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  • Peers as OSCE assessors for junior medical students – a review of routine use: a mixed methods study
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-16
    Simon Schwill; Johanna Fahrbach-Veeser; Andreas Moeltner; Christiane Eicher; Sonia Kurczyk; David Pfisterer; Joachim Szecsenyi; Svetla Loukanova

    Peer-assisted learning is well established in medical education; however, peer tutors rarely act as assessors for the OSCE. In the compulsory, near-peer teaching programme covering basic medical skills at the University of Heidelberg, peer tutors serve as assessors on a formative OSCE. This study aimed to investigate the feasibility and acceptance of peer assessors and to survey the perceived advantages and disadvantages of their use. In 2016 and 2017 all OSCE peer assessors (third to sixth-year medical students) and all of the peer-assessed students in 2017 (second-year-medical students) were invited to participate in a survey. Both groups were asked to complete a tablet-based questionnaire immediately after the OSCE. Peer assessors were asked to rate eight statements and the peer-assessed students to rate seven statements on a five-point Likert scale. Both were asked to comment on the advantages and disadvantages of peer-assessors. Overall, 74 of 76 peer assessors and 307 of 308 peer-assessed students participated in the study. 94% (67/74) of peer assessors and 90% (276/307) of the peer-assessed group thought that it is important to have peer tutors as assessors. Of the peer assessors, 92% (68/74) felt confident in giving structured feedback during the OSCE and 66% (49/74) felt they had improved their teaching skills. Of the peer-assessed students, 99% (306/307) were satisfied with their peers as OSCE assessors and 96% (292/307) considered the peer feedback during the OSCE as helpful. The participants mentioned structural benefits, such as lower costs, and suggested the quality of the OSCE was higher due to the use of peer assessors. The use of peer assessors was found to be beneficial for the learners in the form of high-quality feedback and an overall reduction in stress. Furthermore, the use of peer assessors was found to be beneficial for the peer assessors (improved teaching and clinical skills). From a learner’s perspective, the use of peer assessors for a formative OSCE that is part of a near-peer teaching program aimed at junior medical students is favourable for all. A broad implementation of peer assessment in the formative OSCE should be encouraged to investigate effects on quality and stress-reduction.

    更新日期:2020-01-16
  • Predicting professional school performance with a unique lens: are there other cognitive predictors?
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-15
    Theresa A. Davies; Madeline B. Miller; Vincent A. Moore; Elizabeth A. Kaye

    We investigated the associations between admissions criteria and performance in four cohorts of pre-dental MS in Oral Health Sciences (OHS) program at Boston University Schools of Medicine and Dental Medicine. Previously we have reported that OHS serves as a successful pre-dental pipeline program for students from underrepresented groups. We evaluated academic variables that further affect overall graduate GPA and grades in the first year dental school courses taken by OHS students at Boston University between 2012 and 2016 as part of the MS curriculum. Demographic data, region of residency, undergraduate grade point average, number of science and math credits, major of study, dental admissions test scores and undergraduate institution were collected. The competitiveness of the undergraduate institution was scored based on Barron’s Profiles of American Colleges. OHS-GPA was assessed and individual grades in two first year dental school courses taken as part of the OHS curriculum were collected. Analysis of variance, the Chi-square test and Fisher’s Exact test were utilized to assess associations between academic performance parameters, successful program completion and matriculation to dental school. Results indicate that undergraduate major, age and number of science course credits taken had no impact on MS performance in the Boston University MS in Oral Health Sciences program; however, students who took an undergraduate course in Physiology performed better than those who did not (p = 0.034). This was not the case with courses in Cell Biology and Biochemistry. Students with DAT scores over 20 academic average (p = 0.001), 18 total science average (p = 0.001) and 22 reading comprehension (p = 0.004) performed better in dental school courses taken in OHS. We report that strong test scores, attending a mid or highly rigorous undergraduate institution and completion of an undergraduate Physiology course are positive predictors. We hope these findings will guide admission’s decisions and improve recruitment to, and future success of, graduate student’s pursuit of professional school. Understanding alternative predictors of success may help to reduce the intrinsic bias among applicants from underrepresented groups and continue to look beyond the DATs (or MCATs) to decrease the gap between professionals from underrepresented groups and those they serve.

    更新日期:2020-01-15
  • Simulated patient’s feedback to improve communication skills of clerkship students
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-15
    Ayesha Aleem Qureshi; Tabassum Zehra

    The changing trends of the society and revisions to medical education have changed the way medical students are trained to adroitly care for patients hence, patient centered care has become need of today’s society and communication skills are imperative in developing patient physician relationship. Increasingly, simulations are being used to aid medical students to incorporate theoretical knowledge into practice. There are innumerable studies regarding communication skills in terms of reliability, validity and feasibility but no such study has been documented using simulated patient’s feedback in improving communication skills in Pakistan. The aim of this study is to explore whether simulated patients’ feedback improves the communication skills of undergraduate medical students. During a randomized control trail a group of eighty students in the final year clerkship at Al-Nafees Medical College have participated in pre-post Objective Structured Clinical Exam (OSCE) on communication skills. The students were selected through convenience sampling technique. Four Objective Structured Clinical Exam (OSCE) stations based on different scenarios of communication skills were developed. Each station of fifteen minutes duration was assessed by both simulated patients and faculty using a validated tool LCSAS (Liverpool Communication Skills Assessment Scale). The difference between the pre and post-tests of two groups was explored by applying independent t-test. Cronbach’s alpha was used to check the reliability of scores and effect size was calculated. Results of this study have showed that there is significant improvement in communication skills after receiving feedback from simulated patients (p value ≤0.05) was observed. An overall Cronbach α = 0.83 on LCSAS reveal a high internal consistency and there was adequate demonstration of effect size(r = 0.8). The results on the scores of the students on the Liverpool Communication Skills Assessment Scale confirm that simulated patient’s feedback is essential to enhance the communication skills of the medical students. This study offers significant evidence towards successful conduction of a formal communication skills development initiative at Al-Nafees Medical College using simulated patient feedback during teaching and assessments.

    更新日期:2020-01-15
  • Fostering patient-centredness by following patients outside the clinical setting: an interview study
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-15
    Christel Grau Canét-Wittkampf; Charlotte Eijkelboom; Saskia Mol; Dorien Zwart; Iris Hendriks; Esther de Groot

    Patient-centredness is considered a core competency for health professionals. To support faculty in designing courses focused on patient-centredness, an understanding of how educational interventions lead to patient-centredness is required. This study aims to show how learning mechanisms, which potentially contribute to patient-centredness, are triggered. Thirty-five third-year medical students at the UMC Utrecht followed four different patients for two years. The intervention took place in an out-of-hospital setting. Students visited patients in their home circumstances and accompanied them to clinical events. Twelve students were interviewed. The realist approach was used to construct configurations which relate components of the intervention to the context and learning mechanisms. Following patients in their home circumstances for a prolonged period supported the development of meaningful relationships between students and patients and provided continuity. In the context of a meaningful relationship and continuity, mechanisms contributing to learning patient-centredness were triggered. The most important learning mechanisms found in this study were: reflecting, contextualising disease in a real persons’ life, broadening perspectives and engaging with the patients. Learning mechanisms are triggered by continuity and by meaningful student-patient relationships. These can be enhanced by an out-of-hospital setting and longitudinal contact. Thus, a relationship between students and patients is an important enabler for the development of patient-centredness.

    更新日期:2020-01-15
  • A qualitative analysis of junior doctors’ journeys to preparedness in acute care
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-13
    Samuel Burridge; Thurkaa Shanmugalingam; Fatima Nawrozzadeh; Kathleen Leedham-Green; Amar Sharif

    New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors’ first experiences with unwell patients and how they developed preparedness over time. We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness, first experiences of genuine preparedness, and making sense of how they became prepared. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise. Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences. Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. As preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. Our findings suggest that undergraduates may lack sufficient opportunities for scaffolded decision making in acute care, and that increasing the intensity of clinical shadowing may improve preparedness and should inform future educational interventions.

    更新日期:2020-01-14
  • A scoping review of medical education research for residents in radiation oncology
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-13
    Ching-Hsin Lee; Po-Jui Chen; Hung-Yi Lai; Ching-Yi Lee; Kang-Hsing Fan; Ngan-Ming Tsang; Joseph Tung-Chieh Chang

    Both medical education and radiation oncology have progressed significantly in the past decade, but a generalized overview of educational research for radiation oncology residents has not been produced. This study examines recent research trends in medical education for residents in radiation oncology through a scoping review. We conducted a scoping review of medical education research for residents in radiation oncology to survey the research trends. We used publications available on MEDLINE, PubMed, and Scopus to conduct this scoping review. We screened 221 full-text articles, 146 of which met our inclusion criteria. These publications showed increased activity in medical education research for residents, most involving affiliations in the United States. We identified persistent interest in training-, contouring-, and technology-related issues. An increase in research related to career, treatment quality, and multidisciplinary training was also observed. However, no research about teacher training was identified. This scoping review presents the trends in study interests among stakeholders of medical education research in radiation oncology. With an investigation of existing studies, this research identifies areas of high priority and a lack of studies about teacher training. This study provides potential future directions for medical education research for residents in radiation oncology.

    更新日期:2020-01-14
  • A non-randomised trial of video and written educational adjuncts in undergraduate ophthalmology
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-09
    H. D. Jeffry Hogg; Michael Pereira; Julian Purdy; Richard J. R. Frearson; Gordon B. Lau

    Provision of relevant pre-learning materials has been shown to increase student engagement and improve outcomes in medical education. This non-randomised study attempts to quantify the educational gains, and relative efficacy of video and written pre-learning materials, in ophthalmology undergraduate teaching. Ninety-eight final year medical students were contacted prior to their three-day ophthalmology placements at a British tertiary ophthalmology unit. All participants were sent welcome packs prior to arrival requesting they undertake 90 min of work focusing on a list of specified ophthalmic conditions. One cohort (N = 33) were sent written materials, another (N = 32) was provided with video materials and a third cohort (N = 33) were not sent any materials. On arrival participants completed a simple knowledge test, a questionnaire estimating the time they spent preparing for the placement and a self-reported knowledge score. The teaching on placement was the same for all cohorts. At the conclusion of each placement participants completed a challenging knowledge test, a clinical skills test and repeated self-reported knowledge scores. Eighty seven percent of students receiving specified materials claimed to complete pre-placement work compared to 70% of those receiving learning outcomes alone (p = 0.05). Students receiving learning materials scored higher in the post-placement tests of knowledge (p < 0.001), 74.8% (72.4–77.2%) vs 63.6% (95%CI 59.3–67.9%) and skills (p = 0.04), 86.9% (83.9–89.9%) vs 81.3% (77.2–85.4%). Students using video resources outperformed students using written materials in their visual acuity assessment test (p = 0.03), 90.4% (86.6–94.2%) vs 83.6% (80.1–87.1%) whilst those receiving written rather than video material performed better in the end of placement knowledge test (p = 0.03), 77.7% (74.3–81.1%) vs 72.0% (68.9–75.1%). This study showed that providing pre-placement learning materials improves undergraduates’ commitment and achievement. Written materials better facilitate knowledge acquisition while video materials preferentially promote skill acquisition. This is a novel demonstration within ophthalmology and can help address the imbalance between the expectations placed on undergraduates and the resources committed to ensuring they are met.

    更新日期:2020-01-11
  • Have medical students’ attitudes towards clinical communication skills changed over a 12- year period? A comparative long-term study
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-10
    Tore Gude; Reidar Tyssen; Tor Anvik; Hilde Grimstad; Are Holen; Anders Baerheim; Per Vaglum; Lise Løvseth

    Attitudes towards learning clinical communication skills at the end of medical school are likely to reflect the students’ training and motivation for the continued development of their skills as doctors. Students from two Norwegian medical schools, one with a traditional, and the other with an integrated curriculum, were approached in 2003 and 2015; with regard to changes in students’ attitudes towards acquiring communication skills in two diverse learning environments. This comparison might reveal the effects of the training programs from a long-term perspective, as neither of the medical schools made any major curriculum changes within the study period. The samples comprised final-year medical students. Two separate cross-sectional surveys performed 12 years apart (2003 and 2015) used items from the Communication Skills Attitude Scale in addition to age and gender. The traditional curriculum included only theoretical teaching and no contact with patients was made during the first 2 to 2.5 years of medical school. However, the integrated curriculum combined training in theoretical and clinical communication skills with early patient contact from the beginning. Attitudes improved from the first to the second survey at both schools, however, students from the integrated school reported more positive attitudes than those from the traditional school. Female students from the integrated school contributed the most to the difference in attitudes in both surveys. Students in both traditional and integrated curricula improved their attitudes from the first to the second assessment. However, compared with the traditional curriculum, the integrated one fostered even higher levels of positive attitudes towards acquiring communication skills, and a pronounced influence was observed on female students. These findings suggest that an educational program with greater emphasis on improving attitudes among male students may be required.

    更新日期:2020-01-11
  • Training and evaluating simulation debriefers in low-resource settings: lessons learned from Bihar, India
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-08
    Julia H. Raney; Melissa M. Medvedev; Susanna R. Cohen; Hilary Spindler; Rakesh Ghosh; Amelia Christmas; Aritra Das; Aboli Gore; Tanmay Mahapatra; Dilys Walker

    To develop effective and sustainable simulation training programs in low-resource settings, it is critical that facilitators are thoroughly trained in debriefing, a critical component of simulation learning. However, large knowledge gaps exist regarding the best way to train and evaluate debrief facilitators in low-resource settings. Using a mixed methods approach, this study explored the feasibility of evaluating the debriefing skills of nurse mentors in Bihar, India. Videos of obstetric and neonatal post-simulation debriefs were assessed using two known tools: the Center for Advanced Pediatric and Perinatal Education (CAPE) tool and Debriefing Assessment for Simulation in Healthcare (DASH). Video data was used to evaluate interrater reliability and changes in debriefing performance over time. Additionally, twenty semi-structured interviews with nurse mentors explored perceived barriers and enablers of debriefing in Bihar. A total of 73 debriefing videos, averaging 18 min each, were analyzed by two raters. The CAPE tool demonstrated higher interrater reliability than the DASH; 13 of 16 CAPE indicators and two of six DASH indicators were judged reliable (ICC > 0.6 or kappa > 0.40). All indicators remained stable or improved over time. The number of ‘instructors questions,’ the amount of ‘trainee responses,’ and the ability to ‘organize the debrief’ improved significantly over time (p < 0.01, p < 0.01, p = 0.04). Barriers included fear of making mistakes, time constraints, and technical challenges. Enablers included creating a safe learning environment, using contextually appropriate debriefing strategies, and team building. Overall, nurse mentors believed that debriefing was a vital aspect of simulation-based training. Simulation debriefing and evaluation was feasible among nurse mentors in Bihar. Results demonstrated that the CAPE demonstrated higher interrater reliability than the DASH and that nurse mentors were able to maintain or improve their debriefing skills overtime. Further, debriefing was considered to be critical to the success of the simulation training. However, fear of making mistakes and logistical challenges must be addressed to maximize learning. Teamwork, adaptability, and building a safe learning environment enhanced the quality enhanced the quality of simulation-based training, which could ultimately help to improve maternal and neonatal health outcomes in Bihar.

    更新日期:2020-01-09
  • Students’ perceptions towards self-directed learning in Ethiopian medical schools with new innovative curriculum: a mixed-method study
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-08
    Haftom Hadush Kidane; Herma Roebertsen; Cees P. M. van der Vleuten

    Self-directed learning (SDL) is an appropriate and preferred learning process to prepare students for lifelong learning in their professions and make them stay up-to-date. The purpose of this study was to explore preclinical students following a hybrid curriculum in Ethiopia experiences to SDL and the support of several learning activities from the curriculum on their SDL. A mixed-method research design was employed. Quantitative data were collected by using a self-administered questionnaire of 80 items measuring students’ perceptions on their SDL capability as well as to explore students’ views about the influence of components of the curriculum on their SDL. Additional two focus group discussions, each containing eight participants from year-1 and year− 2 students, were conducted. The quantitative data were analyzed using SPSS. The focus group discussions were reviewed, coded, and then thematically analyzed. Our study showed a significant increase in SDL score on comparing students at year-1 with students at year-2 (p = 0.002). Both year-1 and 2 students rated PBL tutorial discussion and tutors had high influence on their individual learning; whereas, other curricular components such as lectures and testes had low influence on their SDL ability. PBL tutorial discussion and module objectives showed strong correlation with students’ SDL scores, r = 0.718 & r = 0.648 (p < 0.01), respectively. Besides, PBL tutorial discussion was found strongly correlated with tutors (r = 0.599 (p < 0.01)) and module objectives (r = 0.574 (p < 0.01)). Assessment was highly correlated with lectures (r = 0.595 (p < 0.01)). Findings from qualitative data showed that certain curricular components played role in promoting students’ SDL. Tutorials analyzing problems played a major role on students’ self-directed learning abilities. Although the study implied that components of the hybrid curriculum, mainly PBL, could encourage preclinical students’ self-directed learning, the curriculum is still not free from teacher-centred culture as the majority of teachers still have high power in deciding the learning process. A further longitudinal study is needed to verify the actual level and ability of medical students’ SDL.

    更新日期:2020-01-08
  • New doctor-patient communication learning software to help interns succeed in communication skills
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-08
    Chao Sun; Junkai Zou; Lanbo Zhao; Qing Wang; Shaozhi Zhang; Qurat Ulain; Qing Song; Qiling Li

    Nowadays, the research of doctor-patient communication is becoming increasingly important not only in China but also around the world. The study designs a type of learning software to train the interns to advance their communication skills, and whose validity for improving doctor-patient communication in self-controlled trials is evaluated. With the aid of the new learning software, the self-controlled tests were carried out among 183 interns to assess the quality of their communication skill acquisition. The learning effectiveness of the preparation stage, information collection, information given, patient understanding, and inquisition ending was evaluated with the Set Elicit Give Understand End (SEGUE) framework after 3 months of training. More interns (37.16% vs. 10.98%, P < 0.001) could accurately identify the psychosocial or emotional factors contributing to the diseases. An increased number of interns (42.62% vs. 10.40%, P < 0.001) were able to openly discuss lifestyle issues and prevention strategies with patients. The study also revealed that interns who had completed training tended to allow patients more time to describe their feelings and concerns about their illnesses. In addition, more of the trained interns roved capable of being caring and respectful to patients and showing empathetic communication behavior (53.01% vs. 26.59%, P < 0.001). The doctor-patient communication software may help the interns known more about communication skills.

    更新日期:2020-01-08
  • Improving obesity management training in family medicine: multi-methods evaluation of the 5AsT-MD pilot course
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-07
    Thea Luig; Sonja Wicklum; Melanie Heatherington; Albert Vu; Erin Cameron; Doug Klein; Arya M. Sharma; Denise L. Campbell-Scherer

    Quality, evidence-based obesity management training for family medicine residents is needed to better support patients. To address this gap, we developed a comprehensive course based on the 5As of Obesity Management™ (ASK, ASSESS, ADVISE, AGREE, ASSIST), a framework and suite of resources to improve residents’ knowledge and confidence in obesity counselling. This study assessed the course’s impact on residents’ attitudes, beliefs, and confidence with obesity counselling. The course combines lectures with a bariatric empathy suit experience, standardized and in-clinic patient practice, and narrative reflections. Using a multi-methods design we measured changes in 42 residents’ attitudes, beliefs, and self-confidence and thematically analyzed the narrative reflections to understand residents’ experience with the course content and pedagogy. Following the course, residents reported improved attitudes towards people living with obesity and improved confidence for obesity counselling. Pre/post improvement in BAOP scores (n = 32) were significant (p < .001)., ATOP scores did not change significantly. Residents showed improvement in assessing root causes of weight gain (p < .01), advising patients on treatment options (p < .05), agreeing with patients on health outcomes (p < .05), assisting patients in addressing their barriers (p < .05), counseling patients on weight gain during pregnancy, (p < .05), counseling patients on depression and anxiety (p < .01), counseling patients on iatrogenic causes of weight gain (p < .01), counseling patients who have children with obesity (p < .05), and referring patients to interdisciplinary providers for care (p < .05). Qualitative analysis of narrative reflections illustrates that experiential learning was crucial in increasing residents’ ability to empathically engage with patients and to critically reflect on implications for their practice. The 5AsT-MD course has the potential to increase residents’ confidence and competency in obesity prevention and management. Findings reflect the utility of the 5As to improve residents’ confidence and competency in obesity management counselling.

    更新日期:2020-01-07
  • Validation of a competence-based assessment of medical students’ performance in the physician’s role
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-07
    Sarah Prediger; Kristina Schick; Fabian Fincke; Sophie Fürstenberg; Viktor Oubaid; Martina Kadmon; Pascal O. Berberat; Sigrid Harendza

    Assessing competence of advanced undergraduate medical students based on performance in the clinical context is the ultimate, yet challenging goal for medical educators to provide constructive alignment between undergraduate medical training and professional work of physicians. Therefore, we designed and validated a performance-based 360-degree assessment for competences of advanced undergraduate medical students. This study was conducted in three steps: 1) Ten facets of competence considered to be most important for beginning residents were determined by a ranking study with 102 internists and 100 surgeons. 2) Based on these facets of competence we developed a 360-degree assessment simulating a first day of residency. Advanced undergraduate medical students (year 5 and 6) participated in the physician’s role. Additionally knowledge was assessed by a multiple-choice test. The assessment was performed twice (t1 and t2) and included three phases: a consultation hour, a patient management phase, and a patient handover. Sixty-seven (t1) and eighty-nine (t2) undergraduate medical students participated. 3) The participants completed the Group Assessment of Performance (GAP)-test for flight school applicants to assess medical students‘ facets of competence in a non-medical context for validation purposes. We aimed to provide a validity argument for our newly designed assessment based on Messick’s six aspects of validation: (1) content validity, (2) substantive/cognitive validity, (3) structural validity, (4) generalizability, (5) external validity, and (6) consequential validity. Our assessment proved to be well operationalised to enable undergraduate medical students to show their competences in performance on the higher levels of Bloom’s taxonomy. Its generalisability was underscored by its authenticity in respect of workplace reality and its underlying facets of competence relevant for beginning residents. The moderate concordance with facets of competence of the validated GAP-test provides arguments of convergent validity for our assessment. Since five aspects of Messick’s validation approach could be defended, our competence-based 360-degree assessment format shows good arguments for its validity. According to these validation arguments, our assessment instrument seems to be a good option to assess competence in advanced undergraduate medical students in a summative or formative way. Developments towards assessment of postgraduate medical trainees should be explored.

    更新日期:2020-01-07
  • Virtual reality technology for teaching neurosurgery of skull base tumor
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-03
    Xuefei Shao; Quan Yuan; Daqing Qian; Zheng Ye; Gao Chen; Kang le Zhuang; Xiaochun Jiang; Yuelong Jin; Di Qiang

    Neurosurgery represents one of the most challenging and delicate of any surgical procedure. Skull base tumors in particular oftentimes present as a very technically difficult procedures in the setting of neurosurgical teaching. Virtual reality technology is one of the most promising surgical planning tools. It can perform fast three-dimensional (3D) reconstruction of computed tomography (CT), magnetic resonance imaging (MRI) and other imaging data sets under conditions of virtual reality (VR). Surgical simulation can more intuitively understand the anatomical relationship of the surgical area in significantly greater detail. Thirty clinical undergraduates from the class of 2016 were randomly divided into two groups: the traditional teaching group and the virtual reality teaching group. After the study concluded, the teaching effectiveness was evaluated by combining basic theoretical knowledge, case analysis and questionnaire survey methods. Comparative analysis between both groups showed the response effect of the virtual reality teaching group was better than that of the traditional teaching group (P < 0.05). There was also no difference between both groups in terms of the design of the surgical approach and the listing of surgical matters that required attention (P > 0.05).The results of theoretical knowledge assessment between both groups showed that the scores of basic theory, location, adjacent structure, clinical manifestation, diagnosis and analysis, surgical methods and total scores in the VR group exceeded those in the traditional teaching group (P < 0.05). This study showed that VR technology might improve neurosurgical skull base teaching quality, which should be promoted in the teaching of clinical subjects.

    更新日期:2020-01-04
  • A comparison of undergraduate outcomes for students from gateway courses and standard entry medicine courses
    BMC Med. Educ. (IF 1.87) Pub Date : 2020-01-03
    Sally Curtis; Daniel Smith

    Gateway courses are increasingly popular widening participation routes into medicine. These six year courses provide a more accessible entry route into medical school and aim to support under-represented students’ progress and graduation as doctors. There is little evidence on the performance of gateway students and this study compares attainment and aptitude on entry, and outcomes at graduation of students on the UK’s three longest running gateway courses with students studying on a standard entry medical degree (SEMED) course at the same institutions. Data were obtained from the UK Medical Education Database for students starting between 2007 and 2012 at three UK institutions. These data included A-levels and Universities Clinical Aptitude Test scores on entry to medical school and the Educational Performance Measure (EPM) decile, Situational Judgement Test (SJT) and Prescribing Safety Assessment (PSA) scores as outcomes measures. Multiple regression models were used to test for difference in outcomes between the two types of course, controlling for attainment and aptitude on entry. Four thounsand three hundred forty students were included in the analysis, 560 on gateway courses and 3785 on SEMED courses. Students on SEMED courses had higher attainment (Cohen’s d = 1.338) and aptitude (Cohen’s d = 1.078) on entry. On exit SEMED students had higher EPM scores (Cohen’s d = 0.616) and PSA scores (Cohen’s d = 0.653). When accounting for attainment and aptitude on entry course type is still a significant predictor of EPM and PSA, but the proportion of the variation in outcome explained by course type drops from 6.4 to 1.6% for EPM Decile and from 5.3% to less than 1% for the PSA score. There is a smaller significant difference in SJT scores, with SEMED having higher scores (Cohen’s d = 0.114). However, when measures of performance on entry are accounted for, course type is no longer a significant predictor of SJT scores. This study shows the differences of the available measures between gateway students and SEMED students on entry to their medical degrees are greater than the differences on exit. This provides modest evidence that gateway courses allow students from under-represented groups to achieve greater academic potential.

    更新日期:2020-01-04
  • Gender-based differences in letters of recommendation written for ophthalmology residency applicants
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-30
    Fei Lin; Soo Kyung Oh; Lynn K. Gordon; Stacy L. Pineles; Jamie B. Rosenberg; Irena Tsui

    To determine whether gender-based differences may be present in letters of recommendation written for ophthalmology residency applicants. All applications submitted through SF Match to the UCLA Stein Eye Institute Residency Training Program from the 2017–2018 application cycle were analyzed using validated text analysis software (Linguistic Inquiry and Word Count (Austin, TX)). The main outcome measures were differences in language use in letters of recommendation by gender of applicant. Of 440 applicants, 254 (58%) were male and 186 (42%) were female. The two gender groups had similar United States Medical Licensing Exam (USMLE) Step 1 scores, undergraduate grade point averages (uGPA’s), proportions of underrepresented minority (URM) applicants and Gold Humanism Honor Society members, numbers of academic and service activities listed, and gender distributions of their letter writers (all P values > 0.05). However, letters written for male applicants were determined to use more “authentic” words than those written for female applicants (mean difference, 0.800; 95% CI, 0.001–1.590; P = 0.047). Letters written for male applicants also contained more “leisure” words (mean difference, 0.056; 95% CI, 0.008–0.104; P = 0.023) and fewer “feel” words (mean difference, 0.033; 95% CI, 0.001–0.065; P = 0.041) and “biological processes” words (mean difference, 0.157; 95% CI, 0.017–0.297; P = 0.028). There were gender differences detected in recommendation letters in ophthalmology consistent with prior studies from other fields. Awareness of these differences may improve residency selection processes.

    更新日期:2019-12-31
  • Active learning through discussion: ICAP framework for education in health professions
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-30
    Jaeseo Lim; Hyunwoong Ko; Ji Won Yang; Songeui Kim; Seunghee Lee; Myung-Sun Chun; Jungjoon Ihm; Jooyong Park

    The ICAP framework based on cognitive science posits four modes of cognitive engagement: Interactive, Constructive, Active, and Passive. Focusing on the wide applicability of discussion as interactive engagement in medical education, we investigated the effect of discussion when it was preceded by self-study and further investigated the effect of generating questions before discussions. This study was conducted in the second semester of 2018 and was participated in by 129 students majoring in health professions, including medicine, dentistry, veterinary medicine, and nursing. The students were assigned to four different trial groups and were asked to fill out a Subjective Mental Effort Questionnaire after completing each session. Their performance in posttest scores was analyzed using Bonferroni test, and mental effort was analyzed using mediation analysis. These results indicated that the self-study and question group had the highest performance and that the lecture and summary group had the lowest performance when comparing the total score. Using the analysis of mental effort, it was confirmed that the relationship between different study conditions and post-test performance was mediated by mental effort during test. Our findings support the ICAP framework and provide practical implications for medical education, representing the fact that students learn more when they are involved in active learning activities, such as self-study and question generation, prior to discussions.

    更新日期:2019-12-31
  • Medical graduate views on statistical learning needs for clinical practice: a comprehensive survey
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-31
    Margaret MacDougall; Helen S. Cameron; Simon R. J. Maxwell

    This paper seeks to contribute to a reputable evidence base for required competencies across different topics in statistics and probability (statistical topics) in preparing medical graduates for clinical practice. This is in order to inform the prioritization of statistical topics within future undergraduate medical curricula, while exploring the need for preparing tomorrow’s doctors to be producers, and not merely consumers, of statistics. We conducted a comprehensive online survey from July 2013 to August 2014 for a target group of 462 medical graduates with current or prior experience of teaching undergraduate medical students of the University of Edinburgh of whom 278 (60.2%) responded. Statistical topics were ranked by proportion of respondents who identified the practice of statistics, performing statistical procedures or calculations using appropriate data, as a required competency for medical schools to provide in preparing undergraduate medical students for clinical practice. Mixed effects analyses were used to identify potential predictors for selection of the above competency and to compare the likelihood of this selection for a range of statistical topics versus critical appraisal. Evidence was gleaned from medical graduates’ experiences of clinical practice for the need for, not only a theoretical understanding of statistics and probability but also, the ability to practice statistics. Nature of employment and statistical topic were highly significant predictors of choice of the practice of statistics as a required competency ((F = 3.777, p < 0.0005) and (F = 45.834, p < 0.0005), respectively). The most popular topic for this competency was graphical presentation of data (84.3% of respondents) in contrast to cross-over trials for the competency understanding the theory only (70.5% of respondents). Several topics were found to be more popular than critical appraisal for competency in the practice of statistics. The model of medical graduates as mere consumers of statistics is oversimplified. Contrary to what has been suggested elsewhere, statistical learning opportunities in undergraduate medicine should not be restricted to development of critical appraisal skills. Indeed, our findings support development of learning opportunities for undergraduate medical students as producers of statistics across a wide range of statistical topics.

    更新日期:2019-12-31
  • Students with specific learning disabilities experiences of pre-registration physiotherapy education: a qualitative study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-31
    M. Norris; J. Hammond; A. Williams; S. Walker

    Attainment gaps for students with disabilities have been noted in pre-registration physiotherapy courses in the UK. Previous research suggests disclosure, lack of staff knowledge and poor communication between University and placement sites may be relevant, but these are limited to small case studies with students with visual or physical disabilities. The purpose of this study was to explore disabled physiotherapy students’ experiences of their education in order to elucidate factors that may influence success. Qualitative study drawing on phenomenological traditions. Four focus groups including 15 students with disabilities were conducted. Transcripts were analysed thematically. Procedures for transparency and rigour such as member checking and peer debriefing were implemented. Three major themes were derived from data. “It was quite a relief” explores the personal and social implications of diagnosis. “They’re not natural” focuses on academic assessment and the specifics of adjustments made and not made within that context. “My dyslexia doesn’t switch off” explores the inaccessibility of the learning environment and dissects the contrast between the 24-h nature of having a specific learning condition and the somewhat piecemeal nature of adjustments during their education. This study indicates that having a specific learning disability or anxiety creates a number of hurdles to success in physiotherapy education. Most were within the University setting and were perceived to result from staff ignorance or piecemeal approaches to inclusion. A lack of consistency alongside facilitated dialogue and acknowledgement of enhancements results in frustration, ambiguity towards disclosure and reinforcement of a deficit model. Such an approach belies the intention of the profession and the NHS and does not maximise the potential of widening participation.

    更新日期:2019-12-31
  • Mento’s change model in teaching competency-based medical education
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-27
    Yajnavalka Banerjee; Christopher Tuffnell; Rania Alkhadragy

    Resistance to change is customary and is expected in any organization. However, most of the downsides of change can be avoided if the organization/individual prepares for the change by acknowledging guided strategies. In healthcare, change is the state of nature, which has also translated to medical education (ME). ME in the current era has undergone a shift from a traditional content-based curriculum to a competency-based curriculum. Recently, however, the broader social-accountability movement has accelerated this rate of transformation. One of the key challenges to educators harbingering this transformation to competency-based medical education (CBME) is to redesign the processes of teaching. Here we define a framework designed using Mento’s model of change that will totally agree with introducing positive change in teaching in an institution undergoing transformation from a traditional content-based curriculum to a competency-based curriculum. Using Schein’s “unfreezing” as a guide term we critically reflected on the popular change-management models, to home in on Kotter’s model of change to transform organizations. However, Kotter’s change-model draws from Situational and Contingency Leadership Theories, which may not agree with academic organizations involved in ME. As such organizations adhere to Transactional and Transformational Leadership archetypes, where Leadership is constructively executed by “The Leader Team”, we decided to adopt Mento’s change-model for our study. Mento’s model not only draws from the precepts of Kotter’s model, but also incorporates axioms of Jick’s and GE’s change-models. Using Mento’s model a framework was blueprinted to implement active learning (AL) strategies in CBME. Here we have elaborated on the framework using the exemplar of flipped teaching. The development of this framework required the design and execution of a faculty development program, and a step by step guidance plan to chaperon, instruct and implement change in teaching to harbinger CBME. Further, we have also reflected on the change process using Gravin’s framework. To our knowledge this is the first report of the use of Mento’s model of change in medical education. Also, the blueprinted framework is supported by acknowledged leadership theories and can be translated to implement any curricular change in CBME.

    更新日期:2019-12-30
  • Medical students’ resilience: a protective role on stress and quality of life in clerkship
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-27
    Yung Kai Lin; Chia-Der Lin; Blossom Yen-Ju Lin; Der-Yuan Chen

    Resilience refers to the ability to be flexible and adaptive in response to challenges. Medical students in clerkship who are transitioning from medical studies to clinical practice face a variety of workplace demands that can lead to negative learning experiences and poor quality of life. This study explored whether medical students’ resilience plays a protective role against the stresses incurred during workplace training and on their professional quality of life during clerkships. This was a 1-year prospective web-based questionnaire study comprising one cohort of medical students in their fifth year who were working as clerks as part of their 6-year medical education programme at one medical school in Taiwan between September 2017 and July 2018. Web-based, validated, structured, self-administered questionnaires were used to measure the students’ resilience at the beginning of the clerkship and their perceived training stress (i.e. physical and psychological demands) and professional quality of life (i.e. burnout and compassion satisfaction) at each specialty rotation. Ninety-three medical students who responded to our specialty rotation surveys at least three times in the clerkship were included and hierarchical regressions were performed. This study verified the negative effects of medical students’ perceived training stress on burnout and compassion satisfaction. However, although the buffering (protective) effects of resilience were observed for physical demands (one key risk factor related to medical students’ professional quality of life), this was not the case for psychological demands (another key risk factor). In addition, through the changes in R square (∆R2) values of the hierarchical regression building, our study found that medical students’ perceived training stresses played a critical role on explaining their burnout but their resilience on their compassion satisfaction. Medical students’ resilience demonstrated a buffering effect on the negative relationship between physical demands and professional quality of life during clerkships. Moreover, different mechanisms (predictive paths) leading to medical students’ professional quality of life such as burnout and compassion satisfaction warrant additional studies.

    更新日期:2019-12-30
  • Orthopaedic residents demonstrate retention of point of care ultrasound knowledge after a brief educational session: a quasi experimental study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-30
    Samuel Larrivée; Robyn Rodger; Patricia Larouche; Jeff Leiter; Tomislav Jelic; Peter MacDonald

    Musculoskeletal point of care ultrasound (MSK POCUS) has many uses for orthopaedic surgeons, but orthopaedic trainees are rarely exposed to this modality. The purpose of this project was to assess the usefulness in clinical education of a newly implemented MSK POCUS course in an orthopaedic surgery program. An MSK POCUS course for orthopaedic surgery residents was developed by an interdisciplinary team. Online videos were created to be viewed by residents prior to a half-day long practical course. An online survey covering the level of training of the resident and their previous use of ultrasound (total hours) was completed by the participants prior to the course. Resident’s knowledge acquisition was measured with written pre-course, same-day post-course and six-month follow-up tests. Residents were also scored on a practical shoulder examination immediately after the course and at six-month follow-up. Changes in test scores between time points were evaluated using Wilcoxon signed-rank tests. Ten orthopaedic surgery residents underwent the MSK POCUS curriculum. Pre-course interest in MSK-POCUS was moderate (65%) and prior exposure was low (1.5 h mean total experience). Written test scores improved significantly from 50.7 ± 17.0% before to 84.0 ± 10.7% immediately after the course (p < 0.001) and suffered no significant drop at 6 months (score 75.0 ± 8.7%; p = 0.303). Average post-course practical exam score was 78.8 ± 3.1% and decreased to 66.2 ± 11.3% at 6 months (p = 0.012). Residents significantly improved their subjective comfort level with all aspects of ultrasound use at 6 months (p = 0.007–0.018) but did not significantly increase clinical usage frequency. An MSK POCUS curriculum was successfully developed and implemented using an interdisciplinary approach. The course succeeded in improving the residents’ knowledge, skills, and comfort with MSK POCUS. This improvement was maintained at 6 months on the written test but did not result in higher frequency of use by the residents.

    更新日期:2019-12-30
  • Happiness and physical activity levels of first year medical students studying in Cyprus: a cross-sectional survey
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-30
    Joshua J. Fisher; Daphne Kaitelidou; George Samoutis

    Levels of physical activity and happiness may impact the health and performance of future doctors. The specific relationship between physical activity and happiness among first year medical students is unclear. The purpose of this study was to investigate these variables and how they relate within first year, graduate entry Bachelor of Medicine, Bachelor of Surgery students studying in Cyprus. Self-administered questionnaires were provided for all first year medical students at the St. George’s University of London medical programme delivered by the University of Nicosia Medical School in Cyprus. Physical activity was assessed using the International Physical Activity Questionnaire Short Form and happiness was assessed using the Short Depression Happiness Scale. Surveys were completed by 79 of the 120 students (median age of 24 years). Happiness and continuous measures of physical activity amounts were investigated using spearman’s rank-order correlation. Mann-Whitney U Tests were used to make further comparisons between the physical activity levels across happy and depressed groups and gender, as well as to compare the levels of happiness reported by each gender. High levels of physical activity were evident in 60.8% of students. Results suggested depression among 15.2% of students. A positive correlation was observed between happiness and amount of vigorous intensity physical activity among female students (p < 0.05), but not males. Happy females performed more vigorous physical activity than depressed females (p < 0.05). The total amount of physical activity performed, as well as level of happiness, did not significantly differ between genders. A relationship exists between physical activity and happiness among female first year medical students. The intensity of physical activity may play an important role within this group. There appears to be relatively high levels of physical activity and low levels of depression among male and female first year medical students studying in Cyprus. This study provides new knowledge regarding relationships between happiness and physical activity among first year medical students, and is also the first characterization of happiness and physical activity habits among students in Cyprus. This may help to inform future policies aimed at promoting health and wellness within student communities.

    更新日期:2019-12-30
  • Would you do it again? A qualitative study of student and supervisor perceptions of an intercalated MBChB/PhD programme
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-26
    Yassar Alamri; Kate Magner; Tim J. Wilkinson

    Several studies have warned about the diminishing physician-scientist breed. Limited studies, however, have attempted to assess what factors (if any) enhanced or hindered the experience of trainee physician-scientists and their supervisors. Using Vroom’s expectancy theory as a conceptual framework, we explored the highlights, motivations and barriers of an intercalated MBChB/PhD programme as experienced by students of the programme and their supervisors. Previous and current students of the MBChB/PhD programme at the University of Otago, and their supervisors, were invited to provide comments on the programme. Data were analysed using a general inductive approach which involved coding responses, and grouping codes into common themes via an iterative process. A deductive approach was used to interpret the themes and relate them to Vroom’s expectancy theory. A total of 22 students (88% response rate) and 36 supervisors (58.3% response rate) responded to our survey. Three themes were identified through the analysis of the students’ responses. These were: motives for undertaking the intercalated degree, effect on career development, and perceived barriers. Supervisors’ survey yielded two themes: characteristics of successful students, and optimising the intercalated programme. The current study sheds light on the successes and challenges of an intercalated MBChB/PhD programme by considering the views of those most involved. Whereas the combined programme has its advantages for student research and career development, extending the research-time may be worthwhile. Further studies involving a larger cohort of intercalating students and their supervisors may allow for extrapolation of data to address these concerns.

    更新日期:2019-12-27
  • Correction To: Effects of a lifestyle intervention in routine care on prenatal physical activity – findings from the cluster-randomised GeliS trial
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-24
    Julia Hoffmann; Julia Günther; Kristina Geyer; Lynne Stecher; Kathrin Rauh; Julia Kunath; Dorothy Meyer; Christina Sitzberger; Monika Spies; Eva Rosenfeld; Luzia Kick; Renate Oberhoffer; Hans Hauner

    Following publication of the original article [1], the author notified us about incorrectly formatted of Table 2 and Table 3.

    更新日期:2019-12-25
  • Health numeracy skills of medical students:cross-sectional and controlled before-and-after study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-21
    Ivan Buljan; Ružica Tokalić; Matko Marušić; Ana Marušić

    Although numeracy, defined as understanding and handling numbers, is an important skill for the medical profession, it is not clear whether it changes during graduate medical education and whether it can be improved by specific interventions. The objective of this study was to assess objective and subjective numeracy levels at different stages of medical education and explore whether a research methodology/statistics course improves numeracy levels in a longer period. We performed cross-sectional and controlled before-and-after studies. First-year sociology students and first- to sixth-year medical students from the in the cross sectional study and two groups of first-year medical students in a controlled before-and-after study. The intervention was a course on biostatistics and research methodology using blended approach. Numeracy was measured using Subjective Numeracy Scale (Cronbach α = 0.70) and Numeracy Understanding in Medicine instrument (Cronbach α = 0.75). Whereas first-year medical students did not differ from first-year sociology students in objective numeracy, medicine students had higher results on subjective numeracy. Students from higher years of medical school had generally higher subjective and objective numeracy scores. In the controlled before-and-after study, the intervention group improved more in subjective numeracy (median difference on a 0–8 scale = 0.5, 95% CI 0.3 to 0.7 vs − 0.4, 95% CI − 0.4 to − 0.1, P < 0.001) but not in objective numeracy. Although the numeracy levels at the beginning of the medical school are within the range of non-medical population, both objective and subjective numeracy improve during the higher years of medical school. Curriculum during medical school may help in numeracy increase, while research methodology training may help to increase subjective but not objective numeracy skills.

    更新日期:2019-12-21
  • Impact of faculty development programme on self-efficacy, competency and attitude towards medical education in Bhutan: a mixed-methods study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-21
    Karma Tenzin; Thinley Dorji; Tshering Choeda; Krit Pongpirul

    Soon after Bhutan’s first medical university was established in 2012, Faculty Development Programmes (FDPs) were adopted for efficient delivery of postgraduate medical curriculum. Medical education was an additional responsibility for the clinicians who already had multi-dimensional roles in the healthcare system where there is acute shortage of healthcare professionals. We studied the impact of FDPs on postgraduate medical education in Bhutan. This was a mixed-methods study with a quantitative (cohort study – quasi-experimental with 18 participants) and concurrent explanatory qualitative component (focused group discussion (FGD) with 11 teaching faculty members). The 18 participants were given a structured FDP designed by the University. The FGD assessed teacher self-efficacy and competency using standard tools before and after the FDP. Thematic analysis of the FGD explored the impact of FDPs in the delivery of postgraduate residency programmes. There were significant increase in the teacher self-efficacy (31 vs 34, p = 0.009) and competency scores (56 vs 64, p = 0.011). There were significant improvements in self-efficacy in the domain of the teaching relevant subject contents and developing creative ways to cope with system constraints. In teaching-learning assessments, there was a significant appreciation of the effectiveness of lectures and tutorials and the use of essay questions. The FGD demonstrated the acceptance of FDPs and its importance in quality improvement of postgraduate medical education, professional development of teachers and improvement of their communication skills. The teachers have now migrated from the conventional methods of teaching to workplace-based teaching and assessment. The FDPs also resulted in review and revision of postgraduate medical curriculum soon after the first batch graduated in 2018. Lack of adequate support from relevant stakeholders and lack of a medical education centre in the University were seen as major challenges. The FDPs have brought tangible professionalization of postgraduate medical education at an early stage of the medical university. There is a need for continued efforts to strengthen, sustain and consolidate the gains made thus far.

    更新日期:2019-12-21
  • Predictive factors of success at the French National Ranking Examination (NRE): a retrospective study of the student performance from a French medical school
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-21
    Martin Lhuaire; Moustapha Dramé; Mikael Hivelin; Thomas Levasseur; Quentin Maestraggi; Vincent Hunsinger; Peter Abrahams; Laurent Lantieri; Daniele Sommacale

    The national ranking examination (NRE) marks the end of the second cycle (6th university year) of French medical studies and ranks students allowing them to choose their specialty and city of residency. We studied the potential predictive factors of success at the 2015 NRE by students attending a French School of Medicine. From March 2016 to March 2017, a retrospective study of factors associated with the 2015 NRE success was conducted and enrolled 242 students who attended their sixth year at the school of medicine of Reims. Demographic and academic data collected by a home-made survey was studied using univariate and then multivariate analysis by generalized linear regression with a threshold of p < 0.05 deemed significant. The factors independently associated with a better ranking at the NRE were the motivation for the preparation of the NRE (gain of 3327 ± 527 places, p < 0.0001); to have participated in the NRE white test organized by la Revue du Praticien in November 2014 (gain of 869 ± 426 places, p < 0.04), to have participated in the NRE white test organized by la conférence Hippocrate in March 2015 (+ 613 places ±297, p < 0.04). The factors independently associated with poor NRE ranking were repeating the first year (loss of 1410 places ±286, p < 0.0001), repeating a year during university course (loss of 1092 places ±385, p < 0.005), attendance of hospital internships in 6th year (loss of 706 places ±298, p < 0.02). The student motivation and their white tests completion were significantly associated with success at the NRE. Conversely, repeating a university year during their course and attendance of 6th year hospital internships were associated with a lower ranking.

    更新日期:2019-12-21
  • Remote assessment via video evaluation (RAVVE): a pilot study to trial video-enabled peer feedback on clinical performance
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-18
    Kendall Ho; Christopher Yao; Helen Novak Lauscher; Barry E. Koehler; Kamran Shojania; Shahin Jamal; David Collins; Raheem Kherani; Graydon Meneilly; Kevin Eva

    Video review processes for evaluation and coaching are often incorporated into medical education as a means to accurately capture physician-patient interactions. Compared to direct observation they offer the advantage of overcoming many logistical challenges. However, the suitability and viability of using video-based peer consultations for professional development requires further investigation. This study aims to explore the acceptability and feasibility of video-based peer feedback to support professional development and quality improvement in patient care. Five rheumatologists each provided four videos of patient consultations. Peers evaluated the videos using five-point scales, providing annotations in the video recordings, and offering recommendations. The rheumatologists reviewed the videos of their own four patient interactions along with the feedback. They were asked to document if they would make practice changes based on the feedback. Focus groups were conducted and analysed to explore the effectiveness of video-based peer feedback in assisting physicians to improve clinical practice. Participants felt the video-based feedback provided accurate and detailed information in a more convenient, less intrusive manner than direct observation. Observations made through video review enabled participants to evaluate more detailed information than a chart review alone. Participants believed that reviewing recorded consultations allowed them to reflect on their practice and gain insight into alternative communication methods. Video-based peer feedback and self-review of clinical performance is an acceptable and pragmatic approach to support professional development and improve clinical care among peer clinicians. Further investigation into the effectiveness of this approach is needed.

    更新日期:2019-12-19
  • Simulation-based education improves student self-efficacy in physiotherapy assessment and management of paediatric patients
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-16
    Judith Hough; Daniel Levan; Michael Steele; Kristine Kelly; Megan Dalton

    The Australian Physiotherapy Council mandates that physiotherapy clinical education be sufficient to produce graduates who are competent to practice across the lifespan. Due to a lack of opportunities for paediatric clinical placements, there is a risk of graduates not having the opportunity to develop competency in paediatric physiotherapy. To address this risk, simulation-based education (SBE) has been proposed as an educational strategy to address the placement shortfall. Despite encouraging evidence for its use in physiotherapy education, there is limited evidence supporting its use specifically in paediatric populations. The aims of this research were to investigate the effect of SBE on student self-efficacy in the physiotherapy assessment and management of paediatric clients, and to determine student satisfaction with SBE as a learning strategy. Three interactive SBE sessions were run during the undergraduate paediatric physiotherapy unit at the campus of one Australian university. Self-efficacy was surveyed before and after each session, to determine confidence in clinical skills, clinical decision-making, treatment preparation and planning, communication skills; evaluating and modifying interventions, and interprofessional practice. Student satisfaction with SBE as a learning strategy was surveyed after the final SBE session. For the 164 participants included in this study, self-efficacy survey response rate varied from 77 to 96% for each session. Significant increases in mean student self-efficacy were recorded for all questions (p < 0.001). A total of 139 (85%) responded to the learning reactionnaire with 78.6% indicating they were very satisfied with SBE as a learning strategy. Written comments from 41 participants identified ‘experience’ as the primary theme. SBE had a significant positive effect on student self-efficacy in the physiotherapy assessment and management of paediatric patients. Students also perceived SBE to be a valuable learning experience. Future research is needed to investigate whether the improvement in self-efficacy achieved through SBE translates into improved student performance during workplace-based clinical placements.

    更新日期:2019-12-17
  • Self-perceived competencies in the diagnosis and treatment of mental health disorders among general practitioners in Lima, Peru
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-16
    Jessica Hanae Zafra-Tanaka; Kevin Pacheco-Barrios; Fiorella Inga-Berrospi; Alvaro Taype-Rondan

    To assess the self-perceived competencies in diagnosing and treating patients with mental health disorders, among recently graduated general practitioners (GPs) from Lima, Peru. A cross-sectional study was performed in April 2017 at a General Practitioner’s meeting held for those who were going to perform the social service, by the Peruvian College of Physicians in Lima. Attendees were invited to answer a questionnaire that evaluated their self-perception of competence in diagnosing and treating four different mental health disorders; major depression, anxiety disorder, alcohol dependence, and schizophrenia. Out of 434 evaluated GPs, the following percentages were self-perceived as competent in their adequate diagnosis of depression (70.5%), anxiety (73.3%), alcohol dependence (67.6%), and schizophrenia (62.0%). Concerning pharmacological treatment, these percentages were 46.6, 47.5, 39.0 and 37.6%, respectively. Referring to all the studied mental disorders, 41.6% of participants self-perceived competence in providing an adequate diagnosis, 36.1% in providing non-pharmacological treatment, and 20.1% in providing pharmacological treatment. The rate of adequate self-perceived competences was higher for diagnosis than for treatment of patients with mental health disorders. These results highlight the importance of designing and implementing interventions to improve medical education so as to develop the skills necessary to confront mental health disorders.

    更新日期:2019-12-17
  • A novel approach to the program evaluation committee
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-16
    Amy R. Schwartz; Mark D. Siegel; Alfred Ian Lee

    The Accreditation Council for Graduate Medical Education requires each residency program to have a Program Evaluation Committee (PEC) but does not specify how the PEC should be designed. We sought to develop a PEC that promotes resident leadership and provides actionable feedback. Participants were residents and faculty in the Traditional Internal Medicine residency program at Yale School of Medicine (YSM). One resident and one faculty member facilitated a 1-h structured group discussion to obtain resident feedback on each rotation. PEC co-facilitators summarized the feedback in written form, then met with faculty Firm Chiefs overseeing each rotation and with residency program leadership to discuss feedback and generate action plans. This PEC process was implemented in all inpatient and outpatient rotations over a 4-year period. Upon conclusion of the second and fourth years of the PEC initiative, surveys were sent to faculty Firm Chiefs to assess their perceptions regarding the utility of the PEC format in comparison to other, more traditional forms of programmatic feedback. PEC residents and faculty were also surveyed about their experiences as PEC participants. The PEC process identified many common themes across inpatient and ambulatory rotations. Positives included a high caliber of teaching by faculty, highly diverse and educational patient care experiences, and a strong emphasis on interdisciplinary care. Areas for improvement included educational curricula on various rotations, interactions between medical and non-medical services, technological issues, and workflow problems. In survey assessments, PEC members viewed the PEC process as a rewarding mentorship experience that provided residents with an opportunity to engage in quality improvement and improve facilitation skills. Firm chiefs were more likely to review and make rotation changes in response to PEC feedback than to traditional written resident evaluations but preferred to receive both forms of feedback rather than either alone The PEC process at YSM has transformed our program’s approach to feedback delivery by engaging residents in the feedback process and providing them with mentored quality improvement and leadership experiences while generating actionable feedback for program-wide change. This has led to PEC groups evaluating additional aspects of residency education.

    更新日期:2019-12-17
  • Influence of psychiatric or social backgrounds on clinical decision making: a randomized, controlled multi-centre study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-12
    Yosuke Yamauchi; Takashi Shiga; Kiyoshi Shikino; Takahiro Uechi; Yasuaki Koyama; Nobuhiko Shimozawa; Eiji Hiraoka; Hiraku Funakoshi; Michiko Mizobe; Takahiro Imaizumi; Masatomi Ikusaka

    Frequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians’ negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians’ decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient. A randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia). A total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p < 0.001 partial η2 = 0.063). Post hoc pairwise multiple comparison test, Sidak test, showed a significant difference between schizophrenia and no bias condition (p < 0.05). The ratings for patient likability were lower in the biased vignettes compared to the neutral vignettes, which was associated with the lower utilization of medical resources by the physicians. Additional background information on past medical history of schizophrenia increased physicians’ mistakes in decision making. Patients’ psychiatric backgrounds should not bias physicians’ decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.

    更新日期:2019-12-13
  • Factors related to the role of programme directors in association with quality in postgraduate medical education – a cross-sectional study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-12
    Hanna Wijk; Sari Ponzer; Hans Järnbert-Pettersson; Lars Kihlström; Jonas Nordquist

    Educational leaders have been pointed out as being important for quality of medical education. However, their actual influence on the education can be limited. At the postgraduate level, educational leadership and its connection with quality is underexplored and knowledge about how to increase its impact is lacking. An increased understanding could be used in order to prioritize actions for strengthening the role. The aim of this study was to investigate factors related to the role of programme director associated with quality in postgraduate medical education. A cross-sectional study was carried out. A questionnaire was sent to programme directors in Sweden (n = 519) comprising questions about background factors, work characteristics, work tasks, hindering and enabling factors, and the Utrecht Work Engagement Scale. A logistic regression and classification tree were used to identify factors associated with high qualitative education, defined as compliance with national regulations. The response rate was 54% (n = 279). In total, 62% of the programme directors reported high quality and factors associated with high quality included experiences of communication with residents, superiors and supervisors, and support from the supervisors. Other factors were consensus regarding postgraduate medical education at the workplace, adequate financial resources, the programme directors’ competence, and their perceived impact on education. Factors of particular importance seemed to differ depending on whether the programme directors were responsible for one or for multiple units. Most high-quality education was found in cases where programme directors were responsible for a single unit and perceived sufficient impact on education. These results indicated that there was an association between factors related to programme director and quality in postgraduate medical education. The findings pointed out the importance of combining activities at both individual, group and organizational levels. Relational aspects should not be underestimated; faculty development and involvement are crucial.

    更新日期:2019-12-13
  • Implementing a clinical-educator curriculum to enrich internal medicine residents’ teaching capacity
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-11
    Yacob Habboush; Alexis Stoner; Claribel Torres; Sary Beidas

    Physicians-in-training (residents) are typically the primary educators for medical students during clinical clerkships. However, residents are not formally trained to teach or to assess their teaching. The aim of this study was to assess the implementation of a clinical educator rotation aimed at developing residents’ competencies related to clinical teaching. A mixed-methods approach was used to develop and assess the clinical educator rotation at a teaching community hospital. Internal medicine residents who participated in the rotation and consented to the research were assigned to the clinical educator trainee (CET) group, the remaining residents were assigned to the control group. Osteopathic medical students rotating in the medicine service line were invited to participate. The study used descriptive and qualitative analyses to measure primary and secondary outcomes. The primary outcome measure showed a positive change in resident knowledge, skills and behaviors in communication, reflection, feedback, precepting, and facilitation. Medical student perceptions of resident teaching skills confirmed the observed changes in CETs. Some CETs continued to practice and build their capacity for teaching after completing the rotation. Qualitatively, we derived four common themes among the data; communication, professional engagement, practice-based learning, and systems-based learning. Resident teaching capacity was enriched after completing the clinical educator rotation. Other benefits included: enhanced patient communication and education, increased resident confidence, personal satisfaction with training, work life-balance and enhanced career satisfaction. Future research should focus on curricular content, faculty development, and delivery assessment. In addition, research efforts should identify appropriate emerging technologies to include in the curriculum for enhancing teaching capacity.

    更新日期:2019-12-11
  • Medical education trends for future physicians in the era of advanced technology and artificial intelligence: an integrative review
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-11
    Eui-Ryoung Han; Sanghee Yeo; Min-Jeong Kim; Young-Hee Lee; Kwi-Hwa Park; Hyerin Roh

    Medical education must adapt to different health care contexts, including digitalized health care systems and a digital generation of students in a hyper-connected world. The aims of this study are to identify and synthesize the values that medical educators need to implement in the curricula and to introduce representative educational programs. An integrative review was conducted to combine data from various research designs. We searched for articles on PubMed, Scopus, Web of Science, and EBSCO ERIC between 2011 and 2017. Key search terms were “undergraduate medical education,” “future,” “twenty-first century,” “millennium,” “curriculum,” “teaching,” “learning,” and “assessment.” We screened and extracted them according to inclusion and exclusion criteria from titles and abstracts. All authors read the full texts and discussed them to reach a consensus about the themes and subthemes. Data appraisal was performed using a modified Hawker ‘s evaluation form. Among the 7616 abstracts initially identified, 28 full-text articles were selected to reflect medical education trends and suggest suitable educational programs. The integrative themes and subthemes of future medical education are as follows: 1) a humanistic approach to patient safety that involves encouraging humanistic doctors and facilitating collaboration; 2) early experience and longitudinal integration by early exposure to patient-oriented integration and longitudinal integrated clerkships; 3) going beyond hospitals toward society by responding to changing community needs and showing respect for diversity; and 4) student-driven learning with advanced technology through active learning with individualization, social interaction, and resource accessibility. This review integrated the trends in undergraduate medical education in readiness for the anticipated changes in medical environments. The detailed programs introduced in this study could be useful for medical educators in the development of curricula. Further research is required to integrate the educational trends into graduate and continuing medical education, and to investigate the status or effects of innovative educational programs in each medical school or environment.

    更新日期:2019-12-11
  • Advancing the understanding of research during medical education through collaborative learning: the Collaboration of Practitioners and Researchers Seminar Series
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-10
    Charles Yin; Alexander J. Moszcyznski; Jessica N. Blom; Tristan P. E. Johnson; Douglas L. Jones

    The Collaboration of Practitioners and Researchers Seminar Series is student-led program comprised of seminars delivered jointly by medical and graduate students on a topic in medicine of mutual interest to an audience of both medical and graduate students. Following its inaugural year in 2016–2017, we evaluated changes in attendees’ perceived understanding of translational research through an electronic survey and semi-structured interviews with attendees. Study participants rated their understanding of translational research and comfort with interacting with students from the other program higher following attending seminars. Participants believed that the seminars helped in breaking barriers between medical and graduate students. We conclude that this seminar series positively impacted attendees’ understanding of translational research and attitudes towards collaboration between medical and graduate students. We believe that similar initiatives may be of value in fostering new opportunities for collaboration between medical and graduate students at other institutions.

    更新日期:2019-12-11
  • Supervised practice program guided by the Accreditation Council for Education in Nutrition and Dietetics standards improves potential employability of nutrition/dietetics graduates: perspective of employers and preceptors
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-10
    Hiba Bawadi; Ghadir Fakhri Al-Jayyousi; Xiangyun Du; Vijay Ganji; Abdelhamid Kerkadi; Joyce Moawad; Taghreed Abunada

    This study investigated employers’ perspectives on the impact of a supervised practice program (SPP), guided by international accreditation standards on the skill development and potential employability of dietetics students. This study was based on qualitative research. Fifteen potential employers, who also served as SPP preceptors, participated in this study. Participants were interviewed using semi-structured questionnaire. All interviews were conducted face-to-face by a trained interviewer. Participates were invited to discuss their own experiences in the current SPP, their perceptions of the impact of SPP on skills and attributes of graduates, and their overall ideas of how SPP may contribute to the employability of graduates. This study found that the SPP program guided by international accreditation standards shaped the duties and responsibilities of preceptors/supervisors and promoted a beneficial relationship between preceptors and SPP students. The benefits to graduates include bridging the gap between classroom didactic knowledge and practice; improving workplace self-confidence; developing competencies such as critical-thinking, communication, interviewing, and counselling skills in various multidisciplinary and multicultural settings. In addition, the preceptors suggested that accreditation-guided SPP contributes to the employability of graduates. Also, they opined that it reduced the need for orientation and shortened the probation time because students were familiar with the work environment and work flow. This lead to the improved preparedness for work. SPP based on set of competencies guided by international accreditation standards provides an up-to-date curriculum, improves the quality of the nutrition and dietetics services, and increases the potential employability of the graduates.

    更新日期:2019-12-11
  • Uses of quick response codes in healthcare education: a scoping review
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-06
    Chiraag Thakrar Karia; Andrew Hughes; Sue Carr

    To review published literature on the use of quick response (QR) codes within healthcare education. In addition, the authors aimed to gain information on user perceptions and the challenges faced when implementing QR codes in an educational context. Medline, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), HMIC (Healthcare Management Information Consortium) and HBE (Health Business Elite) were searched using specified search terms that included ‘quick response code’ and ‘education’. Title and abstract review of 217 publications was performed. Papers which discussed the application of QR codes relevant to healthcare education were included. A total of 24 articles were reviewed and thematic analysis conducted to generate themes. Use of QR codes in healthcare education were broadly aligned to four common themes. These included: to increase participant engagement, for simulation training, for just-in-time (JIT) learning and to facilitate with administrative tasks in training. Perceptions towards the use of QR codes was generally positive. Challenges identified, included: problems with technical infrastructure, unavailability of smartphones and resistance to use in certain environments. The use of QR codes for healthcare education is increasing, and whilst they offer some advantages there are also some important considerations including: provision of the necessary technological infrastructure, patient and staff safety and governance and adherence to guidelines on safe and appropriate use of this technology in sensitive settings.

    更新日期:2019-12-06
  • Learning and coping through reflection: exploring patient death experiences of medical students
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-04
    Travuth Trivate; Ashley A Dennis; Sarah Sholl; Tracey Wilkinson

    Existing studies have explored many aspects of medical students’ experiences of patient death and propose the importance of faculty support for coping. However, UK-based literature on this subject and research concerning learning through reflection as part of coping are relatively limited. This study, through the lens of reflection, aims to explore students' experiences with patient death in a UK context. These include coping strategies, support from faculty following patient death and the relationship between these experiences and learning. Our research questions were: We employed narrative inquiry to explore how medical students made sense of their experiences of patient death. Twelve students participated in our study via an online narrative questionnaire. Thematic analysis and complementary narrative analysis of an exemplar were applied to address our research aim. Coping strategies comprised internal and external strategies. Internal strategies included (1) re-interpretation of the death into a meaningful experience including lessons learned; (2) normalization; (3) staying busy and (4) enduring negative emotions. External strategies included speaking to someone, which was found to influence normalization, and lessons learned. Both satisfactory and unsatisfactory support from ward staff was identified. Satisfactory support was characterized by the inclusion of emotional and professional support. Unsatisfactory support was often characterized by a lack of emotional support. Narrative analysis further demonstrated how the experience with patient death was re-interpreted meaningfully. Students suggested that support should be structured, active, sensitive, and include peers and near-peers. Many coping strategies, internal and external, were employed in students’ experiences with patient death. Student reflections, enhanced by support from ward staff, were shown to be important for learning from patient death. We encourage faculty to have regular sessions in which medical students can reflect on the death incident and discuss appropriately with others, including peers and near-peers.

    更新日期:2019-12-05
  • The timing of testing influences skill retention after basic life support training: a prospective quasi-experimental study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-04
    Enikő Kovács; Zsigmond Máté Jenei; Katalin Csordás; Gábor Fritúz; Balázs Hauser; V. Anna Gyarmathy; Endre Zima; János Gál

    Proper basic life support (BLS) is key in improving the survival of out-of-hospital cardiac arrest. BLS skills deteriorate in three to 6 months after training. One method to improve skill retention may be using the “testing effect” to test skills at the end of a BLS course. The aim of our study was to investigate whether either testing or the timing of such testing after BLS training have any influence on skill retention. This was a post-test only, partial coverage, prospective quasi-experimental study designed to evaluate a BLS training course among 464 fifth year medical students at Semmelweis University in the first semester of 2013/2014. Groups were systematically but non-randomly assigned to either a control group that took no exam or one of two experimental groups that took an exam (N = 179, NoExam group; N = 165, EndExam group – exam at the end of the BLS training; N = 120, 3mExam group – exam 3 months after the BLS training). The ability to perform ten prescribed essential BLS steps was evaluated during a skill retention assessment 2 months after the course in the NoExam, 2 months after the course (and the exam) in the EndExam and 5 months after the course (2 months after the exam) in the 3mExam group to measure skill retention and the effect of our intervention. Scores were calculated for each BLS step, and also summed up as a total score. We used Kruskal-Wallis test to assess differences in skill retention. Overall, NoExam and EndExam groups showed similar skill retention. The mean total score (and many of the sub-scores) of students was significantly higher in the 3mExam group compared to both the NoExam and the EndExam groups, and there was no difference in the total score (and many of the sub-scores) of the latter two groups. The 3mExam group had less variability in total scores (and many of the sub-scores) than the other two groups. Our study provides evidence that testing these skills 3 months after BLS training may be more effective than either testing immediately at the end of the course or no testing at all.

    更新日期:2019-12-05
  • National recruitment scheme for pre-registration pharmacist training in England and Wales: a mixed method evaluation of experiences of applicant pharmacy students
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-04
    Laura McEwen-Smith; Malcolm James Price; Gail Fleming; Tim Swanwick; Christine Hirsch; Asma Yahyouche; Jonathan Ward; Sharon Buckley; Atif Shamim; Vibhu Paudyal

    A national pre-registration pharmacist training recruitment scheme, which replaces local recruitment models, was introduced in England and Wales in 2017. The national recruitment system allows pharmacy students to apply for the 52 weeks training programmes (mandatory requirement for registration as a pharmacist), through a single application system prior to undertaking a nationally administered assessment. This study aimed to explore experiences of pharmacy students on the national recruitment scheme, particularly their views on the selection methodology, application process, and offer outcomes. This mixed method study involved a) an online survey of all (approximate n = 2800) year 4 (final year of MPharm degree) pharmacy students in England and Wales and b) a qualitative focus group with four students. The study population was eligible to participate in the 2017/18 national recruitment scheme. Survey respondents were invited to participate in a focus group. Quantitative data were analysed using descriptive and inferential analysis. Qualitative data were analysed using the framework technique. Participation was voluntary. Ethical approval from University of Birmingham was obtained. A total of 307 completed surveys were returned (approximate response rate 11%). Respondents were generally satisfied with the application process and commended the fairness of the selection methodology and convenience in allowing them to apply to multiple training providers. Most survey respondents (n = 181, 72.9%) were either satisfied or highly satisfied with the training programme they were offered based on their assessment performances. Three themes and eight sub-themes obtained from the analysis of over 200 open comments data from the survey and transcript of a focus group with four participants. Results suggested the need to widen the timeframe available for applicants to shortlist their preferred employers, improve the method of programme listing in the application system, and consideration of prior achievements including academic performances and placement experiences to be included in the selection methodology. Experiences of pharmacy students on the national recruitment scheme suggest that respondents considered the selection methodology to be fair. Student engagement and satisfaction with the recruitment system can be maximised through improved listing of employers and widening the timescales for students to shortlist their preferred employers during application process. Inclusion of University achievements in the selection methodology will require consideration of evidence based approaches. Low response rate limits generalisation of findings.

    更新日期:2019-12-05
  • Virtual patients versus small-group teaching in the training of oral and maxillofacial surgery: a randomized controlled trial
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-04
    Lukas B. Seifert; Octavian Socolan; Robert Sader; Miriam Rüsseler; Jasmina Sterz

    Computerized virtual patients (VP) have spread into many areas of healthcare delivery and medical education. They provide various advantages like flexibility in pace and space of learning, a high degree of teaching reproducibility and a cost effectiveness. However, the educational benefit of VP as an additive or also as an alternative to traditional teaching formats remains unclear. Moreover, there are no randomized-controlled studies that investigated the use of VP in a dental curriculum. Therefore, this study investigates VP as an alternative to lecturer-led small-group teaching in a curricular, randomized and controlled setting. Randomized and controlled cohort study. Four VP cases were created according to previously published design principles and compared with lecturer-led small group teaching (SGT) within the Oral and Maxillofacial Surgery clerkship for dental students at the Department for Cranio-, Oral and Maxillofacial Plastic Surgery, Goethe University, Frankfurt, Germany. Clinical competence was measured prior (T0), directly (T1) and 6 weeks (T2) after the intervention using theoretical tests and a self-assessment questionnaire. Furthermore, VP design was evaluated using a validated toolkit. Fifty-seven students (VP = 32; SGT = 25) agreed to participate in the study. No competence differences were found at T0 (p = 0.56). The VP group outperformed (p < .0001) the SGT group at T1. At T2 there was no difference between both groups (p = 0.55). Both interventions led to a significant growth in self-assessed competence. The VP group felt better prepared to diagnose and treat real patients and regarded VP cases as a rewarding learning experience. VP cases are an effective alternative to lecture-led SGT in terms of learning efficacy in the short and long-term as well as self-assessed competence growth and student satisfaction. Furthermore, integrating VP cases within a curricular Oral and Maxillofacial Surgery Clerkship is feasible and leads to substantial growth of clinical competence in undergraduate dental students.

    更新日期:2019-12-05
  • Teacher questions and student responses in case-based learning: outcomes of a video study in medical education
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-05
    Martin Gartmeier; Theresa Pfurtscheller; Alexander Hapfelmeier; Marc Grünewald; Janina Häusler; Tina Seidel; Pascal O. Berberat

    Case-based learning (CBL) is a highly interactive instructional format widely used in medical education. One goal of CBL is to integrate basic biomedical knowledge and its application to concrete patient cases and their clinical management. In this context, we focus the role of teacher questions as triggers for reproductive vs. elaborative student responses. Specifically, our research questions concern the kinds of questions posed by clinical teachers, the kinds of responses given by students, the prediction of student responses based upon teacher questions, and the differences between the two medical disciplines in focus of our study, internal medicine and surgery. We analyse 19 videotaped seminars (nine internal medicine, ten surgery) taught by clinicians and attended by advanced medical students. Multiple raters performed a low-inference rating process using a theory-based categorical scheme with satisfactory interrater-reliability. We found that medical teachers mostly posed initial (instead of follow-up) questions and that their questions were more often closed (instead of open). Also, more reasoning (than reproductive) questions were posed. A high rate of student non-response was observed while elaborative and reproductive student responses had a similar prevalence. In the prediction context, follow-up reasoning questions were associated with low non-response and many elaborative answers. In contrast, the highest student non-response rate followed open reproduction questions and initial reasoning questions. Most reproductive statements by students were made following closed reproduction questions. These results deepen our understanding of interactive, questions-driven medical teaching and provide an empirical basis for clinical teachers to use questions in didactically fruitful ways.

    更新日期:2019-12-05
  • Reliability of residents’ assessments of their postgraduate medical education learning environment: an observational study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-03
    Paul L. P. Brand; H. Jeroen Rosingh; Maarten A. C. Meijssen; Ingrid M. Nijholt; Saskia Dünnwald; Jelle Prins; Johanna Schönrock-Adema

    Even in anonymous evaluations of a postgraduate medical education (PGME) program, residents may be reluctant to provide an honest evaluation of their PGME program, because they fear embarrassment or repercussions from their supervisors if their anonymity as a respondent is endangered. This study was set up to test the hypothesis that current residents in a PGME program provide more positive evaluations of their PGME program than residents having completed it. We therefore compared PGME learning environment evaluations of current residents in the program to leaving residents having completed it. This observational study used data gathered routinely in the quality cycle of PGME programs at two Dutch teaching hospitals to test our hypothesis. At both hospitals, all current PGME residents are requested to complete the Scan of Postgraduate Education Environment Domains (SPEED) annually. Residents leaving the hospital after completion of the PGME program are also asked to complete the SPEED after an exit interview with the hospital’s independent residency coordinator. All SPEED evaluations are collected and analysed anonymously. We compared the residents’ grades (on a continuous scale ranging from 0 (poor) to 10 (excellent)) on the three SPEED domains (content, atmosphere, and organization of the program) and their mean (overall department grade) between current and leaving residents. Mean (SD) overall SPEED department grades were 8.00 (0.52) for 287 current residents in 39 PGME programs and 8.07 (0.48) for 170 leaving residents in 39 programs. Neither the overall SPEED department grades (t test, p = 0.53, 95% CI for difference − 0.16 to 0.31) nor the department SPEED domain grades (MANOVA, F(3, 62) = 0.79, p = 0.51) were significantly different between current and leaving residents. Residents leaving the program did not provide more critical evaluations of their PGME learning environment than current residents in the program. This suggests that current residents’ evaluations of their postgraduate learning environment were not affected by social desirability bias or fear of repercussions from faculty.

    更新日期:2019-12-04
  • Evaluation of the undergraduate family medicine programme of Faculty of Medicine, University of Kelaniya: quantitative and qualitative student feedback
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-02
    D. P. Perera; S. S. Withana; K. Mendis; D. V. T. Kasunjith; W. T. S. Jayathilaka; S. Wickramasuriya

    Worldwide there is an increasing emphasis on the importance of primary care. The ministry of health Sri Lanka issued a directive in 2016 that training of doctors in primary care should be strengthened. Medical students of the Faculty of Medicine, University of Kelaniya follow a 1 month long clinical appointment in family medicine in their fourth year of study. Feedback is taken from students on completion of the appointment. Half the students from each group complete a pre tested structured feedback questionnaire that consists of answers to questions based on a likert scale with a space for free comments. The other half provide qualitative feedback. In this evaluation data were gathered from 185 (98%) students from all eight clinical groups throughout the year 2016. Quantitative data were analysed using SPSS version 22. Inductive thematic analysis was used to analyse the qualitative data from the Round Robin activity and free comments from the questionnaire. The qualitative feedback provided a richer indepth overview of student ideas on the appointment compared to the quantitative data. In reflection of a desire for learning to be of relevance students wanted clinically oriented teaching focused on management. They preferred active teaching learning methods such as the opportunity to conduct consultations and receive immediate feedback. Students had a high regard for the teaching sessions by general practitioners at their clinics. The appointment had created an interest in the discipline of family medicine which could have an impact on future choice of career. There were indications to suggest that student attitudes towards patients may have evolved to be more patient centred. Students appreciated the inclusive and low stress ambience of the learning environment. Regular evaluation of teaching programmes helps maintain accountability of faculty and paves the way for more student centred teaching through the incorporation of students’ views in devising teaching methods. This evaluation found that qualitative feedback provided more descriptive material to reflect on and therefore improve teaching on the programme. It is recommended that more use should be made of qualitative methodologies in programme evaluations.

    更新日期:2019-12-03
  • Operating room first case start times: a metric to assess systems-based practice milestones?
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-02
    Christopher Ryan Hoffman; Jay Horrow; Shreyas Ranganna; Michael Stuart Green

    Resident competence in peri-operative care is a reflection on education and cost-efficiency. Inspecting pre-existing operating room metrics for performance outliers may be a potential solution for assessing competence. Statistical correlation of problematic benchmarks may reveal future opportunities for educational intervention. Case-log database review yielded 3071 surgical cases involving residents over the course of 5 years. Surgery anticipated and actual start times were evaluated for delays and residents were assessed using the days of resident training performed at the time of each corresponding case. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status classification (ASA PS), and in-patient versus day surgery status. Mixed-effect, multi-variable, linear regression determined independent determinants of delay time. The analysis identified day of the week (F = 25.65, P < 0.0001), days of training (F = 8.39, P = 0.0038), attending surgeon (F = 2.67, P < 0.0001), and anesthesiology resident (F = 1.67, P = 0.0012) as independent predictors of delay time for first-start cases, with an overall regression model F = 3.09, r2 = 0.186, and P < 0.0001. The day of the week and attending surgeon demonstrated significant impact of case delay compared to resident days trained. If a learning curve for first-case start punctuality exists for anesthesiology residents, it is subtle and irrelevant to operating room efficiency. The regression model accounted for only 19% of the variability in the outcome of delay time, indicating a multitude of additional unidentified factors contributing to operating room efficiency.

    更新日期:2019-12-03
  • Does case-based blended-learning expedite the transfer of declarative knowledge to procedural knowledge in practice?
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-03
    Bela Turk; Sebastian Ertl; Guoruey Wong; Patricia P. Wadowski; Henriette Löffler-Stastka

    Case-Based Learning (CBL) has seen widespread implementation in undergraduate education since the early 1920s. Ample data has shown CBL to be an enjoyable and motivational didactic tool, and effective in assisting the expansion of declarative and procedural knowledge in academia. Although a plethora of studies apply multiple choice questions (MCQs) in their investigation, few studies measure CBL or case-based blended learning (CBBL)-mediated changes in students’ procedural knowledge in practice or employ comparison or control groups in isolating causal relationships. Utilizing the flexibilities of an e-learning platform, a CBBL framework consisting of a) anonymized patient cases, b) case-related textbook material and online e-CBL modules, and c) simulated patient (SP) contact seminars, was developed and implemented in multiple medical fields for undergraduate medical education. Additionally, other fields saw a solo implementation of e-CBL in the same format. E- cases were constructed according to the criteria of Bloom’s taxonomy. In this study, Objective Structured Clinical Examination (OSCE) results from 1886 medical students were analyzed in total, stratified into the following groups: medical students in 2013 (n = 619) before CBBL implementation, and after CBBL implementation in 2015 (n = 624) and 2016 (n = 643). A significant improvement (adjusted p = .002) of the mean OSCE score by 1.02 points was seen between 2013 and 2015 (min = 0, max = 25). E-Case-Based Learning is an effective tool in improving performance outcomes and may provide a sustainable learning platform for many fields of medicine in future.

    更新日期:2019-12-03
  • Student nurses’ career intentions following placements in general practice through the advanced training practices scheme (ATPS): findings from an online survey
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-03
    Robin Lewis; Rachel Ibbotson; Shona Kelly

    The demand for General Practice services in the UK, and elsewhere, is rising quickly. In part, the increasing demand is from an aging population that requires management of multiple long-term conditions. The General Practice Nurse is increasingly taking on the role. It is acknowledged that if general practice is to be able to recruit sufficient General Practice Nurses (GPNs) to meet this increasing demand in the future, new graduate nurses must be encouraged to consider general practice as a viable career option. This research is part of a review of the Advanced Training Practice Scheme (ATPS) which supported clinical placements in participating general practices. The aim of the study was to examine nursing students’ perceptions of GP placements, and their effect upon career intentions following graduation from Sheffield Hallam University (SHU), in the UK. Interviews and an online survey were used collect data. Only the survey is reported here. The bespoke survey examined students’ views of: opportunities for learning new clinical skills and consolidating existing clinical skills; the learning environment in general practice and their views on a career in general practice. One thousand one hundred twenty undergraduate adult-field nursing students were contacted, with a response rate of 41% (N = 462). Ninety respondents had a placement and, 92% (N = 84) viewed practice nursing positively, and 77% (N = 70) felt that the placement had transformed their views on general practice. The opportunity to participate in the management of the various aspects of chronic disease was identified by 84% (N = 76) of the students as a key new skill they had acquired. They also reported that they valued a team ethos, control over aspects of work, and the variety of health problems they encountered. The findings from this study demonstrate a positive experience arising from the provision of General Practice placements for nursing students. The use of ‘targeted’ placement schemes with appropriate support such as this may be seen as a viable way of exposing nursing students to General Practice nursing, and of encouraging new graduate nurses to consider General Practice nursing as a viable career option.

    更新日期:2019-12-03
  • The research performance of Iranian medical academics: a National Analyses
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-03
    Homayoun Sadeghi-Bazargani; Fahimeh Bakhtiary; Mina Golestani; Yasin Sadeghi-Bazargani; Nazila Jalilzadeh; Mohammad Saadati

    Scientometric studies are one of the most important and useful tools to assess the research performance and knowledge impact of researchers. The aim of this study was to map out the scientific performance of the Iranian medical academics with respect to a detailed range of scientometric indicators. Using scientometric approach, individual and scientific performance data of medical academic staff were extracted from the Iranian Scientometric Information Database (ISID). Total number of publications, total number of citations, citation per paper, h-index, international collaboration, self-citation, SJR decile, i10-Index, Quartile distribution were the studied scientometric variables. Out of the registered 19,023 academic staff, 746 were included in the study through simple random sampling method using random sample extraction function in STATA. Data were analyzed using STATA 14 statistical software package. Most of the included academicians were men (60%). A total of 13,682 articles were published by them until 2018, being cited 114,928 times with a mean of 5.77 citation per paper. H-index median was three and about 90% of the staff had an H-index below 10. Number of published papers, cite per paper and H-index metrics were significantly different with respect to gender, academic position/degree, and general field of study (p < 0.05). About 2.5% of published articles were contributed through international collaboration. The scientometric performance of academic staff was highly diverse with respect to the employing institution and its national classification group (type 1, 2, 3). Nevertheless to the great scientific production of medical academics, individual and institutional characteristics were identified as effective variables in academics research performance and should be considered in their assessment. Academicians affiliated with type 2 and 3 universities (based on national ranking of medical universities) had weaker research performance compared to those affiliated with type 1 universities. However, low rate of international research collaborations was a common challenge in medical universities.

    更新日期:2019-12-03
  • A nationwide cross-sectional survey of student experiential practice at community pharmacies in South Korea
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-12-02
    Yejee Kim; Kyeong Hye Jeong; EunYoung Kim

    In South Korea, community pharmacy experiential practice (CPEP) is very important because most pharmacists (71.8%) work in community pharmacies, which also employ the majority of students after graduation. The present study investigated student responses to the current CPEP status, suggestions for improvement, and advancement in their competency after practice based on evaluation of Community Pharmacy Experiential Practice Model (CPEPM) outcomes. A nationwide cross-sectional, self-administered online survey was conducted in 2017 for the sixth-year pharmacy students who completed CPEP, using 50 item questionnaire. The answers were evaluated using the 4-point Likert scale, used a scoring system from 1 (strongly disagree) to 4 (strongly agree). Responses of 1 and 2 were considered negative, and 3 and 4 were considered positive. To identify factors affecting CPEPM outcomes, multivariate linear regression analysis was performed. Initially, 1138 students participated in the survey. Of these, responses from 492 students were excluded due to missing data and eventually, data from 646 students were included in the analysis. In total, 95% of students responded in the affirmative that practical training influenced their future career decision. In addition, 78.5% of students were satisfied with the training. Further, they responded that their ability improved based on CPEPM outcomes. The most positive capability change was in the subdomain “personal and professional development”, followed by “inter professional collaboration”. Students responded with the higher rating for satisfaction factor, who regarded CPEP as helpful in future career decision making, and those who wanted to practice elective Advanced Pharmacy Practice Education at a community pharmacy had a positive CPEPM outcome, while age was found to be a negative factor in terms of the regression analysis. These are valuable findings as they represent the current student perception of CPEP nationwide. They provide a basis to improve the quality of CPEP-based education not only in Korea, but in other countries as well.

    更新日期:2019-12-02
  • Preparing competent graduates for delivering pharmaceutical care: an experience from Northern Cyprus
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-11-29
    Abdikarim Mohamed Abdi; Arijana Meštrović; Rumeysa Demirdamar; Bilgen Basgut

    This paper describes the implementation and evaluation of a clinical pharmacy practice (CPP) course in Northern Cyprus. The course covered a range of subjects, including internal medicine, cardiovascular and respiratory diseases, and drug information services. An 8-week structured CPP course was designed for fifth-year students. Students’ competencies were assessed using an objective structural clinical examination (OSCE) before and after the intervention. The course addressed all CPP competence domains and learning outcomes, and it utilized a wide variety of learning activities. Student perceptions, experience and preceptor evaluations were assessed using surveys. Students reported that the learning objectives of the course were met. Substantial knowledge and skills in different areas of CPP were gained. A significant overall enhancement in the average grades on the OSCE was identified (23.09 ± 0.75 and 27.51 ± 0.71 out of 40). Students received the highest scores in drug information data retrieval and interpretation (4.4 ± 0.13), communication skills (4.2 ± 0.09) and public health promotion (3.92 ± 0.12). The lowest scores were recorded in clinical prescription management problems (2.5 ± 0.23) and pharmacotherapy application (2.54 ± 0.18). Students’ scores significantly improved from the baseline in the core competence domains. Most students found the structure, process and outcomes of the course to be beneficial and satisfactory.

    更新日期:2019-11-30
  • A self-report of the Healer’s art by junior doctors: does the course have a lasting influence on personal experience of humanism, self-nurturing skills and medical counterculture?
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-11-29
    Chanakya Jaiswal; Katrina Anderson; Emily Haesler

    Healer’s Art (HA) is a voluntary course offered during medical school. The course aims to address the growing loss of meaning and commitment experienced by doctors through the exploration of compassion, empathy and awe in medicine, and early exposure to a supportive community of practice. This project aimed to evaluate the potential influence of HA on junior doctor graduates. Junior doctors who had undertaken HA during their medical studies were interviewed. A thematic analysis was performed on the results of these semi-structured interviews. Ten junior doctors who had undertaken the HA course participated in interviews. All interviewees described the HA as a positive and enlightening experience in their medical education. The thematic analysis identified four major themes: developing empathy in the doctor-patient journey, self-care and self-awareness, the creation of a supportive community, and coping with the challenging medical culture. HA provides experiential learning that enables participants to explore humanistic medicine. Self-selected junior doctors recall the course as a positive experience, and perceive themselves to be continuing to employ the techniques from HA in the healthcare setting. The concepts taught in the HA course appear to have a lasting personal impact on some junior doctors, who identify the course as influencing their self-reported positive patient-doctor relationships and supportive relationships with medical peers.

    更新日期:2019-11-30
  • Development of a national medical leadership competency framework: the Dutch approach
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-11-28
    Wouter A. Keijser; Henricus J. M. Handgraaf; Liz M. Isfordink; Vincent T. Janmaat; Pieter-Paul A. Vergroesen; Julia M. J. S. Verkade; Sietse Wieringa; Celeste P. M. Wilderom

    The concept of medical leadership (ML) can enhance physicians’ inclusion in efforts for higher quality healthcare. Despite ML’s spiking popularity, only a few countries have built a national taxonomy to facilitate ML competency education and training. In this paper we discuss the development of the Dutch ML competency framework with two objectives: to account for the framework’s making and to complement to known approaches of developing such frameworks. We designed a research approach and analyzed data from multiple sources based on Grounded Theory. Facilitated by the Royal Dutch Medical Association, a group of 14 volunteer researchers met over a period of 2.5 years to perform: 1) literature review; 2) individual interviews; 3) focus groups; 4) online surveys; 5) international framework comparison; and 6) comprehensive data synthesis. The developmental processes that led to the framework provided a taxonomic depiction of ML in Dutch perspective. It can be seen as a canonical ‘knowledge artefact’ created by a community of practice and comprises of a contemporary definition of ML and 12 domains, each entailing four distinct ML competencies. This paper demonstrates how a new language for ML can be created in a healthcare system. The success of our approach to capture insights, expectations and demands relating leadership by Dutch physicians depended on close involvement of the Dutch national medical associations and a nationally active community of practice; voluntary work of diverse researchers and medical practitioners and an appropriate research design that used multiple methods and strategies to circumvent reverberation of established opinions and conventionalisms. The experiences reported here may provide inspiration and guidance for those anticipating similar work in other countries to develop a tailored approach to create a ML framework.

    更新日期:2019-11-29
  • A night on call or an overnight shift does not reduce residents’ empathy: a randomized crossover multicenter survey
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-10-26
    Michiko Mizobe; Hitomi Kataoka; Hiroshi Yamagami; Chikao Ito; Yasuaki Koyama; Erika Yawata; Takashi Shiga

    Studies have shown that sleep deprivation may reduce empathy among medical students. Yet, little is known about the empathy after a night on call or an overnight shift among resident physicians. Hence, we aimed to examine whether a night on call or an overnight shift reduces the physicians’ empathy. We conducted a multicenter randomized crossover survey using the Jefferson Scale of Physician Empathy (JSE). A total of 260 physicians who worked at academic hospitals and community hospitals in Japan in 2016 were recruited and randomized into two groups. Group A first completed the JSE prior to a night on call or an overnight shift; then, 8 weeks later, Group A completed the JSE after a night on call or an overnight shift. Group B first completed the JSE after a night on call or an overnight shift; then, 8 weeks later, Group B completed the JSE prior to a night on call or an overnight shift. Statistical analyses were performed to compare the JSE scores of pre- and post-night on call or overnight shifts. A total of 117 Group A physicians and 112 Group B physicians returned a completed JSE. The overall response rate was 88.08%. There was no significant difference in the JSE scores between pre- and post-night on call or overnight shift. (Group A before night vs Group B after night, p = 0.40, Group A after night vs Group B before night, p = 0.68). As per our results, a night on call or an overnight shift did not reduce the Japanese physicians’ empathy. To the best of our knowledge, this is the first study on physicians’ empathy after a night on call or an overnight shift.

    更新日期:2019-11-28
  • Factors associated with successful dementia education for practitioners in primary care: an in-depth case study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-10-28
    Cara Sass; Natasha Burnley; Michelle Drury; Jan Oyebode; Claire Surr

    With increasing numbers of people in the UK living with dementia, the provision of good quality person-centred care that meets the often complex needs of this population is required. Given the majority of people with dementia live in the community, significant care and support will be provided by primary care services. This means the primary care workforce needs appropriate education to ensure they have the right knowledge, skills and attitudes to meet these care needs. However, little is understood about the most successful approaches to dementia education in this setting. An in-depth case study was undertaken in a single primary care organisation with the aim of exploring the impact of a person-centred dementia educational programme, and identify barriers and facilitators to implementation. Data was gathered from a wide range of sources and analysed using Kirkpatrick’s evaluative framework. Initially, staff learners struggled to incorporate the ‘whole-person’ approach to dementia care, but gained knowledge and confidence through self-directed learning. They reacted positively to the training and appreciated opportunities to learn from peers in other services. They identified improvements in communication and prescribing practices, despite difficulties implementing changes during busy periods. Resultant impact for service users included more timely routine appointments, and positive satisfaction ratings from patients and families. The findings indicate the perceived value of person-centred dementia education for primary care. Further recommendations for provision in this service setting include tailored programmes designed collaboratively with clinical service providers, and bringing together an interdisciplinary mix of learners to enhance knowledge exchange.

    更新日期:2019-11-28
  • Distribution and retention trends of physician-scientists in Japan: a longitudinal study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-10-28
    Masatoshi Ishikawa

    Physician Scientists (PSs) play a significant role in medical science because of their clinical practice and research expertise. Although it is important to analyze the distribution and retention trends in the number of PSs in Japan, research on this topic has been insufficient. Thus, the purpose of this study is to analyze PSs distribution and retention trends, identify factors related to their retention, and consider the policy implications. I analyzed individual data from 1996 to 2016 from a national census survey that had been administered by the national government of Japan every 2 years. The number of PSs in 1996 and 2016 were 4930 (2.1% of all physicians) and 5212 (1.6%), respectively. I conducted a descriptive analysis and identified retention trends. I then used a multivariable logistic regression analysis to identify the factors related to the retention of PSs. Between 1996 and 2016, the total number of PSs in Japan increased by 6%. The number of PSs aged 39 years or younger decreased by 48%, while those aged between 55 and 69 increased by 91%, indicating a notable decrease in the number of PSs under the age of 39. From 2014 to 2016, the annual retention rate of PSs was estimated to be 75.5%, which represented a low and stable rate compared to other physicians over the study period. The odds of continuing to practice as a PS were significantly higher for those who have between 15 to 29 years of experience after qualification as a physician. This study indicates that it is likely for the total number of PSs to decrease in the future. Although the Japanese government has implemented various measures to retain PSs, these have not been effective. Possible new interventions to address this problem include increasing the knowledge of medical students and younger physicians of the role of PSs and the benefits of a career as a PS, providing specific career paths for PSs, securing specific positions for PSs, and increasing the compensation for PSs.

    更新日期:2019-11-28
  • Association between medical student debt and choice of specialty: a 6-year retrospective study
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-10-28
    Erik M. Fritz; Suzanne van den Hoogenhof; Jonathan P. Braman

    The effect of rapidly increasing student debt on medical students’ ultimate career plans is of particular interest to residency programs desiring to enhance recruitment, including primary care specialties. Previous survey studies of medical students indicate that amount of student debt influences choice of medical specialty. Research on this topic to date remains unclear, and few studies have included the average income of different specialties in analyses. The purpose of this study is to observe whether empirical data demonstrates an association between debt of graduating medical students and specialties into which students match. This was a retrospective cross-sectional study of a public institution including data from graduation years 2010–2015. For each included student, total educational debt at graduation and matched specialty were obtained. Average income of each specialty was also obtained. Statistical hypothesis testing was performed to analyze any differences in average debt among specialties; subanalysis was performed assessing debt for primary care (PC) versus non-primary care (NPC) specialties. Correlation between student debt and average specialty income was also evaluated. One thousand three hundred ten students met the inclusion criteria and 178 were excluded for a final study population of 1132 (86%). The average debt was $182,590. Average debt was not significantly different among the different specialties (P = 0.576). There was no significant difference in average debt between PC and NPC specialties (PC $182,345 ± $64,457, NPC $182,868 ± $70,420, P = 0.342). There was no correlation between average specialty income and graduation debt (Spearman’s rho = 0.021, P = 0.482). At our institution, student indebtedness did not appear to affect matched medical specialty, and no correlation between debt and average specialty income was observed. Different subspecialties and residency programs interested in recruiting more students or increasing diversity may consider addressing alternative factors which may have a stronger influence on student choices.

    更新日期:2019-11-28
  • Implicit gender bias among US resident physicians
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-10-29
    Matt Hansen; Amanda Schoonover; Barbara Skarica; Tabria Harrod; Nathan Bahr; Jeanne-Marie Guise

    The purpose of this study was to characterize implicit gender bias among residents in US Emergency Medicine and OB/GYN residencies. We conducted a survey of all allopathic Emergency Medicine and OB/GYN residency programs including questions about leadership as well as an implicit association test (IAT) for unconscious gender bias. We used descriptive statistics to analyze the Likert-type survey responses and used standard IAT analysis methods. We conducted univariate and multivariate analyses to identify factors that were associated with implicit bias. We conducted a subgroup analysis of study sites involved in a multi-site intervention study to determine if responses were different in this group. Overall, 74% of the programs had at least one respondent. Out of 14,234 eligible, 1634 respondents completed the survey (11.5%). Of the five sites enrolled in the intervention study, 244 of 359 eligible residents completed the survey (68%). Male residents had a mean IAT score of 0.31 (SD 0.23) and females 0.14 (SD 0.24), both favoring males in leadership roles and the difference was statistically significant (p < 0.01). IAT scores did not differ by postgraduate year (PGY). Multivariable analysis of IAT score and participant demographics confirmed a significant association between female gender and lower IAT score. Explicit bias favoring males in leadership roles was associated with increased implicit bias favoring males in leadership roles (r = 0.1 p < 0.001). We found that gender bias is present among US residents favoring men in leadership positions, this bias differs between male and female residents, and is associated with discipline. Implicit bias did not differ across training years, and is associated with explicit bias.

    更新日期:2019-11-28
  • Improving students’ learning environment by DREEM: an educational experiment in an Iranian medical sciences university (2011–2016)
    BMC Med. Educ. (IF 1.87) Pub Date : 2019-10-29
    Hamid Bakhshialiabad; Golnaz Bakhshi; Zahra Hashemi; Amirhosein Bakhshi; Faroukh Abazari

    Students’ perception of the educational setting is an important source for improving and applying changes to the educational environment. In this study, we reassessed undergraduate students’ perception of the educational environment at two colleges of RUMS-Iran in the academic years of 2011 and 2016. In the present prospective study, the DREEM inventory consisted of seven courses for undergraduate paramedical and nursing-midwifery students (n = 982). After the first stage, educational seminars and workshops were set up for academic members and faculty staff on deficiencies and the ideal climate for optimizing the educational environment. The results of students’ responses in 2011 were compared with those assessed in 2016. For the data analysis, the independent t-test and the one-way ANOVA were utilized. In the academic year of 2010–2011, the DREEM inventory scored 115.33/200 (57.66%); it also scored 123.47/200 (60.7%) in the academic year of 2015–2016 (p ≤ 0.01). There was an interesting feeling about the first-year education, and female students felt a more positively perceived learning environment during all courses than male students at both stages of the study. There were significant positive differences (2 to 7%) in all domains of the components of DREEM in all courses between the academic year of 2010–2011 and the academic year of 2015–2016, showing that the DREEM score had changed and increased (p < 0.05), in the latter case. Positive differences were observed in DREEM scores between the two stages of the study. DREEM helped reduce the areas of deficiencies in students’ perception of many aspects of the educational environment. It also helped identify problematic areas in the improvement. In addition, DREEM could be used to optimize and make modifications to the educational environment.

    更新日期:2019-11-28
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