Medical Education Experience Research Articles

Assessing the Learning Environment for Medical Students: An Evaluation of a Novel Survey Instrument in Four Medical Schools.

A practical, reliable, and valid instrument is needed to measure the impact of the learning environment on medical students' well-being and educational experience and to meet medical school accreditation requirements. From 2012 to 2015, medical students were surveyed at the end of their first, second, and third year of studies at four medical schools. The survey assessed students' perceptions of the following nine dimensions of the school culture: vitality, self-efficacy, institutional support, relationships/inclusion, values alignment, ethical/moral distress, work-life integration, gender equity, and ethnic minority equity. The internal reliability of each of the nine dimensions was measured. Construct validity was evaluated by assessing relationships predicted by our conceptual model and prior research. Assessment was made of whether the measurements were sensitive to differences over time and across institutions. Six hundred and eighty-six students completed the survey (49% women; 9% underrepresented minorities), with a response rate of 89% (range over the student cohorts 72-100%). Internal consistency of each dimension was high (Cronbach's α 0.71-0.86). The instrument was able to detect significant differences in the learning environment across institutions and over time. Construct validity was supported by demonstrating several relationships predicted by our conceptual model. The C-Change Medical Student Survey is a practical, reliable, and valid instrument for assessing the learning environment of medical students. Because it is sensitive to changes over time and differences across institution, results could potentially be used to facilitate and monitor improvements in the learning environment of medical students.

Students’ Expectations and Experiences of Meaningful Simulation-Based Medical Education

This study aims to investigate students’ expectations and experiences of meaningful learning in simulation-based learning environments. We set the following research question: How do students’ experiences of meaningful simulation-based learning correspond to their expectations? The students’ (n = 87; male 51, female 36) pre- and post-questionnaires were analyzed using statistical methods. The results indicated that students’ expectations and experiences of meaningful learning were positive, and for most statements, there were statistically significant differences between the mean pre-questionnaire rating and the mean post-questionnaire rating, thereby indicating that students’ actual experiences of simulation-based learning were more positive than their expectations. Thus, students’ experiences exceeded their expectations.

Seminar.net with special issue from Finland

Most of the world has learned to ”see to Finland” over the last decade, beacuse of its reputation as a leading nation in educational achievement, as well as its many creative and diligent approaches in technology. Since 1990 Finnish researchers in media, technology and education have met annually to discuss research matters and further advances in the area. For the conference of 2016, held 13-15th April in Hämeenlinna, Finland, we were asked to have the best papers published in Seminar.net. After a rigourous review process we will print six papers, four in this issue and two in the next.Antti Syvänen, Jaana-Piia Mäkiniemi, Sannu Syrjä, Kirsi Heikkilä-Tammi and Jarmo Viteli, all of the University of Tampere, present the paper “When does the educational use of ICT become a source of technostress for Finnish teachers?» This interesting paper is based on the analysis of questionnaires filled in by 2741 Finnish teachers. It provides significant insight into what causes teachers to experience stress and alienation when using information and communication technologies (ICT) in their classrooms.Tuulikki Keskitalo and Heli Ruokamo of Lapland University present a paper dealing with “Students’ Expectations and Experiences of Meaningful Simulation-Based Medical Education». Simulation in nursing education is a very rapidly developing area, and the students – as well as their teachers – have high expectation. This project is about student’s expectations and the very positive result from this study was that their experiences were even higher than their expectations.Hanna Vuojärvi, of the University of Lapland and Miikka Eriksson, of the University of Eastern Finland, have written the article «Using Mobile Tools to Support Meaningful Work-based Learning in Vocational Education» together. Their case study focused on meaningful work-based learning (WBL) and the pedagogical use of mobile information and communication technologies (ICTs) in vocational tourism education. It demonstrates how the use of smartphones was applied in the project and its usefulness in the student’s work with the learning material.Antero Lindstedt, Kristian Kiili, Pauliina Tuomi and Arttu Perttula, all from Tampere University of Technology, Pori department provide the paper called “A user experience case study: two embodied cognition user interface solutions for a math learning game». They have used a particular game development environment, Semideus, to test out how different user interfaces influenced. They found interesting differences, mainly in favour of the «tilting user interface».

Introduction to Curriculum Development and Medical Education Scholarship for Resident Trainees: A Webinar Series.

A common career aspiration among residents is to become a clinician-educator, though standard postgraduate training may not prepare trainees for the academic and scholarly requirements of this career. To address this need, we designed and implemented an asynchronous, interactive webinar series detailing a systematic approach to medical education research and scholarship. The series was piloted as part of a new track at the University of Chicago for residents interested in additional training and completing an educational learning project in medical education. We aimed to use this series to introduce relevant frameworks in curriculum development, program evaluation, and learning theory. Materials associated with this publication include six webinars and corresponding summary reference handouts, discussion assignments, and answer keys. Additional materials include a faculty course director packet and sample feedback for discussion assignments. Each webinar is an 8- to 20-minute narrated presentation with goals and objectives, an overview of each session's content, and example vignettes. Residents viewed presentations and completed a two-part discussion assignment for each webinar, which included reflection on the educational material and vignettes, faculty feedback on this reflection, and application of webinar material and faculty feedback to their own experiences in medical education. All residents in the pilot completed the webinars and assignments. Residents' reactions to the webinar series have been positive, and residents have commented that self-paced learning with directed faculty feedback is a desirable instructional method for this material. This series is well suited to introduce fundamental concepts in medical education scholarship and inspire self-directed study for motivated learners.

Editorial introductions

Editorial introductions

Resident duty hour modification affects perceptions in medical education, general wellness, and ability to provide patient care.

BackgroundResident duty hours have recently been under criticism, with concerns for resident and patient well-being. Historically, call shifts have been long, and some residency training programs have now restricted shift lengths. Data and opinions about the effects of such restrictions are conflicting. The Internal Medicine Residency Program at Dalhousie University recently moved from a traditional call structure to a day float/night float system. This study evaluated how this change in duty hours affected resident perceptions in several key domains.MethodsSenior residents from an internal medicine training program in Canada responded to an anonymous online survey immediately before and 6 months after the implementation of duty hour reform. The survey contained questions relating to three major domains: resident wellness, ability to deliver quality health care, and medical education experience. Mean pre- and post-intervention scores were compared using the t-test for paired samples.ResultsTwenty-three of 27 (85 %) senior residents completed both pre- and post-reform surveys. Residents perceived significant changes in many domains with duty hour reform. These included improved general wellness, less exposure to personal harm, fewer feelings of isolation, less potential for error, improvement in clinical skills expertise, increased work efficiency, more successful teaching, increased proficiency in medical skills, more successful learning, and fewer rotation disruptions.ConclusionsSenior residents in a Canadian internal medicine training program perceived significant benefits in medical education experience, ability to deliver healthcare, and resident wellness after implementation of duty hour reform.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0703-4) contains supplementary material, which is available to authorized users.

Professional Formation in the Gross Anatomy Lab and Narrative Medicine: An Exploration.

As an early and important experience in medical education, dissection in the gross anatomy lab is a locus of professional formation. Because students often think of their professional development in evolving, narrative terms, the authors propose that close attention to these narratives might add to understanding of professional formation in progress. They solicited written reflections from students, to explore ways that both the content and form of written reflections might illuminate themes relevant to professional formation, and to describe some elements of professional formation in the context of one institution (Baylor College of Medicine, Houston, Texas). Seventeen students participated in writing sessions and wrote in response to an oral interview transcript and to a poem. Using a reading approach that grew out of the narrative medicine movement, the authors collaboratively engaged the content and form of these written reflections.Students' collection of written reflections was a rich source of information about their experiences in the anatomy lab. Through both content (e.g., expressions of gratitude, transitions, self-awareness) and form (e.g., from less detailed writing to literary playfulness), their writings gave a glimpse into the tensions, disappointments, and satisfactions of the practice of gross anatomy.This project models one way that educators can read and respond to the reflective writing that students generate. The authors go on to propose ways that interactions around reflective writing can be part of a broader goal of forming narrative-minded physicians, who become increasingly self- and other-aware as they progress in their education and practice.

Teaching professionalism in graduate medical education: What is the role of simulation?

We systematically reviewed the literature concerning simulation-based teaching and assessment of the Accreditation Council for Graduate Medical Education professionalism competencies to elucidate best practices and facilitate further research. A systematic review of English literature for "professionalism" and "simulation(s)" yielded 697 abstracts. Two independent raters chose abstracts that (1) focused on graduate medical education, (2) described the simulation method, and (3) used simulation to train or assess professionalism. Fifty abstracts met the criteria, and seven were excluded for lack of relevant information. The raters, 6professionals with medical education, simulation, and clinical experience, discussed 5 of these articles as a group; they calibrated coding and applied further refinements, resulting in a final, iteratively developed evaluation form. The raters then divided into 2 teams to read and assess the remaining articles. Overall, 15 articles were eliminated, and 28 articles underwent final analysis. Papers addressed a heterogeneous range of professionalism content via multiple methods. Common specialties represented were surgery (46.4%), pediatrics (17.9%), and emergency medicine (14.3%). Sixteen articles (57%) referenced a professionalism framework; 14 (50%) incorporated an assessment tool; and 17 (60.7%) reported debriefing participants, though in limited detail. Twenty-three (82.1%) articles evaluated programs, mostly using subjective trainee reports. Despite early innovation, reporting of simulation-based professionalism training and assessment is nonstandardized in methods and terminology and lacks the details required for replication. We offer minimum standards for reporting of future professionalism-focused simulation training and assessment as well as a basic framework for better mapping proper simulation methods to the targeted domain of professionalism.

P099: Development and qualitative evaluation of an emergency medicine simulation book to facilitate the use of simulation for our local EM program

Introduction / Innovation Concept: Simulation-based medical education (SBME) has seen increased application in medical education. Emergency medicine (EM) trainees must develop a diverse skill set to smoothly transition to clinical practice and ensure optimal patient outcomes. The competency-based medical education (CBME) framework helps ensure residents develop the required expertise relevant to each of the CanMEDs roles. Simulation is a valuable supplement to hands-on clinical experience and allows skill development in a low-risk setting. The EM Simulation book serves to facilitate the effective application of simulation in our curriculum. Methods: A number of resources were compiled to meet the needs of our simulation program within Memorial University of Newfoundland. Personal knowledge/experience of the author and local contacts provide site relevant content. Prior training helped in review and selection of materials on simulation theory and debriefing. Core EM resources were sourced for information on procedural training. Literature review on simulation was used to compile a list of resources and materials for further reading. The development and revision of the manual continues as an iterative process with sequential edits based on review and feedback. Qualitative evaluation of the design and value of this document is planned to get feedback from key stakeholders including learners, faculty and simulation lab staff. Curriculum, Tool, or Material: The final product is a 94-page document provided in print and electronic format to the EM residents and several faculty involved in simulation. It introduces residents to our simulation program, provides relevant background information and orients them to this modality of curriculum delivery. Theory and rationale behind SBME is included. Information on the key role of debriefing is highlighted. Several core EM procedural topics are covered with tips on practice station set up. Additional learning resources are noted, including information on case development for potential teachers. Conclusion: The simulation book brings together key information to optimize the simulation-based medical education experience for EM residents at Memorial University.

Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq

ObjectiveThis study surveyed all Iraqi medical schools and a cross-section of Iraqi medical students regarding their institutional and student experiences of medical education amidst ongoing conflict. The objective was to...

의무기록 전공학생들의 환자 의료정보 보호인식과 실천인식에 관한 연구

본 연구는 졸업 후 의무기록사로 근무하게 될 의무기록 전공 학생들의 환자 의료정보 보호인식과 실천인식을 조사 분석하여 정보의 중요성을 인식하게하고, 의무기록 교육과정 개발 및 전공교육과 의료정보 보호정책 수립 시 기초 자료를 제공하고자 하였다. 자료조사는 4개 대학에 재학생 340명을 대상으로 2015년 5월 18일부터 6월 5일까지 실시하였고, 자료 분석은 t-검정과 분산분석, 피어슨 상관분석, 다중회귀로 분석하였다. 연구결과 보호인식과 실천인식의 점수는 5점 만점에 각각 3.55점과 3.49점이었으며, 의료정보에 대한 보호인식에서는 학년, 전공만족, 의료정보 보호 교육경험, 법률인지, 실천인식에서는 학년, 전공만족, 교육경험, 의료정보 노출피해에서 유의한 차이를 보였다. 보호인식과 실천인식은 유의한 정(+)의 상관관계가 있었으며, 실천인식에 미치는 요인으로는 정보노출 인식과 사회적 쟁점 인식, 법제도 인식이 유의미한 정(+)의 영향을 미쳤다. 이러한 연구를 바탕으로 보호인식과 실천인식을 높이기 위해서 대학에서부터 의료정보의 유출로 인한 피해와 의무기록 관리의 중요성을 교육시켜 인식을 향상시켜 나가는데 기여할 수 있을 것으로 기대된다. This study is aimed at researching and analyzing the students' recognition and practice of the patents medical information, who are majoring in medical records and will be working as medical records technician, letting them recognize the importance of information, and at offering basic data required for development of medical records curriculum and for establishment of medical records protection policy. This study was conducted from 18th May through 6th June 2015, targeting 340 students enrolled four universities, by t-test, variance analysis, Pearson correlation analysis and multiple regression analysis. As a result of this study, the point of protection recognition and practice recognition is 3.55 and 3.49, respectively, out of 5. With regard to recognition of medical information protection, there was a significant difference in grade, satisfaction for major, experience of medical information protection education and recognition of law, while for recognition of practice, in grade, satisfaction for major, educational experience and damage of medical information exposure. Recognition of protection and recognition of practice had a significant static correlation, and recognition of information exposure, recognition of social issue and recognition of legal system had significant positive effect on recognition of practice. In order to raise the recognition of protection and recognition of practice, based on this study, it is considered necessary for the universities to educate the damage of medical information exposure and importance of medical records management, and to raise the students' recognition.

Using evaluation to improve medical student rural experience.

Objective The aim of this evaluation was to see whether interventions implemented to improve the Rural Medicine Rotation made this a more effective rural medical education experience. Multiple interventions targeting the student experience, lecturers and preceptors were implemented. Methods A quasi-experimental design using pre- and post-measures was used. The participants were all University of Queensland, School of Medicine, Rural Medicine Rotation students who completed the 2009 and 2010 rural medicine rotation evaluations. There were 769 students, with an 84% response rate in 2009 and an 80% response rate in 2010. In addition, all the 25 program preceptors who were visited in 2009 and the 34 who were visited in 2010 participated in the study. Results The implementation of interventions resulted in significant improvement in three outcome measures, namely teaching effectiveness, provision of an environment supportive of learning in a rural/remote setting and opportunities for professional growth. Two of the three other outcome measures - ensuring a safe clinical placement and opportunities for procedural skills experience and development - were very positively evaluated in both 2009 and 2010. Conclusions The interventions contributed to a more effective rural medical education experience, providing students with the opportunity to develop skills and knowledge relevant for rural medicine and to gain an understanding of the context in which rural medicine is practiced. What is known about the topic? Many Australian medical schools offer students rural-based educational opportunities based on the premise that placing medical students in a rural setting may ultimately lead to them choosing careers in rural medicine. However, there is a paucity of evidence on the factors that are considered necessary for medical students to gain a positive rural experience of short conscripted rural placements. What does the paper add? This paper identifies successful interventions to the rotation and placements that provide a positive experience of the rural clinical placement for students. These interventions occurred within an ongoing evaluation program embedded in the rotation. What are the implications for practitioners? Through ongoing evaluation, interventions can be selected and implemented that succeed in contributing to students having a positive rural clinical placement experience. This paper demonstrates how an embedded continuous improvement program serves to provide direction for ongoing modifications.

Overnight Hospital Experiences for Medical Students: Results of the 2014 Clerkship Directors in Internal Medicine National Survey.

Since the 2011 Accreditation Council of Graduate Medical Education (ACGME) work hour rules for residents were implemented, 24-30 h call for interns has been replaced by shift work, including night-float. The impact of these changes on undergraduate medical education experiences in internal medicine has not been described. We aimed to determine the current status of medical students' overnight experiences in Internal Medicine clerkships and sub-internships, and to assess internal medicine educators' perceptions of the importance of overnight work during internal medicine rotations. In May 2014, the Clerkship Directors in Internal Medicine (CDIM) conducted its annual survey. Twenty-eight questions about student participation in overnight work and perceptions of the importance of overnight work (rated on 1-5 Likert scale, 1 = very unimportant and 5 = ery important) were included. Descriptive statistics were used to summarize responses. Free text results were analyzed qualitatively. The response rate was 78 %. A minority of respondents reported students having any overnight experience during the clerkship (38.7 %) or the sub-internship (40.7 %). Only 5 % of respondents reported having students assigned to night-float rotations outside of clerkships or sub-internships. Respondents agreed that overnight experiences were more important during the sub-internship than the clerkship, 4.0 ± 1.1 vs. 3.2 ± 1.2, p < 0.001. Admitting new patients, following their course and responding to emergencies were rated as important overnight tasks for both clerkship and sub-internship students. Overnight experiences offer students additional educational opportunities. Clerkship directors felt that the overnight experience for the sub-intern in particular was an important chance to practice providing emergency cross coverage and other intern roles. In the era of ACGME duty hours, there is a need to further examine whether there is a role for increased overnight hospital experiences for medical students.

Survey of the Child Neurology Program Coordinator Association: Workforce Issues and Readiness for the Next Accreditation System.

In preparation for the implementation of the Next Accreditation System in Child Neurology, the authors organized the first meeting of child neurology program coordinators in October 2014. A workforce and program-readiness survey was conducted initially. Coordinator job titles varied widely. Most respondents (65%) managed 1 or more fellowships plus child neurology residency. Most had worked in graduate medical education less than 5 years (53%), with no career path (88%), supervised by someone without graduate medical education experience (85%), in divisions where faculty knowledge was judged inadequate (72%). A small proportion of programs had established clinical competency committee policies (28%) and was ready to implement milestone-based evaluations (56%). A post-conference survey demonstrated substantial improvements in relevant skills. The complexity of residency program management in the Next Accreditation System era supports substantive modifications to the program coordinator role. Such changes should include defined career pathway, managerial classification, administrative support, and continuing education.

Internists, pharmacists, and psychologists on learning teams: An interprofessional team-based learning experience in graduate medical education

Abstract Background Curricula in graduate medical education should include active learning, enhance critical thinking skills, and promote team-work. Team-based learning (TBL) is an active learning strategy shown to improve both test scores and participants' attitudes about teamwork. Purpose We sought to determine the feasibility of using TBL to enhance the ambulatory education of medical residents, pharmacy residents, and psychology graduate students. These learners often manage outpatients in parallel, but rarely have the opportunity to learn together in teams. Method We delivered three interprofessional TBL modules over the course of one academic year. We assessed learners' self-perceived improvements in knowledge, skills, and attitudes related to the objectives of each module, using a retrospective pre-post survey. Discussion Learners reported improvements in their knowledge, skills, and attitudes after each modules. Conclusions Interprofessional TBL appears to improve learning and participants' perception of managing patients in teams. Challenges include the time to develop modules and coordinating schedules for interprofessional learners.

Breadth vs. Volume: The Outpatient Neurology Clinic Experience in Medical Education (P5.038)

Breadth vs. Volume: The Outpatient Neurology Clinic Experience in Medical Education (P5.038)

The value of postmortem experience in undergraduate medical education: current perspectives.

The autopsy has traditionally been used as a tool in undergraduate medical education, but recent decades have seen a sharp decline in their use for teaching. This study reviewed the current status of the autopsy as a teaching tool by means of systematic review of the medical literature, and a questionnaire study involving UK medical schools. Teachers and students are in agreement that autopsy-based teaching has many potential benefits, including a deeper knowledge of basic clinical sciences, medical fallibility, end of life issues, audit and the “hidden curriculum”. The reasons underlying the decline in teaching are complex, but include the decreasing autopsy rate, increasing demands on teachers’ time, and confusion regarding the law in some jurisdictions. Maximal use of autopsies for teaching may be achieved by involvement of anatomical pathology technologists and trainee pathologists in teaching, the development of alternative teaching methods using the principles of the autopsy, and clarification of the law. Students gain most benefit from repeated attendance at autopsies, being taught by enthusiastic teachers, when they have been effectively prepared for the esthetic of dissection and the mortuary environment.

Physician, know thyself: the role of reflection in bioethics and professionalism education.

Reflection in medical education is becoming more widespread. Drawing on our Jesuit Catholic heritage, the Loyola University Chicago Stritch School of Medicine incorporates reflection in its formal curriculum and co-curricular programs. The aim of this type of reflection is to help students in their formation as they learn to step back and analyze their experiences in medical education and their impact on the student. Although reflection is incorporated through all four years of our undergraduate medical curriculum, this essay will focus on three areas where bioethics faculty and medical educators have purposefully integrated reflection in the medical school, specifically within our bioethics education and professional development efforts: 1) in our three-year longitudinal clinical skills course Patient Centered Medicine (PCM), 2) in our co-curricular Bioethics and Professionalism Honors Program, and 3) in our newly created Physician's Vocation Program (PVP).

Response to Let Me Heal Book Reviews

The September 2014 issue of the Journal featured a series of reviews of Kenneth Ludmerer's recent book Let Me Heal: The Opportunity to Preserve Excellence in American Medicine.1 As I read the reviews, I was intrigued, and I ordered a copy of the book.The authors of the reviews comprised a spectrum of individuals with varying experiences in graduate medical education—residents, medical educators, a designated institutional official, an expert on education from abroad, and a patient. All offered fascinating perspectives, yet I could not help but think that 1 group was missing, a group with close interactions to all those people mentioned previously, and that have a solid understanding of graduate medical education at a program level—residency program coordinators.As a program coordinator who is dedicated to her profession and has a passion for graduate medical education, I thought I might provide an alternative perspective and weigh in on some of the changes in graduate medical education that we have experienced as a profession.As Ludmerer1 points out, residency programs initially were run by department chairs. It wasn't until the 1970s and 1980s that the administrative duties were delegated to a designated “program director.” During this transition, there typically were office personnel who assisted in the running of the program; they may have been “secretaries” or “office assistants,” and they helped administer the residency program, either in part or as a whole function of their job.It did not take long for the members of this group to find each other and form a professional network. One of the earliest formal groups of residency coordinators was the Association of Residency Coordinators in Surgery,2 established in 1988, only 11 years behind the specialty Association for Program Directors in Surgery. The formal organization of such groups showed an early propensity for the members of this group to hold a vital and important role in the life of a resident.With the increased oversight by the Accreditation Council for Graduate Medical Education (ACGME), and the advent of duty hour limits and the competencies, the administration work for each program director grew immensely. It was during this time that the position of a dedicated residency program coordinator really took hold. As listed in Common Program Requirements for many specialties, a need was identified for “professional personnel for the effective administration of the program.”Program coordinators play a multitude of roles. We often are the administrative organizers, experts on the program requirements, life coaches, and connectors,3 to name a few. Our skills, resourcefulness, responsiveness, and professionalism are essential to the attainment of accreditation goals and for full compliance with the ACGME.Let Me Heal1 is an invaluable historical account of graduate medical education that residency program coordinators are proud to be a part of. I would like to think that residency program coordinators today are the “Uncle Hanks” of the early days of residency (this is a reference in the book to Henry Hurd, an early hospital administrator who had profound interest in the success of the residency program and in residents personally).I agree with the author that this book should be required reading for everyone involved in residency training, including residency program coordinators.

Twelve tips for addressing medical student and resident physician lapses in professionalism

Medical educators have gained significant ground in the practical and scholarly approach to professionalism. When a lapse occurs, thoughtful remediation to address the underlying issue can have a positive impact on medical students and resident physicians, while failure to address lapses, or to do so ineffectively, can have long-term consequences for learners and potentially patients. Despite these high stakes, educators are often hesitant to address lapses in professionalism, possibly due to a lack of time and familiarity with the process. Attention must be paid to generalizable, hands-on recommendations for daily use so that clinicians and administrators feel well equipped to tackle this often difficult yet valuable task. This article reviews the literature related to addressing unprofessional behavior among trainees in medicine and connects it to the shared experience of medical educators at one institution. The framework presented aims to provide practical guidance and empowerment for educators responsible for addressing medical student and resident physician lapses in professionalism.