 3MTLs for both topics.

CONCLUSION

Overall, short-duration podcasts were perceived by students as useful supplementary learning tools that aided them for revision and in preparation for assessments.

Sexual Health in Undergraduate Medical Education: Existing and Future Needs and Platforms

INTRODUCTION

This article explores the evolution and current delivery of undergraduate medical education in human sexuality.

AIM

To make recommendations regarding future educational needs, principles of curricular development, and how the International Society for Sexual Medicine (ISSM) should address the need to enhance and promote human sexuality education around the world.

METHODS

The existing literature was reviewed for sexuality education, curriculum development, learning strategies, educational formats, evaluation of programs, evaluation of students, and faculty development.

MAIN OUTCOME MEASURES

The prevailing theme of most publications in this vein is that sexuality education in undergraduate medical education is currently not adequate to prepare students for future practice.

RESULTS

We identified components of the principles of attitudes, knowledge, and skills that should be contained in a comprehensive curriculum for undergraduate medical education in human sexuality. Management of sexual dysfunction; lesbian, gay, bisexual, and transgender health care; sexuality across genders and lifespan; understanding of non-normative sexual practices; sexually transmitted infections and HIV, contraception; abortion; sexual coercion and violence; and legal aspects were identified as topics meriting particular attention.

CONCLUSION

Curricula should be integrated throughout medical school and based on principles of adult learning. Methods of teaching should be multimodal and evaluations of student performance are critical. To realize much of what needs to be done, faculty development is critical. Thus, the ISSM can play a key role in the provision and dissemination of learning opportunities and materials, it can promote educational programs around the world, and it can articulate a universal curriculum with modules that can be adopted. The ISSM can create chapters, review documents, slide decks, small group and roleplay topics, and video-recorded materials and make all this material easily available. An expert consensus conference would be needed to realize these recommendations and fulfill them.

Currently Available Tools and Teaching Strategies for the Interprofessional Education of Students in Health Professions: Literature review

Interprofessional education (IPE) is designed to provide students from different health sectors with opportunities to work together to enhance future collaboration. The implementation of IPE activities is a current trend in various countries. This review exclusively targets IPE issues involving undergraduate health profession students and highlights various approaches in different regions. A total of 28 articles published in peer-reviewed journals between January 2012 and July 2015 were assessed to determine recent trends in IPE implementation. Nine main strategies were identified: simulation-based education programmes; rotations in rural and community settings; interprofessional training wards; patient-centred case studies; theme-centred workshops; student seminars; student-delivered lectures; health promotion activities; and interactive lectures in a common setting. Many of these institutions had not restricted themselves to a single strategy and supplemented these activities with additional teaching or learning methods. Recommendations gathered from these diverse approaches may assist the development of sustainable strategies for implementing IPE in undergraduate medical curricula.

Getting off the carousel: Exploring the wicked problem of curriculum reform

INTRODUCTION

Making substantial changes to the form and delivery of medical education is challenging. One reason for this may be misalignment between existing conceptualizations of curricula and curriculum reform in medical education, with the former perceived as 'complex' yet the latter as linear. Reframing curriculum reform as a process-driven, complex entity may enhance the possibility of change. To explore the utility of this approach, we carried out an exploratory case study of curriculum reform in a real-life context.

METHODS

We used a qualitative case study approach. Data were collected from 17 interviews with senior faculty involved in curriculum reform in one medical school plus document analysis of approximately 50 documents and files, to provide background, context, and aid triangulation.

RESULTS

Data coding and analysis was initially inductive, using thematic analysis. After themes were identified, we applied the 'wicked problem' framework to highlight aspects of the data. This paper focuses on two main analytic themes. First, that multiple players hold different views and values in relation to curriculum reform, resulting in various influences on the process and outcomes of reform. Second, 'solutions' generate consequences which go beyond the anticipated advantages of curriculum reform.

DISCUSSION

This is the first empirical study of curriculum reform in medical education which uses the wicked problem framework to conceptually illuminate the complex processes which occur in relation to reform. Those involved in reform must be reflective and attentive to the possibility that persistent and emerging challenges may be a result of wicked problems.

Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students

OBJECTIVES

In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any "regular, repetitive offer" (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on "physician-assisted suicide," "euthanasia" and "palliative sedation," based on a fictitious case vignette study.

METHOD

The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering). The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures.

RESULTS

Out of 301 students in total, 241 (80%) participated in the survey; 109 answered the version 1 questionnaire (physical suffering) and 132 answered the version 2 questionnaire (emotional suffering). The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal) and euthanasia (illegal) correctly (81.2% and 93.7%, respectively), while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the assessment of the legality of palliative sedation: it was considered legal more frequently in the physical suffering version (88.1% vs. 75.8%).

CONCLUSION

The majority of the students surveyed wrongly assumed that physician-assisted suicide is a punishable offense in Germany. However, a narrow majority considered physician-assisted suicide ethically acceptable in the case study presented. Compared to euthanasia, more than twice as many participants considered physician-assisted suicide acceptable. There was no significant difference between personal attitudes towards palliative sedation, physician-assisted suicide or euthanasia in light of physical or emotional suffering. Educational programs in this field should be expanded both qualitatively and quantitatively, especially considering the relevance of the subject matter, the deficits within the knowledge of legal norms and the now even higher complexity of the legal situation due to the new law from December 2015.

Perceived Benefits of a Peer Mentoring Program for First-Year Medical Students

Problem: Peer mentoring has long been accepted as beneficial in a multitude of fields, but there has been limited description or study of the way these types of relationships may benefit medical students. Peer mentoring may be helpful for 1st-year medical students; however, little evidence is thus far available on which aspects of peer mentoring provide benefit and what those specific benefits are. Intervention: This study examines the perceived benefits and satisfaction derived by 1st-year medical students from participation in a semi-structured, informal cross-year peer mentoring program. It further attempts to characterize the aspects of peer mentoring relationships that are seen as beneficial to 1st-year students. Data were collected on demographic information, frequency and type of contact with mentor, perception of mentor characteristics, perceived benefits derived from the relationship, and their overall satisfaction with the relationship. Context: First-year medical students at a large academic institution were surveyed on their experience in an informal peer-mentoring program with 2nd-year students serving as mentors. Mentors had minimal training. No mandatory agenda or limitations were placed on the type or subject matter of interactions. Outcome: Mean overall satisfaction with the peer mentoring program was 7.47 (SD = 2.45) on a rating scale where 10 is the most satisfied. Students reported that their peer mentors generally exhibited beneficial attributes and behaviors. Ratings of perceived benefits were somewhat more variable and generally lower. Predictors of four outcomes-overall satisfaction, perceived academic benefit, perceived nonacademic benefit, and perceived clinical benefit-were explored using stepwise linear regression with forward entry and backward elimination to retain the most parsimonious model. Expertise in areas of mentee need was a consistent predictor of all outcomes. Regular involvement with a mentor was a consistent predictor of perceived academic and nonacademic benefit. Demographic characteristics were generally not predictive of outcomes. Lessons Learned: Peer mentoring is perceived by 1st-year medical students to provide psychosocial and academic benefits that appear to be independent of and complementary to those derived from faculty mentoring. These benefits can be established with minimal expenditure of institutional resources. Peer mentoring efficacy may be increased by more deliberate matching methods and by training mentors in provision of guidance and feedback, though further study is needed.

The utility of virtual reality surgical simulation in the undergraduate otorhinolaryngology curriculum

OBJECTIVE

To examine the impact of temporal bone virtual reality surgical simulator use in the undergraduate otorhinolaryngology curriculum.

METHODS

Medical students attended a workshop involving the use of a temporal bone virtual reality surgical simulator. Students completed a pre-workshop questionnaire on career interests. A post-workshop questionnaire evaluated the perceived usefulness and enjoyment of the virtual reality surgical simulator experience, and assessed changes in their interest in ENT.

RESULTS

Thirty-two fifth-year University of Auckland medical students were recruited. The majority of students (53.1 per cent) had already chosen their career path. The simulator experience was useful for: stimulating thoughts around career plans (71.9 per cent), providing hands-on experience (93.8 per cent) and teaching disease processes (93.8 per cent). After the workshop, 53.1 per cent of students were more interested in a career in ENT.

CONCLUSION

Virtual reality may be a fun and engaging way of teaching ENT. Furthermore, it could help guide student career planning.

The communication skills course for second year medical students at Hannover Medical School: An evaluation study based on students' self-assessments

In the model medical curriculum HannibaL at Hannover Medical School (MHH, Hannover, Germany), communication skills in taking case histories and disclosing diagnoses (breaking bad news) are assessed through an objective structured clinical examination (OSCE). This is part of the examinations which at the MHH represent the equivalent to the First Part of the Medical Examinations. The second year doctor-patient communication course preparing for these examinations was evaluated during the 2009/10 academic year.

Using questionnaires specific to the learning objectives, learning needs were assessed, pre-post comparisons of self-assessed competencies were performed and key teaching methods were evaluated (5-point Likert scales, “5”=fully agree). At T0 (start of the course) 267 students participated (response rate: 93.7%), of which 180 filled out the T1 questionnaire during the last session of the course (67.4%). Within-subject analyses of variance and paired t-tests were conducted.

The highest learning needs were found for the “to show how”-items regarding history taking and disclosing diagnoses (M=4.4). The T1-T0 comparisons showed the greatest improvements for history taking (“to know how”: mean difference = +1.7, “to show how”: +1.8, p<.0001 as with all tests) and the “to know how”-item regarding the disclosure of diagnoses (+1.6), followed by the “to show how”-items on disclosing a diagnosis (+1.4), shared decision making (+1.2), self-assessing one’s own strengths/weaknesses (+1.0) and confidently approaching new patients (+0.7). Students with T0 values of 1 or 2 on the respective scales improved on average by 2.2 points across all items, students with the value of 3 by 1.1, and from 4 or 5 by 0.1. Methodically, the use of simulated patients was rated the most helpful (M=4.8, 87% with the scale value 5).

This doctor-patient communication course is associated with substantial improvements regarding all key learning objectives. Regarding methods, the deployed simulated patients (2-4 per 10-student-course group in 3 of the 7 course sessions, respectively) were rated the most helpful. The present evaluation calls for both further development of the doctor-patient communication curriculum at the MHH and joint activities across medical schools, which are discussed at the end of the paper.

Student-Initiated Sexual Health Selective as a Curricular Tool

Introduction

Patients’ sexual health functioning is important for physicians in all fields of medicine to consider; however, this topic is lacking from almost half of U.S. medical school curricula.

Aims

This study aims to develop, implement, and assess the feasibility of a preliminary sexual health curriculum for medical students.

Methods

This Sexual Health Selective (SHS) was developed and implemented by a student and faculty champion for first year medical students. Its design incorporated a number of the guiding principles and recommendations from the 2012 Summit on Medical School Education in Sexual Health.

Main Outcome Measures

Feasibility was measured by limited-efficacy testing and participant acceptability of the SHS. Limited-efficacy testing was accomplished by conducting descriptive comparisons of responses to a sexual health attitudes and knowledge survey. These responses were compared between (i) participants vs. nonparticipants prior to the SHS, (ii) participants immediately after vs. participants prior to the SHS, (iii) participants 3 months after vs. participants prior to the SHS, and (iv) participants 3 months after vs. participants immediately after the SHS. Participant acceptability was assessed by asking qualitatively and quantitatively whether students enjoyed the SHS, found it beneficial to their learning, and would recommend it to their classmates.

Results

Immediately after the SHS and 3 months later, participants reported increased comfort and open-mindedness in their attitudes toward sexual health and demonstrated an increase in accurate knowledge about sexual health issues compared with baseline. Objective follow-up also revealed that most participants enjoyed the SHS, found it beneficial to their learning, and would recommend it to their classmates.

Conclusions

The 1-week SHS was successfully implemented through the teamwork of a medical student and faculty champion. It resulted in more accurate knowledge and more open attitudes toward sexual health among participating medical students. Potential benefits to undergraduate medical educators are reviewed.

Perceptions of Plagiarism Among Medical and Nursing Students in Erbil, Iraq

Objectives

The rapidly rising incidence of plagiarism among students at universities throughout the world requires attention. This study aimed to determine the extent to which medical and nursing students in Erbil, Iraq, plagiarise, their knowledge, understanding and perceptions of plagiarism and the underlying factors that may lead them to plagiarise.

Methods

This cross-sectional study was carried out between January and June 2017 among a sample of 400 undergraduate medical and nursing students at Hawler Medical University in Erbil. Plagiarism-related data were collected through a specially designed self-administered questionnaire.

Results

In total, 280 (70%) medical students and 120 (30%) nursing students were included in the study. The reported prevalence of plagiarism was 54.3%, with a slightly higher prevalence among male students compared to female students (54.9% versus 53.8%; P = 0.820) and medical students compared to nursing students (58.9% versus 43.3%; (P = 0.004). Alarmingly, 34.8% of the students did not know what plagiarism was, and only 28% were aware of the legal consequences of plagiarism. Reported reasons for plagiarising included laziness and the ease with which others' work could be plagiarised, confusion, cultural reasons and pressure to meet deadlines.

Conclusion

There was a lack of understanding of plagiarism and its legal ramifications among undergraduate medical and nursing students in Erbil. The findings of this study indicate that there is an urgent need to increase students' understanding of plagiarism and its consequences so as to reduce the incidence of this type of academic misconduct.

Learning outcomes and tutoring in problem based-learning: how do undergraduate medical students perceive them?

OBJECTIVES

To explore opinions of undergraduate medical students regarding learning outcomes of the instructional strategy of Problem Based Learning (PBL). In addition their views were sought about the role of tutors and qualities of effective tutors.

METHOD

This was a cross-sectional, questionnaire based study which was conducted in two colleges of Medicine, Central region, Saudi Arabia during the period of 1st of April to 30(th) June 2012.

RESULTS

One hundred seventy four undergraduate medical students participated in this study. Seventy percent of participants have indicated that PBL strategy contributed to the development of their knowledge, presentation skills, team work abilities, and accepting criticism from other colleagues. Regarding the tutors' role in PBL tutorials, majority of the participants (75%) indicated that this role is essential, nevertheless, only 58% of students indicated that this role is clear and well identified. Sixty three percent of participants preferred a member role in the PBL tutorials and 80 percent of participants preferred both content and process expert tutors in the PBL tutorials. Significant statistical difference was noted between the views of students and their schools, gender, and study phase.

CONCLUSION

Majority of the participants believed that PBL had a positive impact on the development of their cognitive, personal and teamwork skills. The view of the students in this study and the available evidence suggest that tutor should have both qualities; content and process expertise, in order to have the best outcomes from the PBL tutorials.

Acceptability of human papillomavirus vaccination among medical students in Mangalore, India

BACKGROUND

The highly prevalent cervical cancer can be prevented through a vaccine. However, the uptake of the Human Papillomavirus vaccine in the general population continues to be low. Medical students, as healthcare providers in the future, would be influential in affecting the community's views and thereby the uptake of the Human Papillomavirus vaccine. Hence, there is a need to promote the right attitude for prompt implementation of this vaccine among medical students. None of the studies in India have so far documented the proportion of vaccinated population among medical students or an intervention strategy to eliminate the barriers to Human Papillomavirus vaccine.

AIMS AND OBJECTIVES

To determine the proportion of vaccinated medical students and the barriers against HPV vaccination among non-vaccinated participants; and to test the efficacy of an information session on the barrier.

METHODOLOGY

Data on barriers against the Human Papillomavirus vaccination was collected through a questionnaire-based survey. The barriers were reassessed after an intervention in the form of training session using audio-visual aids.

RESULTS

Out of the 263 participants, 46 (18%) had never heard of the vaccine against Human Papillomavirus and only 54 (21%) were vaccinated. Participants thought it was not essential to get vaccinated as they were not sexually active (28%). Lack of information about the vaccine (28%), its access (24%), and high cost (27%) were the other barriers. Following the information session, 59% of the previously non-vaccinated participants responded that they would get vaccinated while 34% were considering getting vaccinated. The most common reason for rejection of the vaccine post- intervention was high cost of the vaccine.

CONCLUSION

Vaccine uptake is very low among medical students and amenable barriers exist against the vaccine. Urgent intervention in the form of information session is recommended targeted at the medical students, to eliminate the barriers of Human Papillomavirus vaccination.

Incorporating ultrasound training into undergraduate medical education in a faculty-limited setting

BACKGROUND

Point of care ultrasound (POCUS) is becoming a major extension of patient care. From diagnostic efficacy to its widespread accessibility, POCUS has expanded beyond emergency departments to be a tool utilized by many specialties. With the expansion of its use, medical education has begun to implement ultrasound education earlier in curricula. However, at institutions without a formal ultrasound fellowship or curriculum, these students lack the fundamental knowledge of ultrasound. At our institution, we set out to incorporate an ultrasound curriculum, into undergraduate medical education utilizing a single faculty member and minimal curricular time.

METHODS

Our stepwise implementation began with the development of a 3-hour fourth-year (M4) Emergency Medicine clerkship ultrasound teaching session, which included pre- and post-tests as well as a survey. The success with this session progressed to the development of a designated fourth-year ultrasound elective, which was evaluated with narrative feedback. Finally, we developed six 1-hour ultrasound sessions that correlated with first-year (M1) gross anatomy and physiology. A single faculty member was responsible for this curriculum and other instructors included residents, M4 students, and second-year (M2) near-peer tutors. These sessions also included pre- and post-tests and a survey. Due to curricular time limitations, all but the M4 Emergency Medicine clerkship session were optional.

RESULTS

87 students participated in the emergency medicine clerkship ultrasound session and 166 M1 students participated in the voluntary anatomy and physiology ultrasound sessions. All participants agreed or strongly agreed that they would like more ultrasound training, that ultrasound training should be integrated into all four years of undergraduate medical education. Students were in strong agreement that the ultrasound sessions helped increase understanding of anatomy and anatomical identification with ultrasound.

CONCLUSION

We describe the stepwise addition of ultrasound into the undergraduate medical education curriculum of an institution with limited faculty and curricular time.

The physician healer track: educating the hearts and the minds of future physicians

Calls to reform medical education recommend explicit training in professional identity formation to promote the development of humanistic, compassionate physicians. The authors report their experience offering The Physician Healer Track, a 500-contact-hour curricula integrated over 4 years, focusing on self-awareness, reflection, being-with-suffering, communication and professional identity development. The voluntary scholarly-concentration program comprises 4 years of monthly dinner meetings with faculty mentors, a two-month preceptorship in the first year, a one-month immersion course in MS4 and one elective. Training in mindfulness, cognitive behavioral therapy, nonviolent communication, motivational interviewing, spirituality in healthcare, wellness, equanimity, and 'being with suffering' is reinforced across all 4 years. Community building and reflection are integral to the training both in the monthly sessions and the immersion courses. Enrollment has grown from 26 students in the first year (11% of class) to a total of 258 students across our first 6 years (average of 20-26% of each class). Graduates in our first two cohorts of PHT have exceeded the numbers in the eight other scholarly concentrations offered at UTMB. Among students participating in the summer preceptorship, there has been less than 1% attrition. In serial assessments, students report continued growth in personal development, professional development, and the ability to empathize. Offering PHT has resulted in the growth of training for our medical residents, faculty, physical therapy students and the creation of a student healer association. Despite the demands on student's time, they are voluntarily participating in a challenging program of integrated training with the intention of keeping them connected to their humanity during the rigors of medical school training.

Factors Influencing Interns' Satisfaction with the Internship Training Programme Offered at Saudi Medical Schools

Objectives

This study aimed to assess the perceptions of medical interns with regards to the internship training programme offered at Saudi medical schools and to explore factors influencing their overall satisfaction with this progamme.

Methods

This exploratory study was conducted at four medical schools in Saudi Arabia between July 2017 and June 2018. All medical interns undergoing internship training at the selected medical schools during the 2017-2018 academic year were invited to participate in the survey. A questionnaire covering 10 internship dimensions and including a total of 76 items and one global item was designed to assess the medical interns' satisfaction with the training programme.

Results

A total of 295 interns returned completed questionnaires (response rate: 92%). Overall, the interns' satisfaction with all 10 internship dimensions was high (mean score: ≥3.6). A multiple regression analysis indicated that various factors were significant predictors of medical interns' overall satisfaction with the internship training programme, including orientation, training site services, supervision, relationships with their superiors and hospital activities (P <0.050 each).

Conclusion

Medical interns were highly satisfied with the internship training programme offered at Saudi medical schools, with various factors found to significantly influence overall satisfaction. The findings of this study may help policymakers in Saudi Arabia to improve the internship training programme so as to ensure medical interns' overall satisfaction and potentially improve their learning outcomes and clinical training.

Peer Teaching to Foster Learning in Physiology

INTRODUCTION

Peer teaching is an effective tool to promote learning and retention of knowledge. By preparing to teach, students are encouraged to construct their own learning program, so that they can explain effectively to fellow learners. Peer teaching is introduced in present study to foster learning and pedagogical skills amongst first year medical under-graduates in physiology with a Hypothesis that teaching is linked to learning on part of the teacher.

MATERIALS AND METHODS

Non-randomized, Interventional study, with mixed methods design. Cases experienced peer teaching whereas controls underwent tutorials for four consecutive classes. Quantitative Evaluation was done through pre/post test score analysis for Class average normalized gain and tests of significance, difference in average score in surprise class test after one month and percentage of responses in closed ended items of feedback questionnaire. Qualitative Evaluation was done through categorization of open ended items and coding of reflective statements.

RESULTS

The average pre and post test score was statistically significant within cases (p = 0.01) and controls (p = 0.023). The average post test scores was more for cases though not statistically significant. The class average normalized gain (g) for Tutorials was 49% and for peer teaching 53%. Surprise test had average scoring of 36 marks (out of 50) for controls and 41 marks for cases. Analysed section wise, the average score was better for Long answer question (LAQ) in cases. Section wise analysis suggested that through peer teaching, retention was better for descriptive answers as LAQ has better average score in cases. Feedback responses were predominantly positive for efficacy of peer teaching as a learning method. The reflective statements were sorted into reflection in action, reflection on action, claiming evidence, describing experience, and recognizing discrepancies.

CONCLUSION

Teaching can stimulate further learning as it involves interplay of three processes: metacognitive awareness; deliberate practice, and self-explanation. Coupled with immediate feedback and reflective exercises, learning can be measurably enhanced along with improved teaching skills.

Implementation of a digital health module for undergraduate medical students: A comparative study on knowledge and attitudes

BACKGROUND

Digital competencies are more and more required in everyday work, and training future healthcare professionals in digital health is highly important.

OBJECTIVE

Aim of this study was to assess medical students' gain of knowledge by participation in a teaching module "Digital Health", and to evaluate their attitudes towards digital health and its role in medical education.

METHODS

Students of the module were asked to complete a questionnaire and a multiple-choice-test before and after completing the classes. Students of the same educational level in different modules served as reference group.

RESULTS

34 students took part (n= 17 "Digital Health group"; n= 17 "reference group"). There was no significant difference in pre-existing knowledge between the groups. After having completed the module, participants reached significantly higher scores, compared to their preexisting knowledge (p< 0.05) and the reference group (p< 0.05). Most students found that digital medicine is not sufficiently represented in undergraduate medical education, but will influence everyday work of physicians in the next five years.

CONCLUSIONS

Students showed a high awareness for the impact of digital health on physicians' work. The results suggest that the format can sufficiently transfer knowledge about digital health. Teaching of digital knowledge and competencies should be firmly implemented into medical education to form digitally competent future doctors.

'The Virtual Check-In': A tool to facilitate virtual patient interaction for early clinical learners in a longitudinal integrated clerkship

This article was migrated. The article was marked as recommended. In response to restrictions on learner placements in clinical environments during the COVID-19 pandemic the authors developed a tool, 'The Virtual Check-In', for clinical clerks in the University of Calgary Longitudinal Integrated Clerkship. These learners, who had been pulled from their rural and remote communities because of the pandemic, used the tool to continue to develop their clinical skills while working with their preceptors and patients online. This paper describes the rapid development of the tool using Kern's principles for curriculum development and implementation, the format and uses of the final tool, and its potential use in other contexts.

Use of Virtual Reality to Educate Undergraduate Medical Students on Cardiac Peripheral and Collateral Circulation

Many medical schools are looking to utilize virtual reality (VR); however, due to its novelty, we know little about how VR can be effectively used in medical education. This study evaluates a case-centered VR task that supported students with learning peripheral and collateral circulation, anatomical features that are not easily observed in cadavers. Data sources included a quiz, survey, and focus group. Based on quantitative and qualitative analyses, we support the claim that this activity was an effective use of VR and identify features that made it effective, which can guide other educators who are interested in developing VR activities.

Association between Undergraduate Education for Community-Based Medicine and General Practice Majors: A Longitudinal Study in Japan

Background

There is a shortage of general practitioners in Japan. With the revision of educational guidelines, general practice (GP) education has improved. However, the amount of education on GP in medical schools remains inconsistent. This study examined the relationship between medical students' amount of GP-related education and their subsequent choice of GP majors.

Methods

A retrospective cohort study was conducted in a teaching hospital in Japan. Participants were residents in the hospital. The exposure comprised compulsory lectures and training time for community-based medicine in medical schools. The outcome included participants choosing GP majors after their initial 2-year junior residency.

Results

Fifty-one participants were included in the final analysis. Of these, 14 majored in GP and 37 in non-GP after their initial 2-year junior residency. Of the participants who took GP lectures for 18 hours or more, 11 chose GP majors, and 18 chose non-GP majors (risk ratio, 2.78; 95% confidence interval [CI], 0.88-8.79). Of the participants who underwent training for 12 days or more, 10 chose GP majors, and 16 chose non-GP majors (risk ratio, 2.40; 95% CI, 0.87-6.68).

Conclusion

The results do not support the association between the amount of compulsory undergraduate education for community-based medicine and the subsequent increase in the number of residents choosing GP majors in Japan. Educators would do well to explore different approaches, such as improving the quality of education to increase the number of GP residents. Further research is needed to reach more definitive conclusions.

Twelve tips for designing assignments that foster independence in learning

Independent learning refers to opportunities in which responsibility for learning shifts to learners. Providing health professions learners with independent learning opportunities can be challenging because of the often highly structured curricula of health professions education. Structured independent learning assignments that give learners the opportunity to begin developing the skills and strategies to take on self-directed opportunities in the future may lend themselves to these contexts. However, in health professions education contexts, few guidelines exist for designing effective assignments that foster independence in learning. These twelve tips provide recommendations for how to improve structured independent learning assignments for health professions learners and help them develop the skills and experience required for more self-directed opportunities and for lifelong learning.

Overcoming the language barrier: a novel curriculum for training medical students as volunteer medical interpreters

BACKGROUND

Over 41 million people in the United States speak Spanish as their primary language, of which 16 million have limited English proficiency (LEP). It is well-established that language barriers contribute to health disparities and that the use of ad-hoc interpretation by untrained family members results in substandard care. We developed a novel interpreter training program for medical students to serve as in-person interpreters at a charitable, resident continuity clinic so as to overcome the language barrier in the delivery of healthcare to LEP patients.

METHODS

The Medical Student Interpreter Training Program (MSITP) consists of three steps. First, fluent Spanish-speaking students shadowed a licensed interpreter. Second, students took a standardized phone exam to demonstrate language proficiency. Finally, students completed a three-hour training on the methodology and ethics of interpreting conducted by the Department of Interpreter Services.

RESULTS

Pre- and post-tests were administered to assess students' familiarity with the Interpreter Code of Ethics and interpreter skills. Familiarity with the Interpreter Code of Ethics increased significantly with all students reporting feeling comfortable (47%) or very comfortable (53%) after training. The pre- and post-tests included free response questions, which were administered to assess competence in the methodology and ethics of interpreting. The cohort's aggregate score increased by 35% after the training (Wilcoxon signed rank z-score = 2.53; p = .01).

CONCLUSIONS

Implementing the MSITP resulted in an increased number of trained, Spanish-speaking interpreters available to provide their services to LEP patients at an affiliated charitable clinic and throughout the university hospital. Unlike other program models which are time and resource-intensive, this program is replicable and easily managed by volunteers. The MSITP is an effective model for training students as medical interpreters to ensure the delivery of quality healthcare for LEP patients.