Medicine Education Research Articles

Evidence-Based Medicine Culture, Curriculum, and Program Outcomes: A CERA Study.

Limited faculty development is a barrier to advancing evidence-based medicine (EBM) education. This study sought to describe program director perception of EBM culture in family medicine residency training and to assess the association among structured faculty roles, EBM curricula, and specific resident outcomes including publications in EBM. Members of the Society of Teachers of Family Medicine EBM collaborative drafted survey questions based on a literature review. The questions were electronically distributed in May 2023 to all US family medicine residency program directors who had not previously opted out by the Council of Academic Family Medicine Educational Research Alliance within its study of family medicine program directors. We analyzed results using descriptive and comparative statistics. The overall response rate was 44.7% (309/691). We found that 260/281 (92%) of program directors reported an EBM curriculum of some kind, and 253/281 (90%) of program directors agreed/strongly agreed that EBM was accepted by residents. Of the respondents, 72/281 (25.6%) reported that no specific faculty member was responsible for their EBM curriculum. Most program directors reported that less than 50% of residents will leave their programs with the ability to detect an error in original research (23.8%; 67/281), detect an important omission in an UpToDate article (16%; 45/281), or author a narrative review for American Family Physician (10%; 28/281). Program directors reported strong acceptance of EBM among residents and a high prevalence of a formal curriculum. However, many lacked a specific faculty lead, and few reported that residents had strong EBM skills. This study identified gaps in residency training to support future EBM-skilled family physicians as well as concerns about pathways for the development of future EBM faculty.

Health disparities among incarcerated populations: a crucial laboratory and pathology review.

The United States notoriously has one of the highest rates of incarceration in the world, yet scant attention to the health care needs of those incarcerated exists within laboratory medicine and pathology training and education. This article explores health disparities among incarcerated and released individuals regarding diagnostic laboratory testing and pathology services. A literature search was conducted for articles published between 2002 and 2023 using keywords including "healthcare," "incarcerated," "laboratory services," "pathology services," and "health insurance for prisoners." Central themes were extracted and discussed to reveal the realities of health care during and after release from incarceration. Excluded from the analysis were articles about the immediate or extended family of incarcerated persons. Incarcerated individuals have an increased risk for the development and exacerbation of communicable and noncommunicable diseases and mental health disorders, which results in exceedingly high morbidity and mortality rates. Policy changes are needed to mitigate disparities and improve health outcomes for incarcerated and released persons. Central to these disparities is decreased access to laboratory and pathology services, impeded by inadequate health care funding for these carceral institutions. Providing additional funding to the carceral system's health care budget is necessary to improve access to pathology and laboratory services.

Teaching integrative and complementary medicine in health undergraduate courses: systematic review

Background: Health undergraduate courses have their curricula focused on conventional medicine. Integrative and Complementary Practice also known as Complementary and Alternative Medicine (CAM) have been included in this worldwide scenario motivated by the growing need for new care possibilities that value Traditional Medicines and the individual-centered view. This work aims to analyze published evidence about CAM in health teaching around the world. Methods: This is a systematic review about the teaching of CAM on fifteen different undergraduate health courses, published between 2010 and 2020, in Portuguese and English, indexed in the Pubmed and VHL databases. The descriptors were “complementary and alternative medicine teaching” or its variations and the name of fifteen undergraduate health courses. The methodological quality was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Results: The initial search identified 351 articles. After exclusion criteria, 22 articles were read to identify the courses that offers CAM, the modalities and the effects of including CAM in health courses. Different modalities were found and varies according to the country and health course, as well as they are offered as elective format. The contact with integrative medicine at undergraduate increases the interest, confidence and level of knowledge. In students’ opinions, the professional who adds CAM in their training tends to take full care of patients. Conclusions: There is a clear need to include integrative medicine in all undergraduate health courses curriculum to provide safe and complete information about integrative medicine.

A study on the impact of open source metaverse immersive teaching method on emergency skills training for medical undergraduate students

BackgroundIn recent years, the traditional simulation-based medical teaching approach has faced challenges in meeting the requirements of practical emergency medicine education. This study utilized open-source tools and software to develop immersive panoramic videos using virtual reality technology for emergency medical teaching. It aims to investigate the efficacy of this novel teaching methodology. This transformation shifted the focus from physical simulation to virtual simulation in medical education, establishing a metaverse for emergency medical teaching.MethodsIn accordance with the curriculum guidelines, the instructors produced panoramic videos demonstrating procedures such as spinal injury management, humeral fracture with abdominal wall intestinal tube prolapse, head and chest composite injuries, cardiopulmonary resuscitation, and tracheal intubation. Using Unity software, a virtual training application for bronchoscopy was developed and integrated into the PICO4 VR all-in-one device to create a metaverse teaching environment. Fourth-year medical undergraduate students were allocated into either an experimental group (n = 26) or a control group (n = 30) based on student IDs. The experimental group received instruction through the metaverse immersive teaching method, while the control group followed the traditional simulation-based medical teaching approach. Both groups participated in theoretical and practical lessons as usual. Subsequently, all students underwent a four-station Objective Structured Clinical Examination (OSCE) to assess the effectiveness of the teaching methods based on their performance. Additionally, students in the experimental group provided subjective evaluations to assess their acceptance of the new teaching approach.ResultsBefore the training commenced, there were no significant statistical differences in the first aid test scores between the experimental and control groups. Following the training, the experimental group outperformed the control group in the four-station OSCE examination, with all P-values being less than 0.05. The satisfaction rate among the experimental group regarding the new teaching method reached 88.46%, reflecting levels of satisfaction and extreme satisfaction.ConclusionThe open-source metaverse immersive teaching method has demonstrated a positive impact on enhancing the emergency skills of medical undergraduate students, with a high level of acceptance among students. In comparison to traditional simulated medical teaching methods, this approach requires less time and space, incurring lower costs, and is deemed worthy of wider adoption.

2224 What are we teaching UK medical students about ageing? Results of the third BGS national curriculum survey

Abstract Introduction The ageing population means all doctors, regardless of specialty, will need knowledge, skills, and attitudes to care for older people with complex health conditions. An essential component of preparing the medical workforce to best care for older people is by including teaching on ageing and geriatric medicine in undergraduate medical curricula. Here we present results of the British Geriatrics Society (BGS) national curriculum survey 2021–22, highlighting progress made in undergraduate teaching in geriatric medicine. Methods All 35 UK GMC-registered medical schools at the time of data collection were invited to participate in an online survey on content, methodology, timing, and duration of teaching in ageing and geriatric medicine. The survey was structured around the 2013 BGS recommended undergraduate curriculum, for consistency with previous surveys. Results 30/35 of UK medical schools responded (83% response rate). Most teaching occurred in the fourth year of study (21/30, 70%). The majority (15/30, 50%) reported a discrete module for geriatric medicine lasting 4–8 weeks, an increase on previous surveys. However, several programmes have reduced the amount of in-person teaching since the COVID-19 pandemic. Notably, three schools reported geriatric medicine exposure lasting >12 weeks. Of these, two were integrated clerkships and one a dedicated geriatric medicine module. There is increasing focus on multidisciplinary education, with emphasis on combining virtual or simulated teaching with other healthcare professions (n = 7). Every school (n = 30) taught at least one topic as small-group or case-based learning. Conclusion There is a trend towards increasing exposure to geriatric medicine compared to previous surveys in 2008 and 2013. However, several of the programmes reporting greater exposure incorporate geriatric medicine in an integrated clerkship rather than as a dedicated module. Programmes demonstrated a move from didactic teaching towards small-group and case-based learning, employing a wider variety of assessment methods than previous.

Current trends and obstacles in off-the-job nursing ethics training in Japanese hospitals: a cross-sectional study.

This study aims to fill the existing gap by examining the current status of off-the-job nursing ethics training in large hospitals in Japan and its integration with on-the-job training to provide targeted insights for enhancing future ethics training. A cross-sectional study was conducted among the nursing education staff of large Japanese hospitals [N=309] by self-administered questionnaire. The questionnaire was the following main points 1) current trends in nursing ethics training 2) planners' concerns, and 3) the link between training and clinical practice. Descriptive statistics were used, closed-ended questions were analyzed through simple tabulations while open-ended questions underwent textual analysis. The hospitals of 76.6% (309) conducted off-the-job nursing ethics training. Their training consists of a combination of lectures and exercises. The focus was to raise nurses' awareness of ethical problems or improve their analytical ability. The objectives were to be able to participate in discussions from an ethical perspective. The main problems were the lack of connection with on-the-job, and a shortage of training personnel. The key to providing off-the-job and on-the-job is to create a mechanism for circulation. The implications of the results are the necessity of constructing ethics education in medicine to develop medical professionals who can discuss and act from ethical perspectives. Future research is expected to include the creation of a multidisciplinary ethics training program for the hospital.

Problems of Simulation Education: Opinions of a Student, Teacher, Doctor and Manager

The authors of the study are trying to answer the question of whether simulation education in medicine is a "classic" or an "innovation", and also to assess the implementation of its advantages in practical realities, the reasons for failures and difficulties of both participants in the process on the part of students and on the part of education and practicing specialists.

2241 ‘You learn by doing, and by falling over’: a simulation-based approach to frailty, falls and fractures.

Abstract Background Studies show that newly qualified doctors feel unprepared for clinical practice in several key areas in the care of older people, despite older people occupying two thirds of inpatient beds [1,2]. Grounded in experiential learning theory, simulation has been hugely effective in undergraduate education in geriatric medicine [3]. We aimed to evaluate a novel simulation series exploring practically challenging aspects of geriatric medicine, such as ‘silver trauma’ and using de-escalation strategies in the management of delirium. Methods Using quality improvement methodology, we developed two inpatient simulation scenarios for fourth-year medical students on their geriatric medicine clerkships. The scenarios (managing delirium and post-falls assessment) are commonly encountered during on-call shifts, with learning outcomes aligned to Outcomes for Graduates. Our initial cycle involved eight students piloting the two scenarios and evaluation tool. Using their feedback, we will iteratively improve the methods and evaluation before repeating and obtaining pre- and post-simulation data on students’ ‘preparedness for F1’. Results Following the pilot, 100% of participants agreed that they felt more prepared for clinical work in geriatrics as an F1 doctor. 12.5% felt confident assessing a patient following a fall pre-session, which increased to 100% afterwards. Confidence in using de-escalation techniques in managing delirium improved from 50% (pre-) to 100% (post-session). Common themes in free-text feedback were that the simulation felt realistic and effectively tested prioritisation. Conclusion Our work highlights the merits of using simulation in geriatric medicine to help undergraduates prepare for the complexities and uncertainty involved in caring for the ageing population.

Undergraduate occupational medicine education in European Medical Schools: better training to meet today’s challenges

BackgroundOccupational medicine (OM) faces considerable challenges today, one of them related to the university training of future physicians considered suboptimal at a global level as it has been pointed out in many studies. The aim of this study is to update the state of OM medical education in European universities.MethodsBetween March and August 2022, an e-mail survey regarding OM training to undergraduate medical students was conducted among OM professors at European universities in 28 countries (n = 347).ResultsOf the 347 universities, 53 medical schools from 19 countries responded (response rate = 15.3%). In 89% of cases, OM was taught. The average number of hours per academic year was 24.3, with significant variation within the same country. Lectures were the most popular teaching technique (98%), with a considerable use of modern approaches such as problem-based learning (61%), and e-learning (57%). While occupational diseases and principles of prevention were covered, other subjects such as the environmental impact or collaboration with an OM physician were poorly represented in the educational program.ConclusionAccording to data, several European medical schools may provide insufficient OM education and training to their students. The education of undergraduate occupational medicine students in European medical schools should be designed to equip them with the knowledge and skills required to meet today’s challenges. It is critical that undergraduate OM education in European medical schools be enhanced, harmonized, and standardized.

Efforts to Reduce Bias in Clerkship Evaluations: A CERA Study.

As the number of medical students who identify as underrepresented in medicine (URiM) increases, the disparities related to gender and URiM status persist. This study examines the current initiatives within family medicine clerkships to reduce bias in evaluations. Our 10-item survey was included as a module in the 2022 Council of Academic Family Medicine Educational Research Alliance national survey of family medicine clerkship directors. Our survey questions asked about whether programs had strategies to reduce bias in student evaluations, antiracism initiatives, perceptions on effectiveness of the initiatives, and type and cadence of faculty development on evaluations for preceptors. The overall response rate for the survey was 59.12% (94/159); all respondents completed our module. Seventy percent said they had implemented strategies to reduce bias in evaluations, 60% felt these were effective, and 80% felt that reducing bias in evaluations was a priority. The majority, 89/91(95%), indicated that their medical schools had a current social justice, diversity, or antiracism initiative. We identified a positive association between specific antibias medical school initiatives and clerkship directors undertaking practices to reduce bias in evaluations (P=.005). Most programs had implemented strategies to reduce bias and felt that doing so was a priority. Community-based preceptors were less likely to have faculty development around reducing bias compared to those in academics. Further improvements may need to prioritize including community preceptors in educational efforts to reduce bias.

Long-term Outcomes of Geriatric Medicine Teaching Strategies: Comparing no Content, Traditional Lecture, and Flipped Classroom 2 Years Postintervention

Long-term Outcomes of Geriatric Medicine Teaching Strategies: Comparing no Content, Traditional Lecture, and Flipped Classroom 2 Years Postintervention

Expectations And Motivations Of Young Occupational Medical Physicians: A Quantitative Survey Of Five German Academies

The aim of this study was to describe the characteristics of future occupational physicians and to evaluate their expectations from and motivations for undertaking postgraduate medical education courses in occupational medicine. This will provide a basis for further increasing the attractiveness of occupational medicine as a discipline in preventive medicine and counteracting the shortage of occupational medical physicians. At five locations in Germany, physicians in postgraduate medical education courses in occupational medicine were asked about their expectations from occupational medicine, their reasons for starting postgraduate medical education courses, and their assessment of these courses. The survey took place between 2018 and 2021. The data were analysed descriptively, and a cluster analysis was applied to identify the types of motives for continuing postgraduate medical education courses in occupational medicine. Of the 233 respondents, the majority were female (68.5%) and the mean age was 43.1 years (SD 7.9 years). The response at the State Chamber of Physicians of Saxony was 50% and at the remaining four academies was between 18% and 23%. The analysis revealed four different types of motives: "career & interest", "work & life balance", "self-employment" and "desire for change". Two-thirds of the participants were in favour of a greater integration of occupational medicine into medical school curriculum. The results suggest that there are different motives that lead physicians to pursue continuing education in occupational medicine. These motives should be considered when recruiting young occupational physicians.

Advancing equity in spine surgery: unraveling the impact of affirmative action reversal

Affirmative action has been pivotal in addressing historical and systemic discrimination, particularly within healthcare. This paper delves into the impact of affirmative action policies on diversity in spine surgery, elucidating their critical role in fostering inclusivity and equal opportunities for individuals of underrepresented racial and ethnic groups. Historically, affirmative action has been instrumental in breaking down barriers to education and careers in medicine. Landmark cases such as Brown v. Board of Education have been influential in shaping these policies. However, the recent reversal of affirmative action poses a substantial threat to diversity in medical school admissions, potentially diminishing the presence of minority groups in spine surgery.We examine the historical foundation and transformative impact of affirmative action, focusing on key legal cases and their influence on educational and professional inclusivity. The current landscape of diversity in medical education and spine surgery highlights the role of affirmative action in cultivating an inclusive workforce. Counterarguments to affirmative action are critically evaluated, emphasizing the extensive benefits of diversity in enhancing patient care, driving research innovation, and informing policy advocacy. To counteract the adverse effects of the affirmative action reversal, we propose proactive initiatives, including targeted support for college students, medical students, residents, and practicing surgeons. These strategies are designed to ensure the recruitment and retention of a diverse workforce in spine surgery, thereby enriching patient care and advancing the field.

Relationship between forensic medicine education, stress factors, and mobbing perception from the perspective of specialists in Turkey's universities

IntroductionThe current situation needs to be presented with scientific data to ensure and improve the quality of specialist training. This study examined the quality of education, instructor competence, stress factors, mobbing, and their interconnections in the domain of forensic medicine specialty education in Turkey. Materials and methodsThis cross-sectional study was conducted through an anonymous, web-based survey targeting forensic medicine specialists who have completed their specialist training in university forensic medicine departments within the last three years. The survey consisted of questions regarding issues included in the core education curriculum, educator characteristics, and perceptions of stress and mobbing. Based on the responses provided, the relationships between these factors were statistically analysed. Results72.7 % of the study population completed the survey. Nearly half of the participants (46.3 %) did not consider the number of instructors adequate. The quality of instructors (scientific competence, educational and teaching skills, interpersonal relations, accessibility, management, and problem-solving abilities) was determined to be partially sufficient (mean = 3.36). Approximately one-third of the respondents indicated that instructors made the greatest contribution to their specialist training, whereas the proportion of those who said otherwise was much higher. Education received for topics included in the core curriculum was partially sufficient level (mean = 3.04). It was observed that there was a significant relationship between the instructor characteristics, sufficiency score of the taught topics, and perception of mobbing (p < 0.01). The sufficiency scores of instructor characteristics had a 1.02-fold impact on sufficiency ratings of the topics covered in residency training. Among the respondents, 76.9 % reported encountering stress factors during their specialty training, with the most frequently exposed stress factor (52.2 %) being disorganisation within the training program. Among the participants, 22.8 % reported experiencing mobbing. ConclusionsEducation and instructor qualifications were correlated; however, stress factors and mobbing adversely affected education. A close association was observed between education, instructors, stressors, and mobbing. Thus independent and objective auditors tasked with verifying whether institutions meet the established educational standards need to be established.

Professor Ivan Ivanovich Neiding: Touches to the portrait

2024 marks the 120th anniversary of the death of Ivan Ivanovich Neiding, a prominent Russian forensic scientist and professor of the medical faculty of Imperial Moscow University. The formative years of forensic medicine in Russia are inextricably linked to natural development and success in medical science. An analysis of the history of the forensic medical service also showed its close connection with the law and the needs of judicial investigative institutions. This interaction revealed the nature of scientific research and the practical orientation of forensic medical examination. I.I. Neiding has made significant contributions to the development of Russian forensic medical science and practice and was one of the best representatives of the faculty of Moscow University at the end of the XIX century. His name is associated with the period of brilliant scientific flourishing of the Department of Forensic Medicine of the Faculty of Medicine. During his 22 years as head of the department, I.I. Neiding had done a lot to ensure that the teaching of forensic medicine meets the ever-increasing practical demands. The creative path of this scientist can be an example for young specialists in the field of forensic medicine. His image was recreated based on the memoirs of his contemporaries and speeches. The article provides information about the life and work of I.I. Neiding. The memoirs of this scientist’s contemporaries and views on forensic medicine are presented. This study has not only cognitive significance but also carries the idea of educating young professionals. Among others, I.I. Neiding makes up the color of Russian medicine and pedagogy. Many of the provisions of I.I. Neiding’s research have not lost their relevance even today.

A Study Protocol on Disaster Medicine Preparedness among Medical Students in a Public Military Medical School in Malaysia: Assessment of Knowledge, Attitude and Readiness to Practice

Disaster preparedness is defined as the measures taken to prepare for or decrease the impact of disaster. Medical students’ perception on disaster preparedness provides further insights into their learning needs, strengthens the disaster medicine curriculum, and improves their personal professional development. There is scarce information regarding this topic and disaster medicine education is scattered in the current medical curriculum. The aim of this study is to assess the knowledge (K), attitude (A) and readiness to practice (rP) towards disaster preparedness among medical students in a military university. A cross-sectional study will be conducted among all the medical students in Universiti Pertahanan Nasional Malaysia using a self-administered validated questionnaire via a Google Forms. The calculated minimum sample size is 176 using the twoproportion formula via Power and Sample Size (PS) software. The questionnaire consists of (a) demographic data; (b) knowledge of disaster; (c) attitude; (d) readiness to practice with responses categorised as high, moderate and low. Independent t-test and chi-square test are used to evaluate the bivariate association between demographic data with K, A and rP. Multiple linear regression is used to evaluate association of rP based on predictor variables (K, A and sociodemographic factors). A preliminary result of the study will be presented in conferences and scientific meetings. This research contributes valuable insights to the field of disaster medicine education, guiding curriculum development, and informing policy decisions within institutions.

Reflections on the evolution of Community Medicine education

Reflections on the evolution of Community Medicine education

Artificial Intelligence in Medicine and Medical Education: Current Applications, Challenges, and Future Directions

AI's rise in medicine promises personalized care, better diagnoses, and innovative training. It analyzes images, predicts diseases, and tailors treatments. However, ethical concerns loom. Biased data can lead to unfair diagnoses, and some AI systems lack transparency, raising trust issues. The editorial proposes solutions: ethical frameworks, transparent AI, and legal regulations. It envisions a future where AI complements doctors, requiring collaboration across fields. To prepare future physicians, medical schools need to integrate AI and ethics into their curriculum. AI holds immense potential, but challenges must be addressed. Through collaboration and responsible development, AI can revolutionize medicine alongside human expertise.

Client experiences and perceptions of naturopathic treatment in New Zealand: A qualitative study

IntroductionNaturopathy is a well-known and utilised form of traditional, complementary, and integrative medicine (TCIM). Limited New Zealand research exists that has examined the utilisation of naturopathy from the perspective of users. The present study was designed to identify and explore individual's experiences and perceptions of naturopathic care. MethodsTwenty clients (18 female and two male) who attended a student naturopathy and herbal medicine teaching clinic in Auckland, New Zealand were individually interviewed via Zoom video conferencing using open-ended questions. Interview transcripts were anlysed using an inductive thematic approach, focusing on similarities in participants' experiences and perceptions of their naturopathic treatment. ResultsSix main themes were identified regarding individual's experiences and perceptions of naturopathic care (1) feeling heard, (2) perceived attributes of the student practitioner and feeling looked after, (3) perceived knowledge of student practitioners, (4) high degree of client education, (5) partnership, empowerment and ownership, and (6) recommending naturopathy based on own experiences. ConclusionsParticipants reported positive experiences and perceptions of their naturopathic treatment. Participants felt heard and looked after and indicated that their student naturopaths were caring, supportive and knowledgeable. Client education enhanced health literacy and participants felt empowered and in control of their health and healing. Client education was perceived to be important for individuals with chronic health conditions, as the information imparted was not always covered by their other healthcare practitioners.

Evaluation of Pediatric Patients Admitted to the Hospital for Drug Intoxication

Abstract Objective: Drug poisoning is the most common form of poisoning in children, and it is a situation that can lead to fatal consequences, but can be prevented if appropriate precautions are taken. Children are the future of a society, so drug poisoning poses an important public health problem. Factors such as high-dose drug combinations, misuse, poor storage conditions, and children's access to drugs can all contribute to drug intoxication. The aim of this study is to understand the effects of drug poisoning on children, to identify the characteristics of these children and to raise awareness about the measures that can be taken to prevent this problem. Material and Methods: This study was conducted retrospectively on 100 patients who applied to the pediatric emergency department of Karabuk University Faculty of Medicine Education and Research Hospital with the complaints of drug use and drug exposure. Results: It was observed that the mean age of the patients was 7.65±6.51 years, 58% of them were girls and 71% of them accidentally drank drugs. When the drugs consumed by the patients were examined, it was determined that the analgesic-anti-inflammatory (Paracetemol) group was the highest with 18%. When the hospitalization status of the patients was examined, it was seen that 22% of them were not hospitalized. It was observed that 56% of the patients experienced symptoms, and the most common symptom was nausea and vomiting with 33%. No mortality was observed in any of the patients. Conclusion: Study results show that children often take drugs accidentally. The fact that analgesic-antipyretic group drugs are mostly encountered suggests that it is a predictable result of their widespread use in the community. In addition, the high hospitalization rate with 78% unfortunately leads to an extra expenditure of our limited resources for a condition that could have been prevented. For this reason, establishing an effective public health policy and taking preventive measures for commonly used drugs can reduce the frequency of poisonings. We think that our findings will guide clinicians. Keywords: Drug poisoning, intoxication, drugs, pediatric patients