Approach In Medical Education Research Articles

The violence of curriculum: Dismantling systemic racism, colonisation and indigenous erasure within medical education.

Epistemic violence is enacted in medical curricula in mundane ways all the time, negatively impacting learners, teachers and patients. In this article, we address three forms of such violence: White supremacy, indigenous erasure and heteronormativity. In this article, we examine the knowledge systems of medicine as a global phenomenon, impacted by Western and European ideologies of race and colonisation, both produced by them, helping to reproduce them through authoritative and hegemonic ideologies. We seek not only to problematise but also to propose alternative teaching approaches rooted in the Global South and in Indigenous ways of knowing. Taking inspiration from Paulo Freire, we advocate for the development of critical consciousness through the integration of critical pedagogies of love, emancipation and shared humanity. Drawing on Irihapeti Ramsden, we advocate for cultural safety, which emphasises power relations and historical trauma in the clinical encounter and calls for a rights-based approach in medical education. Deliberately holding space for our own vulnerabilities and that of our students requires what Megan Boler calls a pedagogy of discomfort. Our perspectives converge on the importance of critical consciousness development for culturally safe practice in medical education, acknowledging the need to emphasise a curriculum of shared humanity, introducing the concept of Ubuntu from Southern Africa. Ubuntu can be encapsulated in the phrase 'I am because we are', and it promotes a collective approach to medical education in which there is active solidarity between the profession and the diverse populations which it serves.

The impact of simulation-based training in medical education: A review.

Simulation-based training (SBT) has emerged as a transformative approach in medical education, significantly enhancing healthcare professionals' learning experience and clinical competency. This article explores the impact of SBT, tracing its historical development and examining the various types of simulations utilized today, including high-fidelity mannequins, virtual reality environments, standardized patients, and hybrid simulations. These methods offer a safe and controlled environment for students to practice and hone technical and non-technical skills, ultimately improving patient safety and clinical outcomes. The benefits of SBT are manifold, including enhanced skill acquisition, error reduction, and the opportunity for repeated practice without risk to actual patients. Immediate feedback and structured debriefing further solidify learning, making Simulation an invaluable tool in medical education. However, the implementation of SBT is challenging. It requires substantial financial investment, specialized equipment, and trained faculty. Additionally, there are concerns about the realism of simulations and the transferability of skills to real-world clinical settings. Despite these challenges, numerous case studies and empirical research underscore the effectiveness of SBT compared to traditional methods. Looking ahead, advancements in technology, such as artificial intelligence and improved virtual reality applications, promise to enhance the efficacy and accessibility of simulation training. The integration of Simulation with other training modalities and its adoption in diverse global contexts highlight its potential to revolutionize medical education worldwide. This article affirms the crucial role of SBT in preparing the next generation of healthcare professionals and its ongoing evolution driven by technological innovations.

The role of competency based medical education in addressing health inequities and cultivating inclusive learning environments

Pediatric health inequities are pervasive and reflect the confluence of social and structural determinants of health including racism in all its forms. Current approaches in graduate medical education that prepare trainees to address health inequities and improve population health are inadequate. Competency based medical education (CBME) can advance equity-oriented efforts to improve patient outcomes, optimize the learning environment and encourage lifelong learning. We briefly describe the impact of racism and discrimination on the clinical learning environment. We then highlight how to apply the 5 core principles of CBME to equip learners across the continuum to address health inequities. We provide specific examples including 1) how CBME can inform teaching, assessment and professional development activities to promote equitable pediatric health outcomes via enturstable professional activities, 2) competency-focused instruction that address racism and inequities, 3) multimodal learning approaches to facilitate the acquisition of the desired competencies to address health inequities, 4) sequenced learning approaches across the continuum of practicing pediatricians, and 5) tools and resources for programmatic assessment of trainee and program performance in addressing pediatric health inequities.

Physician perceptions of medically unexplained symptoms in adolescent patients presenting to the emergency department

IntroductionAdolescents presenting with medically unexplained symptoms (MUS) in non-mental healthcare settings, particularly Emergency Departments (EDs), pose diagnostic challenges necessitating a comprehensive bio-psycho-social approach. Amid the youth mental health crisis, recognising psychological distress is imperative. This study delved into physicians' perceptions and diagnostic tendencies regarding such cases, exploring the potential overshadowing of psychosomatic presentations by medicalized diagnoses in EDs. MethodsOur study involved 74 physicians, representing 82% of eligible respondents in the Paediatric Emergency Medicine Department, and was conducted using an online questionnaire examining perceptions of case scenarios with psychosomatic presentations. ResultsResults disclosed a prevalent inclination toward medical diagnoses, with less than 10% of physicians considering psychosomatic conditions in specific scenarios. Interestingly, psychosomatic diagnoses were more probable for symptoms like headaches, shortness of breath, and chest pain. The study uncovered a possible bias among physicians towards medical diagnoses in EDs for adolescents with MUS, possibly stemming from physicians’ focus on physical care, diagnostic uncertainties, cognitive biases, and concerns about stigmatisation. ConclusionAdolescents with MUS seeking assistance in non-mental health settings may encounter delayed mental health diagnoses and interventions. Psychosomatic symptoms could signify stressors or underlying mental health disorders. Recognising psychosocial distress early on is crucial for optimal mental health outcomes. Consequently, the study advocates for a paradigm shift towards a holistic bio-psychosocial approach in both medical education and practice.

Learner Competence Across Cognitive Levels In Undergraduate Medical Education: An Item Response Approach.

Objective: The current study endeavors to evaluate competence of learners using item response theory approach in undergraduate medical education. Methodology: The responses of the examinees from first professional year (MBBS) were evaluated for Anatomy discipline to gauge learner competence through knowledge, understanding and application in the subject using item response theory approach (IRT) which is an effective tool to measure the validity (discrimination and difficulty index) of assessment, while KR-20 is used to gauge reliability of the items with statistical software STATA 17. The quality of question and level of examinee responses provide skill level and competence of learners. Results: The current study found that the C1 and C3 level items from the Anatomy discipline are mostly acceptable and effectively gauge learner competence while flawed C2 level items need complete restructuring. The study also identified weak areas of average learner for items in each cognitive level. Conclusion: The study found significant role of IRT in effectively estimating competence of the examinees across cognitive levels for each discipline and in building of an effective test pool through assessment of learner ability and construction of quality SBAs to achieve valid and reliable assessment tool. Keywords: Difficulty index; Discrimination index; Single best answer questions; Cognitive levels; Item characteristic curve.

Normative and narrative approach in secondary medical education

Normative and narrative approach in secondary medical education

Redefining the Role of Medical Affairs Professionals as Innovators and Leaders in Industry-Led Medical Education.

Medical affairs professionals are pivotal players at the intersection of medical innovation and practice in the pharmaceutical industry. They are uniquely positioned to translate complex medical knowledge into actionable insights for internal and external stakeholders. Industry-led continuing medical education (CME) programs, guided by these professionals, hold the potential to markedly improve clinicians' application of evidence-based medicine (EBM) in clinical settings, thereby elevating patient care outcomes. However, current CME techniques often overlook the integration of diverse disciplines such as educational theories, cognitive psychology, information mastery, and implementation science, which are important for effective real-time decision-making in patient care. This gap in integrating implementation science is vital, as it is key in ensuring that medical innovations are not just developed but also effectively implemented and efficiently utilized in clinical settings. In this opinion article, we aim to highlight the crucial yet often underrecognized role of medical affairs professionals in shaping robust and practical CME programs within the industry. We explore emerging trends and approaches in medical education and CME based on the principles of adult education. Additionally, we explore how medical affairs professionals can effectively drive the adoption of EBM in clinical practice. This exploration aims to provide insights into enhancing CME programs, with medical affairs professionals at the forefront of innovation and leadership in bridging gaps in clinical practice.

Comparative evaluation of open book and conventional assessment methods in medical undergraduate students.

Medical science is a dynamic field of knowledge that is constantly broadening with upcoming clinical research and analysis. Traditional medical education has been focused on textbook-based recall assessments-closed book assessment (CBA). However, the availability of newer technologies has made the accessibility to encyclopedic knowledge expeditious, which demands for a new approach for medical education. As medical professionals, the purpose of learning should be higher cognitive skills such as interpretation and synthesis. So, analyzing students' ability to comprehend the concepts and learning to apply it in a realistic context than merely recalling the facts has come into attention. In this study, we aimed to evaluate and compare the performance of 250 first-year MBBS students at Maulana Azad Medical College, New Delhi, India, between closed book and open book method for biochemistry. Students were divided into two groups, Group A and Group B, based on their average monthly internal assessment marks. CBA was followed by open book assessment (OBA) 1 week apart with similar questionnaire pattern and allotted time. A significant difference in average marks obtained by the two groups was observed in CBA. Group A scored better in CBA, but performance was comparable with Group B in OBA. OBA and CBA can contribute to an assessment program in part because of their complementary pros and cons, and OBA should not be thought of as an alternative to CBA, but their value may be in expanding beyond what is measured by CBA.

IJCM_394A: Participation of Undergraduate Medical Students in Health Research and Factors Influencing It in a Medical College of Puducherry- A Cross-Sectional Study

Background: Developing, maintaining, and sustaining undergraduate medical students’ research involvement will enable future healthcare practitioners to practice more appropriate evidence-based clinical medicine. Objective: To assess the participation in health research and factors promoting it among undergraduate medical students in Puducherry. Methodology: A descriptive cross-sectional study was conducted among undergraduate medical students in Puducherry over a period of three months (August-October 2023). Systematic random sampling was applied to recruit 360 study participants based on Chellaiyan et al. A pre-tested, semi-structured questionnaire was used to collect the data, including socio-demographic characteristics, academic performance, participants’ attitudes, perceived motivational and barrier factors towards health research, and current involvement in health research. Data were entered in MS Excel 2019 and analyzed using SPSS v16.0. Results: A total of 360 participants were interviewed, of whom 51.6% were female and the majority (86.7%) were hostelers. Among the 360 study participants, only around one-tenth of the participants”41 (11.39%)” have participated in the health research. The factors of gender, competency-based medical education approach, and grade of the participants in the recent university exam were associated with participation in health research. The majority (90.4%) of the participants were highly motivated to participate in health research. The main barriers identified are lack of funds, collaboration, mentorship, time to conduct, and systematic training in the research methodology. Conclusion: Participation in health research has doubled since the introduction of competency-based medical education. Still, participation could be improved by addressing the identified barriers. Studentship programs, young researcher awards, systematic training programs integrated into the curriculum, etc. could also compute the participation in health research among undergraduate medical students.

Role Of A Teacher In A Blended Learning MHPE Program: A Qualitative Analysis

Background: During the last two years, the pandemic has taken a toll on education. However, E learning tools and other innovative computer software technologies are being widely adopted to deliver educational elements of different courses to students who are placed in far off areas from the university campus. However, Teaching is demanding and complex task and the key limitations in total e-learning format included limited interactions with peer and teachers, communication problems, and insufficient sense of bonding between the teacher and student. To address these issues concept of “blended learning” was adopted. Blended learning escalates the chances of student engagement, enhance critical-thinking development and improve learning processes in the presence of a valued teacher. However, whenever innovative techniques are introduced, it becomes essential to ensure that there is no impact on instructional integrity. Thus, the response of students who are amongst the main stakeholders is absolutely vital to confirm an effective implementation of any teaching and learning approach. Objective: This study provides help to the faculty who newly incorporate BLA (blended learning approach), also it provides guidance for educators and curriculum planners to effectively plan their modules while incorporating a BL approach in medical education. Study Design: Qualitative study (Phenomenology). Settings: Three universities, Riphah International University Islamabad, University of Lahore, Lahore and Khyber Medical University, Peshawar in Pakistan. Duration: Six months from February to August 2017 Methods: Sampling was done by purposive (homogenous) sampling. Study population included MHPE students from three different universities of Pakistan. Population size was 10 MHPE students who completed their course work, and data was collected through one on one semi structured interviews. All interviews were audio recorded, transcribed and analyzed manually as well as by importing in NVivo software version 11. Results: By a thematic analysis a total of six major areas were identified that influences the student learning in blended programs. Out of these the major influencing factor came out to be the role of teachers’ both in online and face to face sessions. This blended course design helped them to become more self-regulated, self-directed, lifelong and active learners, and they were also able to transfer these learning skills to their students as well. Conclusion: Students hold a positive perception of the BLA being offered in this MHPE program. Research findings suggests that a BL course design can be successfully used in postgraduate education as well as undergraduate studies it helped to impart new learning approaches in them. The main factors which were appreciated in these courses were flexible or hybrid course design, role of a teacher as facilitators who reinforced learning strategies towards learners’ professional needs.

Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education.

Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.

Interface Between Motivational Interviewing and Burnout.

The contemporary challenges of improving patient engagement in chronic disease management and addressing the growing problem of physician burnout are commonly viewed as separate issues. However, there is extensive evidence that person-centered approaches to patient engagement, such as motivational interviewing (MI), are associated both with better outcomes for patients and improved well-being for clinicians. We conducted an exploratory survey study to ascertain whether resident physicians who perceive that they embrace and utilize the MI approach also report less burnout. A total of 318 residents in several specialties were invited via email to complete a 10-question survey about patient engagement and the experience of burnout. Frequencies and percentages were calculated for all categorical/ordinal variables to describe survey participants and question responses. Correlation coefficients were obtained to assess relationships between all burnout and engagement questions. A total of 79 residents completed the survey (response rate of 24.8%). There was broad agreement about the importance of patient engagement and the use of the MI approach, and approximately 60% of residents indicated that burnout was a problem. Two items related to residents' perceived use of MI were correlated with feeling a sense of personal accomplishment, one of the protective factors against burnout. Consistent with other studies indicating that person-centered approaches are associated both with better patient outcomes and provider wellbeing, our data suggest that residents' self-reported use of the MI approach in patient care may be related to less burnout. It appears that training in the MI approach in graduate medical education may be simultaneously good for patient outcomes and good for resident well-being.

Trainee Experience in Levels of Difficulties for Flaps in Plastic Surgery

The competency-based medical education (CBME) approach has introduced medical curricula across the globe, designed to provide flexibility, Responsibility and learner-centredness for medical learners. While traditional surgical skills training in most places has relied on "see one, do one, teach one model", simulation model-based training has been shown to improve surgical interns skills. Safely performing local and regional flaps is often a challenge for surgical residents. Therefore, the aim of this study was to assess the difficulty classification of flaps and establish equivalence between them at each level. A questionnaire and an assessment of surgical skills were sent to all plastic surgery residents and young specialists in Morocco analyzing the theoretical and procedural knowledge of flaps. Skills are assessed using a modified version of an objective structured assessment of the Technical Skills Score.

Integrating Basic Sciences and Clinical Practice: A Cross-Sectional Study of UQUMED's Medical Education Approach

Introduction. Since the early 20th century, medical education has evolved, notably with the Flexner report emphasizing the fusion of foundational sciences and clinical reasoning. As the field grew, educators adeptly incorporated new sciences and technologies, ensuring curriculum balance and depth.
 Aim. This research aimed to explore the role of basic sciences in contemporary medical education, focusing on their integration with clinical practice.
 Methods. An institutional-based cross-sectional study design was implemented at Umm Al Qura University, College of Medicine, Makkah, Saudi Arabia, from March to June 2023. This study involved surveying 470 medical students, from a total campus population of 1,360 students (excluding preparatory year), using a pre-tested and structured self-administered questionnaire. All questions in the survey were formatted to elicit dichotomous responses, namely “yes” or “no”, and the collected data were analyzed using SPSS version 20.
 Results. The study discovered that while a high percentage of medical students (96.6% in earlier years to 94% in senior years) recognized the importance of basic sciences in the MBBS curriculum, there was a noticeable decline in this belief as students advanced through their clinical years. Similarly, the perception of the utility of foundational knowledge of basic sciences for understanding clinical subjects decreased slightly from 93% in earlier years to 85% in senior years. About 92.7% of students across all years believed a strong understanding of basic sciences was crucial for clinical proficiency. However, the perceived benefit of suggested readings/textbooks declined from 82% in earlier years to 77% in senior years. Feedback on curriculum enhancements showed robust support for more engaging teaching methods, with over 90% favoring the incorporation of multimedia tools and group-based sessions.
 Conclusions. Our findings underscore the foundational role of basic sciences in medical education for clinical competency, highlighting a gradual shift in student perceptions as they progress through their training. This shift signals the necessity for adaptive teaching strategies that effectively integrate basic sciences with clinical practice to maintain relevance and efficacy in medical curricula.

Effectiveness of the “Hand as Foot” teaching method in human physiology: A randomized controlled trial

BackgroundThe "Hand as Foot" teaching method, an innovative approach in medical education, utilizes hand gestures to simulate anatomical structures and functions. This study aimed to assess the effectiveness of the "Hand as Foot" teaching method compared to traditional method in the "Human Physiology" course. MethodsDuring the 2023 spring semester, a randomized controlled trial involved 84 health management students. Participants were randomly assigned to the "Hand as Foot” teaching group or the traditional teaching group. A self-designed Likert scale was used to evaluate students' perceptions of teaching effectiveness, covering dimensions such as engagingness, intuitiveness, facilitation of understanding, enhancement of memorization, and effortlessness of learning. Additionally, a knowledge assessment test was administered to measure knowledge acquisition. ResultsThe "Hand as Foot teaching method" group (41 students) reported significantly higher ratings for all dimensions of teaching effectiveness compared to the traditional teaching group (43 students) (p ≤ 0.01). Despite the lack of statistical significance, the experimental group's test scores were notably superior (Mean = 6.35 vs. Mean = 5.94). DiscussionThe "Hand as Foot" teaching method demonstrated superior effectiveness in engaging students, facilitating comprehension, and enhancing memorization. Its interactive and tangible nature provided a holistic learning experience, enabling students to visualize complex physiological mechanisms. Additionally, it fostered active student participation and a desire for deeper understanding. ConclusionWhile the "Hand as Foot" teaching method demonstrated strengths in engaging students and aiding comprehension, further researches with larger and diverse cohorts are needed to gauge its impact on learning outcomes and broader applicability.

Integration of simulation-based teaching in anaesthesiology curriculum.

Simulation refers to the replication of various elements of a real-world situation to achieve pre-specified objectives by enabling experiential learning. As the global burden of preventable medical errors remains high, simulation-based teaching may be used to standardise medical training and improve patient safety. With the same intent, the National Medical Commission has adopted simulation as part of the Competency Based Medical Education approach. Simulation-based training creates immersive and experiential learning, which keeps the new generation of learners actively involved in the learning process. Simulation is widely used to impart technical and non-technical skills for postgraduate trainees in anaesthesiology, but it is still not integrated as a structured part of the curriculum. This article aims to identify technical and non-technical skills that can be taught using simulation and suggests opportunities for using the existing infrastructure and resources to integrate simulation as part of the anaesthesiology training curriculum.

Competency-Based Medical Curriculum: A Resurgent Paradigm for Medical and Dental Graduates

Present society is characterized by its growing complexity, dynamics and knowledge intensity, which requires professionals who are able to face new situations and problems confidently and expertly. Education faces the problem that knowledge acquisition does not necessarily mean the successful application of the same knowledge. In case of academic professionals, they should possess a broad and profound domain-specific knowledge and skills, the capability to acquire knowledge expeditiously and know-how where and when needed. Learning in a professional context has, therefore, become more important and general academic education is becoming more professional oriented. Medical education is changing to meet the demands of ever evolving health care system. One of these changes is the development and implementation of competency-based medical education (CBME). Competency-based learning and training is an approach to teaching and learning more often used in learning concrete skills than abstract learning. It differs from other non-related approaches in that the unit of learning is extremely fine-grained. Rather than a course or a module, every individual skill or learning outcome (known as a competency) is one single unit. Learners work on one competency at a time, which is likely a small component of a larger learning goal. The student is evaluated on the individual competency and can only move on to other competencies after they have mastered the current skill being learned. After that, higher or more complex competencies are learned to a degree of mastery and are isolated from other topics. Another common component of competency-based learning is the ability to skip learning modules entirely if the learner can demonstrate mastery. This can be determined through prior learning assessment or formative testing. This article pertaining to the discipline of medical education gives a broad overview and elaborates on this emerging competency based medical education approach and its related concepts.

Snippets of Student Centric Methods for Postgraduate Teaching

The field of medical education has witnessed a transition from traditional teaching methods to competency-based medical education, with an increasing focus on student-centered learning. This study aims to provide additional evidence supporting the effectiveness of student-centric approaches in medical education. The main objectives of this study are to assess the implementation of student-centered methods for second-year pathology postgraduate students and to evaluate the outcomes in terms of feedback and performance. In the Department of Biochemistry, several student-centered methods, including experiential learning, flipped classroom, student-led seminars, and a constructivist learning model, were employed for the assigned second-year pathology postgraduate students. Following a 15-day posting period, feedback was collected from the students, and their performance was assessed through graded examinations. Feedback from the participating postgraduate students was obtained, and their performance in the end-of-posting exams was analyzed. The results indicated positive student outcomes, with all students passing the exams. Self-perceived increased critical thinking and reasoning skills were reported during focus group discussion. The findings of this study support the effectiveness of student-centered approaches in medical education. The successful implementation of various student-centered methods for second-year pathology postgraduate students highlights the importance of incorporating learner-centric strategies. These results emphasize the need for faculty development at all levels to facilitate the adoption of student-centered teaching methods in medical education. Keywords: Competency based education, Postgraduate medical education

Wymagania akademickie studentów medycyny w kontekście ich kształcenia zawodowego

The research aims at studying academic requirements of medical students in the context of their professional education. The paper defines the appropriateness of academic goals in relation to modern professional trends and requirements of future health care professionals. The survey involved 407 participants. It was directed at defining the state of student’s learning environment at the department of Latin and foreign languages, in particular it concerned the quality and efficacy of learning and teaching the subject “English for professional purposes”. The results prove that all of the defined academic aims of the subject “English for professional purposes” correspond to academic requirements of medical students. The following is confirmed by a significantly higher number of responses “very important” and “important” compared to the responses “unimportant” and “absolutely unimportant” (p<0.05), while evaluating the importance of the academic aim. Thus, the performed analysis of survey results concerning the academic requirements of medical students confirmed the appropriateness of setting academic goals in the context of professional education of future physicians. The system of academic goals aids realization of competence-based approach in higher medical education and consequently the development of professional readiness to communicate in a medical setting with health care professionals and patients.

The effect of virtual simulation technology applied to undergraduate teaching of periodontal probing.

The rise of virtual simulation technology and dental simulators has created a new pedagogical approach for undergraduate medical education. The purpose of this study is to evaluate the effect of virtual simulation (VS) technology on improving the students' comprehensive abilities in periodontal probing teaching in pre-practicum periodontology, such as increasing the accuracy of probing, tactile perception and performance on force control. Twenty students were randomly selected among the fourth-year students and equally divided into VS technology teaching group (VS group) and traditional teaching group (TT group) by drawing half lots. One day later, students were required to probe the periodontal pathology model. The consistency rate between PD measurements and PD reference values, time consumption and final exam scores were recorded and statistically analysed using an unpaired Student's t test and p < .05 was considered statistical significance. Finally, questionnaires relating to teaching methods evaluation and the fidelity of the digital VS training system were distributed to students and teachers. VS group had a significantly higher consistency rate (72.976 ± 6.811%) than TT group (64.107 ± 4.988%, p = .004). To specify, the difference of consistency rates between the two groups in posterior teeth was larger than anterior teeth. Similarly, a larger difference was also found in proximal surfaces compared with buccal-lingual surfaces. As the pocket depth increased, the difference between the two groups increased too. These results indicated that VS is more efficient in complicated parts of periodontal probing teaching. In addition, students in VS group spent less time and gained a higher score than TT group (p < .05). The overall satisfaction rating in VS group was significantly higher than TT group. Lastly, teachers gave significant lower scores than students concerning the fidelity of VS system. Although there are much to improve, VS technology has obvious advantages in periodontal probing teaching in pre-practicum periodontology.