Medical Education Case Research Articles

Arguing for a case of bedside medical education

Arguing for a case of bedside medical education

Students as advocates of global health goals: the case of medical education in Germany

Abstract Background Germany has started to take on greater responsibility in global health policy. Furthermore, new threats, such as climate change, have increased sensitivity. However, health professionals are not well prepared to respond to the new tasks and the changing needs of the population. Global health is still largely missing from the education and training programmes of the vast majority of professional groups in Germany. This paper aims to illustrate how students can become advocates of global health education and enhance institutional change, when health policy fails to act effectively. Methods An elective programme introduced in September 2019 in the undergraduate medical curriculum at Hannover Medical School, Germany, serves as a case study to explore the tools and substance of the programme, as well as the stakeholders involved. Results The new global health programme utilises a window of opportunity in the curriculum, which includes a small number of mandatory seminars which students can chose from. It builds on five major pillars: collaboration between students and the programme coordinator and participatory curriculum development; the SDGs as framework and guidance of the curriculum; a multiprofessional and transsectoral teaching team; collaboration with NGOs; strong networks through collaboration with the national German medical students' association. Sustainability remains a major challenge, yet there is now institutional and financial support at Hannover Medical School and the new German National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education also includes global health issues. Conclusions Students as advocates for global health can make a difference and enhance institutional change through transsectoral, participatory teaching programmes.

Innovation Technologies in Student’s Independent Activity and Creativity Development: The Case of Medical Education

Adaptive learning technologies, applied with supportive symbols and signals allow developing the subject and communicative competencies, as well as shaping the creative abilities of students. This article provides the assessment criteria for preliminary, formative, midpoint and summative assessments. This article substantiates the hypothesis on improving the Emergency Medical Service student’s independent performance at the stage of supportive notes introduction. Methodology is original as it contains the following method: students are the one to write notes as an effective means of independent activity organization. Besides, this method can be useful as an alternative recording technique. Accordingly, innovation-driven education (in our case, independent learning and skills developing for quality outcomes) is one of the main components of the teaching and learning process. The statistics have revealed that students gain better subject knowledge through this learning technology.

Comparing and Contrasting Quantitative and Qualitative Research Approaches in Education: the Peculiar Situation of Medical Education

Research is about trying to discover the world and its phenomena in a systematic and structured manner. Humans have approached research in different ways based on their assumptions about social reality, knowledge, and human nature, namely ontology, epistemology, and methodology. These assumptions gave rise to two poles; quantitative and qualitative research and they have long been viewed as a dichotomy that can never be subject to compromise. This view has slightly changed with the realisation that quantitative and qualitative research can be complementary to each other. This is usually the case when the need for theory emerges and gets realised by qualitative research in order to guide quantitative research. Medical education is a social science that has almost the same categorisation of assumptions about the world. Medical educators and educationists apply both quantitative and qualitative research in order to elucidate some insights about teaching and learning in medicine, and about the best evidence and the best practices that can be applied by healthcare providers and medical educators. The aim of this review is to highlight the main similarities and differences between quantitative and qualitative research approaches/paradigms, present their origins from a historical and philosophical background, and focus on the case of medical education in terms of how it tackles quantitative and qualitative research, and what special attributes of medical education should be taken into consideration while conducting research.

A stakeholder‐based approach to leadership development training: the case of medical education in Canada

This paper reports the use of a stakeholder‐based, bottom‐up approach to determining leadership training needs and designing leadership training programs which contrasts with the top‐down policy that is often applied. The context is a Canadian medical school. Leadership training in medicine is in its infancy. Discussed and outlined in this study are stakeholder opinions on the pillars and priorities upholding leadership development. Seventy‐seven semi‐structured interviews were conducted with stakeholder groups including Trainees, Mid‐Level University Leaders, Senior Medical Clinician Leaders, Senior University Leaders, Medical Scientists and Senior Executives and Directors external to the University. Conventional content analysis was used to group the text into common themes and then group the themes into more general categories. Five general categories emerged: formal programming, organizational support, program evaluation, skill development and participant selection. A successful training program starts with identifying the individuals most likely to benefit from such a program. It emphasizes early training, mentorship and experiential learning. Programs should focus on developing: self‐awareness, communication skills and team‐building capability. Formal training programs would be most successful if they were regularly evaluated and strongly supported by their parent organizations.

Open Appendectomy: No Longer an Intern Case

Laparoscopy and work-hour restrictions are altering surgical training. We hypothesized interns were no longer gaining experience in open appendectomy, historically an intern index case. We retrospectively reviewed Accreditation Council for Graduate Medical Education (ACGME) case logs of postgraduate Year (PGY) 1 general surgery trainees from our academic teaching program for the last 9 years. Number of appendectomies performed (Current Procedural Terminology codes 44950, 44960, and 44970) were recorded and analyzed. The national ACGME database was similarly evaluated for resident experience during junior (PGY-1 to 4) years. Data were available for 47 residents completing internship at our institution between 2003 and 2011. Mean number of appendectomies performed per intern steadily decreased throughout the study period from 22 in 2003 to 5 in 2011 (P=0.0367). Mean percentage of cases done open decreased from 79.5 to 2.4 per cent (P=0.0001). National data found residents graduating in the year 2000 performed an average of 26.6 open appendectomies during junior years, whereas those graduating in 2011 had done only 13.7. Surgical trainees are performing fewer open appendectomies than just several years ago. Open appendectomy traditionally served as an introduction to open surgery. Because outcome differences are small between open and laparoscopic appendectomy, we propose teaching institutions consider performing open appendectomies in select patients to preserve an important educational experience.

Local and National Trends in General Surgery Residents’ Operative Experience: Do Work Hour Limitations Negatively Affect Case Volume in Small Community-Based Programs?

The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was -1.20 (P = 0.52) vs 1.78 (P = 0.07) for the national program average with statistically significant difference on comparison (P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 (P < 0.01) vs -1.08 (P = 0.54)], abdomen [8.48 (P < 0.01) vs -6.29 (P < 0.01)], breast [1.91 (P = 0.89) vs -3.6 (P = 0.02)], and vascular [4.03 (P = 0.02) vs -3.98 (P = 0.01)]. Comparing the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement institutional modifications which are too resource demanding for smaller training programs.

The development of new functional features by instruction: The case of medical education

Medical education provides many examples of the development of functional features, but as a response to deliberate instruction. These features require so much specificity and context sensitivity that they seem likely to require the development of new categories of appearances rather than just reweighting old features. A suggested implication is that feature development may help to explain the problematic noticing of features in diagnosis.

The Internationalisation of Higher Education: the Case of Medical Education

The most visible aspect of the internationalisation of Higher Education is foreign students and this article outlines the factors which influence patterns and trends in international student mobility. Using the case study of undergraduate medical education, insights are provided on the issues which determine a student's choice of host nation and institution. Students who opt to study overseas to gain an award (the basic qualification to practice medicine) are the focus of this study, and the views expressed by them and individuals associated with international education, shed light on country and institution specific aspects which make the experience abroad either magic or misery.

Subsidizing the affluent: The case of medical education

State and federal funds are important sources of revenue for medical schools, and a strong case can be made for public support for these institutions. Although the federal role is more widely known, the states in fact provide the bulk of direct support for medical training. The nature of aid from the two sources differs in significant ways. Most federal aid supports research or patient care, but much of state aid goes to support unconditional tuition subsidies. The primary beneficiaries of these subsidies are relatively affluent nonminority students who are beginning lucrative careers in the medical field--careers that would be lucrative even if no subsidies were provided. Nor does it appear that general subsidies are needed to attract poor and minority applicants. While targeted loans and scholarships to individuals may be justified, general tuition subsidies are not.

Subsidizing the Affluent: The Case of Medical Education

Subsidizing the Affluent: The Case of Medical Education

Some More Problems with Income-contingent Loans: The Case of Medical Education

In a recent article in this Journal, Nerlove (1975) notes that incomecontingent loans for financing higher education may affect the borrower's income profile. This is true both ex ante and ex post: ex ante, because adverse selection loads the plan with poor insurance risks; ex post, because the of repayments alters the borrower's choice between income and leisure. Nerlove regrets that unfortunately there is very little empirical evidence on these profiles and effects. In this comment I will present evidence on the moral hazard created by incomecontingent loans for financing medical education.' Awareness that medicine is a secure and remunerative career, coupled with rising costs and tight public budgets, has fostered proposals for placing more of the burden on the student.2 It is argued that the obligation should be financed by income-contingent loans because of moral hazard. By taking income3 the plan changes the earnings profiles of alternative medical specialties to favor the low-income primary care fields. Challoner (1974) considers this a positive feature of the plan: As a result of the pooled risk or insurance principle, no borrower would have to worry about a large debt that he could not repay. Thus, his decision for a higher or lower paying professional activity need not be colored by the specter of a large conventional debt, soon to be repaid. This scheme could have important effects on specialty distribution. Since federal policy encourages training more primary care physicians (Kennedy 1974), income-