Final-year Medical Students Research Articles

Lists of potential diagnoses that final-year medical students need to consider: a modified Delphi study

BackgroundContrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. However, there is no international consensus on lists of diagnostic considerations across different medical disciplines regarding the common signs and symptoms that should be learned as part of the undergraduate medical curriculum. In Japan, the national model core curriculum for undergraduate medical education was revised in 2016, and lists of potential diagnoses for 37 common signs, symptoms, and pathophysiology were introduced into the curriculum. This study aimed to validate the list of items based on expert consensus.MethodsThe authors used a modified Delphi method to develop consensus among a panel of 23 expert physician-teachers in clinical reasoning from across Japan. The panel evaluated the items on a 5-point Likert scale, based on whether a disease should be hypothesized by final-year medical students considering given signs, symptoms, or pathophysiology. They also added other diseases that should be hypothesized. A positive consensus was defined as both a 75% rate of panel agreement and a mean of 4 or higher with a standard deviation of less than 1 on the 5-point scale. The study was conducted between September 2017 and March 2018.ResultsThis modified Delphi study identified 275 basic and 67 essential other than basic items corresponding to the potential diagnoses for 37 common signs, symptoms, and pathophysiology that Japanese medical students should master before graduation.ConclusionsThe lists developed in the study can be useful for teaching and learning how to generate initial hypotheses by encouraging students’ contrastive learning. Although they were focused on the Japanese educational context, the lists and process of validation are generalizable to other countries for building national consensus on the content of medical education curricula.

Nutrition in medical education in Latin America: Results of a cross-sectional survey.

The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final-year medical students. Eighty-five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0-150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students' average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients' health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. Positive attitude and interest in nutrition among final-year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.

Deprived of the Sea: Being a Kenyan Final-year Medical Student During the COVID-19 Outbreak

Five months after the confirmation of the first case of COVID-19 in Kenya, the cases and fatalities due to the disease is still on the rise. The effects of the disease in the developing country have been far-reaching, and closure of all learning institutions has now shifted attention to online learning. However, challenges such as inconsistent access to the internet and electricity have led to inequality in education access. As final-year medical students, online lectures have been a new exciting experience, but it also came with challenges. The halt in clinical medical education has significantly affected the learning and school calendar. Although we are almost done with our journey through medical school, we cannot proceed any further. However, we remain hopeful that a leeway shall be found, and we shall join other healthcare workers in serving our country.

Perspective matters: assessment of medical students' communication and interpersonal skills by simulated patients from the internal and external patient perspective.

Background: Communication and interpersonals skills are important qualities of professionalism in medicine. In medical curricula, they are usually acquired in communication trainings and assessed in OSCEs. Studies show correlations as well as differences between communication ratings of examiners and simulated patients. In our study, simulated patients assessed medical students’ communication and interpersonal skills after a consultation hour from the internal and the external patient perspective.Methods: In December 2019, 52 final-year medical students participated in a consultation hour as part of a simulated first day of residency assessment. They were assessed twice with a questionnaire for communication and interpersonal skills (ComCare) by the simulated patients: directly after each consultation from the internal perspective of the patient’s view (internal perspective) and four month later from the 208 consultation videos from an external perspective of the patient’s view (external perspective). All eight ComCare items were assessed on a five-point Likert scale (1=full disagreement to 5=full agreement). Differences between the item means of internal and external perspective were examined by paired t-tests. Results: Overall, significantly higher ratings were found for all ComCare items from the external perspective except for the item “Interest”. Ratings for the items “Language” and “Listening” were significantly higher from the external perspective for all simulated patients. Significantly higher ratings for all items from the external perspective were observed for two simulated patients.Conclusion: Simulated patients’ ratings after a conversation seem to represent a more authentic view on students’ communication and interpersonal skills because of the emotionally experienced situation. The evaluation of those skills from a simulated patient perspective could be a valuable complement to communication ratings by examiners.

Revisiting the ATP 30: the Factor Structure of a Scale Measuring Medical Students’ Attitudes Towards Psychiatry

Among the scales developed for assessing medical students' attitudes regarding psychiatry, "attitude towards psychiatry-30" (ATP-30) is probably the most widely used. Although this scale was originally deemed to form a unitary dimension without any meaningful subscales, the authors sought to re-examine its factor structure and the viability of subscales. Secondary data from a survey of 743 final-year medical students from nine medical schools in Sri Lanka were analyzed using exploratory factor analysis (EFA) with promax rotation and confirmatory factor analysis (CFA), to assess the underlying factor structure of ATP-30. Parallel analysis was used in determining the number of factors to retain. Items conceptually external to the emerging factors were discarded. Three models based on literature (one-, five-, and eight-factor) were disproved by CFA. A six-factor solution encompassing 18 items was supported by EFA and CFA and was gender-invariant. These factors were, namely, the image of psychiatrists, psychiatric patients and mental illness, the efficacy of treatment, psychiatric teaching, career choice, and psychiatry as an evidence-based discipline. While "the image of psychiatrists" formed the most consistent subscale (ω = 0.71), the internal consistencies of the other subscales were modest (ω = 0.55-0.67). The overall 18-item scale showed good internal consistency (ω = 0.78). The findings provide evidence of a multi-dimensional structure in medical students' attitudes towards psychiatry, endorsing six meaningful subscales of the ATP-30. Future researchers and educators can utilize these subscales in identifying specific areas where students' attitudes are more stigmatized, to be intervened during undergraduate training.

Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates.

ContextWork readiness is often described in terms of the clinical competence medical graduates bring to day 1 of internship. Despite being increasingly viewed as a key graduate outcome, work readiness has remained poorly defined.ObjectiveThis narrative review draws on the international literature to explore how different research methods provide differing insight into what constitutes work readiness of medical graduates. From this, we explored contributory factors and developed a conceptual framework to better understand work readiness.MethodsDatabases were searched using the terms including “ready,” “readiness,” “preparedness,” “medical graduates,” “intern,” and “junior doctor.” Information was summarized using a textual description template that included information on study setting, participants, methodologies, limitations, and key result areas (including measures/themes and study conclusions). Consensus discussions between authors led to the naming and understanding of the key themes.ResultsSeventy studies were included in the review. Study participants included final‐year medical students (n = 20), junior doctors early in internship (n = 24), and junior doctors late in internship or postgraduate year 2 and above (n = 23). Most studies explored work readiness through the retrospective self‐report of the students and/or junior doctor participants. Quantitative research methods elaborated on key skills‐based competencies, whereas qualitative research methods provided insight into key contextual and individual characteristics that contributed to preparedness.ConclusionsDifferent research methods provided insight into competencies, as well as individual and contextual aspects, associated with preparedness for practice. The transition from university to clinical practice is significant and requires personal capability and confidence, as well as a supportive training context. Enabling students to engage authentically in clinical environments enhanced preparedness by promoting understanding of role and responsibility. Individual resilience is important, but contextual factors, including provision of adequate support and feedback, can enhance or subtract from feeling prepared. We propose a novel conceptual framework for better understanding work readiness.

Medical students' attitudes towards the teaching of cervical and ovarian cancer screening protocols in Ireland: a qualitative study.

Screening programmes decrease the incidence of colorectal, breast and cervical cancer. As such, it is imperative that medical health professionals are educated on the screening programmes available and are aware of the research basis justifying them. To establish the attitudes of final-year medical students to a gynaecological cancer screening teaching session, provided as part of their core Obstetrics and Gynaecology module. A 3-h workshop, aimed to critically appraise research papers, reviewed cervical and ovarian cancer screening methods. The workshop was facilitated by a Consultant in Gynae-oncology Surgery. Anonymous evaluation was requested from two hundred nine students attending during the 2018/2019 academic year. Qualitative research with thematic analysis of content was performed. One hundred fifty-six students gave evaluation on the workshop itself (74.6%). Three main themes were identified-support for the importance of teaching screening methods, appreciation of the importance of understanding cervical screening and a wish for further teaching in Critical Appraisal. Students identified that there was a need to understand screening, that it was "..important for us to consider the value of screening programmes". The teaching on Cervical screening was "..helpful, especially with cervical screening". Medical students expressed a wish to understand the research basis of a common clinical screening programme (for cervical cancer) as well as the research basis for not providing screening to low risk populations (for ovarian cancer). Further research in this area may include exploring how this is taught in other medical schools.

Experiences of a new training programme for final-year medical students during the COVID-19 pandemic

The COVID-19 pandemic has seen the rapid introduction of innovative schemes to maximise the medical workforce and utilise untapped capacity within the NHS. One such innovation was the recruitment of final year medical students as medical support workers (MSWs) immediately following their final examinations and 4 months before they would have traditionally been employed in their foundation year 1 (FY1) roles. In this article we will describe how a unique programme, with a focus on welfare and pastoral support, was developed and implemented at a hospital in North London and illustrate why the overwhelmingly positive feedback from both the participants and their supervisors has had implications for how medical student training has been shaped for the September 2020 intake at this hospital.

Paradigms about the COVID-19 pandemic: knowledge, attitudes and practices from medical students

BackgroundAs the disease caused by the novel coronavirus has spread globally, there has been significant economic instability in the healthcare systems. This reality was especially accentuated in Ecuador where, the shortage of healthcare workers combined with cultural and macroeconomic factors has led Ecuador to face the most aggressive outbreak in Latin America. In this context, the participation of final-year medical students on the front line is indispensable. Appropriate training on COVID-19 is an urgent requirement that universities and health systems must guarantee. We aimed to describe the knowledge, attitudes, and practices of Ecuadorian final-year medical students that could potentially guide the design of better medical education curricula regarding COVID-19.MethodsThis was a cross-sectional 33-item online survey conducted between April 6 to April 2020 assessing the knowledge, attitudes, and practices toward the diagnosis, treatment, prevention, and prognosis toward COVID-19 in Ecuadorian final-year medical students. It was sent by email, Facebook, and WhatsApp.ResultsA total of 309 students responded to the survey. Out of which 88% of students scored high (≥ 70% correct) for knowledge of the disease. The majority of students were pessimistic about possible government actions, which is reflected in the negative attitude towards the control of COVID-19 and volunteering during the outbreak in Ecuador (77%, and 58% of the students, respectively). Moreover, 91% of students said they did not have adequate protective equipment. The latter finding was significantly associated with negative attitudes.ConclusionsAlthough a large number of students displayed negative attitudes, the non-depreciable percentage of students who were willing to volunteer and the coexisting high level of knowledge displayed by students, suggests that Ecuador has a capable upcoming workforce that could benefit from an opportunity to strengthen, improve and advance their training in preparation for COVID-19. Not having personal protective equipment was significantly associated to negative attitudes. Providing the necessary tools and creating a national curriculum may be one of the most effective ways to ensure all students are trained, whilst simultaneously focusing on the students’ most pressing concerns. With this additional training, negative attitudes will improve and students will be better qualified.

Ultrasound-guided cannulation for medical students.

There is growing recommendation to integrate ultrasound training into undergraduate medical curricula; with limited evidence of its implementation in the United Kingdom. Peripheral intravenous cannulation (PIVC) often has high failure rates-particularly for patients with difficult vascular access. Ultrasound-guided PIVC (US-PIVC) has been shown to increase the rates of success and may reduce dependence on seniors. Teaching US-PIVC to senior medical students may prove a clinically valuable and feasible means of introducing ultrasound into medical programmes. We initially surveyed 18 doctors to assess their perceptions and experience of ultrasound. Thirty-five final-year medical students took part in a novel US-PIVC course. Students' competence was assessed at the end of the session using an objective assessment. Students' pre- and post-course attitudes and confidence were evaluated using questionnaires. All doctors surveyed reported difficulty performing PIVC since starting work: 66% on a monthly basis. None of the students (0%) and 11% of the doctors had previously received ultrasound training. By the end of the course, all students 'agreed' or 'strongly agreed' that the session was enjoyable and that they felt confident performing US-PIVC. Thirty-four of 35 participants attained the minimum competence standard. Students' confidence performing PIVC, regardless of ultrasound guidance, increased significantly (p=0.002) following the session. As ultrasound becomes a more readily available point-of-care technology, it should be considered for inclusion in the undergraduate medical curriculum. Our course appears to be an effective model of teaching US-PIVC to final-year medical students. Similar courses could act as a pragmatic and clinically rewarding means of implementing US-PIVC teaching into the latter years of undergraduate curricula.

Online teaching of basic surgical skills to medical students during the COVID-19 pandemic: a case-control study.

PurposeMedical education has been disrupted by the COVID-19 pandemic in many countries, with face-to-face lectures replaced by pre-recorded videos. However, surgical skills training cannot be replaced easily by videos, as a high level of tutor–student interaction is required. Thus, we developed a new web-based surgical skill learning session (WSSL). This case–control study evaluates the surgical skills competency of medical students taught by the WSSL.MethodsThis case–control study compares WSSL with face-to-face tutorials. Students were assigned randomly to one of two groups according to the teaching method. Independent blinded assessment was performed by a standardized marking scheme, modified from the Objective Structured Assessment of Technical Skills (OSATS) global rating scale.ResultsWe recruited 62 final-year medical students into the study, with 33 randomized to the face-to-face teaching group (control group), and 29 to the WSSL group(case group) according to their student number. The baseline demographic characteristics of the two groups were comparable. The mean score at the clinical competency assessment of the control group was 4.8/5 (range 4–5) and that of the case group was 4.7/5 (range 4–5) (p = 1). There were no difficulties with program or hardware installation reported by the WSSL students.ConclusionsSurgical skills performance was comparable between students who were taught by the WSSL and those taught by conventional face-to-face tutorials.

Senior medical student attitudes towards patient communication and their development across the clinical elective year – A Q-methodology study

To be proficient in communicating with patients, physicians need specified knowledge, skills and attitudes. Until now, medical educators have mostly focused on undergraduate students’ communication knowledge and skills in training and assessment. Attitudes towards communication with patients have been researched less frequently, but it is plausible that they also influence physicians’ behaviours in many ways. The present study investigates the communication-focused attitudes of senior medical students and their development through the clinical elective year using an innovative approach based on Q-methodology. We conducted a Q-methodology study using statements from the Kalamazoo Communication Skills Assessment Form. A total of 47 final-year medical students documented their attitudes towards communication by sorting these statements in regard to their importance into a normal distribution grid in medical interviews. Our innovative approach included three time points during the elective year at which these statements were sorted, with only a slight decrease of participants. We applied a Q-factor analysis and found three attitude profiles that were structurally stable over time. Attitude profile #1 focused on providing information and fostering shared decision making; profile #2 focused on the patients’ concerns and emotions while meeting the patients’ demands for sufficient information. Finally, the focus of attitude profile #3 was on using appropriate conversation techniques to structure communication and gather sufficient information. Overall, the respondents assigned increasing importance to building good relationships and making shared decisions with patients over time. Statements about structuring conversations and communication techniques were evaluated as less important by the end of the clinical elective year.

Assessment of final-year medical students' performance in diagnosing critical findings on chest X-ray.

PurposeDue to the recently emerging shortage in medical staff during the novel corona virus pandemic, several countries have rushed their undergraduate medical students into the emergency department. The accuracy of diagnosing critical findings on X-rays by senior medical students is not well assessed. In this study, we aim to assess the knowledge and accuracy of undergraduate final-year medical students in diagnosing life-threatening emergency conditions on chest x-ray.MethodThis is a cross-sectional nationwide survey across all medical schools in Jordan. Through an electronic questionnaire, participants were sequentially shown a total of six abnormal X-rays and one normal. For each X-ray, participants were asked to choose the most likely diagnosis, and to grade the degree of self-confidence regarding the accuracy of their answer in a score from 0 (not confident) to 10 (very confident).ResultsWe included a total of 530 participants. All participants answered at least six out of seven questions correctly, out of them, 139 (26.2%) participants answered all questions correctly. Pneumoperitoneum was the highest correct answer (93.8%), whereas flail chest was the least correctly answered case with only 310 (58.5%) correct answers. Regarding self-confidence for each question, 338 participants (63.8%) reported very high overall self-confidence level. Answers related to tension pneumothorax had the highest confidence level.ConclusionSenior Jordanian medical students showed good knowledge with high confidence levels in diagnosing life-threatening conditions on chest x-rays, supporting their incorporation in the emergency department during pandemics and confirming the reliability of information they can extract.

What should medical students be taught about abortion? An evaluation of student attitudes towards their abortion teaching and their future involvement in abortion care

BackgroundOne in three women in the United Kingdom (UK) will have an abortion before age 45, making abortion provision an essential aspect of reproductive healthcare. Despite this, abortion remains ethically contested and stigmatised, with variable teaching in UK medical schools and concerns about falling numbers of doctors willing to participate in abortion care. University College London Medical School (UCLMS) has designed practical, inclusive, teaching that aims to give students an understanding of the importance of abortion care and prepare them to be competent practitioners in this area. This study aimed to determine students’ opinions of this teaching and their wider attitudes towards abortion.MethodsWe invited all 357 final-year UCL medical students to complete an online survey consisting of closed-ended questions, exploring their opinions on their abortion teaching, their personal beliefs about abortion and their future willingness to be involved in abortion care. We analysed responses using non-parametric tests.ResultsOne hundred and forty-six questionnaires (41% response rate) showed 83% of students identified as pro-choice (agree with the right to choose an abortion). Fifty-seven percent felt they received the right amount of abortion teaching, 39% would have liked more and 4% stated they received too much. There was no correlation between students’ attitudes to abortion and the rating of teaching; both pro-choice and pro-life (opposed to the right to choose an abortion) students generally rated the teaching as important and valued the range of methods used. Students requested more simulated practice speaking to patients requesting an abortion. Students with pro-life beliefs expressed lower willingness to discuss, refer, certify and provide future abortions. Students interested in careers in specialties where they may encounter abortion were more likely to be pro-choice than pro-life.ConclusionsThe majority of participating UCL medical students were pro-choice and willing to be involved in future abortion care. Efforts to make teaching on abortion practical, engaging, sensitive and inclusive were appreciated. As well as preparing students to be competent and caring practitioners, the teaching appears to contribute towards them viewing abortion as an essential aspect of women’s healthcare, and may contribute to destigmatising abortion.

Knowledge and Confidence of Final-Year Medical Students Regarding Critical Care Core-Concepts, a Comparison between Problem-Based Learning and a Traditional Curriculum.

Background:Medical undergraduates should be prepared to recognize life threating critical conditions. Undergraduate medical curriculum development to incorporate more critical care education is an essential requirement. Problem Based Learning curriculum has a potential advantage in providing more focused critical care education to medical undergraduate.Objectives:We aimed to evaluate the final year medical students’ knowledge and confidence in key critical care concepts in Problem Based Learning (PBL) curriculum compared to those in Traditional (Lecture) Based Learning curriculum. We also aimed to evaluate undergraduate’s level of satisfaction with the exposure to critical care education during medical education and training.Materials and methods:This is a cross-sectional anonymous self-administered survey questionnaire completed by two groups of final-year medical students (PBL and TBL) from three Saudi medical schools to assess the degree of undergraduate exposure to critical care and their knowledge of key critical care assessment parameters.Results:The responses of 279 final year medical students was analyzed (70% response rate). The majority (53%) was male and the mean age 23.9 ± 1.4 years. Only 13% of students felt confident to manage hypovolemic shock and 15% could recognize the signs of a threatened airway. One third of the students (29%) correctly identified the critical level of lactic acid in shock and less than 2% of the sample responded correctly to all the questions related to the formal assessment of critically ill patients. Lectures were the main source of information in acute care. More than two-thirds (46%) of the sample indicated that they received tuition in critical care, however the total duration spent in a critical care rotation or teaching was 1 day or less. The medical students, who completed their training with a Problem-Based Learning curriculum, had a higher knowledge base and were more confident in many critical care concepts. Only 6.5% choose critical care as their likely future career.Conclusion:Medical undergraduates in PBL have an overall better knowledge on key concepts and assessment tools applicable to evaluating and managing critically ill patients compared to students in TBL. However the gap in knowledge and confidence in assessing ill patients in both groups is evident. Critical care was not chosen as a preferred future career in all surveyed students. There is a need for institutional support and endorsement of undergraduate critical care exposure and education in Saudi Universities both to better prepare medical students for their imminent post-graduates exposure to ill patients and to help in closing the gap in critical care physicians through promoting the specialty.

Tıpta Uzmanlık Sınavı Dershanesine Devam Eden Tıp Fakültesi Son Sınıf Öğrencilerinde Anksiyete ve Mesleki Kaygı Düzeyi

Objective: Our study aimed to evaluate anxiety and occupational anxiety level in final-year medical students attending a medical board exam course. Methods: This study was conducted between February and May 2020 in a medical board exam course center in Istanbul within the necessary permissions. The study was completed with 210 final year medical students who responded appropriately to the Beck Anxiety Inventory (BAI) and Occupational Anxiety Questionnaire (MKA) form, and a questionnaire which is consisted of sociodemographic data prepared by us and statistical analyzes were performed. Results: The mean age of participants was 23.60±1.36 years, with 53.3% (n=112) identified as male and 46.7% (n=98) identified as female. The mean score of BAI was 14.15±11.01, and according to the level of BAI, 81 (38.6%) of participants had minimal, 43 (20.5%) had mild, 48 (22.9%) had moderate, and 38 (18.1%) had severe anxiety. The mean score of OCQ was 55.92±12.81, and 136 (64.8%) participants had a moderate level of OCQ. There was a positive correlation between BAI and OCQ mean score (r=0.228, p=0.01). Conclusion: The study results revealed that most final-year medical students had minimal anxiety levels and moderate occupational anxiety levels.

Assessing empathy in final-year medical students using the Persian version of the Jefferson Scale of Physician Empathy.

BACKGROUND:A doctor–patient relationship built on the concept of empathy is so essential to attain the best clinical outcomes in medicine. Since empathy has a positive role in interpersonal relationships and medical outcomes, its assessment is highly crucial. The aim of this study was to assess the empathy in last-year medical students using the Persian version of the Jefferson Scale of Physician Empathy (JSPE) and correlate empathy scores with demographic features.MATERIALS AND METHODS:In this cross-sectional study, last-year medical students at Shiraz Medical School, Shiraz, Iran, were recruited for this study. In this research, we used the Persian version of JSPE. The validity and reliability of the Persian version of this tool were confirmed in the previous research. For the analysis of data, we employed descriptive statistics and the independent sample t-test.RESULTS:One hundred and eighty-five final-year medical students were included in this study. The maximum score of the questionnaire was 140, and the total mean score of empathy was 98.15 ± 13.29. The females' total mean score (102.05 ± 11.89) was higher than the males' score (93.57 ± 13.46). The difference between the mean score of gender and empathy was significant (P value <.001), but there was no significant difference between empathy and the two other demographic factors (P > 0.05).CONCLUSIONS:Although physicians would gain the essential characteristics of empathy during their career, attending professors and other responsible policymakers in medical education should focus more on the factors related to physicians' empathy to train better and more professional physicians.

The short- and long-term effects of a course on rational drug use: A comparative study between prefinal- and final-year undergraduate medical students who attended the course in different clinical years.

BACKGROUND:Rational pharmacology use and appropriate prescribing are among the key learning outcomes in medical education. Some medical faculties include rational pharmacotherapy course in their education programs at different years of education in Turkey. The aims of this study were to investigate the differences in effect of rational pharmacotherapy course on short- and long-terms by comparing two cohorts who attended the course in different clinical years of medical education by identifying which parameters of prescription items are different among groups.MATERIALS AND METHODS:This quasi-experimental study was conducted in School of Medicine. Participants consisted of 157 students who attended the course in Grade 4 (n = 110, Group A) and Grade 5 (n = 47, Group B). Students were asked to complete a prescribing task both upon completion of the course and 1 year after. The performance in prescribing was determined by prescription scoring form. Repeated measures ANOVA was employed to test the intervention effect between two periods. McNemar test was employed to measure the change in each item on the prescription. Point-biserial correlations between each item on the prescription and their scores on the test as a whole were calculated.RESULTS:The mean score of Group A dropped to 59.41 (standard deviation [SD] = 14.06) from 90.43 (SD = 8.90), and the mean score of Group B dropped to 73.37 (SD = 12.56) from 83.91 (SD = 10.03). All the prescription components in the scripts of the Group A students worsened significantly, except the “name of drug,” whereas Group B students maintained most of them after 1 year.CONCLUSIONS:This study shows that the long-term retention effect of rational pharmacotherapy course conducted in later years of education is better than the course conducted in earlier years of education, which may be related to the fact that students in later years are more likely to take on responsibility for patient therapy process in clinical education.

Online course in geriatrics for final-year medical students

Background: The new competency-based MBBS undergraduate curriculum articulates 24 competencies in geriatrics. Acknowledging the dearth of faculty in the country, a group of geriatricians developed and conducted an online modular course for final-year medical students. Methods: This 6-week online course included 13 modules and the study materials were developed through a two-stage vetting process. The course was advertised to potential students through social media and was delivered over Google classroom platform. Students' learning was assessed by multiple-choice questions (MCQs), and the course was evaluated with comparison of pretest and posttest, feedbacks from students with both structured and open-ended questionnaires. Results: Out of 200 eligible students from 38 medical colleges who applied, 142 students joined the course. Out of 142 students joined, 98 (69%) completed the course with 80% attendance; 91 (64.1%) secured scores above 50%; and 46 (32.4%) secured scores above 80% in MCQ test. Posttest scores were significantly higher than pretest scores (P

Pregraduation online curriculum delivery of internal medicine course during the COVID-19 pandemic: Experience of a medical college in Saudi Arabia

Background: The COVID-19 pandemic has challenged medical education and resulted in a rapid and unexpected global shift toward online education. The study presents the experience of the College of Medicine of King Saud University in delivering a comprehensive internal medicine course for final-year medical students, which includes the implementation of novel methods of assessment. Methods: A 2-week revision of the internal medicine course was conducted for 70 pregraduation medical students. Lectures and focused case-based tutorials were conducted online. Novel assessment methods included brief written essays summarizing the tutorials, open-book short-answer question (SAQ) examination, and a virtual standardized oral examination (vSOE). A questionnaire was sent to the students (n = 70) on the contents of the course, clarity of objectives, duration, and online platform. Results: The response rate was 99.3%. Students scored higher in the SAQs compared with traditional multiple-choice tests (mean score: 92.3% vs. 69.8%). The vSOE was efficient, and grades were comparable to traditional objective structured clinical examination. The majority of students (93%) reported the scientific content as good or excellent, whereas approximately 30% found the course goals lacked a clear description. The majority (76%) found the course length appropriate, and 94% reported the online platform installation and operation easy or very easy. Conclusions: The comprehensive online internal medicine course was successfully delivered to pregraduation students. Innovative online examination methods can be a reasonable alternative in the case of lockdown. This modality of teaching and assessment was considered useful and met the expectations of students.