BMC Medical Education

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Online ISSN: 1472-6920
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Article
Background Since 2014, the Government of Bihar and CARE India have implemented a nurse mentoring program that utilizes PRONTO International’s simulation and team trainings to improve obstetric and neonatal care. Together they trained simulation educators known as Nurse Mentor Supervisors to conduct simulation trainings in rural health facilities across the state. Sustaining the knowledge and engagement of these simulation educators at a large-scale has proven difficult and resource intensive. To address this, the University of Utah with PRONTO International and with input from the University of California San Francisco, created an interactive, virtual education module based on a comic superhero named Super Divya to reinforce simulation educator concepts. This study examined the perceptions of Nurse Mentor Supervisors on Super Divya’s accessibility, usefulness, and potential after implementation of Super Divya: Origin Story. Methods We conducted qualitative interviews with 17 Nurse Mentor Supervisors in Bihar, India. In light of the COVID-19 pandemic, interviews were conducted virtually via Zoom™ using a semi-structured interview guide in Hindi and English. Participants were identified with strict inclusion criteria and convenience sampling methods. Interviews were analyzed using a framework analysis. Results Nurse Mentor Supervisors found Super Divya to be engaging, innovative, relatable, and useful in teaching tips and tricks for simulation training. Supervisors thought the platform was largely accessible with some concerns around internet connectivity and devices. The majority reacted positively to the idea of distributing Super Divya to other simulation educators in the nurse mentoring program and had suggestions for additional clinical and simulation educator training topics. Conclusions This study demonstrates the potential of Super Divya to engage simulation educators in continuous education. At a time when virtual education is increasingly important and in-person training was halted by the COVID-19 pandemic, Super Divya engaged Supervisors in the nurse mentoring program. We have incorporated suggestions for improvement of Super Divya into future modules. Further research can help understand how knowledge from Super Divya can improve simulation facilitation skills and behaviors, and explore potential for reinforcing clinical skills via this platform. Ethical approval This study was approved by the institutional review board at the University of California San Francisco (IRB # 20–29902).
 
Self-rated knowledge of historical terms
Agreement with statements regarding the role of health equity, education, and preparedness to act
Article
  • Charles SankyCharles Sanky
  • Halbert BaiHalbert Bai
  • Celestine HeCelestine He
  • Jacob M. AppelJacob M. Appel
Background Medical schools have increasingly integrated social justice, anti-racism, and health equity training into their curricula. Yet, no research examines whether medical students understand the complex history of racial injustice. We sought to investigate the relationship between medical students’ historical knowledge and their perceptions regarding health equity. Methods Medical students at one large urban medical school self-rated their familiarity and importance of various racially-significant historical events and persons, as well as their agreement with statements regarding health equity, education, and preparedness to act. Descriptive and multivariate analyses were conducted in R. Results Of 166 (RR=31.3%) participants, 96% agreed that understanding historical context is necessary in medicine; yet 65% of students could not describe the historical significance of racial events or persons. Only 57% felt that they understood this context, and the same percentage felt other medical students did not. A minority of students felt empowered (40%) or prepared (31%) to take action when they witness racial injustice in healthcare. Multiracial identity was significantly associated with increased knowledge of African American history ( p <0.01), and a humanities background was significantly associated with increased knowledge of Latin American history ( p =0.017). There was a positive, significant relationship between advocacy statements, such as “I have taken action” ( p <0.001) and “I know the roots of racism” ( p <0.001) with mean familiarity of historical events. Conclusions This study demonstrates that while students agree that racism has no place in healthcare, there remains a paucity of knowledge regarding many events and figures in the history of American race relations and civil rights, with implications for future physicians’ patient care and health equity efforts.
 
A slide explaining the online etiquette students are expected to adhere to in the synchronous IPE session
Article
  • Hend E. AbdelhakimHend E. Abdelhakim
  • Louise BrownLouise Brown
  • Lizzie MillsLizzie Mills
  • [...]
  • Mine OrluMine Orlu
Background Interprofessional education (IPE) at university level is an essential component of undergraduate healthcare curricula, as well as being a requirement of many associated regulatory bodies. In this study, the perception of pharmacy and medical students’ of remote IPE was evaluated. Methods A series of IPE sessions took place via Zoom and students’ feedback was collected after each session. Both qualitative and quantitative data were collected and analysed. Results 72% (23/32) of medical students strongly agreed that the sessions had helped to improve their appreciation of the role of pharmacists, whereas 37% (22/59) of pharmacy students strongly agreed, reporting a median response of ‘somewhat agreeing’, that their appreciation of the role of general practitioners had improved. This difference was found to be statistically significant (p = 0.0143). Amongst students who responded, 55% (53/97) identified remote teaching as their preferred mode of delivery for an IPE session. Conclusions The survey demonstrated that the students valued the development of their prescribing skills as well as the ancillary skills gained, such as communication and teamwork. Remote IPE can be a practical means of improving medical and pharmacy students’ understanding of each other’s professional roles, as well as improving the skills required for prescribing.
 
Teaching flow chart
Article
  • Xueling LiXueling Li
  • Yanshan LiYanshan Li
  • Xiaolan LiXiaolan Li
  • [...]
  • Ling YangLing Yang
Background Complete denture, as an important restoration method for edentulism, is difficult to study for beginners, especially in linking the theory with clinical practice. Objective This study was aimed to compare the teaching effects between case-based learning combined with Rain Classroom teaching and traditional lecture method in the clinical course of complete denture prosthesis for undergraduate interns. Methods In a course called “Problems and treatment strategies of complete denture after wearing”, interns were divided into two groups: one for traditional lecture-based teaching with PowerPoint slideshow (the control group, n = 28); and the other for case-based learning combined with Rain Classroom teaching, which published information before class, discussed specific clinic cases in class and got real-time interns’ feedback via WeChat (the test group, n = 22). Both groups received the same exam and questionnaire survey after class. The Q&A participation of interns in class, theoretical test scores and questionnaire survey responses were used to evaluate the teaching effects. An independent sample t-test and the chi-square test or Fisher’s exact test were used for statistical analysis in this study. Results The Q&A participation of interns in the test group was much better than that of the control group. The average score on the theoretical test after class in the test group (72.14 ± 12.24) was significantly higher than that in the control group (61.29 ± 20.12) ( P < 0.05). In the test group, 94.54% (21/22) of the interns preferred the new teaching mode. Conclusion Case-based learning combined with Rain Classroom teaching is helpful to enliven the classroom atmosphere, inspire studying enthusiasm, and achieve a good learning effect in both theory and clinical practice related to complete denture prosthesis.
 
PRISMA Scoping Review Flow Chart
Article
Background There remains a paucity of evidence for curricula for the transition to practice (TTP) stage of Competence by Design internal medicine (IM) training programs. Current entrustable professional activities are based on expert consensus rather than robust subspecialty-specific needs assessment. Methods A scoping review was completed to identify studies with TTP focus. A national survey was conducted to identify transition experiences for general internal medicine physicians. Results were assessed by grounded theory analysis to identify core topics for TTP curricula. Results Neither scoping review nor national survey identified TTP topics related to the CanMEDS Medical Expert role. Scoping Review: 41 relevant studies were identified. Most (97.6%) were from North America. The most common study types were observational (survey) or curriculum (13/41 31.7% for each). Only two studies were exclusively in IM, and the most common subspecialty studied was surgical (13/41, 31.7%). The most common TTP topics were mentorship, billing and coding, practice management, negotiating contract and job, and financial aspects of practice. National Survey: There were 44 respondents, with the majority (25/44, 56.8%) having completed an IM subspecialty fellowship. Most (38/44) completed medical school in Canada, and most were from academic practice settings (33/44, 75.0%). The most common TTP topics were billing and coding, personal financial planning, practice management, work-life balance and mentorship. Grounded Theory Analysis: There were six themes that encompassed all TTP topics from the scoping review and national survey, being (i) building a career, (ii) continuing professional development, (iii) expectations of the profession, (iv) practice management, (v) Life, health and well-being and (vi) clinical skills. Curriculum competencies and resources for curriculum development were provided. Conclusions This study identifies topics critical for curricula development for IM transition to practice. Further research is required to evaluate effectiveness of curricula including topics and themes developed from this scoping review and national survey.
 
Comparison of pre-test and post-test scores between the FC and FC-TBL groups in three experiment sessions. Both FC and FC-TBL groups completed the same pre- and post-tests in each experiment session. Although no differences were found in pre-test scores between the two groups across all three sessions, the post-test scores were significantly higher in the FC-TBL group than in the FC group. S1, session 1; S2, session 2; S3, session 3. ***P < 0.001, compared with the post-test scores of the FC group in the same session
Comparison of final exam scores between the FC and FC-TBL groups in three experiment sessions. The FC-TBL group had higher final exam scores than the FC group in the first two sessions. ***P < 0.001, compared with the FC group in the same session
Article
Background Basic medical laboratory courses (BMLCs) play an essential role in medical education and offer several benefits to students. Although various student-centered and active learning strategies have been increasingly incorporated into medical education, their applications in BMLCs are limited. This paper aimed to explore the educational effects of a flipped classroom (FC) combined with team-based learning (TBL) strategy in BMLCs at Zhejiang University School of Medicine. Methods Four hundred eight 3rd-Year medical students were assigned to either the FC-TBL group ( n = 235) or the FC group ( n = 173) to complete three experiments on the respiration block of BMLCs. The two groups’ immediate and long-term academic performance were compared, and the FC-TBL students’ perceptions of different instructional strategies were surveyed. Results Students in the FC-TBL group scored higher on the immediate post-tests after class and higher on the final exams in two of the three experiment sessions. They preferred FC-TBL to FC for its higher engagement, more feedback, and better learning environment. Students felt the FC with TBL blended instructional strategy stimulated their interest in learning and deep thinking. Conclusions Compared with the FC group, students in the FC-TBL group improved academic performance and had a more positive experience overall. Our findings support the feasibility and advantage of the flipped classroom with team-based learning as a blended learning strategy in the BMLC curriculum.
 
PRISMA flow diagram [28]
An image from an OSCE with infection control measures (off-site examiner using video-conferencing; PPE) at Duke-NUS Medical School [72]. (Taken with permission from the study author. Participants and simulated patients in the photo gave written consent.)
Examples of simulated patient cases at National University, Singapore [73]. (Taken with permission from the study author)
A diagram to illustrate the OSCE cycle on Microsoft Teams at the University of Buckingham [74]. (Taken with permission from the study author)
3D prototype of a virtual patient created at Centro Universitario Christus (Campyus Parque Ecologico) [75]. (Taken with permission from the study author)
Article
Introduction Clinical examinations (assessments) are integral to ensuring that medical students can treat patients safely and effectively. The COVID-19 pandemic disrupted traditional formats of clinical examinations. This prompted Medical Schools to adapt their approaches to conducting these examinations to make them suitable for delivery in the pandemic. This systematic review aims to identify the approaches that Medical Schools, internationally, adopted in adapting their clinical examinations of medical students in response to the COVID-19 pandemic. Methods Three databases and four key medical education journals were systematically searched up to 22 October 2021; a grey literature search was also undertaken. Two reviewers independently screened at title, abstract stage and full text stage against predefined eligibility criteria. Discrepancies were resolved by discussion and involvement of senior authors. Risk of bias assessment was performed using an adapted version of a pre-existing risk of bias assessment tool for medical education developments. Results were summarised in a narrative synthesis. Results A total of 36 studies were included, which documented the approaches of 48 Medical Schools in 17 countries. Approaches were categorised into in-person clinical examinations (22 studies) or online clinical examinations (14 studies). Authors of studies reporting in-person clinical examinations described deploying enhanced infection control measures along with modified patient participation. Authors of studies reporting online clinical examinations described using online software to create online examination circuits. All authors reported that adapted examinations were feasible, scores were comparable to previous years’ student cohorts, and participant feedback was positive. Risk of bias assessment highlighted heterogeneity in reporting of the clinical examinations. Conclusions This review identified two broad approaches to adapting clinical examinations in the pandemic: in-person and online. Authors reported it was feasible to conduct clinical examinations in the pandemic where medical educators are given sufficient time and resources to carefully plan and introduce suitable adaptations. However, the risk of bias assessment identified few studies with high reporting quality, which highlights the need for a common framework for reporting of medical education developments to enhance reproducibility across wider contexts. Our review provides medical educators with the opportunity to reflect on past practises and facilitate the design and planning of future examinations.
 
Study design
Article
Background Shock causes significant morbidity and mortality in children living in resource-limited settings. Simulation has been successfully used as an educational tool for medical professionals internationally. We sought to improve comfort and knowledge regarding shock recognition and fluid management by implementing a pediatric shock curriculum using simulation as an assessment for trainees in Manila, Philippines. Methods We assessed a shock curriculum focused on patients with malnutrition in a prospective cohort study, using a written test and a videotaped simulation-based objective standardized clinical examination. Implementation occurred in March 2020 with 24 Filipino pediatric residents at a single institution in Manila. Outcomes included time to initiation of fluid resuscitation, improvement in confidence, knowledge on a written assessment, and performance in simulation. Results were compared pre- and post-intervention using Wilcoxon signed-rank test. Results The time to initiation of fluids did not change between the baseline simulation (median [interquartile range] = 71.5 seconds [52–116.5]) and the final simulation (68 seconds [52.5–89]; P = 0.42). Confidence in identifying shock and malnutrition, managing hypovolemic shock, managing septic shock, and placing intraosseous access all increased ( P < 0.01) post-intervention. Written test scores showed no improvement, but performance in simulation, measured using a checklist, improved from a total score of 10 [8.5–11] to 15 [13-16] ( P < 0.01). Conclusion In our study of a simulation-based shock education program, we showed improvement in confidence and knowledge as measured by a resuscitation checklist. It is feasible to establish a successful simulation-based education program in a low-resource setting.
 
Article
Background The process of determining the best strategy for increasing the uptake of evidence-based practice might be improved through an understanding of relevant clinician-level factors. The Pathways to Comorbidity Care (PCC) training program (Louie E, et al., J Dual Diagnosis 17:304–12, 2021) aimed to facilitate integrated management of comorbid drug and alcohol and mental disorders amongst drug and alcohol clinicians. We hypothesised that uptake of integrated management of comorbidity following the implementation of the PCC program would be associated with clinician-level: (i) demographics (gender, education, experience), (ii) attitudes (evidence-based practice, therapist manuals, counselling self-efficacy), and (iii) organisational readiness to change. Methods Twenty clinicians participated in the 9-month PCC training program. Attitudes towards evidence-based practices and psychotherapist manuals, self-efficacy, and organisational readiness to change, along with demographics, were measured at baseline. At follow-up, change in Comorbidity Practice (CoP) scores related to integrated comorbidity management were obtained using a file audit checklist and categorised into high (at least 60% increase in CoP), medium or low (a decrease of − 20% or less in CoP). Clinician-level characteristics were examined across the implementation categories. Results There were no significant differences found between implementation groups on sociodemographic variables (p’s > 0.30), attitudes to evidence-based practices, attitudes to therapist manuals, and self-efficacy (p’s > 0.52). The high implementation group demonstrated significantly higher scores on leadership practices aspect of organisational readiness to change relative to the low and medium implementation group ((F(2, 16) = 3.63, p = 0.05; Cohen’s d = .31) but not on the other subscales (p’s > 0.07). Conclusions Confidence that leadership will play a positive role in the implementation process may improve effectiveness of comorbidity training programs for drug and alcohol clinicians. On the other hand, contrary to our hypothesis, counselling self-efficacy, evidence-based practice attitudes, attitudes towards therapist manuals, gender, education and experience were not distinguishing factors.
 
Newly graduated doctors’ collaborators and the reasons they were consulted
Article
Background Newly graduated doctors find their first months of practice challenging and overwhelming. As the newly graduated doctors need help to survive this period, collaborators such as peers, senior doctors, registered nurses and other junior doctors are crucial. However, little is known about what characterise these collaborations, and how much is at stake when newly graduated doctors are striving to establish and maintain them. This study aims to describe and explore the collaborations in depth from the newly graduated doctors’ point of view. Methods We conducted 135 h of participant observations among newly graduated doctors ( n = 11), where the doctors were observed throughout their working hours at various times of the day and the week. Furthermore, six semi-structured interviews (four group interviews and two individual) were carried out. The data was analysed thematically. Results Newly graduated doctors consulted different collaborators (peers, senior doctors, registered nurses, and other junior doctors) dependent on the challenge at hand, and they used different strategies to get help and secure good relationships with their collaborators: 1) displaying competence; 2) appearing humble; and 3) playing the game. Their use of different strategies shows how they are committed to engage in these collaborations, and how much is at stake. Conclusions Newly graduated doctors rely on building relationships with different collaborators in order to survive their first months of practice. We argue that the collaboration with peer NGDs and registered nurses has not received the attention it deserves when working with the transition from medical school. We highlight how it is important to focus on these and other collaborators and discuss different work-agendas, mutual expectations, and interdependence. This could be addressed in the introduction period and be one way to ensure a better learning environment and a respectful interprofessional culture.
 
Flow chart over the study participants
Residents-reported experience of transfer to other healthcare institutions and of new assignments normally performed by other professions
Article
Background: To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes. Methods: As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson's Chi-2-test for dichotomous data. The association between residents' worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis. Results: Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 ± 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents. Conclusion: The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in Sweden. Residents were concerned over the negative impact of the pandemic on their training program and senior residents reported more missed educational opportunities as compared to junior residents. Program directors, head of institutions and clinical supervisors can use the problem areas pinpointed by this study to support residents and compensate for missed educational opportunities. While hands-on-training and operating time cannot be compensated for, the authors hope that the findings of the study can help develop new strategies to minimize the negative impact of the current and future pandemics on resident education and work situation.
 
Overview of participant gender and experience as an osteopathy clinical educator
Article
Background For many allied health disciplines, pre-professional clinical education takes place in student-led, on-campus clinic environments. In these environments, pre-professional students undertake patient care under the supervision of qualified health professionals. Literature exploring the benefits of the student-led clinical learning environment is limited and little is known about the role student-led clinics play in preparing pre-professional osteopathy students for professional practice. Aim To explore the perceptions of osteopathy clinical educators about the role of the student-led clinic at Victoria University (VU) in preparing pre-professional students for professional practice. Methods A qualitative collective case study methodology was utilised to explore clinical educator perceptions. Individual interviews were conducted with clinical educators employed in the university osteopathy clinic. Interview questions were framed around the Capabilities for Osteopathic Practice which set the Australian osteopathy practice standards. Data were assessed by two of the authors using thematic analysis. Results Nine clinical educators out of 31 employed at the university clinic (29%) agreed to participate. Qualitative analysis generated three themes: perceptions of the student-led clinic (SLC) as a learning environment; clinical educator perception of their role in the SLC; and, challenges to and of the SLC environment. Conclusions Clinical educators perceived that the student-led osteopathy clinical learning environment develops pre-professional learners to meet some, but not all, of the capabilities for professional practice as an osteopath in Australia. The environment may be improved through faculty development, fostering a proactive learning approach, addressing system-based issues, and providing opportunities to interact with other health professions.
 
Percent achievement of daily rounding time goal by team and month
Article
Background Rounds are a foundational practice in patient care and education in the inpatient healthcare environment, but increased demands on inpatient teams have led to dissatisfaction with inefficient, ineffective rounds. In this study, we describe the design, implementation, and evaluation of a novel rounding framework (“NET Rounding”) that provides behaviorally-based strategies to inpatient teams to achieve efficient rounds while preserving patient safety and education. Methods NET Rounding consists of nine recommendations divided into three categories: N ovel rounding strategies, shared E xpectations, and T ime management. This framework was introduced as a bundled intervention at a single-site, quaternary-care, academic hospital from March–May 2021. Eighty-three residents and 64 attendings rotated on the inpatient teaching service during the intervention period. Participants were surveyed before, during, and after their rotation about rounding’s contribution to educational value, patient safety, resident duty hour violations and rotation experience. Additionally, rounding duration was recorded daily by team attendings. Results Thirty-two residents (38.5%) and 45 attendings (70%) completed post-intervention surveys. Rounding duration was recorded on 529/626 rounding days (80.6%) and resulted in achieving efficient rounds on 412/529 days (77.9%). Residents reported improvement in perceived patient safety (54 to 84%, p = 0.0131) and educational value of rounds (38 to 69%, p = 0.0213) due to NET Rounding; no change was observed amongst attendings in these areas (79 to 84% and 70 to 80%, p = 0.7083 and 0.4237, respectively). Overall, 29/32 residents (91%) and 33/45 attendings (73%) reported a positive impact on rotation experience. Conclusions NET Rounding enabled inpatient teaching teams to complete rounds more efficiently while preserving patient safety and education.
 
Eyesi Surgical simulator in use
10th semester medical students’(n = 79) self-rated microsurgical ability before and after training with Eyesi Surgical. Blue represents rating prior to training and orange represents rating after training. Students ranked themselves on a scale of 0–10, 0 meaning ‘little to no ability’ and 10 meaning ‘high ability.’
10th semester medical students’ (n = 79) rating of the usefulness of Eyesi Surgical as part of ophthalmology clerkship as reported on the post-simulation questionnaire. Please note, a rating of 1 corresponded with ‘strongly disagree’ that the simulator is a useful component and a score of 7 corresponded with ‘strongly agree’ that the simulator is a useful component
Article
Background Microsurgery is a growing field which requires significant precision and skill. Eyesi Surgical, which is usually introduced during residency or fellowship, is an ophthalmologic microsurgery simulator which allows users to practice abstract microsurgical skills and more specialized skills. The purpose of this study was to assess the inclusion of microsurgical simulation training during medical school. Methods Seventy-nine German medical students in their 10 th semester of education completed up to two days of training on the simulator during their ophthalmology clerkship. They received an objective numeric score based on simulator performance and completed pre and post training subjective questionnaires. Results There was no relationship found between students’ Eyesi Surgical performance scores and their specialty interests ( p = .8). The majority of students (73.4%) rated their microsurgical skills to be higher after simulator training than before training ( p < 0.001). 92.4% of students found the Eyesi Surgical to be a useful component of the ophthalmology clerkship. Objective scores from Navigation Training Level 1 showed that students achieved better results in the criteria categories of Completing Objects and Tissue Treatment than in the categories of Instrument and Microscope Handling. The mean Total Score was 25.7 (± 17.5) out of a possible 100 points. Conclusion The inclusion of surgical simulation in the ophthalmology clerkship led to increased confidence in the microsurgical skills of medical students. Offering surgical simulation training prior to residency can help to expose students to surgical fields, identify those that have particular talent and aptitude for surgery, and assist them in deciding which specialty to pursue.
 
Overview of results. Quantitative data collected at baseline and 6-month follow-up in both the intervention and control groups (blue), and qualitative data collected post-intervention (green). Both the propensity to ask older patients questions about abuse and providers’ perceived ability to manage the response (yellow arrows) were improved in the intervention group at follow-up. The change was possibly mediated by an increased self-efficacy for asking questions and a higher awareness about the issue. Also, the results indicated that the perceived ability to manage the response affected the propensity for asking questions
Article
Aabstract Background Elder abuse is prevalent and associated with ill-health. However, health care providers often lack education about elder abuse and older patients’ victimization often remains unknown to them. In this pilot study we performed initial testing of an educational model aiming at improving health care providers’ preparedness to care for older adults subjected to abuse, or more specifically their self-reported propensity to ask older patients questions about abuse and perceived ability to manage the response. Methods The educational model consisted of a full training day about elder abuse, including theory, group discussions and forum theatre. Forum theatre is an interactive form of drama in which participants are not only observers, but rather spect-actors, urged to participate in the scene. They are thereby given the opportunity to discuss and practise difficult health care encounters. Medical interns (intervention group n = 16, control group n = 14) in Sweden participated in the study and a mixed method convergent parallel design was used. Quantitative data was collected at baseline and 6 months post-intervention using a questionnaire (the REAGERA-P). Qualitative interviews were conducted with four of the participants in the intervention group and data was analysed using qualitative content analysis. Results The reported frequency of asking older patients questions about abuse increased in the intervention group (p = 0.047), but not the control group (p = 0.38) post-intervention. Potential mediators for the improvement were an increased awareness of elder abuse and higher self-efficacy for asking questions about elder abuse. Participants also reported a higher perceived ability to manage cases of elder abuse, even though uncertainties concerning how to provide the best possible care remained. The qualitative interviews indicated that learning from each other in group discussions and forum theatre likely was an important contributor to the positive results. Conclusion This pilot test indicated that the educational model may be effective in improving health care providers’ preparedness to care for older adults subjected to abuse. However, uncertainties about how to handle elder abuse cases remained post-intervention. In a future full-scale test of the model more focus needs to be put on how to manage cases of elder abuse.
 
Respondent perceptions toward implicit bias training in PA/NP postgraduate education. N = 30
Implicit bias educational strategies in PA and NP postgraduate training program. N = 30. Respondents were permitted multi-select response
Barriers to offering implicit bias training in PA/NP postgraduate education. N = 30. Respondents were permitted multi-select response
Article
Background There has been renewed focus on advancing inclusivity within organized medicine to reduce health disparities and achieve health equity by addressing the deleterious effects of implicit bias in healthcare and clinical outcomes. It is well documented that negative implicit attitudes and stereotypes perpetuate inequity in healthcare. The aim of this study is to investigate implicit bias training in postgraduate physician assistant (PA) and nurse practitioner (NP) education; describe delivery of content to trainees; and detail program directors’ attitudes toward this type of training. Although there is research examining implicit bias training in physician residency education, there are no published studies on implicit bias training in postgraduate PA and NP postgraduate residency/fellowship programs. Method A non-experimental, descriptive study was designed to obtain information via survey from members of the Association of Postgraduate Physician Assistant Programs (APPAP). Results The response rate was 41%. The majority of respondents (76%) felt that PA and NP postgraduate programs should include implicit bias instruction. Educational strategies used by PA and joint PA/NP postgraduate programs or their sponsoring institution to deliver implicit bias content to trainees include: implicit bias training modules (50%), facilitated group discussions (36%), invited speaker on implicit bias (33%), case studies on implicit bias (16%), and implicit association test (10%); however, 30% of postgraduate programs do not provide implicit bias training to PA and/or NP trainees. Barriers to implementing implicit bias training expressed by some postgraduate programs include: uncertainty in how to incorporate implicit bias training (16%); lack of strategic alignment with training program or sponsoring institution (13%); time constraints (10%); financial constraints (6%); lack of access to content experts (6%); and unfamiliarity with evidence supporting implicit bias training (6%). Conclusion The present study sheds some light on the current state of implicit bias training in PA and joint PA/NP postgraduate residency/fellowship programs. While the majority of programs offer some sort of implicit bias training, there is a need to standardize this training in PA and joint PA/NP postgraduate education curricula using an actionable framework.
 
Implementation of special regulations in the practical dental courses - Main- and subcategories
Adaption of the course structure due to specific regulations - Main- and subcategories
Article
Background The coronavirus pandemic led to a lockdown of public life. For universities, this meant suspensions or corresponding adaptations of practical courses. In Germany, Kiel Dental Clinic received special permission to start practical courses under appropriate hygiene conditions. The study aimed at recording the experiences and associated challenges of course implementation under the special regulations from the perspective of students and teachers. Methods Qualitative guided interviews were conducted with students and teachers at Kiel in the summer semester 2020. Students (4th, 6th, 8th, 10th semesters) were recruited and lecturers responsible for conducting the practical courses within the dental clinic’s four departments. Evaluation was carried out by means of qualitative content analysis, whereby deductive procedures were supplemented by inductive ones. Results Thirty-nine students and 19 lecturers took part. The flow of information at the start of the course was welcomed by students and teachers across the board. The lack of or limited adjustment to the scope tended to be assessed positively by students. The majority of both groups suspected there had been no reduction in learning, and learning had been improved due to the smaller group sizes. Regarding the necessary conditions for conducting the course, positive and negative aspects became apparent. Conclusion Students and teachers felt very relief to start the practical courses under special conditions although the implementation was very challenging for both groups. The structural and content-related course adaptations required a high degree of flexibility on the part of students and lecturers alike, but also meant that courses were able to be conducted without serious deficits in learning gains.
 
Example of ‘T-shaped’ acetabular fracture (a) simple textbook type used in routine teaching versus (b) complex pattern as seen in one of the real cases
a Reconstruction of images from the CT scan of case of ‘T-shaped’ acetabular fracture and (b) 3D printed models of the same demonstrating the orientation of the fracture
Comparison of number of participants in each group who were correctly able to identify each fracture type during the pre-test and post-test: Elementary fractures (PW – posterior wall, PC – posterior column, AW – anterior wall, AC – anterior column, Tr—transverse). Associated fractures (PC + PW – posterior column with posterior wall, TR + PW – transverse with posterior wall, T – T shaped, A + PHTr – Anterior with posterior hemitransverse, BC – both column)
Proficiency comparison between groups for correct identification of surgical approach in 75% of cases
Article
Objective To evaluate the use of 3-D printed models as compared to didactic lectures in the teaching of acetabular fractures for Orthopaedic trainees. Methods This was a randomised prospective study conducted in a tertiary hospital setting which consisted of 16 Orthopaedic residents. Ten different cases of acetabular fracture patterns were identified and printed as 3-D models. The baseline knowledge of orthopaedic residents regarding acetabular fracture classification and surgical approach was determined by an x-ray based pre-test. Trainees were then randomly assigned into two groups. Group I received only lectures. Group II were additionally provided with 3-D printed models during the lecture. Participants were then assessed for comprehension and retention of teaching. Results Sixteen trainees participated in the trial. Both Group 1 and 2 improved post teaching with a mean score of 2.5 and 1.9 to 4.4 and 6 out of 10 respectively. The post test score for fracture classification and surgical approach were significantly higher for 3-D model group (p < 0.05). Trainees felt that the physical characteristics of the 3-D models were a good representation of acetabular fracture configuration, and should be used routinely for teaching and surgical planning. Conclusion 3-D printed model of real clinical cases have significant educational impact compared to lecture-based learning towards improving young trainees’ understanding of complex acetabular fractures.
 
Visual of the FCN home page shown on (A) mobile phone and (B) laptop
Course content page of the FCN (A) mobile phone view and (B) laptop view
Sample topic page and quizzes of the flipped classroom navigator (A & C) mobile phone view and (B & D) laptop view
Intended learning outcomes and topics included in the Flipped Classroom Navigator
Article
Background Flipped classroom pedagogy is a blended learning approach applied in undergraduate health professions education. However, teachers and students may require training to effectively engage in flipped classroom pedagogy. Thus, this study aimed to design, develop, and evaluate a web-based tool for fostering flipped classroom pedagogy in undergraduate health professions education. Methods This is an educational design-based research with a descriptive evaluation component which was conducted in two steps: (i) design & development and (ii) evaluation of an educational website. An expert panel was formed to evaluate the website by using a website evaluation questionnaire (WEQ). Descriptive statistics were employed to calculate the experts’ agreement level. Results An innovative website design was used to provide access to a range of digital devices. The development process occurred concurrently in two steps: (i) website development and (ii) learning content development. The educational website was branded as the Flipped Classroom Navigator (FCN). Based on WEQ scores, the FCN obtained a good level of agreement (≥ 80%) for its’ ease of use, hyperlinks, structure, relevance, comprehension, completeness, and layout. Conclusions The FCN is an effective method for providing training to promote flipped classroom pedagogy in health professions education. The FCN achieved good evaluation scores and comments from experts. However, it is also necessary to obtain acceptance from the end-users, which could be the focus of future research. Nonetheless, the expert panel pinpointed areas for further development before introducing the FCN to end-users.
 
The average total scores and 95% confidence intervals of the respondents with different factors, including had experience in ECP use and had been taught about ECPs
Article
Background First-year undergraduates are at risk of unexpected pregnancy due to changes in their lives. Adequate knowledge and attitudes towards emergency contraceptive pills (ECPs) are essential to help prevent pregnancy. The objective of this study was therefore to investigate knowledge and attitudes towards ECPs among first-year undergraduate students in a university in Thailand. Methods This cross-sectional survey study was performed using developed questionnaires that were validated by four experts. The questionnaires were distributed to all first-year students at the university via an online platform. The characteristic data were descriptively analysed, and the knowledge data were analysed using the chi-square test, Mann‒Whitney U test and one-way ANOVA. Results Data from a total of 335 students who responded to the questionnaires and met the eligibility criteria for the study were analysed. The mean knowledge score of all respondents was 7.76 ± 0.15 out of 15. The most correctly answered questions were those relating to the efficacy and safety of ECPs in pregnant women (78.5% and 72.2% correctly answered, respectively). In contrast, the least correctly answered questions were about the ECP regimens and using ECPs instead of combined oral contraception (COC) (30.4% and 34.9%, respectively). In addition, the results indicated that experience in using ECPs and in ECP education were significant factors in high knowledge scores. Moreover, most respondents trusted and would like to receive information on ECPs from health professionals in hospitals, academic institutions, or pharmacies. Conclusion The average knowledge of ECPs of first-year students in a university in Thailand was at a moderate level. More information about the regimens of the drugs and the use of ECPs instead of COC should be provided to students, particularly at universities or pharmacies, and should be performed by health care staff.
 
Overview of subthemes and themes in relation to overarching theme and CFIR
Article
Background There is an increasing trend towards person-centred care (PCC) worldwide, suggesting that PCC should be mastered by future health care professionals. This study aims to explore programme directors’ views on facilitators and barriers to implementing PCC in four of the largest national study programmes in Sweden training future health care professionals. Methods A qualitative design was applied and interviews were conducted with 19 programme directors of Swedish national study programmes in medicine, nursing, occupational therapy and physiotherapy. The interviews were analysed using qualitative content analysis. Themes were sorted according to the Consolidated Framework for Implementation Research (CFIR) in an abductive approach. COREQ guidelines were applied. Results The overarching theme, as interpreted from the programme directors’ experiences, was ‘Person-centred care is on the move at different paces.’ The theme relates to the domains identified by the CFIR as outer setting, innovation, inner setting and process. PCC was understood as something familiar but yet new, and the higher education institutions were in a state of understanding and adapting PCC to their own contexts. The movement in the outer setting consists of numerous stakeholders advocating for increased patient influence, which has stirred a movement in the inner setting where the higher educational institutions are trying to accommodate these new demands. Different meanings and values are ascribed to PCC, and the concept is thus also ‘on the move’, being adapted to traditions at each educational setting. Conclusion Implementation of PCC in Swedish higher education is ongoing but fragmented and driven by individuals with a specific interest. There is uncertainty and ambiguity around the meaning and value of PCC and how to implement it. More knowledge is needed about the core of PCC as a subject for teaching and learning and also didactic strategies suitable to support students in becoming person-centred practitioners.
 
Percentage of R-track items per competence area and specialty
Article
Background Medical graduates should have acquired basic competences that enable them to practice medicine independently as physicians and to enter postgraduate training in any specialty they wish. Little is known about advanced undergraduate medical students' perceptions of basic medical competences needed to start postgraduate training and about specialty-specific competences. This qualitative study aims to identify medical students’ perceptions of basic medical competences and specific competence requirements for different specialties. Methods In December 2020, sixty-four advanced undergraduate medical students participated in the role of a resident in a competence-based telemedicine training simulating a first day in postgraduate training. After the training, eight focus group interviews were conducted about students’ perceptions of basic medical competences and specialty-specific competences using a semi-structured interview guide. The interviews were transcribed and analysed thematically according to the six steps of Braun and Clarke. The analysis was carried out by an inductive search for themes, which were deductively assigned to the six competence areas of the requirement-tracking questionnaire (R-Track). Results Regarding basic medical competences, four R-Track competence areas could be identified as main themes. The students considered ‘ Social-interactive competences’ to be particularly relevant for basic clinical work, including ‘ Structuring information’ , ‘ Tactfulness ’, and ‘ Stress resistance’ . Students especially emphasized ‘ Concentration ’ as an important aspect of the competence area ‘ Mental abilities ’. Among ‘ Personality traits ’, ‘ Honesty ’ was mentioned most frequently, and students were also aware that ‘ Expertise ’ is particularly important for ‘ Motivation ’. For different specialties, some competence areas were newly added to the competences needed for the respective specialty. For surgery, the competence areas ‘ Sensory abilities ’ and ‘ Psychomotor & multitasking abilities ’ were mentioned anew. ‘ Sensory abilities ’ were also newly attributed to radiology. ‘ Mental abilities ’ were mentioned as new competence area for psychiatry and internal medicine, while for anaesthesiology, 'Psychomotor & multitasking abilities ' were newly added. Conclusions Advanced students seem to be well aware of basic competences needed for clinical practice. Good consensus between students and physicians was only found for psychiatry-specific competences. Medical schools should support their students in matching their perceptions of competences needed for specific specialties with specialty-specific requirements for a realistic choice of a specialty for postgraduate training.
 
Six phases of thematic analysis completed, as described by Braun and Clarke
Results from the quantitative data in evaluation of the MOF
Article
Objectives Dental graduates must graduate with high levels of clinical skills. Education in the clinical environment needs to be more than didactic supervision of practice by clinical teachers. Appropriate feedback in this context, is therefore critical to the development of student competence and confidence. This study was conducted to enhance and develop the assessment and feedback processes during clinical sessions in a Dental University Hospital in an effort to contribute to the development of students’ self-assessment skills, reflective ability and clinical competence. Methods A new evidence-based model of feedback was introduced between clinical teachers and dental students. The implementation of this model was evaluated by students through a survey and focus groups. Descriptive and inferential statistics were applied to the quantitative data, while thematic analysis applied to the qualitative data. Results Findings from the survey indicated that students perceived the new model of feedback to be a positive addition to their learning experiences. The majority indicated a preference to continue using it. Quantitative analysis also demonstrated that students placed a high value on the feedback they received through the new model and associated it with improved individual performance. Five themes generated from the qualitative analysis echoed the perception that the model of feedback enhanced learning opportunities, especially when it was focused on individual performance and incorporated peer feedback. Students’ preferences in relation to feedback processes were also gleamed from quantitative and qualitative analyses, that is, provision of positive and constructive feedback, both in dialogue and in written formats, delivered during and after each clinical session and addressing their individual competency learning goals for the future. Some challenges to be addressed were also identified (e.g., time constraints, inter-personal issues, and non-conducive environments). Conclusions Feedback is central to learning and remains a complex and challenging area. By adopting effective and evidence-based feedback practices through the introduction of a feedback model, students can be supported in regulating their own learning in the clinical learning environment.
 
Modular course structure of the SOS Course. Module A: Theoretical part; Module B: Practical part with live online sessions; Module C: Learning outcome
Example view of Module A (theoretical part). Interactive interface for self-study (e.g., local anesthesia, wound management, surgical incision techniques, and basics of local pedicled and free flaps) based on an online teaching platform called StudOn (Friedrich-Alexander-Universität Erlangen-Nürnberg, FAU, Erlangen, Germany; realized with ILIAS 5.4.17 and Institut für Lern-Innovation, ILI, Fürth, Germany)
“Skills Lab” of the Department of Oral and Cranio-Maxillofacial Surgery, Friedrich‑Alexander-Universität Erlangen‑Nürnberg (FAU). Premises and technical equipment/setup for executing the SOS Course
Examples of students’ results during their practical online/home sessions
Article
Abstract Background Due to the SARS-CoV-2 pandemic and the accompanying contact restrictions, a new challenge arose for dental education. Despite the limited overall situation, it must be ensured that, in addition to theoretical content, practical skills in particular continue to be taught. Therefore, the aim of this study was to develop and implement an online hands-on course for dental students that ensures practical training, even during the pandemic. Methods The newly developed course was held from April 2020 to March 2021. A total of six groups (each consisting of approximately 40–50 students) took part in the course. The participating students were in their 3rd, 4th or 5th year of study. The course taught theoretical basics (via an online platform) and promoted the learning of practical/surgical techniques on models such as bananas, pork bellies, or chicken thighs with live demonstrations (via ZOOM) and interactive post-preparation by students at home (and in a rotating small group of 3–7 students on site). Student self-evaluation (at the beginning and end of the course) and course evaluation were performed using questionnaires. The learning success was analyzed (through self-evaluations) using Wilcoxon signed-rank tests (significance level alpha = 0.05). Results Concerning students´ self-evaluations, the theoretical knowledge, general surgical skills (such as surgical instrument handling), and specific surgical skills (such as performing a kite flap) improved during the course, with significant results (p
 
a Annotated 2D gross pathology image of the uterus with fibroids. b Annotated 3D gross pathology image of the uterus with fibroids. Users can zoom in, drag and rotate the specimen. c Magnified screenshot of the annotated 3D gross pathology image of the uterus with fibroids. The ultra-high-resolution is maintained even at all levels of magnification. The users can delineate each fibroid on the 3D image of the uterus. d Study process flow showing design, development and evaluation of the iDPR website
a Screen-based eye tracking of participant viewing image of uterus specimen. The participant observes 2D / 3D gross pathology images on the monitor with eye-tracking capability (Tobii TX300, Sweden), while the researcher monitors the Visualisation Data in real time. b Visualisation Data (Qualitative Data) recorded by Tobii TX300, Sweden: gaze plot—to track the participant’s gaze from the start and to the end (only for the 2D gross pathology image). c Visualisation Data (Qualitative Data) recorded by Tobii TX300, Sweden: heat map—the most frequent areas which participants focus on (only for the 2D gross pathology image). d Visualisation Data (Qualitative Data) recorded by Tobii TX300, Sweden: bee swarm—collection of gaze in a moving object (only for the 3D gross pathology image)
evaluation of iDPR website with a focus on pedagogical, functional and technical impacts as an e-learning tool (showing mean % responses by senior medical students/ pre-interns)
Fixation Count during observation, identification and counting the number of endometriotic lesions by participants when viewing 2D vs 3D images of the same pathology specimen. Most participants demonstrated higher fixation counts for viewing 2D compared to 3D pathology images
Article
Literature review demonstrated a surprising lack of publications on digital e-learning pathology resources for senior medical undergraduates and interns. An interactive Digital Pathology Repository (iDPR) integrating two- and three-dimensional (2D, 3D) high-resolution anatomical pathology images with correlated digital histopathology was developed. The novel iDPR was rigorously evaluated using mixed methods to assess pathology knowledge gains (pre- and post-tests), quality impact analysis (questionnaire), user feedback (focus group discussions) and user visual behaviour (eye gaze tracking analysis of 2D/ 3D images). Exposure to iDPR appeared to improve user pathology knowledge, as observed by significantly increased test scores on topic-related quizzes (n = 69, p < 0.001). In addition, most users were highly satisfied with the key design elements of the iDPR tool. Focus group discussion revealed the iDPR was regarded as a relevant online learning resource, although some minor technical issues were also noted. Interestingly, visual behaviour trends indicated that specific diagnostic pathological lesions could be correctly identified faster in 3D images, when compared to 2D images. The iDPR offers promise and potential in pathology education for senior clinical students and interns, gauging from both qualitative and quantitative positive user feedback. With incorporation of image annotations and interactive functionality, and with further technology development, this would prove a useful tool for diagnostic pathology and telepathology. As images with added visual-spatial dimension can provide enhanced detail and aid more rapid diagnosis, future applications of the iDPR could include virtual reality or holographic images of anatomical pathology specimens.
 
Article
Background: Medical student journals (MSJs) help to introduce the fundamentals of academic research and publication to future doctors. It has recently been shown that MSJs can influence doctors' future academic and professional success, however these findings have not been replicated in an Australian cohort. The aim of this study was to examine the association between publication in the Australian Medical Student Journal (AMSJ) and markers of a student's future academic trajectory, including future publication, attainment of higher academic degree or entry into specialist training. Methods: Articles authored by medical students in the AMSJ from 2010 to 2015 were retrospectively identified. A list of these student authors was made, with university- and year- matched control students randomly selected from university graduation databases. For all students, data related to academic success were obtained from multiple sources including PubMed®, Google, university databases and author affiliation information from publications. A multivariable conditional logistic regression model was used to assess correlation between variables. The primary outcome measure was the number of postgraduate PubMed®-indexed publications. Secondary outcome measures included attainment of higher degree or faculty position. Clinical speciality was also recorded. Results: Fifty-five AMSJ authors (14 case reports, 17 original research, 21 review articles) from 14 Australian universities were included. Publication in the AMSJ was associated with future PubMed® indexed publications (OR 3.43, 95% CI 1.74-6.77, P < 0.001) and higher degree attainment (OR 4.05, 95% CI 1.99-8.22, P = 0.0001). AMSJ authors were also significantly more likely to enter into surgical training (OR 2.53, 95% CI 1.10-5.84, P = 0.029). A multivariable conditional logistic regression model demonstrated that publication in the AMSJ was predictive of future PubMed indexed publication, independent of higher degree or faculty position attainment (OR 2.56, CI 1.22-5.39, P = 0.01). Conclusion: We have shown that publication in a MSJ is associated with markers of academic success in an Australian cohort. PubMed®-indexed publications, attainment of a Masters degree, and entry in to surgical training were all significantly correlated to AMSJ publication. A conditional logistic regression model demonstrated that medical student publication in the AMSJ influences the number of future PubMed®-indexed publications, independent of major academic confounding variables.
 
Article
Background The medical case vignette has long been used in medical student education and frequently includes demographic variables such as race, ethnicity and gender. However, inclusion of demographic variables without context may reinforce assumptions and biases. Yet, the absence of race, sexual orientation, and social determinants of health may reinforce a hidden curriculum that reflects cultural blindness. This replication study compared proportions of race, ethnicity, and gender with University of Minnesota (UMN) findings. This study sought to determine if there has been progress in the representation of demographic characteristics in case vignettes. Methods: University of North Carolina (UNC) case vignettes from 2015–2016 were analyzed and compared to UMN case vignettes from 1996–1998. Data included mentions of race, ethnicity, gender and social determinants of health. Results: In the 278 UNC vignettes, white race was noted in 19.7% of cases, black race was in 7.9% cases, and 76.6% of cases were unspecified. In the 983 UMN vignettes, white race was recorded in 2.85% cases, and black race in 0.41% cases. The institutions were significantly different in the proportion of their cases depicting race (0.20; 95% CI (0.15, 0.25)). Males were represented in the majority of vignettes. Discussion: Comparing case vignettes results from two medical schools suggests that reporting explicit demographic diversity was not significantly different. The findings illustrate that sex was the demographic characteristic consistently described, where males were over-represented. Based on these findings, greater cultural diversity as it intersects with social determinants of health is needed in medical student education.
 
Overview model showing the factors contributing to learners’ session engagement and learning outcomes
Case scenarios as related to core and cross-cutting domains
Post-session survey respondent characteristics
Article
Background Health system science (HSS) encompasses both core and cross-cutting domains that emphasize the complex interplay of care delivery, finances, teamwork, and clinical practice that impact care quality and safety in health care. Although HSS skills are required during residency training for physicians, current HSS didactics have less emphasis on hands-on practice and experiential learning. Medical simulation can allow for experiential participation and reflection in a controlled environment. Our goal was to develop and pilot three simulation scenarios as part of an educational module for resident physicians that incorporated core and cross-cutting HSS domains. Methods Each scenario included a brief didactic, an interactive simulation in small-group breakout rooms, and a structured debriefing. The case scenario topics consisted of educational leadership, quality and safety, and implementation science. Learners from four residency programs (psychiatry, emergency medicine, orthopedics, ophthalmology) participated January – March 2021. Results A total of 95 resident physicians received our curricular module, and nearly all (95%) participants who completed a post-session survey reported perceived learning gains. Emotional reactions to the session were positive especially regarding the interactive role-play format. Recommendations for improvement included participation from non-physician professions and tailoring of scenarios for specific disciplines/role. Knowledge transfer included use of multiple stakeholder perspectives and effective negotiation by considering power/social structures. Conclusions The simulation-based scenarios can be feasibly applied for learner groups across different residency training programs. Simulations were conducted in a virtual learning environment, but future work can include in-person and actor-based simulations to further enhance emotional reactions and the reality of the case scenarios.
 
Description of the CMOs related to the concurrent implementation of CBME and a new CMS
Article
Background Implementing competency-based medical education (CBME) in post-graduate medical education (PGME) is a complex process that requires multiple systemic changes in a complex system that is simultaneously engaged in multiple initiatives. These initiatives often compete for attention during the implementation of CBME and produce unintended and unanticipated consequences. Understanding the impact of this context is necessary for evaluating the effectiveness of CBME. The purpose of the study was to identify factors, such as contexts and processes, that contribute to the implementation of CBME. Methods We conducted a realist evaluation using data collected from 15 programs through focus groups with residents (2 groups, n = 16) and faculty (one group, n = 8), and semi-structured interviews with program directors (n = 18), and program administrators (n = 12) from 2018 to 2021. Data were analyzed using a template analysis based on a coding framework that was developed from a sample of transcripts, the context-mechanism-outcomes framework for realist evaluations, and the core components of CBME. Results The findings demonstrate that simultaneous initiatives in the academic health sciences system creates a key context for CBME implementation – rivalries for attention – and specifically, the introduction of curricular management systems (CMS) concurrent to, but separate from, the implementation of CBME. This context influenced participants’ participation, communication, and adaptation during CBME implementation, which led to change fatigue and unmet expectations for the collection and use of assessment data. Conclusions Rival initiatives, such as the concurrent implementation of a new CMS, can have an impact on how programs implement CBME and greatly affect the outcomes of CBME. Mitigating the effects of rivals for attention with flexibility, clear communication, and training can facilitate effective implementation of CBME.
 
Measurments of the PRISM task. All distances were measured in millimetre using a ruler. A: Distance between the outer edge of Object and Subject disc were measured as the main quantitative result. B: Distance between different Objects can be measured and were in the current study only used to classify the cluster of Objects (see Fig. 2). C: If any Object disc touches the edge of the Subject disc, its distance was set as “0 mm” (as was the distance for Objects placed in the center of the Subject)
Illustration of Object clustering. A Objects are close to each other (“close cluster”), B Objects are branched with a remarkable distance between each other (“branched cluster”)
Article
Background: PRISM is a novel approach to support self-reflection and learning appraisal in dental students, based on a visual metaphor. The aim of this study was to evaluate whether PRISM measurments would be reproducible and sensitive to detect learning progress in undergraduate dental students in their clinical years. Methods: Voluntarily participating dental students were included. To evaluate reproducibility, a mixed cohort of 10 students each in 3rd, 4th and 5th year (total n = 30) was recruited and received three identically structured PRISM interviews within one week without any other teaching events. To assess perceived learning progress, 29 volunteer 3rd year students participated in three interviews during their clinical simulation course (beginning, middle, end). Distances between Subject and Objects was measured in millimeter; objects were classified into close or branched clusters depending on their distance from each other on the PRISM board. Results: Values for perceived competencies within PRISM interviews during one week were comparable between the three time points in the mixed cohort (n = 30; p > 0.05). Comparing the three subgroups (3rd, 4th and 5th year, each n = 10), PRISM indicated that 3rd year students perceived their competencies are significantly lower than the 4th and 5th year students (p < 0.01). 3rd year students had less often a branched cluster of objects than the other two groups (p < 0.05). PRISM showed that over time, 3rd year students perceived a gain in their competencies in conservative dentistry and its sub-disciplines (p ≤ 0.01). The PRISM data indicated that by the end of the simulation course, the students appeared to show higher discrimination of their self-perceptions between sub-topics in conservative dentistry than at the start of the course (p = 0.01). Conclusion: PRISM yields a reproducible measure of individual students' learning progress. It is a promising novel approach for appraisal in dental education. Further work is needed to confirm the generalisability of the findings.
 
Article
Background There is significant variability in the performance and outcomes of invasive medical procedures such as percutaneous coronary intervention, endoscopy, and bronchoscopy. Peer evaluation is a common mechanism for assessment of clinician performance and care quality, and may be ideally suited for the evaluation of medical procedures. We therefore sought to perform a systematic review to identify and characterize peer evaluation tools for practicing clinicians, assess evidence supporting the validity of peer evaluation, and describe best practices of peer evaluation programs across multiple invasive medical procedures. Methods A systematic search of Medline and Embase (through September 7, 2021) was conducted to identify studies of peer evaluation and feedback relating to procedures in the field of internal medicine and related subspecialties. The methodological quality of the studies was assessed. Data were extracted on peer evaluation methods, feedback structures, and the validity and reproducibility of peer evaluations, including inter-observer agreement and associations with other quality measures when available. Results Of 2,135 retrieved references, 32 studies met inclusion criteria. Of these, 21 were from the field of gastroenterology, 5 from cardiology, 3 from pulmonology, and 3 from interventional radiology. Overall, 22 studies described the development or testing of peer scoring systems and 18 reported inter-observer agreement, which was good or excellent in all but 2 studies. Only 4 studies, all from gastroenterology, tested the association of scoring systems with other quality measures, and no studies tested the impact of peer evaluation on patient outcomes. Best practices included standardized scoring systems, prospective criteria for case selection, and collaborative and non-judgmental review. Conclusions Peer evaluation of invasive medical procedures is feasible and generally demonstrates good or excellent inter-observer agreement when performed with structured tools. Our review identifies common elements of successful interventions across specialties. However, there is limited evidence that peer-evaluated performance is linked to other quality measures or that feedback to clinicians improves patient care or outcomes. Additional research is needed to develop and test peer evaluation and feedback interventions.
 
Student satisfaction with faculty communication on internal medicine. Graph displays the percentage of students reporting satisfaction with faculty communication on prior rotations (pre-rotation survey) versus communication on their internal medicine rotation (post-rotation survey)
Student satisfaction with ancillary staff communication on internal medicine. Graph displays the percentage of students reporting satisfaction with ancillary staff communication on prior rotations (pre-rotation survey) versus communication on their internal medicine rotation (post-rotation survey)
Most notable reported effects of Secure Chat on educational experience. Graph displays the reasons students reported improvement in their educational experience through use of Secure Chat displayed as percentages. More than one selection was allowed. The Other category had two write-ins that reported the ease of communication was the most prominent effect of Secure Chat on the educational experience
Secure message content by category. Graph displays the percent of the 826 total message threads containing each content category. Note that a single message thread may contain more than one content category
Article
Background Instant messaging applications and texting are useful for educating and communicating with medical students; however, they present patient privacy concerns and do not address the challenge of student inclusion in patient care communication. EMR-integrated secure messaging offers an opportunity to include students on team communication, enhance their medical education, and ensure patient privacy. Methods Between July 2019 through March 2020, we performed a mixed method study to evaluate use of EPIC® Secure Chat as a means of enhancing student education and team communication. We promoted use of secure messaging in orientation, performed a pre- and post-rotation survey to assess perceptions of Secure Chat effect on communication, and directly reviewed and categorized messages. Results Twenty-four 3rd and 4th year students completed the pre-rotation survey, and 22 completed the post-rotation survey. Twelve (50%) students reported the quality of communication with faculty was either good or very good prior to internal medicine rotation, while 20 (91%) reported this post-rotation (p-value 0.001). There was a similar improvement in communication with ancillary staff. Nineteen (86%) students felt that secure messaging improved their communication with faculty. On message review, threads were frequently logistical, but also often included discussions of patient management. Conclusions Students viewed Secure Chat as having a favorable effect on their communication with team members and reported communication on internal medicine to be improved compared to prior rotations. Messages included students on important patient care conversations. Secure messaging offers a novel medium to improve team communication, enhance student education, and maintain patient privacy.
 
Experimental procedure. We used the 10 min before the start of the training to present the rubric table, explain the evaluation criteria and the physical equipment used for the evaluation. After the explanation, each group trained on the lateral elbow and PA chest radiography for about an hour. Then, within two weeks, the teachers conducted an evaluation using the rubric method on the students. After the evaluation was completed, the students evaluated their own proficiency using a rubric table. In addition, a questionnaire on learning was administered
Captured image of patient positioning in VR X-Ray. Users can operate the X-ray equipment and the examinee in a highly immersive VR space. Users can also perform X-ray imaging in the VR space and train while checking the captured X-ray images
Total score using the rubric method administered to the students by the teachers. Box plot of the total evaluation scores in the rubric table when the students’ proficiency was evaluated by the teacher. The center line of the box plot indicates the median of the data. The top of the box indicates the third quartile and the bottom of the box indicates the first quartile. The upper whiskers and lower whiskers indicate the maximum and minimum total scores
Evaluation of each skill in the HMD-VRC group and the RP group. The radar chart shows the average scores of the teachers’ evaluations of the students’ skills on the 12 items of the rubric table. Each individual was scored on a four-point scale from 0 to 3. The dotted line indicates the RP group, and the solid line indicates the HMD-VRC group. Each item corresponds to an item in Table 1. Compared to the HMD-VRC group, the RP group was rated significantly higher in #3 and 7 for lateral elbow and #6, 8, 11, and 12 for PA chest radiography
Evaluation of each skill by teachers and students themselves in the HMD-VRC group. The radar chart shows the average scores of the 12 items in the rubric table when the skills of the students using HMD-VRC were evaluated by the teachers and when the students performed a self-evaluation. The dotted line indicates self-evaluation, and the solid line indicates evaluation by the teachers. Each item corresponds to an item in Table 1. Each individual was scored on a four-point scale from 0 to 3. Self-ratings were significantly higher than teacher ratings in #3 for lateral elbow and #6 for PA chest radiography
Article
Background The use of head mounted display (HMD)-based immersive virtual reality (VR) coaching systems (HMD-VRC) is expected to be effective for skill acquisition in radiography. The usefulness of HMD-VRC has been reported in many previous studies. However, previous studies have evaluated the effectiveness of HMD-VRC only through questionnaires. HMD-VRC has difficulties in palpation and patient interaction compared to real-world training. It is expected that these issues will have an impact on proficiency. The purpose of this study is to determine the impact of VR constraints in HMD-VRC, especially palpation and patient interaction, on radiographic skills proficiency in a real-world setting. Methods First-year students (n = 30) at a training school for radiology technologists in Japan were randomly divided into two groups, one using HMD-VRC (HMD-VRC group) and the other practicing with conventional physical equipment (RP group) and trained for approximately one hour. The teachers then evaluated the students for proficiency using a rubric method. Results In this study, it was found that some skills in the HMD-VRC group were equivalent to those of the RP group and some were significantly lower than those of the RP group. There was a significant decrease in proficiency in skills related to palpation and patient interaction. Conclusions This study suggests that HMD-VRC can be less effective than real-world training in radiographic techniques, which require palpation and patient interaction. For effective training, it is important to objectively evaluate proficiency in the real world, even for HMD-VRC with new technologies, such as haptic presentation and VR patient interaction. Trial registration The study was conducted with the approval of the Ethics Committee of International University of Health and Welfare (Approval No.21-Im-035, Registration date: September 28, 2021).
 
Article
Background Oral health is an important component of medical education given its connection to overall health and quality of life; however, oral health is infrequently incorporated into medical school curricula in the United States. The aim of this study was to pilot a novel oral health care clerkship for United States medical students that implemented the Smiles for Life (SFL) curriculum, in-person clinical activities, and pre and post curricula assessments to assess knowledge acquisition, attitude change, and clinical skill development. Methods Third year medical students at Albert Einstein College of Medicine, Bronx, New York, volunteered ( n = 37) for a clerkship in oral health. Students completed the Smiles For Life National Oral Health Curriculum and participated in three half-day clinical sessions in a hospital-based dental clinic. The participants were evaluated on knowledge acquisition, attitude change, and clinical skill development through a pre and post clerkship assessment in order to assess the efficacy of the intervention. Results There was a 23.4% increase in oral health knowledge ( p < 0.001) following participation in the online modules and clerkship. Additionally, attitudes in the following domains showed improved familiarity and proficiency: causes and prevention of dental caries (78.4%, p < 0.001) and periodontal disease (83.8%, p < 0.001), provision of oral health information to patients (67.6%, p < 0.001), and ability to conduct an oral examination (62.2%, p < 0.001). Conclusions Third year medical students who participated in a novel oral health clerkship demonstrated significant increases in basic oral health knowledge and reported increased comfort in providing oral examinations and anticipatory guidance to patients. The results support the feasibility of this approach to incorporating oral health education into a medical school curriculum in the United States.
 
Hybrid online team-based learning for community healthcare providers
Article
Background: Health literacy (HL) has proven to be a determining factor influencing the health of individuals. Community health providers (CHPs) work on the front line of improving public HL. Increasing their understanding of HL and their ability to incorporate HL into healthcare can reduce obstacles in healthcare services. This study evaluated the effectiveness of an HL training program for CHP by using the hybrid online team-based learning (TBL) model. Methods: A quasi-experimental study and focused group interviews were conducted. We developed a six weeks HL online course for CHPs. The program included teaching videos for pre-class preparation, a 90-min online TBL model, and a case discussion in the last two weeks. Team application activities were designed for each class to enhance knowledge application. A total of 81 CHPs from 20 public health centers took the course and provided complete data for analysis. Learning effectiveness was evaluated based on the familiarity, attitude, and confidence in implementing HL practices, course satisfaction, and participants' learning experiences. Results: The comparison showed that the participants' familiarity with HL (4.29 ± 1.76 vs 6.92 ± 1.52, p < .001), attitude (7.39 ± 1.88 vs 8.10 ± 1.44, p = .004), and confidence in implementing HL practices (6.22 ± 1.48 vs 7.61 ± 1.34, p < .001) increased after the course. The average satisfaction with the teaching strategies was 4.06 ± .53 points, the average helpfulness to practice was 4.13 ± .55 points, and the overall feedback on satisfaction with learning was 4.06 ± .58 points (the full score was 5 points). According to the learning experience of the 20 participants in the focus group discussion, the experiences of teaching strategies and the learning experiences of the HL course were summed up into two categories, seven themes, and 13 subthemes. The results showed a positive experience with the hybrid online TBL program. Conclusion: The use of hybrid online TBL model is a feasible and valid approach for the HL training of CHPs. The result can serve as a reference for the on-the-job training of various healthcare workers.
 
Article
Background Twitter has gained increasing popularity and attention as a professional learning environment to share knowledge, exchange information, make connections, and build networks. To evaluate the effectiveness of Twitter-facilitated online discussions, a community of inquiry framework could be used with the three key elements of online environments: cognitive presence, social presence, and teaching presence. This study aims to explore how medical educators participate in synchronous online discussions on Twitter using #MedEdChat, and how participants’ perceptions toward the three presences, sense of connectedness and interactions influenced their online satisfaction. Methods A survey invitation was emailed using the medical education email list DR-ED and was posted during the weekly Twitter conversations in December 2020, to solicit participants who have been involved in any kind of #MedEdChat activities (i.e., read transcripts or directly participate in discussions). Results A total of 68 people responded. Through descriptive analysis and path analysis, we found that almost half of the survey respondents were lurkers on #MedEdChat who read others’ tweets or transcripts. In addition, participants mainly used Twitter for resource sharing, collaborating with others, and networking. Participants rated teaching (i.e., moderator) presence the highest, followed by overall satisfaction, cognitive presence, sense of connectedness, social presence, and interactions. Among them, sense of connectedness and cognitive presence were significantly associated with participants’ overall satisfaction. Conclusions This study provided significant implications for using Twitter as a professional learning community to conduct online discussion activities. Facilitators could think of ways to improve participation by providing tutorials on how to participate on Twitter discussions, introduce or ask new participants to introduce themselves, facilitate discussion with intriguing questions, and invite medical educators of different roles as well as medical students and residents to join to bring in diverse perspectives.
 
Article
Background: The number of international students who choose China as their destination for quality medical education is rising, particularly those from developing countries, but little is known about their adaptation and educational experiences at Chinese universities. This study explored the factors that these students perceived to have influenced their academic success. Methods: Semi-structured interviews were conducted with international students (N = 40) from developing countries from September 2020 to January 2021. Participants were graduates or in their second, third, fourth, fifth, or sixth academic year in two university medical schools. Interviews were audio-recorded, transcribed, and analyzed using a thematic analysis approach. Results: The participants chose China to study medicine based on cost, teaching resources, quality of medical education, recommendation, and safety factors. They considered an increase in medical knowledge, clinical skills and communication skills as an indicator of academic success. Positive factors affecting academic success were the support system (family, friends, seniors) and campus resources (library, laboratories, extra-curricular activities, scholarship). Negative factors were (i) issues affecting learning (English language barrier), adjusting to the medical education system in China, learning difficulties, failing exams, internship difficulties, problems with online learning during the pandemic, (ii) sociocultural issues (lacking knowledge of the Chinese language, challenges in daily life, perceived discrimination, interpersonal relationships), (iii) wellbeing issues (physical and mental health issues), and (iv) other challenges (climate, food, finance, scholarship). The influence of teachers, administrators and classmates was perceived as both positive and negative. Conclusions: Factors affecting the academic success of international medical students at Chinese universities are multi-faceted. It is the collective responsibility of the host society, universities, teachers, administrators, classmates, families, and students themselves to address these factors in order to support and help students achieve academic success. Findings in our study support recommendations to improve teachers’ English language skills and pedagogy and to invest in administrators’ professional development. They also suggest that greater awareness of students’ sociocultural and mental challenges and optimizing the positive influence of classmates could strengthen student support and better address student academic difficulties. The English proficiency and prior academic performance of international students should be considered during recruitment. Given the rapid growth in international MBBS programs in China, further research on the experiences of international students in China’s medical programs is needed.
 
Article
Background The most important factor in evaluating a physician’s competence is strong clinical reasoning ability, leading to correct principal diagnoses. The process of clinical reasoning includes history taking, physical examinations, validating medical records, and determining a final diagnosis. In this study, we designed a teaching activity to evaluate the clinical reasoning competence of fourth-year medical students. Methods We created five patient scenarios for our standardized patients, including hemoptysis, abdominal pain, fever, anemia, and chest pain. A group history-taking with individual reasoning principles was implemented to teach and evaluate students’ abilities to take histories, document key information, and arrive at the most likely diagnosis. Residents were trained to act as teachers, and a post-study questionnaire was employed to evaluate the students’ satisfaction with the training activity. Results A total of 76 students, five teachers, and five standardized patients participated in this clinical reasoning training activity. The average history-taking score was 64%, the average key information number was 7, the average diagnosis number was 1.1, and the average correct diagnosis rate was 38%. Standardized patients presenting with abdominal pain (8.3%) and anemia (18.2%) had the lowest diagnosis rates. The scenario of anemia presented the most difficult challenge for students in history taking (3.5/5) and clinical reasoning (3.5/5). The abdominal pain scenario yielded even worse results (history taking: 2.9/5 and clinical reasoning 2.7/5). We found a correlation in the clinical reasoning process between the correct and incorrect most likely diagnosis groups (group history-taking score, p = 0.045; key information number, p = 0.009 and diagnosis number, p = 0.004). The post-study questionnaire results indicated significant satisfaction with the teaching program (4.7/5) and the quality of teacher feedback (4.9/5). Conclusions We concluded that the clinical reasoning skills of fourth-year medical students benefited from this training course, and the lower correction of the most likely diagnosis rate found with abdominal pain, anemia, and fever might be due to a system-based teaching modules in fourth-year medical students; cross-system remedial reasoning auxiliary training is recommended for fourth-year medical students in the future.
 
Global feedback score assessed objectively (Likert scale 1–5, 1 = poor and 5 = excellent) of 2020 senior students and 2013 clinical teachers (A with no prior training in teaching skills – B with prior training in teaching skills)
Article
Purpose of the article During the Covid-19 pandemic, formative OSCE were transformed into online OSCE, and senior students (near peers) substituted experienced clinical teachers. The aims of the study were to evaluate quality of the feedbacks given by near peers during online OSCEs and explore the experience of near-peer feedback from both learner’s and near peer’s perspectives. Materials and methods All 2nd year medical students (n = 158) attended an online OSCE under the supervision of twelve senior medical students. Outcome measures were 1) students’ perception of the quality of the feedback through an online survey (Likert 1–5); 2) objective assessment of the quality of the feedback focusing on both the process and the content using a feedback scale (Likert 1–5); 3) experience of near peer feedback in two different focus groups. Results One hundred six medical students answered the questionnaire and had their feedback session videotaped. The mean perceived overall quality of senior students’ overall feedback was 4.75 SD 0.52. They especially valued self-evaluation (mean 4.80 SD 0.67), balanced feedback (mean 4.93 SD 0.29) and provision of simulated patient’s feedback (mean 4.97 SD 0.17). The overall objective assessment of the feedback quality was 3.73 SD 0.38: highly scored skills were subjectivity (mean 3.95 SD 1.12) and taking into account student’s self-evaluation (mean 3.71 (SD 0.87). Senior students mainly addressed history taking issues (mean items 3.53 SD 2.37) and communication skills (mean items 4.89 SD 2.43) during feedback. Participants reported that near peer feedback was less stressful and more tailored to learning needs– challenges for senior students included to remain objective and to provide negative feedback. Conclusion Increased involvement of near peers in teaching activities is strongly supported for formative OSCE and should be implemented in parallel even if experience teachers are again involved in such teaching activities. However, it requires training not only on feedback skills but also on the specific content of the formative OSCE.
 
An oilcloth session
Article
Background The aim of this study was to explore healthcare professionals, managers, and other key employees’ experiences of oilcloth sessions as a strategy when implementing new emergency departments in Denmark, based on their participations in these sessions. The study addresses the importance of securing alignment in implementation strategies. Too often, this does not get enough attention in the literature and in practice. In this study, alignment among components was achieved in an educational implementation strategy called oilcloth sessions. Methods The study is based on participants’ observations of 13 oilcloth sessions and follow-up via 53 semi-structured interviews with the board of directors, managers, and key employees from the present emergency department and different specialty departments. Data were analysed deductively using Biggs and Tang’s model of didactic alignment. Results The analysis showed the complexity of challenges when using oilcloth sessions as a strategy when implementing a new emergency department described in terms of three phases and nine main themes (a–i): the preparation phase: (a) preparing individually and collectively, (b) objectives, (c) involving participants, (d) selecting cases; the execution phase: (e) using materials, (f) facilitating the sessions, (g) temporal structures; evaluation: (h) following up on the sessions, (i) adapting to the context. Conclusions This study shows that it is important to ensure alignment among elements in implementation strategies. Thus, oilcloth sessions with high alignment are useful if the challenges experienced are to be overcome and the strategy will be experienced as a useful way to support the implementation of a new emergency department from the participants’ point of view. Bigg and Tang's didactic model is useful as an analytical framework to ensure alignment in implementation strategies in general.
 
Article
Background Interprofessional collaboration is key to improving the health of individuals and communities. It is supported by provision of Interprofessional education (IPE) which has recently emerged in the Middle East region. This study investigated changes in healthcare students’ attitudes towards interprofessional collaboration after undertaking the Interprofessional Education and Collaboration (IPEC) course. Methods A paper-based anonymous survey using the Interprofessional Attitude Scale (IPAS) was administered to a sample of 346 health students (nursing, medicine, and public health) pre/post undertaking the IPEC course. Less than half of the students provided a post response, with pre/post survey results of 111 pairs subsequently matched and analyzed. Results Results showed elevated pre-course scores, an improvement in students’ attitudes towards the interprofessional biases domain of the IPAS, and a slight decline in their scores in the remaining 4 domains (team roles and responsibilities, patient centeredness, community centeredness, and diversity and ethics). These changes were not statistically significant, except for the patient centeredness domain ( p = 0.003**). Conclusions The study provided important results about attitudes towards interprofessional collaboration. These findings are essential because our institution is one of few in Lebanon that provides this mandatory course to a large group of health professionals. Future studies should investigate these changes in attitude scores in a larger sample size, and how these attitudes would influence collaboration post-graduation.
 
PRISMA flow diagram. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram shows the detailed process of information retrieval and literature screening
The three-stage UDBRE system mimicking the dental clinical training system. Since the education model of UDBRE is still under exploration and the dental clinical training system is relatively mature, we have attempted to arrange and classify the training contents of UDBRE into three stages mimicking the current clinical training system, including didactic course, probation, and internship
Detailed information of an example of UDBRE system which consisted of three stages. The prospective education goals, course forms, and assessment system of the undergraduate dental basic research education (UDBRE) program are listed in detail along the timeline
Article
Background Undergraduate dental basic research education (UDBRE) is broadly regarded as an important approach for cultivating scientific research talent. This scoping review aims to summarize the current status of UDBRE in terms of educational goals, teaching program and content, assessment system, training outcomes, barriers, and reflections. Methods The authors performed a systematic literature search in PubMed, Web of Science, and Education Resources Information Center (ERIC) to identify peer-reviewed articles written in English from their inception to January 29, 2021. Articles were reviewed and screened according to the inclusion and exclusion criteria. Related data from the included publications were then collected and summarized. Results The authors searched 646 publications and selected 16 articles to include in the study. The education goals included cultivating five major dental basic research capabilities ( n =10, 62.5%) and developing interest in basic research ( n =2, 12.5%). As for the teaching program, the mentor-guided student research project was the most popular ( n =11, 68.8%), followed by didactic courses ( n =5, 31.3%), experimental skills training ( n =1, 6.3%), and the combination of the above forms ( n =3, 18.8%). However, the assessment system and training outcome diverged. Existing evidence showed that UDBRE reached satisfying education outcomes. Barriers included excessive curriculum burden ( n =2, 12.5%), tutor shortage ( n =3, 18.8%), lack of financial support ( n =5, 31.3%), and inadequate research skills and knowledge ( n =5, 31.3%). Conclusions Although efforts were made, the variation between studies revealed the immature status of UDBRE. A practical UDBRE education system paradigm was put forward. Meanwhile, more research is required to optimize a robust UDBRE system with clear education goals, well-designed teaching forms, and convincing assessment systems.
 
Article
Background: Reasoning and moral action are necessary to resolve day-to-day moral conflicts, and there are certain professions where a greater moral character is expected, e.g., medicine. Thus, it is desirable that medical students develop skills in this field. Some studies have evaluated the level of moral reasoning among medical students; however, there are no comparative studies involving other types of populations. Therefore, the objective of this study was to compare the moral reasoning among medical graduates with that of a group of young graduates with other degrees and of a group of nonprofessional adults. Methods: An exploratory cross-sectional study was conducted. Pediatric residents and pediatric subspecialty residents at a pediatric hospital were invited to participate, forming the group of "medical graduates". A group of young people from a social program and students with a master's degree in a science from the same pediatric hospital were also invited to participate, comprising the group of "graduates with other degrees". Finally, a group of beneficiaries of a family clinic was invited to participate, which we categorized as "nonprofessionals". To evaluate the differences in moral reasoning between these 3 groups, we applied the Defining Issues Test (DIT), a moral reasoning questionnaire designed by James Rest using Kohlberg's theory of moral development. Results: The moral reasoning of 237 subjects-88 from the "medical graduates" group, 82 from the "graduates with other degrees" group and 67 from the "nonprofessionals" group- was evaluated. We found differences in the profiles of moral development of the groups. The profile of the "nonprofessionals" showed a very high predominance of subjects at the preconventional level, 70%, but only 4.5% at the postconventional level. Among the "medical graduates", we observed 37.5% at the preconventional level and 34% at the postconventional level (X2 p < 0.001); this group had the highest percentage in this category. This large difference could be because the differences in the ages and socioeducational levels of nonprofessionals are much wider than those among medical graduates. However, significant differences were also found when the profiles of medical graduates were compared with those of graduates with other degrees, since the latter demonstrated 56% at the preconventional level and 18% at the postconventional level (X2 test, p = 0.02). Conclusions: Significant differences were found in moral reasoning among the groups that we evaluated. Among the group of medical graduates, there was a higher percentage of subjects at the postconventional level than among the group of graduates with other degrees and a much higher percentage than among the group of nonprofessionals. Our conclusions give the first evidence that studying medicine seems to influence the development of moral reasoning in its students. Therefore, we consider it relevant to develop educational strategies where the student is involved in simulated but realistic decision-making situations, where there are moral dilemmas to resolve from their early years of training.
 
Study design
Comparison of the pre-and post-scores of SOCS
Article
Background Collaborative learning is a group learning approach in which positive social interdependence within a group is key to better learning performance and future attitudes toward team practice. Recent attempts to replace a face-to-face environment with an online one have been developed using information communication technology. However, this raises the concern that online collaborative learning (OCL) may reduce positive social interdependence. Therefore, this study aimed to compare the degree of social interdependence in OCL with face-to-face environments and clarify aspects that affect social interdependence in OCL. Methods We conducted a crossover study comparing online and face-to-face collaborative learning environments in a clinical reasoning class using team-based learning for medical students ( n = 124) in 2021. The participants were randomly assigned to two cohorts: Cohort A began in an online environment, while Cohort B began in a face-to-face environment. At the study’s midpoint, the two cohorts exchanged the environments as a washout. The participants completed surveys using the social interdependence in collaborative learning scale (SOCS) to measure their perceived positive social interdependence before and after the class. Changes in the mean SOCS scores were compared using paired t-tests. Qualitative data related to the characteristics of the online environment were obtained from the focus groups and coded using thematic analysis. Results The matched-pair tests of SOCS showed significant progression between pre- and post-program scores in the online and face-to-face groups. There were no significant differences in overall SOCS scores between the two groups. Sub-analysis by subcategory showed significant improvement in boundary (discontinuities among individuals) and means interdependence (resources, roles, and tasks) in both groups, but outcome interdependence (goals and rewards) improved significantly only in the online group. Qualitative analysis revealed four major themes affecting social interdependence in OCL: communication, task-sharing process, perception of other groups, and working facilities. Conclusions There is a difference in the communication styles of students in face-to-face and online environments, and these various influences equalize the social interdependence in a face-to-face and online environment.
 
Article
Background During the 2020–21 residency interview season, interviews were conducted through virtual platforms due to the COVID-19 pandemic. The purpose of this study is to assess the general perceptions of applicants, residents and attendings at a single, large, metropolitan orthopaedic residency with regards to the video interview process before and after the interview season. Methods Surveys were sent to all orthopaedic applicants, residents, and attendings before the interview season. Applicants who received interviews and responded to the first survey (46) and faculty who responded to the first survey (28) were sent a second survey after interviews to assess how their perceptions of video interviews changed. Results Initially, 50% of applicants (360/722) and 50% of faculty and residents (28/56) responded before interview season. After interviews, 55% of interviewees (25/46) and 64% of faculty and residents (18/28) responded. Before interviews, 91% of applicants stated they would prefer in-person interviews and 71% were worried that video interviews would prevent them from finding the best program fit. Before interviews, 100% of faculty and residents stated they would rather conduct in-person interviews and 86% felt that residencies would be less likely to find applicants who best fit the program. Comparing responses before and after interviews, 16% fewer applicants (p = 0.01) perceived that in-person interviews provide a better sense of a residency program and faculty and residents’ perceived ability to build rapport with interviewees improved in 11% of respondents (p = 0.01). However, in-person interviews were still heavily favored by interviewees (84%) and faculty and residents (88%) after the interview season. Conclusions In-person interviews for Orthopaedic Surgery Residency are perceived as superior and are preferred among the overwhelming majority of applicants, residents, and interviewers. Nevertheless, perceptions toward video interviews improved in certain domains after interview season, identifying potential areas of improvement and alternative interview options for future applicants.
 
The effectiveness of tutor shadowing for novice PBL tutors. ****: p < 0.001; PBL: problem-based learning; EFA: exploratory factor analysis
Article
Background To enhance tutors’ teaching skills, tutor shadowing for novice tutors of problem-based learning (PBL) in addition to conventional faculty development (FD) was applied. This study aimed to develop a tutoring-skill scale (TS-scale) and evaluate the effect of shadowing on PBL tutors. Methods This study employed a before-and-after study design with three phases. In phase 1, a TS-scale was elaborated. A validity examination was performed in phase 2. Phase 3 was a study of the effectiveness using a TS-scale survey of novice PBL tutors before and after the FD course. The FD course for novice PBL tutors included an FD workshop and PBL shadowing activities. Results A TS-scale with a 32-item questionnaire of self-rated confidence for PBL tutors was identified in phase 1. In phase 2, 7 experienced specialists in medical education were invited to evaluate the content validity of the scale. The item content validity index (I-CVI) ranged from 0.86 to 1, and the scale-CVI (S-CVI) was 0.95. A total of 85 novice PBL tutors completed the TS-scale before the FD course, yielding a Cronbach’s alpha of 0.98. An exploratory factor analysis with varimax rotation was performed. The twenty-four items with significant loadings greater than 0.5 were incorporated into a new TS-scale and were grouped into three factors: student contact, medical expertise, and teaching expertise. In phase 3, 76 novice PBL tutors completed the 24-item TS-scale before (pretest) and after (posttest) the FD course. Their self-rated confidence improved significantly across the three factors after the FD course. The pretest and posttest scores did not differ according to the tutors’ gender, the grades they taught, or their specialty background. Conclusions Novice PBL tutors benefit from FD that incorporates tutor shadowing in the 3 key domains of tutoring competencies. The TS-scale developed in this study can be applied in future research on FD design.
 
Medical student knowledge of obesity management scores by individual question, grouped by knowledge domain (n = 133). Questions adapted from Obesity Knowledge among Final-Year medical Students in Norway, by Martins and Norsett-Carr (2017) [26]
Medical student knowledge of obesity management scores averaged by knowledge domain (n = 133). Questions adapted from Obesity Knowledge among Final-Year medical Students in Norway, by Martins and Norsett-Carr (2017) [26]
Medical Student Self-Assessed Competencies (n = 180). Question begins with “I can…” followed by the stem below. Some stems have been condensed for presentation here. The full survey may be found in Additional file 4. Q1: Use 24-hour recall, food record, or food frequency to obtain diet history; Q2: Determine body mass index (BMI); Q3: Assess diet for unhealthy behaviours associated with obesity; Q4: Ascertain each patient’s readiness and ability to work on weight loss; Q5: Recognize and screen for common psychosocial comorbidities in those with obesity; Q6: Perform targeted history and physical examination to identify common obesity-related comorbidities; Q7: Discuss risks associated with obesity; Q8: Respond to a patient’s questions regarding treatment options; Q9: Assess level of physical activity and provide guidance; Q10: Assist in goal setting related to permanent lifestyle changes; Q11: Prescribe plan for exercise / physical activity; Q12: Use motivational interviewing to change behaviour; Q13: Provide counselling intervention regarding weight loss; Q14: Recognize and refer patients with eating disorders; Q15: Collaborate with and refer to allied health
Article
Background With over 26% of Canadian adults living with obesity, undergraduate medical education (UGME) should prepare medical students to manage this chronic disease. It is currently unknown how the management of patients living with obesity is taught within UGME curricula in Canada. This study (1) examined the knowledge and self-reported competence of final-year medical students in managing patients living with obesity, and (2) explored how this topic is taught within UGME curricula in Canada. Methods We distributed two online surveys: one to final-year medical students, and another to UGME deans at 9 English-speaking medical schools in Canada. The medical student survey assessed students’ knowledge and self-reported competence in managing patients living with obesity. The dean’s survey assessed how management of patients living with obesity is taught within the UGME curriculum. Results One hundred thirty-three (6.9%) and 180 (9.3%) out of 1936 eligible students completed the knowledge and self-reported competence parts of the survey, respectively. Mean knowledge score was 10.5 (2.1) out of 18. Students had greatest knowledge about etiology of obesity and goals of treatment, and poorest knowledge about physiology and maintenance of weight loss. Mean self-reported competence score was 2.5 (0.86) out of 4. Students felt most competent assessing diet for unhealthy behaviors and calculating body mass index. Five (56%) out of 9 deans completed the survey. A mean of 14.6 (5.0) curricular hours were spent on teaching management of patients living with obesity. Nutrition and bariatric surgery were most frequently covered topics, with education delivered most often via large-group sessions and clinical activities. Conclusions Canadian medical students lack adequate knowledge and feel inadequately prepared to manage patients living with obesity. Changes to UGME curricula may help address this gap in education.
 
Article
Background Smooth reciprocal relationships enable a preceptee’s growth, and it has been suggested that without such relationships, the preceptee may not be able to grow successfully. This study explored the differences in perceptions by matching the perspectives of both the preceptees who did not make progress in workplace adjustment and their preceptors. Identifying the differences in perceptions between the two groups is important for improving nursing education and the relationship between preceptees and preceptors. Methods A pair of nurses who had been with the company for less than 3 years and who had previously been transferred or had resigned due to poor workplace adjustment were designated as preceptees, and those who had directly supervised the preceptee during their first year of employment were included as preceptors in the study. A 50-minute semi-structured interview was conducted separately to examine the perceptions of the preceptee and preceptor. A thematic analysis was used to analyse the interview data. Results This study explored the differences in perceptions regarding the clinical practice of nursing between preceptors and their preceptees who did not make progress in workplace adjustment during nursing education; six themes were identified. After interviewing both sides, it became clear that the same event was interpreted differently depending on their positions, perspectives, and contexts. As the preceptees were nurses who had left or had been transferred, the existence of these differences in perceptions suggests that these factors may impact their departure or transfer. However, we do not aim to place blame on one side or the other for the preceptee’s turnover or transfer and would like to consider effective support, not only for the preceptee, but also for the preceptor. Conclusions It is necessary to examine nursing education on the premise that differences may occur depending on the position and role of nurses in the workplace and to look at curricular framework changes to bring in a systemic influence towards the training of young nurses.
 
Top-cited authors
Cees Van der Vleuten
  • Maastricht University
Paul Glasziou
  • Bond University
Inocencio Daniel Maramba
  • University of Plymouth
Steve Wheeler
  • University of Plymouth
Maged N Kamel Boulos
  • University of Lisbon