Medical Competence Research Articles

Building healthier communities: the role of health educational programs in enhancing health literacy in Prairie View, Texas.

Increasing health literacy, the ability to understand and process health information, within underserved communities can improve health outcomes. We hypothesized that educational programs tailored by age group would effectively improve an individual's health literacy in underserved communities. Our study examined the implication of a health-related education program among different age groups in Prairie View, Texas. The study aimed to (i) improve health literacy within the Prairie View, Texas community; (ii) encourage healthy lifestyles in study participants; and (iii) provide an educational experience for medical and pre-medical students. Monthly educational modules were presented for 5 months to three groups (high school students, college students, and older adults). The improvement in health literacy after the study was evaluated based on the average of correct responses on the pre- and post-monthly assessments. We also assessed the change in pre-med and medical students' willingness to work within underserved communities. The average percentage of correct answers increased. By the end of the study, high school students answered 96% of the questions correctly, college students answered 95% correctly, and older adult participants answered 90% correctly. Medical student and pre-med student willingness to practice medicine in underserved communities increased. Programs to increase health literacy within underserved communities can lead to improved medical knowledge competency, positive health outcomes, and informed decision making. Students exposed to the research were more willing to practice medicine in underserved communities.

Outcomes of a PA/APRN grand rounds pilot: A novel model for increasing engagement.

This article describes a framework for the development, implementation, and effect of advanced practice provider (APP) grand rounds. A team of certified registered nurse anesthetists (CRNAs), NPs, and physician associates/assistants (PAs) developed and operationalized a grand rounds initiative in 2019. Since January 2020, 34 live monthly learning sessions have been held in person and virtually. Surveys using Likert-scale questions were provided postattendance to attendees to assess educational growth and opportunities for improvement in future programming. Attendees also were offered an opportunity to give open-ended feedback. Recordings of each presentation were analyzed to identify content alignment with stated academic medical center system goals. Most attendees reported increased projected medical competence, performance, and perceived projected effect on patient outcomes after attending grand rounds. Grand rounds are a novel model for increasing PA, NP, certified nurse-midwife, and CRNA engagement; enhancing evidence-based medical knowledge; and advancing stated academic medical center system goals.

P-964. Case-Based Learning Outcomes for Pre-Exposure Prophylaxis Education for the Preventative Medicine Plus One Maternal Health Track

Abstract Background As HIV prevention methods continue to develop with new agents added for Pre-Exposure Prophylaxis (PrEP). Prep uptake has remained low among US women since its approval in 2012. One major barrier to increasing PrEP uptake remains lack of knowledge of PrEP among patients and providers and lack of access to PrEP care in regions with high HIV prevalence. This study aims to increase PrEP knowledge and medical competence among Maternal Health Track Preventive Medicine residents at a single academic center in Southern California. Pre-Test and Post-Test Scores and % Improvement A pre-test was given at the start of each module. The same questions were made into a post-test after the curriculum was completed. Open and closed book portions were offered, and the % improvement was recorded. Methods Three Preventative Medicine Fellows from Family Medicine and Obstetrics and Gynecology backgrounds enrolled in multidisciplinary curriculum involving women’s health. A series of twelve case-based lectures were completed from July 2023 through December 2023. Each four-hour session included a pre-test, lecture, and a problem-based learning module. Simultaneous, they provided direct care for women in a combined clinic for PrEP and HIV care weekly for 3-6 months. In March 2024, the pre-test questions were combined into 47 post-test questions. Results Two of the three fellows had improvement in the closed book portion of the exam with a mean improvement of 9.5%. However, all of them had significant improvement for the open book exam with an average improvement of 16.2%. This suggests that although the memory retention of the material can wane with time, the ability to use resources to address clinically challenging questions has been strengthened. Of note, the questions were designed to simulate the American Academy of HIV Medicine (AAHIV) certification exam, which is an open-book test. Conclusion The combination of lectures, self-assessments, case-based discussions, and clinical experience has enhanced the fellows’ knowledge of PrEP care for women based on the improvement of exam scores after the curriculum. This will enhance their ability to provide multidisciplinary preventative care for women in underserved areas. Disclosures Kristin A. Carr, MD, Preventive Medicine Plus One Maternal Health Track: Grant/Research Support

Pharmacogenomic curriculum in Australian medical schools: a content analysis study.

To ascertain and describe pharmacogenomic concepts included in the intended curriculum of accredited Australian medical schools. Content analysis of curriculum learning objectives of Australian medical schools was conducted, focusing on keywords and phrases pertaining to pharmacogenomic education. Learning objectives related to pharmacogenomics were categorized using (1) undergraduate medical genomic competencies per the Association of Professors in Human and Medical Genetics (2) Bloom's Taxonomy for cognitive and knowledge dimensions and (3) knowledge translation (enabling science, translation science and clinical implementation). The curricula of 19 accredited medical schools in Australia were analyzed. Two-thirds (68%) contained genomic/pharmacogenomic education. Eight schools had content relating to undergraduate medical genomic competencies. Of those which had pharmacogenomic-related learning objectives, the majority (65%) were categorized in Bloom's Taxonomy's lower levels (Remember and Understand) and 15% were deemed to be at the level of 'Clinical Implementation.' The majority of Australian medical schools have incorporated pharmacogenomics in their current curriculum; however, learning objectives addressing application and clinical implementation are required. Doctors have a unique role to play in implementing pharmacogenomics into clinical practice. Comprehensiveness of course curricula across all learning domains would support uptake of pharmacogenomics into routine practice.

Enhancing Medical Collocation Competence through a Lexical-Based Approach on Writing among Saudi EFL Medical Learners

The present research aims to evaluate the effectiveness of the proposed lexical approach in improving English Foreign Language (EFL) students’ Lexical knowledge, particularly their ability to use medical collocations in writing within the medical English context. This paper adopted a mixed methods approach; the quantitative data was obtained from a survey conducted on (24) English Foreign Language (EFL) medical learners at Majmaah University, Saudi Arabia, whereas the qualitative data was obtained from interviews with (5) of the participants. The purpose of the study was to identify students’ attitudes toward the benefits and possible difficulties of learning medical collocations. The study establishes their significance in enhancing academic and professional writing as students exhibit adequate motivation to understand medical collocations. However, the study points out the following limitations including inadequate perceptions of culture and lack of practice as key barriers that affect its acquisition. The study suggests that several changes should be made in the context of medical ESP curricula, including systematic instruction in medical collocations, as well as offering the students authentic practice in using knowledge gained throughout the process. Through this study, a noble contribution is provided to the field of applied linguistics since medical collocations are viewed as an impactful method of enhancing EFL learners’ performance in medical English and as a result strengthens their academic and professional oral and written communication abilities as well.

STUDI LITERATUR: Faktor Kualitas Pelayanan terhadap Loyalitas Pasien di Rumah Sakit Indonesia

This study aims to examine the service quality factors that influence patient loyalty in Indonesian hospitals. Service quality is a crucial aspect in maintaining and enhancing patient trust and loyalty. This literature review identifies five key dimensions of service quality: reliability, responsiveness, assurance, empathy, and tangibles. Each dimension plays a significant role in shaping patient loyalty, through consistent service delivery, quick responses, medical staff competence, personal attention, and the quality of physical facilities. Several studies indicate that patient satisfaction also acts as a mediator between service quality and loyalty, good service increases satisfaction, ultimately affecting patient loyalty. Amid the intense competition in healthcare services in Indonesia, optimal service quality is a key factor in patient retention. Therefore, hospital management must focus on each service quality dimension to create a satisfying patient experience. The findings of this review are expected to guide hospitals in developing effective strategies for improving service quality to retain and increase patient loyalty.

Parallel Chart Writing and Resilience Impact the Narrative Competence of Medical Staff in China: A Cross-Sectional Study.

Narrative competence is essential for good communication between medical staff and patients. It is a powerful instrument for the delivery of holistic healthcare. However, little research focuses on the influencing factors of narrative competence and the relationships among resilience, self-efficacy, and narrative competence. The study aims to explore the influence factors of narrative competence of medical staff and confirm the relationships among self-efficacy, resilience, and narrative competence. A cross-sectional survey was conducted among 606 medical staff from two affiliated hospitals in Zhejiang and Heilongjiang provinces, respectively. The participants were scored using the Chinese narrative competence scale, the brief Chinese version of the resilience scale, and the Chinese version of the self-efficacy scale. This study showed that the score of narrative competence was 149.76 ± 28.70, including the scores of listening dimension (48.01 ± 9.36), understanding dimension (67.75 ± 13.55), and reflecting dimension (34.00 ± 6.77). A high narrative competence score was associated with hospital location and parallel chart writing (p < 0.01). Pearson's correlation analysis showed resilience and self-efficacy were positively related to narrative competence. Medical staff's narrative competence is intermediate in China. Parallel chart writing and resilience would impact this competence, which should be further improved.

The need for acute assessments in home healthcare - Swedish registered nurses’ experiences

ABSTRACT Purpose The study aims to describe Swedish RNs’ experiences of acute assessments at home. More patients with complex nursing needs are cared for at home due to an ageing population. Registered nurses (RNs) who work with home healthcare need a broad medical competence and clinical experience alongside adapted decision support systems for maintaining patient safety in acute assessments within home healthcare. Methods A content analysis of qualitative survey data from RNs (n = 19) working within home healthcare in Sweden. Results There were challenges in the acute assessments at home due to a lack of competence since several of the RNs did not have much experience working as an RN in home healthcare. Important information was missing about the patients, such as access to medical records due to organizational challenges and limited access to equipment and materials. The RNs needed support in the form of cooperation with a physician, support from colleagues, and a decision support system. Conclusion To increase the possibility of patient-safe assessments at home, skills development, collegial support, and an adapted decision support system are needed. Collaboration with primary healthcare, on-call physicians, and nursing staff, and having the opportunity to consult with someone also provide security in acute assessments.

BUILDING ACTIVE LEARNING IN MEDICAL EDUCATION: HOW TO BRIDGE VISION WITH REAL PRACTICE?

Introduction: This manuscript explores the role of active learning in medical education, focusing on innovative strategies that bridge theoretical knowledge with practical skills essential for future healthcare professionals. With insights from both global and local applications, the paper highlights the implementation of active learning techniques to improve competencies in medical, pharmaceutical, and nursing education. Methods: A review of current student-centered active learning methodologies was conducted using guidelines from leading medical education societies. Practical applications of simulation-based, problem-based, game-based learning, and other interactive approaches were examined to understand their impact on skill acquisition and knowledge retention. Results: Active learning fosters critical clinical reasoning, communication, and teamwork skills. Techniques like simulation exercises, case-based discussions, and flipped classrooms enhance students’ abilities to tackle real-world clinical scenarios. Additionally, integrating interdisciplinary and preventive medicine elements supports a holistic understanding of healthcare. Incorporating online tools and gamification has further enhanced student engagement and motivation for independent learning. Conclusion: The active learning model effectively equips students with essential medical competencies, preparing them for complex clinical environments. By bridging theoretical concepts with practical experiences, active learning promotes lifelong learning, critical thinking, and adaptability, ultimately advancing the quality of healthcare training.

Primary care in rural areas: a qualitative study on medical students’ images and experiences of working in rural areas in southern Germany

BackgroundRural areas are increasingly moving back into the focus of social research, especially in the context of health care. As the shortage of general practitioners (GP) in rural areas is a significant challenge in Germany, there are several programs to counteract underuse effectively, acutely, and sustainably. One of those programs is ’Beste Landpartie Allgemeinmedizin’ (BeLA), which was developed to strengthen primary care in rural areas and to sustainably promote young doctors to work as general practitioners in rural regions through didactical and financial support. The program includes an accompanying qualitative study exploring the motivational structures of medical students from a sociological perspective. For this study, the nexus of working in rural areas from the perspective of medical students with different forms of rural experiences was of interest.MethodsQualitative interviews have been conducted at regular intervals on an ongoing basis since 2020 to investigate motivational retention effects during the program. The current 33 interviews were analysed using the sociological conceptual framework of spatial methods.ResultsThe images and experiences of working in rural areas condition medical education in various ways. In addition to general images of living and working in rural areas in a biographical dimension, the idea of working as a GP in rural areas includes images of specific medical competencies and is conditioned by different medical tasks. From such a perspective, the images and attributions of working in primary care in a rural region demonstrate particularities, challenges, and the potential attractiveness of working in rural regions.DiscussionThe images and experiences of rural areas condition medical education in various ways and shape the expectations and the decision-making of possibly working in rural areas. The particularities, opportunities, and challenges of working in rural areas, which relate to both professional aspects and social life, are a major factor in the attractiveness of a potential rural practice. Didactical and educational curricula need to adapt the various attributions of working in rural areas.

Criteria for the authorization of training in medical specialist competence in internal medicine and rheumatology-A position paper of the German Society for Rheumatology and Clinical Immunology

The model advanced training regulations define the content of advanced training to achieve the qualification of medical specialist in internal medicine and rheumatology. There are currently no criteria for issuing the authorization in advanced training. This position paper describes the criteria proposed by the German Society for Rheumatology and Clinical Immunology (DGRh), which should be the foundation for the issuance of authorization for advanced training in the field of internal medicine and rheumatology and for the assessment of the duration. The model advanced training regulations 2018 and the advanced training plan recommended by experts function as the basis for this. Based on the criteria, the authorization for advanced training to advanced specialist training in internal medicine and rheumatology can be allocated in a standardized, graded and transparent manner throughout Germany. This enables an optimal quality of advanced training in rheumatology, which can be adapted to the future developments in the discipline.

Preparing future healthcare professionals for evidence-based decision-making using health technology assessment as an experiential learning tool

The rapid evolution of healthcare, driven by the rise of new health technologies and the growing emphasis on evidence-based care, requires health professionals skilled in assessing and utilizing evidence to support decision-making. Health technology assessments (HTAs), which involve evidence synthesis and appraisal, analysis across various domains, and tailoring evidence to local contexts, can develop these skills. These skills are also part of medical competencies. However, there is a dearth of literature on teaching HTAs to health professionals and on how the skills learned through HTA align with medical competencies. We developed an innovative experiential project that had students conduct mini-HTAs for community partners considering new technologies. Students worked in teams to evaluate and synthesize evidence, delivering a website and brief to our partners justifying their recommendations. Success was achieved by providing authentic tasks and using supportive learning strategies. The project engaged students deeply, offering them valuable skills for post-graduation work and education. In this article, we demonstrate how the learning outcomes of the project align with the CANMEDS framework of medical competencies. Secondly, we demonstrate an effective, adaptable, and unique approach of using mini-HTAs to equip students with the knowledge and skills needed to navigate the rapidly evolving landscape of evidence and technologies, preparing them as our future healthcare professionals.

Advances in Shared Decision Making in Brazil: The role of patient autonomy in curriculum reform, health system and clinical care.

Clinical practice in Brazil has rapidly transformed. Doctor-patient relationships are the focus of these transformations, either within health policies or in the context of medical training. The Brazilian Curriculum Guidelines have emphasized the doctor-patient relationship as part of medical skills and competences, based on patient-centered care. In this article, we present the political advances in patient-centered care. In addition, we address an overview of the Brazilian status quo of decision support tools. Finally, we share experiences in curriculum reform for the advances of communication skills and the interfaces with narrative medicine and the arts in curricular medical training as a means to advance towards the practice of shared decision making.

History of the medical licensure system in Korea from the late 1800s to 1992.

The introduction of modern Western medicine in the late 19th century, notably through vaccination initiatives, marked the beginning of governmental involvement in medical licensure, with the licensing of doctors who performed vaccinations. The establishment of the national medical school "Euihakkyo" in 1899 further formalized medical education and licensure, granting graduates the privilege to practice medicine without additional examinations. The enactment of the Regulations on Doctors in 1900 by the Joseon government aimed to define doctor qualifications, including modern and traditional practitioners, comprehensively. However, resistance from the traditional medical community hindered its full implementation. During the Japanese colonial occupation of the Korean Peninsula from 1910 to 1945, the medical licensure system was controlled by colonial authorities, leading to the marginalization of traditional Korean medicine and the imposition of imperial hierarchical structures. Following liberation in 1945 from Japanese colonial rule, the Korean government undertook significant reforms, culminating in the National Medical Law, which was enacted in 1951. This law redefined doctor qualifications and reinstated the status of traditional Korean medicine. The introduction of national examinations for physicians increased state involvement in ensuring medical competence. The privatization of the Korean Medical Licensing Examination led to the establishment of the Korea Health Personnel Licensing Examination Institute in 1992, which assumed responsibility for administering licensing examinations for all healthcare workers. This shift reflected a move towards specialized management of professional standards. The evolution of the medical licensure system in Korea illustrates a dynamic process shaped by the historical context, balancing the protection of public health with the rights of medical practitioners.

The role of mindfulness and emotional intelligence in mediating the effects of job burnout on job performance

Healthcare delivery relies on human resource management to ensure quality. However, employee performance dropped from 2019 to 2022, highlighting the need to address job fatigue, which lowers performance. This study examines how mindfulness and emotional intelligence mediate the effects of occupational fatigue on medical and paramedic performance. This integrated study intends to understand healthcare job performance and improve medical professionals' competency and well-being in Indonesia. A 5% margin of error was used to choose 213 medical staff and paramedics from the Mojokerto City Government Health Agency in Indonesia using the Slovin algorithm. The Sobel Test and SEM with AMOS were used to analyse data. Mindfulness and emotional intelligence decreased considerably with job burnout, affecting job performance. Mindfulness and emotional intelligence also improved job performance. The results also showed that emotional intelligence and mindfulness moderate the job burnout-performance link. These findings show that emotional and psychological aspects are crucial to understanding how job fatigue affects employee performance.

Human Judgment versus ChatGPT: Preserving the Essence of Medical Competence in the Age of Artificial Intelligence.

Human Judgment versus ChatGPT: Preserving the Essence of Medical Competence in the Age of Artificial Intelligence.

Enhancing puncture skills training with generative AI and digital technologies: a parallel cohort study.

Traditional puncture skills training for refresher doctors faces limitations in effectiveness and efficiency. This study explored the application of generative AI (ChatGPT), templates, and digital imaging to enhance puncture skills training. 90 refresher doctors were enrolled sequentially into 3 groups: traditional training; template and digital imaging training; and ChatGPT, template and digital imaging training. Outcomes included theoretical knowledge, technical skills, and trainee satisfaction measured at baseline, post-training, and 3-month follow-up. The ChatGPT group increased theoretical knowledge scores by 17-21% over traditional training at post-training (81.6 ± 4.56 vs. 69.6 ± 4.58, p < 0.001) and follow-up (86.5 ± 4.08 vs. 71.3 ± 4.83, p < 0.001). It also outperformed template training by 4-5% at post-training (81.6 ± 4.56 vs. 78.5 ± 4.65, p = 0.032) and follow-up (86.5 ± 4.08 vs. 82.7 ± 4.68, p = 0.004). For technical skills, the ChatGPT (4.0 ± 0.32) and template (4.0 ± 0.18) groups showed similar scores at post-training, outperforming traditional training (3.6 ± 0.50) by 11% (p < 0.001). At follow-up, ChatGPT (4.0 ± 0.18) and template (4.0 ± 0.32) still exceeded traditional training (3.8 ± 0.43) by 5% (p = 0.071, p = 0.026). Learning curve analysis revealed fastest knowledge (slope 13.02) and skill (slope 0.62) acquisition for ChatGPT group over template (slope 11.28, 0.38) and traditional (slope 5.17, 0.53). ChatGPT responses showed 100% relevance, 50% completeness, 60% accuracy, with 15.9s response time. For training satisfaction, ChatGPT group had highest scores (4.2 ± 0.73), over template (3.8 ± 0.68) and traditional groups (2.6 ± 0.94) (p < 0.01). Integrating AI, templates and digital imaging significantly improved puncture knowledge and skills over traditional training. Combining technological innovations and AI shows promise for streamlining complex medical competency mastery.

A Mixed-Methods Investigation of First-Year Medical Students’ Professionalism Competency Development over the Gross Anatomy Course

Abstract Background While competency-based medical education (CBME) and competency assessment in clinical training are well documented, they are less commonly included in preclinical medical education. The gross anatomy laboratory is an opportune setting to incorporate competency assessment and reflection during preclinical medical education. This mixed-methods study determined how first-year medical student assessments of professionalism skills in the gross anatomy lab change over time and analyzed student reflections to contextualize the experiences they had developing the Professionalism competency. Methods First-year medical students at the University of Louisville completed self- and peer-assessments using the Professionalism Assessment Scale (PAS) at the beginning and end of their gross anatomy course (n = 83). The students also completed three competency development portfolio (CDP) entries throughout the course (n = 83). Qualitative thematic analysis with grounded theory was used to analyze comments related to professionalism skill development in the CDP reflections during the course. Results There was no statistical difference in PAS self-assessment scores from Time 1 (M = 4.81, SD = .209) to Time 2 (M = 4.85, SD = .217), p = .108. There was a statistically significant increase in PAS-peer-assessment scores from Time 1 (M = 4.89, SD = .165) to Time 2 (M = 4.93, SD = .127), p = .005. Thematic analysis of CDPs revealed that students believed they developed interpersonal relations/social skills, responsibility skills, and gross anatomy lab-specific skills over the gross anatomy course. Conclusions The Professionalism competency is inherently present and able to be assessed in the gross anatomy lab context for first-year medical students.

Root causes behind patient safety incidents in the emergency department and suggestions for improving patient safety - an analysis in a Finnish teaching hospital.

Adverse events occur frequently at emergency departments (ED) because of several risk factors related to varying conditions. It is still unclear, which factors lead to patient safety incident reports. The aim of this study was to explore the root causes behind ED-associated patient safety incidents reported by personnel, and based on the findings, to suggest learning objectives for improving patient safety. The study material included incident reports (n = 340) which concerned the ED of a teaching hospital over one year. We used a mixed method combining quantitative descriptive statistics and qualitative research by inductive content analysis and deductive Ishikawa root cause analysis. Most (76.5%) incidents were reported after patient transfer from the ED. Nurses reported 70% of incidents and physicians 7.4%. Of the reports,40% were related to information flow or management. Incidents were evaluated as no harm (29.4%), mild (46%), moderate (19.7%), and severe (1.2%) harm to the patient. The main consequences for the organization were reputation loss (44.1%) and extra work (38.9%). In the qualitative analysis, nine specific problem groups were found: insufficient introduction, adherence to guidelines and protocols, insufficient human resources, deficient professional skills, medication management deficiencies, incomplete information transfer from the ED, language proficiency, unprofessional behaviour, identification error, and patient-dependent problems. Six organizational themes were identified: medical staff orientation, onboarding and competence requirements; human resources; electronic medical records and information transfer; medication documentation system; interprofessional collaboration; resources for specific patient groups such as geriatric, mental health, and patients with substance abuse disorder. Entirely human factor-related themes could not be defined because their associations with system factors were complex and multifaceted. Individual and organizational learning objectives were addressed, such as adherence to the proper use of instructions and adequate onboarding. System factors caused most of the patient safety incidents reported concerning ED. The introduction and training of ED -processes is elementary, as is multiprofessional collaboration. More research is needed about teamwork skills, patients with special needs and non-critical patients, and the reporting of severe incidents.

Narrative competence disparities between Children's hospital and General hospital in China: A comparative survey.

Narrative medicine was introduced in China in 2011 and has been applied as a tool for humane medical practice. The prominent problem in the narrative medicine is the lack of adequate attention and devotion. This study aimed to investigate Chinese medical staffs' narrative competence and the influencing factors, confirming whether the level of narrative competence is different in different hospital settings. A cross-sectional survey was conducted among 1003 medical staffs, including 201 from Children's hospital and 802 from the General hospital. The participants were scored based on the Chinese narrative competence scale, a brief Chinese version of the resilience scale, and a Chinese version of the self-efficacy scale. Data were analyzed using IBM SPSS version 25.0. A total of 1003 medical staff from Children's hospital and General hospital participated in the survey, with a response rate of 94.36%. Our results showed that the score of narrative competence of General hospital and Children's hospital was 149.45±26.22 and 147.10±18.87, respectively, both of which were in intermediate level. Resilience, familiarity with narrative medicine were influencing factors of narrative competence in 2 kinds of hospitals, and whether having written parallel charts before were the influencing factors of narrative competence in General hospital. Besides, our study found that the level of narrative competence (χ2 = 13.672, p≤0.001), resilience score (personal ability dimension, t = 3.439, p≤0.001) and self-efficacy (t = 1.976, p<0.005) are different between General and Children's hospital. Narrative competence is different between General hospital and Children's hospital. Medical staff in General hospital are more familiar with narrative medicine. The competence of medical staff in China needs to be improved.