Issues In Medical Education Research Articles

THE MEDICAL EDUCATION AND GLOBALIZATION CHALLENGES

The article considers actual issues of medical education initiated by globalization. The impact of globalization on medical education has multi-vector, multi-factor, multi-directional, parallel and cumulative character. This singularity merges all factors, effects, changes and processes adding by globalization to medical education into heterarchy system formed by crossing, manifold, and simultaneously coexisting structures. The alterations of systemic conditions of functioning of medical education as priority of economic principle, substitution of notion "medical care" by "medical service", diseases of rich and diseases of poor, uncertainty factor, chaotization, priority of applied medical knowledge, individualistic paradigm of medical training are considered. The role and value of the World directory of medical schools in international medical organization is demonstrated.

The charismatic journey of mastery learning.

A collection of articles in this issue examine the concept of mastery learning, underscoring that our journey is from a 19th-century construct for assuring skill development (i.e., completing a schedule of rotations driven by the calendar) to a 21st-century sequence of learning opportunities focused on acquiring mastery of special key competencies within clerkships or other activities. Mastery learning processes and standards have the potential to clarify learning goals and competency measurement issues in medical education. Although mastery learning methods originally focused on developing learners' competency with skillful procedures, the author of this Commentary posits that mastery learning methods may be usefully applied more extensively to broader domains of skillful practice, especially those practices that can be linked to outcomes of care. The transition to mastery-focused criteria for educational advancement is laudatory, but challenges will be encountered in the journey to mastery education. The author examines several of these potential challenges, including expansion of mastery learning approaches to effective but relational clinician advice-giving and counseling behaviors, developing criteria for choosing critical competencies that can be linked to outcomes, avoiding a excessively fragmented approach to mastery measurement, and dealing with "educational comorbidity."

Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country.

BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final (6th) year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia.

Role modeling in clinical educators: An important issue in medical education

Abstract not availableSouth East Asia Journal of Public Health Vol.5(1) 2015: 49-50

Learning throughout a continuum, an innovative and feasible educational agenda!

In this new special medical education issue of Military Medicine, we find a wide array of interesting and timely research about challenging topics in medical education. One of the themes that immediately emerge is the interest, the exploratory effort, and the curiosity to further investigate clinical reasoning and its multifaceted aspects from a variety of dimensions such as preclerkship assessment, neuroimaging, and various educational methods. The research performed in such an area certainly contributes to the current literature but more importantly, paves the way to new thinking in learning and assessing clinical reasoning skills. We can appreciate the longitudinality of the research presented in this special issue. In a time where the Association of American Medical Colleges 1 and the Accreditation Council for Graduate Medical Education are stressing the importance of developing a true medical educational continuum, the series of articles in this edition that link the educational journey before, during, and after medical school contribute a great deal to show how building knowledge on pre-existing knowledge, stemming from a constructivist approach, 2 is a key educational, effective yet feasible paradigm. Exploring premedical school measures and their association with board certification is a clear effort by Durning et al to investigate in depth new aspects of such educational continuum. The variety of educational methods that span from the use of CIP by Capaldi et al to the multistep examination by Hemmer et al applied to clinical reasoning to the innovative use of concept maps in TBL by Knollmann-Ritschel provides a quick yet rich view of a research agenda aiming at the investigation of new collaborative, active learning tools to foster learners’ growth. The innovation and the breadth of learning strategies utilized and described in this issue are testimony to the continuous exploration of active and new learning strategies. One key issue I wonder about is whether some of the results or learning methods described in this issue can be generalizable to other schools. We are all aware that learning is contextual and that context plays a major role in all aspects of learning. Research about learning tools such as CIP, multistep examination, or concept maps, under the guidance of experienced educators, can certainly be implemented in other institutional environments. It might be argued that the organizational structure of Uniformed Services University of the Health Sciences (USU) may facilitate the follow-up and longitudinality of these studies related to career outcomes; however, other institutions can certainly work on developing a robust system to follow the educational path of their graduates, perform rigorous studies, and obtain long-term career outcomes. Such outcomes can then be compared across institutions and may assist the educational community to make important curricular decisions. Furthermore, the USU experience can serve as a motivation and as an example for many other educational institutions to systematically design and accomplish more studies aimed at career development and outcomes. Finally, the continuous pursuit of innovation in the use of learning methods in crucial areas of medical education, for example, clinical reasoning, coupled with assessment of long-term career outcomes, is a core and integral part of this issue and is a testimonial to the commitments of USU educational researchers and leadership to pursue the road less traveled while furthering true discovery and growth.

EMPATHY AND SYMPATHY AMONG MEDICAL STUDENTS: CHANGING TRENDS

Objectives: There is general belief that empathy is crucial for the physician-patient relationship and thus an important issue in medical education. This comparative study was designed to establish the changing attitude in empathy and sympathy among the first year, second year and final year medical students. Methodology: A comparative study among 100 first year, 100 second year and 75 final year medical students was conducted in Government Kilpauk medical college Chennai from January 2012 to June 2012. The study subjects were selected using simple random sampling technique from the list of the students. Study participation was voluntary. Results: Out of the total 275 students, according to our analysis, we found 82.67% of final year students and 80.21% of second year students and 40% showing average or above average levels of empathy. Sympathy scores of final year, second year and first year students were 32%, 40%, and 80% respectively. Conclusion: The results of our study show that students in the first year have higher sympathy levels, students in their second year and final year had higher empathy levels compared to first year students and final year students had highest empathy levels.

An Ethical Issue in Medical Education of Obstetrics and Gynecology.

There are four principles of medical ethics; Beneficence, Respect for autonomy, Non-maleficence, and Justice. It is not easy to apply to principles of medical ethics in the special circumstances of obstetrics and gynecology. Student doctors must learn to be familiar with principles of medical ethics tailored to the special circumstances while the obstetrics and gynecology practice.

Perception of Medical Faculties towards Early Clinical Exposure and MCI Vision 2015 Documents in Western Maharashtra.

The Medical Council of India (MCI) has advocated early clinical exposure for students in medical colleges. In its 'Vision-2015' document for further reforms in undergraduate medical education, the MCI underlined the need for clinical teaching from first year onwards in medical colleges. Our aim was to collect and analyse perception of medical faculties towards early clinical exposure and MCI Vision 2015 and to study the awareness, depth and interest among medical faculties towards these changes. We used 10-item self developed survey questionnaires, which was validated from experts in medical education. 10-item questionnaire was based on awareness, depth and interest among medical faculties towards early clinical exposure and MCI Vision 2015 documents released by MCI in 2011. Qualitative data was assessed using percentage scale. We were approached to 182 preclinical medical faculties, however responses were received from 127 medical faculties from first year medical course subjects from six different college's viz. two from Deemed University, two from Government sector and two from private sector but affiliated to Maharashtra University of Health sciences, Nasik, India. A 94.48% faculty members were aware regarding MCI Vision 2015 documents released by MCI in 2011. Average 12% faculties could answer specific approach MCQs based on MCI Vision 2015 documents. However, 82.67% faculties agreed early clinical exposure will be definitely helpful if implemented in curriculum. The present work underlines need of special coaching and attention towards this important issue in medical education.

世界のめまい診療: 韓国

With regard to the similarities in the social welfare system and cultural background between Korea and Japan, clinical practice for dizziness as well as the entire otolaryngologic practice have a lot in common. The two countries are sharing not only the present issues of medical education, training and healthcare insurance, but also the social demand and requirements for the future, which will be caused by the aging society and the concomitant increment in health care expenditure. Based on an awareness of commonalities and differences between the two countries, we can develop a medical approach for the patients as well as providing worldwide academic leadership. In this paper, I would like to introduce Korea's medical and health care system, and my personal opinions regarding the development of the future relationship between the two countries.

Resident duty hours: past, present, and future.

Background Postgraduate medical education is founded on a tradition of service and education and is grounded in the realities of the twenty-first century. The very nature of the postgraduate enterprise is evolving in front of us all, and this is having a wide-ranging impact in a varziety of areas. At stake is both the delivery of quality patient care and the preparation of the next generation of competent physicians. The engagement of the medical profession is an essential part of this reformation. zOne of the fundamental questions facing contemporary medicine is how best to organize the work hours of physicians who are undergoing clinical training. The postgraduate medical education of the physicians we refer to as “residents” is recognized by those within and outside medicine as an enterprise dedicated to preparing new physicians to enter independent practice. It is a time of great commitment for all involved – to learning, to patient care, and to the professional development of future leaders of health care teams. It is also a period that can be experienced through a number of perspectives: that of the residents and the patients they care for, the faculty who teach them, the training programs that support their progress, the certifying bodies that ultimately endorse them for entry into practice, and the administrators in the teaching hospitals where residents learn to balance their dual roles as learners and service providers on a health care team. These perspectives differ and diverge, and they also, ultimately, lead to thze inherent tensions within residency in the modern era: education versus service, supervision versus autonomy, and quantity versus quality of care, among many others. Throughout much of the world, the hours that residents work have gradually decreased since the 1980s. This change has accelerated within the past five years with recent legislative and regulatory changes in Europe, the United States, Canada, and other jurisdictions. The question of how long residents should work has been the subject of heated discussion within the profession and among the broader public for almost three decades. The impetus for this special issue of BMC Medical Education arose from symposia on the topic of resident duty hours held at the annual International Conference on Residency Education in 2010 and 2011. These symposia, entitled respectively “Duty hours across borders” and “Solutions across borders,” took place as the most recent round of duty hour reforms were announced and implemented in the United States, the United Kingdom, and Canada, and both symposia included presentations by many of the authors of papers included in this issue. Importantly, these sessions provided an international forum to explore the challenges that can arise as a result of – and potential solutions to – changing duty hours, a dialogue we have capitalized on with this special issue.

Ethnographic edutainment for transformative medical education: Thailand.

Transformative learning is a most important issue in medical education. Ethnographic edutainment is a concept that consists of reward, competition, and motivation strategies, which are more effective in engaging with learners. First-year medical students (N = 321) were included in this study during the Doctor and Society course at Chulalongkorn University in 2011. Four preset learning objectives were set and participants assigned a term group project with clouding technologies. The deliverables and the attitude toward this method were evaluated. Nineteen of 20 (95%) groups achieved all objectives. Females rated higher scores for this activity than males (P < 0.001). Statistically significant differences were found between lecture-based sessions and field visit sessions as well as ethnographic edutainment activity sessions and other types (P < 0.01). The results were consistent in both male and female groups. Ethnographic edutainment can be well-accepted with higher satisfaction than some other types of teaching.

DEVELOPMENT OF CLINICAL SCENARIO’S INFORMATION MODEL IN THE MEDICAL SIMULATION CENTER

There is the big issue in medical education which is students don’t have enough skills. Often even with theoretical knowledge graduate medical students need to improve their skills by working with patients. Obviously it can be a risk for patients and takes quite long time. This situation could be changed with applying simulation technologies in medical education. Medical education with virtual simulators allows reducing the time of skills development and improving the quality of training. The aims of this work are developing informational model and creating clinical scenarios of emergency states in the Medical Simulation Center. Objectives: – to analyze the process of scenario conducting; – to create clinical scenarios of emergency states (anaphylactic shock, hypovolemic shock, obstructive shock) with specialist’s help. The scenarios consist of sections such as main aim, skills, required mannequins, preparation of the mannequins, preparation of medical equipment and instruments for the scenario, preparation of special materials, scenario description, guide for operator, information for trainees. By analyzing the process of scenario conducting the key participants were defined who are operator, assistant, trainer, trainees. Also the main scenario stages were defined. Based on the stages diagram of variants of scenario conducting was designed. As an example there are fragments of scenario “Obstructive shock – a pulmonary embolism” in this article. Learn skills are cognitive, technical, social ones. Results. This paper presents an analysis of the clinical scenario conducting. Information model was developed which based on object-oriented decomposition. The model is the diagram of variants of scenario conducting. Scenario’s structure for emergency states was formulated. The scenarios are anaphylactic shock, hypovolemic shock, obstructive shock (pulmonary embolism, tension pneumothorax), pulmonary edema, hypertensive crisis, respiratory distress syndrome of the newborn, meconium aspiration syndrome.

Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment.

BackgroundAcquiring the values of medical professionalism has become a critical issue in medical education. The purpose of this study was to identify lapses in professionalism witnessed by medical students during their four year MD curriculum, and to categorize, from the students’ perspective, who was responsible and the settings in which these occurred.MethodsAn electronic survey, developed by faculty and medical students, was sent to all students with two email reminders. It included quantitative responses and some open-ended opportunities for comments. All analyses were performed with SAS version 9.1.ResultsThe response rate was 45.6% (255 of 559 students) for all four years of the medical school curriculum. Thirty six percent of students had witnessed or been part of an exemplary demonstration of professionalism; 64% responded that they had witnessed a lapse of professionalism. At the pre-clerkship level, the most frequent lapses involved students: arrogance (42.2%), impairment (24.2%), followed by cultural or religious insensitivity (20.5%). At the clerkship level of training, where students are exposed to real clinical situations, the lapses involved primarily faculty (including preceptor and clinician) or other staff; these included arrogance (55.3%), breach of confidentiality (28.3%), and cultural or religious insensitivity (26.6%); impairment involved mostly students (25.5%). These findings are analyzed from the perspective of role modeling by faculty and in the context of the learning environment.ConclusionsMedical students witnessed a lapse of professionalism involving both fellow students as well as faculty and administrative staff, in several domains. Results from this study emphasize the importance of role modeling and the need for faculty development, to improve the learning environment. This study adds to the limited emerging literature on the forces that influence medical student professional identity formation.

Higher satisfaction with ethnographic edutainment using YouTube among medical students in Thailand.

Purpose:At present, transformative learning is one of the most important issues in medical education, since a conventional learning environment is prone to failure due to changing patterns among students. Ethnographic edutainment is a concept that consists of reward, competition, and motivation strategies that be used to effectively engage with learners.Methods:A total 321 first-year medical students took part in ethnographic edutainment sessions in 2011. We defined four preset learning objectives and assigned a term group project using clouding technologies. Participatory evaluation was conducted to assess the delivery of and attitudes towards this method.Results:Career lifestyles in the general population and expected real-life utilization of the final product were used as motivating factors, with competition and rewards provided through a short film contest. Nineteen out of twenty groups (95%) achieved all learning objectives. Females were more satisfied with this activity than males (P<0.001). We found statistically significant differences between lecture-based sessions and field visit sessions, as well as ethnographic edutainment activity sessions and other instructional approaches (P<0.01). The results were consistent in male and female groups.Conclusion:Ethnographic edutainment is well accepted, with higher satisfaction rates than other types of teaching. The concepts of health promotion and the social determinants of health can be learned through ethnographic edutainment activities, which might help train more humanized health professionals.

Acquisition and retention of basic pathophysiological knowledge in psychiatry

An important and yet underexplored issue in medical education concerns the extent to which students retain early taught theoretical knowledge during subsequent stages of their academic schooling. This study aimed to assess the degree to which medical students retain basic pathophysiological knowledge on biological psychiatry across different stages of medical education. A cross-sectional investigation was conducted using a multiple choice questionnaire (MCQ) of objective pathophysiological knowledge taught in a course given to second-year students, supplemented by questions measuring subjective interest and attributed importance to the content taught. Comparisons (ANOVA with post hoc Tukey tests) were carried out among five groups (n = 417): baseline (freshmen), pre-intervention group (second-year students attending the first day of the course), immediate tested group (second-year students on the final day of the course), 1-year delayed tested group (third-year students), and 3-years delayed tested group (interns). In comparison to the baseline and pre-intervention groups, the other three groups that received teaching displayed significantly better levels of knowledge (p < 0.0001). Differently, scores of interest and attributed importance were higher in the pre-intervention group relative to all other groups that were tested after having been given the course (p < 0.005). There were no significant associations between knowledge retention, attributed importance, and interest within pre-intervention or post-intervention groups. The only modest loss of knowledge over time indicates that a large proportion of early taught content is retained throughout the later years of medical education. Nevertheless, retained knowledge does not seem to be associated with subjective interest and attributed importance to such early taught content.

Development of a Framework for Assessing Professionalism in Medical Students

Background: professionalism assessment is one of the most difficult issues in medical education. In related references, it is recommended that professionalism assessment should be according to the status and attention to culture of each society. The purpose of the study was to design an appropriate framework in order to assess professionalism among medical students of Mashhad University of Medical Sciences. Methods: the professionalism assessment framework was developed in accordance with experts’ perspective. Q methodology, that is a mixed research method to study people’s viewpoint and subjectivity about the components of professionalism, was used to determine the relevant factors. The data were collected through focus group discussion and interview and analyzed quantitatively using exploratory factor analysis. In order to determine the most appropriate method, time, place and person to carry out the assessment, qualitative methods and interviews were used. Results: the factors influencing professionalism assessment included individual capacity and attention to culture - knowledge, medical skills and responsibility - managerial skills and preserving human dignity - organizational commitment and excellence - respecting other people’s rights and duty – respecting laws, communication skills and altruism. Direct observation, professors, hospital wards, duration of clinical courses were considered as the most appropriate method, assessor, place and time to assess professionalism among medical students. Conclusion: a framework was designed in the study that included assessing factors, the best assessor and the most appropriate method, time and place in order to assess professionalism among medical students. On the condition that the shortcomings of the framework are corrected by further researches and localization, it could be used in other medical schools.

Autopsy in undergraduate medical education—what do students really learn?

Forensic medicine can provide access to autopsies for students in undergraduate medical education. Previous qualitative studies reported that attending autopsies promotes learning and is helpful in organising information in the context of self-directed learning, covering cognitive, emotional and societal issues. In the present study, learning outcome regarding specific pathophysiological learning objectives of students who attended an autopsy elective (intervention group, n = 32) was estimated in comparison to peer students who signed up for the course but were not selected (control group A, n = 47) and students who had not signed up (control group B, n = 186). Learning outcome (expressed as a percent knowledge gain) was measured by means of comparative self-assessments (CSA). Furthermore, group interviews were conducted to evaluate the attending students' perceptions and experiences of the course. In the intervention group, the percent knowledge gain for learning objectives reflecting pathophysiological mechanisms was about twice as high than that in the control groups, while all three groups showed comparable knowledge gain for learning objectives covered by mandatory courses that were held during the study period. Results of mandatory post-course assessments showed no statistically significant differences between the intervention and control groups. Therefore, the knowledge gain regarding learning objectives not covered by mandatory courses that was observed in the intervention group reflected the additional benefit of attending the autopsy course. Group interviews with the participants revealed gain of integrated knowledge and understanding of pathophysiological relations as important issues, while negative effects were reported infrequently. Our findings suggest that attendance of a series of autopsies fosters learning and understanding of important issues in medical education and should therefore be part of undergraduate medical curricula wherever possible.

The Effectiveness of Electronic Learning and Lecture-Based Education in the Improvement of Interns’ knowledge About Advanced Cardiopulmonary Resuscitation Drug Pharmacology

Background:Conventional educational systems seem to be improper throughout the cardiopulmonary resuscitation (CPR) teaching process. The most common causes of failed resuscitation are unfamiliarity with cardiopulmonary resuscitation algorithms, poor performance of leader of the CPR team and lack of skilled personnel, coordination among members during resuscitation, and responsibility of staff.Objectives:Electronic learning, as a new educational method is controversial issue in medical education for improving physicians’ practical knowledge and it is inevitable that further research on its effectiveness should be done.Materials and Methods:The present study is a prospective, pre- and post-educational, cross-sectional research, in which 84 interns were randomly divided into two groups. pre- and post- educational interventions that took place in the Department of Emergency Medicine, interns were evaluated by 21 multiple choice questions related to American Heart Association guidelineson cardiopulmonary resuscitation drugs. Questions were assessed in terms of routes for CPR drugs administration, CPR drug dosage forms, clinical judgment and appropriate CPR drug administration, and the alternative drugs in emergency situations. Data were analyzed by generalized estimating equations regression models and P < 0.05 was considered statistically significant.Results:Evaluating the effectiveness of both educational methods revealed that the mean answering score for 21 questions before education was 7.5 ± 2.6 and no significant difference was observed in groups (P = 0.55). However, after education, the average scores significantly increased to 11.0 ± 3.9 (P < 0.001). Electronic learning method was not associated with considerable increase in the knowledge of interns in this group compared with the lecture-based group (P = 0.49).Conclusions:No significant differences were observed between electronic learning and lecture-based education in improving interns’ knowledge of CPR drugs.

Assessments of empathy in medical school admissions: what additional evidence is needed?

The Association for the Study of Medical Education (ASME) sponsored a symposium on the theme of Examining the Evidence with Regard to Character, Personality and Values in Medical School Selection which was held on October 14, 2013 at the University of Sheffield Medical School in the United Kingdom. I was invited to speak about credibility issues related to personality assessments in health profession educations. To my pleasant surprise, I found the European audience receptive (more than their counterparts in the United States) to the idea of using personality assessments in admission decisions. There seems to be a hesitation among leaders in medical education in the United States to use personality assessments for selection purposes. They argue that convincing evidence is needed to support using personality assessments in medical school admission. In my presentation, I provided evidence to refute the argument against using personality assessments in admission decisions. Because of our extensive research at Jefferson Medical College on the topic of empathy in medical education and patient care, I placed the emphasis on credibility of evidence for using assessments of empathy, as a personality attribute, in the selection of applicants and professional development of students in any academic health profession institution. The editor of this journal who has a keen interest in medical education issues attended the symposium and suggested that I write an opinion piece about the issue for international audience of the journal. This editorial is based, in part, on my presentation at that symposium. Why is personality relevant to medical school admissions? There is a consensus among behavioral and social scholars that personality plays an unquestionable role in human behavior. In the practice of medicine, the importance of personality in professional assessments has been acknowledged in a paradigm of physician performance.1,2 There is a large volume of research in medical education about the contribution of personality to academic achievement, clinical competence, and specialty interest of doctors-in-training and in-practice.3 The notion that personality is a contributing factor to academic achievement, clinical competence, career choice, and professional behavior implies that personality should be considered as a pertinent measure not only for the assessment of professional development of doctors-in-training, but more importantly as an additional requirement for the admission of qualified applicants to medical schools.

Cost and value in medical education--what we can learn from the past.

What lessons can be learned from the history of cost and value in medical education? First, the issue of cost and value in medical education has been around for a long time. Rising costs and an economic recession have made us focus on the subject more, but the issue has been just below the surface for over 200 years. A problem like this will not go away by itself - we must tackle it now. Second, the history of cost and value in medical education makes us look critically at who should pay. Should it be students, institutions or governments? We can see from the past that several different models have been tried; that all have their advantages and disadvantages; and that none are perfect. Third, looking at the past should make us realise that the issue of cost in medical education cannot be viewed in isolation. Medical educators throughout history have looked at how cost can affect selection for medical school, how costs can be related to benefits, and the effect of rising costs on career choices. Cost in medical education has always had far reaching consequences and implications. It probably always will. Looking at issues in medical education from the perspective of cost often makes them more stark and explicit - this in turn may help us to start to find solutions. In the future our solutions must be evidence based and must take account of cost.