Aspects Of Medical Training Research Articles

Medical training in the context of primary health care: reflexive portfolios as an innovative didactic proposal

Medical education in Brazil is shifting towards student-centered teaching and personalized care. The National Curriculum Guidelines emphasize the development of competence in health care, health management, and health education through real or simulated professional practices. Undergraduate institutions use active teaching and learning methods, such as the constructivist spiral and reflective portfolios, to promote student reflection and improve patient care. This study focuses on the importance of involving medical students in practical training through reflective portfolios during their first two years of education. This research is a qualitative and exploratory study that uses the 18 reflective portfolios written by one of the authors while they were a medical student. The data was collected from a Family Health Strategy (FHS) integrated with a Medical School in São Paulo, Brazil, between May 2017 and September 2018. The analysis of the data took place between September 2021 and June 2022 and was conducted through Content Analysis. Four themes emerged, stating the portfolio is a A) Reflexive instrument on Health Care; B) Reflexive tool on Health Management; C) Reflexive instrument on health education; and D) Self-reflexive and self-assessment instrument. Reflective portfolios allow students to reflect on various aspects of medical training, bring knowledge closer to reality, and contribute to the development of a professional identity that considers the biopsychosocial needs of patients. We conclude that the portfolios provide learning beyond the classroom and help students become competent health professionals who understand patients as individuals in a social context. However, the small sample size of one student is a weakness of the study, and further research with a larger sample is needed to better understand the impact of reflective portfolios on professional identity formation.

Why we should view the decision of medical trainees to cheat as the product of a person-by-situation interaction.

Cheating during medical training is a delicate subject matter with varying opinions on the prevalence, causes and gravity of cheating during training. In this article, the authors suggest that the decision to cheat is best viewed as the product of a person-by-situation interaction rather than indicating inherent dishonesty and/or extrinsic motivation in those who participate in cheating. This framework can explain why individuals who would typically default to honesty may participate in cheating if there is perceived justification for cheating and where situational variables, such as ease of cheating, rewards for cheating and perceived risk associated with cheating, make the decision to cheat appear rational. They discuss why the impression that there is a culture of cheating can provide perceived justification for medical trainees to cheat if they have the opportunity. They then describe how aspects of medical training and assessment may enable or hinder cheating by trainees. Consistent with the person-by-situation interaction framework, they contend that our response to cheating should include interventions directed at both the person who cheated and situational variables that enabled cheating. Recognising that some forms of cheating may be widespread, difficult to detect and contentious (such as the creation and use of exam reconstructs), their proposal for dealing with suspected and pervasive cheating is to identify and target enabling variables such that the decision to cheat becomes less rational. Their hope is that in so doing, we can gradually nudge trainees and the culture of medical training towards honesty.

S613 Standardized General Endoscopy Lexicon for Learners

Introduction: Physicians completing subspecialty training in gastroenterology are expected to develop competence in performing general endoscopic procedures including upper endoscopy, colonoscopy, and flexible sigmoidoscopy. Endoscopy education is often provided through an apprenticeship model where trainees work with various endoscopists and develop skills in real-time procedures. Inherent to this model is heterogeneity in the education provided. Recent research exploring essential teaching competencies for those involved in endoscopic education suggests usage of succinct standardized language when teaching endoscopy, but to date no one has examined the breadth of terms used or developed consensus around specific language to be used in this aspect of medical training. In this study we surveyed terminology used worldwide by expert teachers of endoscopy and, through a Delphi process, developed a standardized lexicon for general endoscopic education. Methods: We invited 26 physicians identified as expert endoscopy educators from various countries around the world to participate in this Delphi process. A total of 20 physicians participated. Four rounds of surveys were completed. Common terminology was identified in round 1. Rounds 2 through 4 consisted of surveys where participants indicated terms they were most likely to use when instructing learners during endoscopy. A consensus threshold of 70% was defined for term inclusion into the lexicon. Terms that achieved a 70% minimum consensus were included as “recommended terms”. Terms that offered balance to the lexicon but did not reach the threshold consensus were included as “suggested terms”. Results: After 4 rounds of surveys, 36 recommended terms and 5 suggested terms were included in our general endoscopy lexicon (Table). Conclusion: Through this international Delphi project, we constructed a general endoscopy lexicon for learners. The use of standardized language has been shown to have several benefits in other areas of healthcare including improved communication, quality of patient care, and knowledge generation. We expect that adopting a uniform lexicon will improve quality of endoscopic education for learners. In addition, because this study was conducted on an international level, we anticipate this lexicon to be applicable to trainees throughout the world. Future projects exploring standardized language for advanced endoscopic procedural education should be considered. Table 1. - Terms included in general endoscopy lexicon post-survey Endoscopy Instruction Committee Consensus (%) Final Stance Scope Manipulation Rotate (torque)clockwise/counterclockwiseRotate (torque) right/left 100* Recommended Big wheel/dial up 94.42 Recommended Big wheel/dial down 88.9 Recommended Little wheel/dial up 88.9 Recommended Little wheel/dial down 88.89 Recommended Advance scope 77.78 Recommended Pull scope back 100% Recommended Brush Manipulation Put brush out 100%* Recommended Pull brush inWithdraw brushAdvance brush 83.33* Recommended Brush tissues 56.25 Suggested Clip Manipulation Open clip 93.75 Recommended Close clip 81.25 Recommended Rotate clip 87.5 Recommended Deploy clipFire clip 91.67* Recommended Cautery - Monopolar, Bipolar – Manipulation Advance cautery probe 75 Recommended Start cauteryCut/coagulate 58.33* Suggested Forceps Manipulation Open forceps 93.75 Recommended Close forceps 81.25 Recommended Advance forceps 91.67 Recommended Withdraw forceps 100 Recommended Pictures/Video Take a picture/video 77.78 Recommended Air (blue button) Insufflate 72.22 Recommended Water (blue button) Clean your lens 88.89 Recommended Suction (red button) Suction 77.78 Recommended Through the Scope Balloon Dilator Manipulation Advance dilator 56.25 Suggested Inflate balloon 100 Recommended Deflate balloon 56.25 Suggested Bougie Dilator Manipulation Advance wire 81.25 Recommended Advance dilator over wire 87.5 Recommended Net Manipulation Open net 93.75 Recommended Close net 93.75 Recommended Use of Electrocautery Pedals (blue, yellow) Blue pedal 81.25 Recommended Yellow pedal 81.25 Recommended Snare Manipulation Open snare 93.75 Recommended Close snare 93.75 Recommended Cut 56.25 Suggested *The committee consensus to include both terms in the lexicon

Development and evaluation of asimulation-based transition to clerkship course.

BackgroundTransition to clerkship courses bridge the curricular gap between preclinical and clinical medical education. However, despite the use of simulation-based teaching techniques in other aspects of medical training, these techniques have not been adequately described in transition courses. We describe the development, structure and evaluation of a simulation-based transition to clerkship course.ApproachBeginning in 2012, our institution embarked upon an extensive curricular transformation geared toward competency-based education. As part of this effort, a group of 12 educators designed, developed and implemented a simulation-based transition course. The course curriculum involved seven goals, centered around the 13 Association of American Medical Colleges Core Entrustable Professional Activities for entering residency. Instructional techniques included high-fidelity simulation, and small and large group didactics. Student competency was determined through a simulation-based inpatient-outpatient objective structured clinical examination, with real-time feedback and remediation. The effectiveness of the course was assessed through a mixed methods approach involving pre- and post-course surveys and a focus group.EvaluationOf 166 students, 152 (91.6%) completed both pre- and post-course surveys, and nine students participated in the focus group. Students reported significant improvements in 21 out of 22 course objectives. Qualitative analysis revealed three key themes: learning environment, faculty engagement and collegiality. The main challenge to executing the course was procuring adequate faculty, material and facility resources.ReflectionThis simulation-based, resource-heavy transition course achieved its educational objectives and provided a safe, supportive learning environment for practicing and refining clinical skills.Electronic supplementary materialThe online version of this article (10.1007/s40037-020-00590-4) contains supplementary material, which is available to authorized users.

The Role of Gender in Ophthalmology Resident Evaluations

Abstract Background Gender affects various aspects of medical training. Prior research in surgical specialties has shown that female residents are given less positive feedback, granted less autonomy in the operating room, perform fewer procedures, and achieve competency milestones at a slower rate as compared with their male counterparts. Purpose The purpose of this research is to evaluate whether gender affects ophthalmology resident evaluations at a single institution. Methods Ophthalmology resident evaluations at a single residency program from 2010 to 2018 were reviewed. Data were collected on faculty gender, resident gender, and year of resident training. A linear mixed-effects model was utilized to analyze the degree to which differences in evaluation scores could be predicted from demographic data, while accounting for multiple sources of nonindependence of data. Results A total of 490 evaluations for 43 residents by 34 faculty were analyzed. Evaluations consisted of up to 23 questions graded on a scale from 0 (poor) to 9 (excellent). Female residents received marginally higher scores than male residents on average (coefficient of male residents = −0.2). Both male and female residents received marginally lower scores from male faculty than from female faculty on average (coefficient of male faculty = −0.21). Male faculty also appeared to have scored male residents lower to a greater degree than did female faculty (coefficient of male faculty by male resident interaction = −0.14), though this result was sensitive to model specifications. There was no significant interaction between year of resident training and gender. Conclusion In contrast to other procedural specialties, female residents appear to have been graded at a similar level or higher than male residents on average. Male faculty gave slightly lower scores to both male and female residents than female faculty did. Male faculty also may have graded male residents marginally lower than female residents to a greater degree than female faculty did.

The stethoscope goes digital: Learning through attention, distraction and distortion

For centuries, those training doctors have been faced with the challenges of standardising subjective experiences and constructing “the universal body” in learning situations. Various technologies have been introduced to address these challenges, with varying degrees of success. In this article we focus on the stethoscope, specifically the electrical and digital stethoscope models. Historical and social studies of medicine have already underlined the sociomateriality of learning in medicine. In this article we underscore the per formative nature of teaching and learning in the sociomaterial context. We do so by juxtaposing ethnographic and historical events that stage electrical and digital stethoscopes. These are not documentations of everyday practices but rather reconstructions of choreographed performances for learning about the body. In these stagings, the novice is taught to focus attention and avoid distraction, when learning the sounds of “the body”. Through engaging with, and comparing, different ethnographic and historic materials and artefacts, and through methodological reflection, we examine the importance not only of attention and distraction in learning a bodily skill, but also of dealing with distortion. We argue that these ethnographic and historic insights into distortion illuminate a neglected aspect of medical training, and more generally, in shaping sensory perceptions.

Special Cluster Learning Practice from Texts: Jews and Medicine in the Later Middle Ages

Abstract The study of the medical practices of medieval European Jews has tended to centre on the dynamics of inclusion and exclusion of Jews in European societies, with medical practices and non-learned practitioners within Jewish communities receiving less attention. Information is particularly lacking on the more rudimentary aspects of medical training and practice, daily medical care and household medicine. This essay highlights features of the historiography of Jewish activity in medicine that beckon new or renewed scholarly attention. The essay introduces a cluster of articles, which begin to fill this lacuna while charting methodological keys for future work in the field.

Associations Between National Board Exam Performance and Residency Program Emphasis on Patient Safety and Interprofessional Teamwork.

Several aspects of medical training may contribute to the ultimate goal of producing excellent physicians whose patients will have the best possible outcomes. However, the relative importance of education, evaluation and feedback, duty hours, practice structure, and program culture in achieving this goal is unclear. This study assessed associations among in-training exam performance, Accreditation Council for Graduate Medical Education (ACGME) Resident Survey responses, and American Board of Medical Specialties (ABMS) national board exam performance. Residency training programs at a university teaching hospital were classified as having 5-year first-time ABMS pass rates above (n=12) or below (n=3) the national average for their specialty. These groups were compared by ACGME Resident Survey data and in-training exam performance. Surveys were collected from 484/543 eligible residents (89%), including 177 surveys from programs with below-average board pass rates and 307 surveys from programs with aboveaverage board pass rates. In-training exam performance was similar between groups. Aboveaverage programs had stronger agreement with statements that their culture reinforced patient safety (4.72 vs. 4.30, p=0.006) and that information was not lost during transitions of care (4.14 vs. 3.63, p=0.001). Although the occurrence of interprofessional teamwork was similar between groups, above-average programs had stronger agreement with the statement that interprofessional teamwork was effective (4.60 vs. 4.17, p=0.003). Residency programs emphasizing patient safety and effective interprofessional teamwork had above-average first-time national board pass rates.

PERCEPTION OF FIRST-YEAR VERSUS SIXTH-YEAR MEDICAL STUDENTS IN SERBIA ON STUDYING MEDICINE AND POSTGRADUATE CAREER.

SummarySelf-perceived stress during undergraduate medical training could influence forthcoming career choices. The aim of this study was to explore the attitudes and potential differences between 1st and 6th year students regarding aspects of medical training and career plans. As many as 570 students in 1st and 400 in 6th year of studies at the Faculty of Medicine, University of Belgrade, were recruited on December 2-9, 2013. Data were acquired through a self-administered questionnaire. Students in both years rated “Helping other people” as the most important reason to study medicine. Freshmen rated statistically significantly higher ‘good incomes’ and ‘social status’ as reasons to study medicine (p=0.003 and p=0.037, respectively). The most desirable fields of specialization were surgery and internal medicine (36.4% and 18.7% for 1st year, and 26.3% and 36.6% for 6th year, respectively). Significantly more freshmen would prefer working abroad (χ2=3.891, p=0.029). In terms of careers abroad, students in both years expressed the highest interest in working in western and northern Europe. Desires for specialty training among medical students follow the pattern of the most frequent disciplines in the Serbian physician population, with gender differences comparable to other populations. A certain percentage of students would likely emigrate.

Tools for Simulation; Low Budget and No Budget

Interventional Radiology (IR) incorporates a unique set of technical skills such as ultrasound-guided needle placement, inferior vena cava filter placement, and wire/catheter exchange, which are not easily attained in other aspects of medical training. Simple, low cost models can allow medical students and residents to attain these skills in a low risk setting. These simulated tasks will ultimately combine to improve preparedness of trainees during patient procedures allowing them to advance more quickly through the training paradigm without patient risk. Many commercially available devices may be cost prohibitive, so low cost solutions are presented.

Effectiveness of echocardiography simulation training for paediatric cardiology fellows in CHD.

Simulation is used in many aspects of medical training but less so for echocardiography instruction in paediatric cardiology. We report our experience with the introduction of simulator-based echocardiography training at Weill Cornell Medicine for paediatric cardiology fellows of the New York-Presbyterian Hospital of Columbia University and Weill Cornell Medicine. Knowledge of CHD and echocardiographic performance improved following simulation-based training. Simulator training in echocardiography can be an effective addition to standard training for paediatric cardiology trainees.

Shape of Training: the right people with the right skills in the right place

A medical student entering medical school in 2014 will become a consultant sometime around 2027. The whole face of healthcare will have changed by then. The population is ageing, there...

Training in general medicine – are juniors getting enough experience?

There is a widespread perception that trainees in medicine in the UK are 'not as good as they used to be' and reduction in hours of training is often cited as one cause. However, there are no data on the current experience of medical trainees in general medicine. The experience of foundation year doctors (FY1/2) and core medical trainees (CTs) inthe management of 10 common medical conditions, eight common medical procedures and other aspects of medical training were collected by national survey in 2011. Trainees reported finding out-of-hours care the best setting for acute general medical experience and that the medical registrar was a key part of training. There was a significant lack of experience in both the management of medical conditions and the use of common procedures. These results highlight the challenges in general medical training and show that there is substantial room for improvement.

Emerging inequality and potential unconstitutionality — the case for reform of the intern priority system

Internship selection is becoming more competitive due to substantial increases in numbers of medical graduates. Australian states operate a "priority system" for medical internship selection which discriminates against Australian interstate applicants. This discrimination arguably infringes section 117 of the Australian Constitution, which seeks to ensure that all citizens are treated equally and promotes national unity. The priority system should be reformed. It is inequitable and inconsistent with other aspects of medical training and regulation.

Practicing Pelvic Examinations by Medical Students on Women Under Anesthesia

As I write this essay, I am a fourth-year medical student and recently completed my third-year obstetrics and gynecology clerkship. During my third year, I had the chance to participate actively in various aspects of medical training, which spanned the emotional spectrum from fascinating to mundane

A Framework for Conceptualizing the Current Role and Future Trends of Information Systems in Medical Training

Despite the growing investment in information systems for training in healthcare establishments (HCEs), there is a lack of holistic understanding of the role of information systems in different aspects of medical training. In this paper, the authors attempt to arrive at a framework that summarizes different kinds of training required in HCEs and the role of information systems in each of these areas. The authors contribute to research by systematically summarizing the current role of information systems in medical training and discussing future trends. The authors contribute to practice by providing a technique to assess and plan training activities in HCEs.

Validation of a Global Rating Scale for Shoulder Arthroscopy: A Pilot Study

Background Reliable, valid, feasible and objective assessment is desirable in all aspects of medical training to allow monitoring of progress and to ensure high standards. At present, no assessment model for shoulder arthroscopy exists that indisputably meets these criteria. The global rating scale (GRS) has been validated as a measure of technical performance in various surgical procedures. We have developed and aim to validate a GRS for shoulder arthroscopy (GRSSA). Materials and Methods Using the GRSSA, 13 shoulder surgeons, rated 10 videos of diagnostic shoulder arthroscopy showing different levels of proficiency. Assessments were performed remotely using an online system developed for the study; assessors were blinded to the experience of the surgeon who was performing the arthroscopy. Construct validity was assessed via Cronbach's a and inter-rater reliability was assessed via two-way analysis of variance (ANOVA). Results The results suggest good construct validity (high internal consistency of GRSSA categories: Cronbach's a = 0.89 to 0.96). Two-way ANOVA demonstrated a good discriminatory ability of the GRSSA but variability between raters ( p = 0.0002 to 0.01), suggesting a current lack of inter-rater reliability. Discussion The GRSSA appears to be a useful tool for the assessment of diagnostic arthroscopic skills and, using our online system, the assessor can be remote to the surgeon who is performing the procedure.

Who Picks Psychiatry? Perceptions, Preferences and Personality of Medical Students

This study aimed to characterise the personality profiles of junior medical students most likely to choose psychiatry as a career, determine aspects of psychiatry that most attract potential recruits, and identify misperceptions about psychiatry that may dissuade students from pursuing this specialism. A total of 580 second-year medical students from the University of New South Wales, Australia completed a set of questionnaires that measured the likelihood with which various medical specialties were being considered as careers, personality traits using the NEO Five-Factor Inventory (NEO-FFI), and the degree to which students perceived each specialty as attractive across a number of parameters. Only 86 students (15%) indicated a strong likelihood of choosing psychiatry, compared to other specialties which attracted higher proportions of students (range 19-49%). These 86 students had significantly higher openness scores than those who indicated a lesser likelihood of pursuing psychiatry. Students who were highly interested in psychiatry ranked it as very attractive in respect to providing interesting and challenging subject matter, and relatively attractive in respect to financial reward, work enjoyment, good lifestyle, having a bright and interesting future, and association with colleagues. However, psychiatry remained less attractive with respect to prestige, perceived low effectiveness of treatments, degree to which it draws upon aspects of medical training, and lack of reliable scientific foundation. Within the entire sample, psychiatry was ranked most unattractive compared to the other specialties across eight of the 13 parameters assessed. Students interested in psychiatry are more likely to be 'open' and view the specialty as interesting and challenging. Such characteristics should be promoted more widely along with countering myths that as a specialty, psychiatry lacks a scientific foundation or is somehow different from mainstream medicine in terms of training and outcomes. Championing psychiatry in this manner may attract more recruits and enhance its prestige.

Empathy and competence

There has been a call to include empathy as a selection criterion in medical training. Empathy is a complex construct currently assessed by self-rating and observational scales, which may be complicated by the subjectivity of such measurements. Neuroscientific research into disorders of empathy such as autism should be encouraged to help further refine the evolving construct of empathy. Empathy may be more common in females, and selection for higher empathy may discriminate against males unless sex-specific adjustments are included in selection criteria. Physician empathy may lead to greater patient satisfaction and confidence in physicians, but more evidence is needed to support links to physician competence. In contrast, academic performance and conscientiousness have been clearly linked to physician competence. Competence and empathy may be independent qualities developed by different aspects of medical training. Provision of better work conditions and environments for physicians may forestall erosion of empathy, reducing the need to predict and enhance its development. Empathy should be valued in medical students and doctors, but more research is needed into the nature, assessment, and correlates of empathy before its adoption as a selection criterion for medical students.

Mixed metaphors

If a journal such as The Clinical Teacher, aimed as it is at the busy clinical practitioner, is going to hit the spot, the content obviously needs to be varied and interesting enough to hook the unwitting potential reader. Having risen to the bait, once they've read and digested the article that caught their eye, the chances are that something else will interest, then something else, and so on and so on, until the journal has been read from cover to cover. What's more, the reader, by now, will be cajoling their local Education Centre Library to take out a block subscription to the journal whilst enthusiastically encouraging their colleagues to take a look, setting in motion a cascade of interest…soon everyone is reading The Clinical Teacher, and…OK, fantasy over. But the journal content certainly needs to appeal to a range of interests, and I think this issue of The Clinical Teacher is a good example. We have themed the content to reflect three areas of contemporary concern to those involved in clinical education and training: the social responsiveness of medical schools; personal and professional development; and patient safety and simulation. Medical schools have been exhorted to become more socially responsive, the ultimate aim being to produce graduates who are better orientated to the needs of the communities they serve. Papers on cultural competence, community-based medical education, and a report of an innovative approach to widening access through outreach, including a participating student's views, address this important area. Personal and professional development is another aspect of medical training currently exercising educators’ minds. There are two papers in this theme, one on the use of portfolios, the other on the challenge of training the trainers to take on new assessment roles (in this case, assessing Foundation trainees). Patient safety as a distinct subject is a (relatively) ‘new kid on the block’ in medical education, and the first paper in this section gives an overview of what clinical teachers should know about the topic. Inextricably linked with patient safety is the use of simulation, and two papers tackle this, one describing how to bridge the gap between simulation in the classroom and the realities of the clinical environment, the other an overview of the use of simulation in teaching and assessment – the comment by the author of the latter paper, that we are at the start of ‘a very long journey’ suggests this won't be the last time the topic crops up in The Clinical Teacher. Finally, along with the regular features of Digest and In Brief, we have an ‘Airmail’ from Eire, in which the authors describe and discuss new policy developments in medical education, which, although specific to Ireland, have a familiar ring to them, not least the challenges of introducing graduate entry and the sustainability of programmes in the context of increased student numbers and stretched clinical facilities. So that's it for this issue. Hooked? I hope so. Apologies for the mixed metaphors…I appreciate there are more there than you can shake a stick at…