Greek Medical Schools Research Articles

Obstetricians and midwives perspective of the alarming high cesarean section rates in Greece and worldwide

IntroductionThis study aimed to outline the perspectives of obstetricians/gynecologists (physicians) and midwives regarding the alarmingly high rates of cesarean sections (CSs) to identify areas for improvement and describe the role of a regional obstetric quality initiative. Material and methodsA cross-sectional study was performed utilizing real-world data from questionaries provided to Greek midwives and obstetricians. Primary outcomes included the attitudes of Greek physicians and midwives toward the CS rates in Greece and around the world, as well as identifying potential solutions for lowering these rates. The secondary outcome was the potential correlation between the answers of the participants and their demographic parameters. ResultsA total of 456 physicians and 234 midwives participated in the survey. Greek CS rates (>50 %) were considered “acceptable” and inevitable by 29.7 % and 32 % of the participants, respectively. Stratified analysis based on profession showed that significantly fewer midwives compared to obstetricians would agree with current CS rates. Participants who had obtained their degrees abroad were more likely to consider all CS rates more justified than physicians and midwives who had graduated from Greek medical schools. For all questions, the younger age subgroups responded in a way toward the non-acceptability of CS rates and favored the implementation of rules and practice control according to guidelines. The responses did not differ significantly between male and female physicians. ConclusionsGreek midwives, to a greater degree than obstetricians/gynecologists, consider the current CS rates unjustified and agree on the importance of implementing appropriate interventions to reduce them.

Transgender Attitudes and Beliefs Scale-Greek (TABS-Gr) version: translation and initial evaluation of psychometric properties among medical students

BackgroundTransgender people face significantly greater discrimination and health disparities in health care settings than cisgender people. The role of education in eliminating this phenomenon has been increasingly recognized by many medical schools. However, transgender health content is sparse or lacking in the medical curricula of many countries.MethodThis study was designed to validate the Greek version of the Transgender Attitudes and Beliefs Scale (TABS-Gr). The study adopted a cross-sectional, comparative-descriptive research design. Participants (N = 203) were contacted through online recruitment and invited to complete an anonymous web-based survey. The data were collected between December 2022 and February 2023.ResultsThe overall reliability of the TABS-Gr questionnaire was high (Cronbach’s α = 0.961, p. from Hotelling’s T-squared test < 0.000). High Cronbach’s alpha values were estimated for the three subscales, with α = 0.958 for Interpersonal Comfort, α = 0.906 for Gender Beliefs, and α = 0.952 for Human Values. Hotelling’s T-squared test confirmed that all items on the scale had the same mean (p < 0.001 for all subgroups). Explanatory factor analysis (EFA) demonstrated adequate fit. Convergent and discriminant validity were validated based on the estimated correlations. The three-factor structure of the Greek TABS version was confirmed. The mean total score was 155.95 (SD = 30.63), indicating that medical students had a moderately positive attitude towards transgender people. Participants showed significantly less biased (more tolerant, positive) attitudes towards transgender people on the Interpersonal Comfort (IC) and Human Value (HV) subscales than on the Sex/Gender Beliefs (SGB) subscale. A demographic comparison was conducted and demonstrated a correlation between scores and sociodemographics, except for place of origin. A statistically significant increase in the total mean score was estimated for women compared to men.ConclusionThe overall psychometric findings provide some evidence to support the validity of the Greek version of the TABS. However, we call for further validation research in Greek medical schools. Since our claims for validity are based in part on an exploratory factor analysis, a future confirmatory factor analysis (CFA) is part of our call for further validation research. While the results of this study are mostly in line with the results of previous research, some nuances were identified. These results may inform educators, medical school curricula and education policy-makers.

Advanced trauma life support course for medical students. A new era?

Trauma represents a major public health issue and is one of the leading causes of death and disability worldwide. A systematic approach toward dealing with trauma patients was facilitated through the ATLS program, which has become a milestone in trauma care. Our new ATLS course for medical students was set in motion in 2015. Our aim was to make medical students familiar with trauma patients interactively, through a program like ATLS, and here we present the results of this endeavor. A two-day ATLS-Medical Student (MS) course was offered from November 2015 to July 2018, and analysis was performed retrospectively on the data gathered over a three-month period through online questionnaires. Before graduating, 261 newly qualified medical doctors were interviewed and evaluated as part of the ATLS course. After the course, the vast majority of medical students (251 MSs; 96.16%) felt more capable of managing severely injured patients and 58% of students felt that the medical services they offered were better due to the ATLS training. Regarding the educational fee for the course, 56.7% of the students reported that they felt the fee of 100 euros was fair. The interactive format of the course, which differs from more traditional methods of teaching, has been endorsed by medical students. Though they lack clinical experience, that does not prohibit them from acquiring more specialized or specific knowledge, enabling them to excel. Most of the students improved their skillset either in theoretical knowledge, practical skills, or even in the emotional component of the course, i.e., dealing with treating a severely injured patient. It was decided that the program would be re-evaluated and extended to all Greek Medical Schools. The advantage of providing doctors with trauma training at the beginning of their careers is evident. For that reason, it was decided that the program would be re-evaluated and extended to all Greek Medical Schools.

Detection of Angioectasias and Haemorrhages Incorporated into a Multi-Class Classification Tool for the GI Tract Anomalies by Using Binary CNNs

The proposed deep learning algorithm will be integrated as a binary classifier under the umbrella of a multi-class classification tool to facilitate the automated detection of non-healthy deformities, anatomical landmarks, pathological findings, other anomalies and normal cases, by examining medical endoscopic images of GI tract. Each binary classifier is trained to detect one specific non-healthy condition. The algorithm analyzed in the present work expands the ability of detection of this tool by classifying GI tract image snapshots into two classes, depicting haemorrhage and non-haemorrhage state. The proposed algorithm is the result of the collaboration between interdisciplinary specialists on AI and Data Analysis, Computer Vision, Gastroenterologists of four University Gastroenterology Departments of Greek Medical Schools. The data used are 195 videos (177 from non-healthy cases and 18 from healthy cases) videos captured from the PillCam(R) Medronics device, originated from 195 patients, all diagnosed with different forms of angioectasia, haemorrhages and other diseases from different sites of the gastrointestinal (GI), mainly including difficult cases of diagnosis. Our AI algorithm is based on convolutional neural network (CNN) trained on annotated images at image level, using a semantic tag indicating whether the image contains angioectasia and haemorrhage traces or not. At least 22 CNN architectures were created and evaluated some of which pre-trained applying transfer learning on ImageNet data. All the CNN variations were introduced, trained to a prevalence dataset of 50%, and evaluated of unseen data. On test data, the best results were obtained from our CNN architectures which do not utilize backbone of transfer learning. Across a balanced dataset from no-healthy images and healthy images from 39 videos from different patients, identified correct diagnosis with sensitivity 90%, specificity 92%, precision 91.8%, FPR 8%, FNR 10%. Besides, we compared the performance of our best CNN algorithm versus our same goal algorithm based on HSV colorimetric lesions features extracted of pixel-level annotations, both algorithms trained and tested on the same data. It is evaluated that the CNN trained on image level annotated images, is 9% less sensitive, achieves 2.6% less precision, 1.2% less FPR, and 7% less FNR, than that based on HSV filters, extracted from on pixel-level annotated training data.

ЗНАЧЕНИЕ ДРЕВНЕГРЕЧЕСКИХ И ДРЕВНЕРИМСКИХ МЕДИЦИНСКИХ ШКОЛ ДЛЯ РАЗВИТИЯ МЕДИЦИНСКИХ ЗНАНИЙ

ЗНАЧЕНИЕ ДРЕВНЕГРЕЧЕСКИХ И ДРЕВНЕРИМСКИХ МЕДИЦИНСКИХ ШКОЛ ДЛЯ РАЗВИТИЯ МЕДИЦИНСКИХ ЗНАНИЙ

Gendered and classed performances of ‘good’ mother and academic in Greece

The enduring significance of gender and how it intersects with class in the organization of parenting, domestic and professional work has been obscured in contemporary neoliberal contexts. This article examines how Greek academic women conceptualize and enact motherhood and the classed and gendered strategies they adopt to reconcile ‘good’ motherhood with notions of the ‘good’ academic professional. It draws on semi-structured interviews about the career narratives of 15 women in Greek medical schools in the aftermath of the Greek recession. The analysis presented in this article is informed by a feminist post-structuralist paradigm and an emic approach to intersectionality. Motherhood emerged in the data as a dynamic concept, and a network of practices both constrained and enabled by gendered and classed family and work cultures. Drawing on a neoliberal ‘DIY’ and ‘having it all’ discourse, Greek mothers claimed that they could achieve almost anything professionally, if they organized their private lives sensibly. They drew on idealized discourses of motherhood, but they also contradicted these notions by doing non-traditional forms of motherhood, such as remote or transnational motherhood, afforded by their privileged social positioning and academic careers. Further research is required to investigate configurations of classed motherhood in less prestigious professions.

The undergraduate teaching of vascular surgery in Greek medical schools: theory and clinical practice.

The objective of this survey was to document and analyze the teaching methods of vascular surgery (VS) in the undergraduate curricula of the seven Greek medical schools. The type of VS subject (core, selective, integrated in other subject), the type of clinical practice, and the specialty of the VS tutors were recorded from the curriculum of each medical school, as documented online. The information was cross-checked with the academic tutors of each Medical School via phone contact and verified by ten medical students of Medical School. VS is taught mainly as part of general surgery (GS) in four medical schools, as part of another academic subject in two MS but as a core subject in only one Medical School. Five out of seven curricula offer VS as selective subject while three of them focusing on the hemodynamic principles of Angiology and VS. The specialty of instructors was VS in every Greek Medical School. Despite the great need for diagnosis and treatment of vascular diseases we recorded a limited VS training among the undergraduate Greek curricula. This heterogeneity does not ensure high-quality education in VS. Furthermore, emphasis on clinical skill acquisition should be further encouraged.

Gendered pedagogic identities and academic professionalism in Greek medical schools

ABSTRACTFeminist scholarship has considered how pedagogical identities and emotions are implicated in the gender politics of belonging and othering in higher education. This paper examines how gendered and embodied pedagogy is mobilised in Greek medical schools to construct notions of the ideal academic and assert women’s position women in Academic Medicine. I employ thematic analysis to illustrate that formations of pedagogy and academic professionalism are bound up with emotions and embodied practices of relating, connecting, creating learning communities and promoting virtuous academic citizenship. Women’s gendered accounts of pedagogy and their boundary practices of identification demonstrate agency, intentionality and operate as highly political actions of legitimacy and resistance within the patriarchal realm of Greek higher education. I argue that gendered discourses of pedagogy in Greek medical schools become resources for resisting neo-liberal notions of academic work, individualism and women’s exclusion in the highly prestigious discipline of academic medicine in Greece.

Lupus in Medical Education: Student Awareness of Basic, Clinical, and Interdisciplinary Aspects of Complex Diseases

Objective: Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease that necessitates a multidisciplinary approach. The aim of our study is to assess the awareness and depth of knowledge of SLE in medical students. By identifying the shortcomings of lupus-related medical education, the results can be generalized to other disease processes that require care from multiple medical specialties. Methods: We surveyed undergraduate medical students in two Greek medical schools using a structured questionnaire. The questionnaire consisted of two parts. Part A assessed the students’ knowledge of SLE regarding the disease epidemiology, pathology, pathophysiology, diagnosis and treatment. Part B inquired the students about ways that SLE is currently taught in their medical school and suggested methods to improve it. Students were divided into 2 groups according to their medical school curriculum: the preclinical and the clinical years. Results: A total of 260 students from both universities participated in our study, 114 students in preclinical years and 146 students in clinical years. We identified several misconceptions about the students’ perception of the disease’s epidemiology, pathophysiology, clinical manifestations and prognosis as well as statistically significant differences in the responses between the two groups. In addition, students in both groups stated that they would like a more in-depth understanding of SLE through more extensive hands-on experience with its laboratory investigation, seeing more patients in the wards or patient-actors in the auditoriums, watching educational videos and discussing clinical vignettes during lectures. Conclusions: These findings could potentially guide medical school faculty on modifying the school curriculum in order to prepare the next generation of physicians. In an era of rapidly enlarging biomedical knowledge, having an intimate understanding of complex disease processes is of paramount importance for optimal health care delivery to patients.

Developing an International Combined Applied Surgical Science and Wet Lab Simulation Course as an Undergraduate Teaching Model.

Background. Essential Skills in the Management of Surgical Cases (ESMSC) is an international, animal model-based course. It combines interactive lectures with basic ex vivo stations and more advanced wet lab modules, that is, in vivo dissections and Heart Transplant Surgery on a swine model. Materials and Methods. Forty-nine medical students (male, N = 27, female N = 22, and mean age = 23.7 years) from King's College London (KCL) and Greek Medical Schools attended the course. Participants were assessed with Direct Observation of Procedural Skills (DOPS), as well as Multiple Choice Questions (MCQs). Paired t-test associations were used to evaluate whether there was statistically significant improvement in their performance. Aim. To evaluate the effectiveness of a combined applied surgical science and wet lab simulation course as a teaching model for surgical skills at the undergraduate level. Results. The mean MCQ score was improved by 2.33/32 (P < 0.005). Surgical skills competences, as defined by DOPS scores, were improved in a statically significant manner (P < 0.005 for all paired t-test correlations). Conclusions. ESMSC seems to be an effective teaching model, which improves the understanding of the surgical approach and the basic surgical skills. In vivo models could be used potentially as a step further in the Undergraduate Surgical Education.

Contribution of integrated teaching in the improvement of an undergraduate ophthalmology curriculum.

PurposeConventional medical curriculum is the rule of medical teaching in Greek Medical Schools. Medical students are often taught irrelevant details with little or no reference to their potential clinical significance. Alternatively, integrated teaching warrants that the complete teaching material is covered by each faculty member not considering areas of personal expertise. The aim of this study was to evaluate the implementation of integrated teaching in ophthalmic training.MethodsThe main outcome measures of this retrospective study were a) comments and recommendations made anonymously by the fifth-year medical students in the evaluation questionnaires filled in at the end of their training, and b) scores obtained by students in their final examination at the end of their training in the 2nd Department of Ophthalmology as part of the core Curriculum of the Medical School of the Aristotle University of Thessaloniki. The latter outcome was analyzed with respect to the implementation of integrated teaching.ResultsThe score obtained by students in the final examination, which is an objective outcome measure, increased significantly after the implementation of integrated teaching. The final grade (scores out of 10) of students who were trained with the integrated system (6.17±1.67, mean ± standard deviation) was significantly higher compared to those (5.52±2.20) trained with the conventional system (P<0.001). The positive outcome of this process was evident as there was a significant increase in the number of students satisfied with the teaching process compared to previous academic years.ConclusionBased on the experience of eight academic years and as a result of interactive assessment process our department has modified its medical student teaching process from conventional to integrated; all teaching staff members are involved in the teaching process, while students are divided in small groups. In conclusion, integrated teaching in small student groups appears to be an efficient teaching method (for both theoretical and clinical skills) of ophthalmic training for medical students.

Development and Validation of the ‘iCAN!’ - A Self-administered Questionnaire Measuring Outcomes/ Competences and Professionalism of Medical Graduates

The Tuning-Medicine Project produced a set of 'level one' and 'level two' learning outcomes/ competences to be met by European medical graduates. In the learner-centered era self-assessment becomes more and more important. Our aim was to develop a self-completion questionnaire ('iCAN!') evaluating graduates' learning outcomes. The Tuning 'level two' learning outcomes were transformed to a 104 closed items questionnaire, tested with a convenient sample of 512 graduates from the seven Greek medical schools during the 2009-2011 graduation cohorts, 21 practitioners, and seven different undergraduate student groups. Cronbach alpha, factor analysis, and mean score comparisons were used to check internal consistency, construct validity, and sensitivity respectively. Question mean scores were used to differentiate weak and strength areas of competence. Among graduates, all overall alphas were >0.95 and all subscale alphas higher than expected, indicating an at least acceptable internal consistency. Factor analysis produced one factor per 'level one outcome', except for 'practical procedures' which was split in two meaningful factors. Overall mean score was 44.4%, 52.2%, 61.2%, 73.4%, 81.4% among 2 nd -year, 4 th -year, 6 th -year students, graduates, and practitioners respectively (p<0.001); improvement through progressively matured groups suggest good sensitivity, indicating also good responsiveness. Among graduates, question mean scores ranged from very weak (blood transfusion, 39%) to very strength (measuring blood pressure, 95%), indicating good differentiation of strengths and weaknesses. A consistent, well-structured, and sensitive version of a questionnaire is hereby released for graduates' abilities and professionalism self-assessment and differentiation of strengths and weaknesses that could be

Evaluating the research performance of the Greek medical schools using bibliometrics

Quality in Higher Education Institutions is the subject of several debates in the academic community in a worldwide basis and various efforts are made towards identifying ways to quantify it. In this respect, the use of bibliometrics gains significant ground as an effective tool for the evaluation of universities' research output. In the present study, the research performance of the seven Greek medical schools is assessed by means of widely accepted and advanced bibliometric indices, such as total and average publications and citations, average and median h- and g-index with and without self-citations for all the 1,803 academics, while statistical analysis of the data was also performed in order to compare the observed differences in the mean values of the calculated indices. Considerable effort was exerted to overcome all inherent limitations of a bibliometric analysis through a meticulous data collection. This large-scale work was conducted both in school and academic rank level leading to interesting results concerning the scientific activity of the medical schools studied as units and of the various academic ranks separately, which can be partially justified with geographic and socioeconomic criteria. In general, bibliometrics demonstrate statistically significant difference in favour of Crete University medical school, while it was also found that self-citations have only marginal effect on the individual's research profile and the average indices. Finally, the useful findings of the present study render the methodology adopted of high viability for assessing the research performance of Higher Education Institutions even in a broader context.

The status of undergraduate oncology education in medical schools in Greece and abroad: A comparative study

Abstract Background. The authors sought to determine how undergraduate oncology education in Greece compared with that in other countries, and how it might be improved. Method. A questionnaire, based on information previously collected from schools in Greece and elsewhere, was distributed to 450 students in five Greek medical schools. Results. Analysis of the 256 responses received showed that clinical symptoms, diagnostic procedures, and psychological support of patients were underemphasized in Greek medical schools. The level of oncology education was believed to be average by 45.8%, satisfactory by 35.2%, high by 10.7%, and low by 8.3% of the students. Insufficiencies (58.6%) were attributed to a lack of practical experience, too few hours of instruction, and limitations of infrastructure and research, whereas sufficient education (29.3%) was attributed to instruction by specialists and adequate numbers of instruction hours. Most of the students believed that oncology should be taught as a discrete sub...

Knowledge and practice of contraception among Greek female medical students

Objective In Greece, modern contraceptive methods are used on a limited scale. This study aimed to investigate the knowledge as well as the practice of contraception among female medical students in Greece.Study design Knowledge and practice of contraception of 102 female graduating medical students were assessed with a self-administered, anonymous questionnaire.Results Most students were using condoms as the only contraceptive method (45.1%) and 16.7% were not applying any contraceptive method at all. Oral contraceptives were used as only contraceptive means by 4.9% of the students and in combination with condoms by another 4.9%. Condoms were thought to be the most effective contraceptive method available by 28.4% of the students, whereas 4.9% responded that they did not consider any contraceptive method to be effective. Only 55.9% of the students had ever asked their gynaecologist about contraception.Conclusion Much more time should be spent in teaching contraception in the Greek medical schools to ensure the delivery of adequate family planning guidance by future practitioners.

Medical practice in Graeco-Roman antiquity

The roots of modern medicine can be traced back to the 5th century BC when Hippocratic rational medicine originated on the Greek islands of Cos and Cnidos. In this study we examine the way in which practitioners conducted their profession in Graeco-Roman times, as well as their training. Medical training was by way of apprenticeship with recognized doctors, but no qualifying examinations existed and the standard of practice thus varied enormously. Even in the Roman era the vast majority of medical doctors were Greek and in private practice as itinerant physicians. Civic doctors in the paid service of local communities appeared in Greek society from the 5th century BC onwards, but much later in Rome - probably as late as the 4th century AD. Rome's unique contributions to medicine lay in public health measures (e.g. their aqueducts, public baths and sewages systems) and an excellent medical service for their armies and navy. Hospitals (valetudinaria) were established for military purposes and for slaves on large Roman estates from the 1st century BC, but civic hospitals for the general public originated as late as the 4th century AD. The Greek medical schools of Cos and Cnidos were eventually superseded by the school of Alexandria in Egypt and towards the end of the Roman Empire by that of Carthage in northern Africa. Its gradual demise in the Christian era lowered the curtain on original medical endeavours during antiquity.

Greek medical students’ career choices indicate strong tendency towards specialization and training abroad

The aim of the study was to investigate the career choices, location preferences and criteria among medical students in Greece. We applied a questionnaire-based analysis using a sample of 591 students of four out of seven Greek Medical Schools. The sample included students of all academic years. The vast majority of students wish to specialize (97.6%), while general practice gathered a very low percentage (1.7%). The scientific challenge (61.4%) and interaction with patients (60.6%) seem to be the major influencing factors for most of the students’ specialty preferences, whilst less common variables influencing career choice are the high demand/supply ratio for certain health services (40.4%), the income potential (31.4%), the active tempo (26.2%) and prestige (15%). 70.3% of those asked consider the possibility of specializing abroad. The low concern of Greek medical students for general practice reveals today's drastic deficiency in Greek primary health care. Such a situation will escalate, unless targeted strategies to produce more general practitioners are adopted. Furthermore, the results reflect a lower education and organizing level urging students to specialize abroad. The National Health System (NHS) should be reformed towards a rationalistic distribution of the medical specialties and medical workforce.