Medical Education Curriculum Research Articles

Twelve tips for implementing and teaching anti-racism curriculum in medical education

Racism has implicit and explicit manifestations that perpetuate disparities and negatively influence patient-centered health outcomes. Subsequently, a list of action items was provided to assist medical schools in becoming anti-racist institutions. A deep subject matter knowledge, beliefs, and reflections were a driving force for the management of medical schools or faculty members involved in undergraduate and postgraduate medical education to move forward toward inclusion of anti-racism in traditional medical curriculum or adapting existing training modules on diversity, equity, and inclusion. This paper proposes twelve practical and specific tips for implementing and teaching anti-racism in medical education. These twelve tips elaborate on the proposed actions for leaders in undergraduate and postgraduate medical education, valuable for designing future curricula and educational activities.

Homeopathy: A State of the Science Review With Recommendations for Practical Therapies in Midwifery Practice.

A substantial proportion of adults and children in the United States use complementary and alternative health practices, including homeopathy. Many homeopathic therapies are readily available over the counter, and many individuals access and self-administer these therapies with little or no guidance from health care practitioners. In addition, patients and health care providers are often confused by terminologies associated with complementary practices and may be unable to distinguish homeopathy from naturopathy, herbalism, holistic medicine, Ayurveda, traditional Chinese medicine, or other forms of health care. Compared with European and Asian countries, education in the United States about complementary and alternative health practices is not typically found within traditional nursing, midwifery, or medical education curricula. Given this lack of education and the broad acceptance and popularity of homeopathy, it is necessary for health care practitioners to improve their knowledge regarding similarities and differences among therapies so they can fully inform and make appropriate recommendations to patients. The intent of this article is therefore to examine the state of existing science of homeopathy, distinguish it from other complementary methods, and provide midwives and women's health care providers with an introduction to common homeopathic therapies that may be recommended and safely used by persons seeking midwifery care. This review also presents the evidence base, pharmacology, manufacturing, and regulation of homeopathic therapies. We also consider controversies and misunderstandings regarding safety and efficacy of homeopathic remedies relevant to women and birthing persons. Examples of practical applications of homeopathic therapies for use in midwifery practice are introduced. Implications for practice and sample guidelines are included.

Using online flipped classroom in problem-based learning medical curriculum: A mixed method study

The coronavirus disease (COVID-19) pandemic has changed the education system, including problem-based learning (PBL), which is the main curriculum model in medical education. Social interaction and acquisition of knowledge and skills are one of the challenges in online learning during a pandemic. This study evaluated the use of the flipped classroom in the PBL curriculum of medical education. This study used mixed-methods design with a concurrent approach. The data collection technique was secondary data collection in the form of data from the block learning evaluation form. The evaluation form contains statements regarding the quality of the learning process, in the form of Likert scales. At the end of the form, there was a fill-in/essay question for more in-depth exploration. The quantitative data were analysed using descriptive univariate analysis, meanwhile, the qualitative data were analysed using thematic analysis techniques. Unbalanced learning load on the block, block learning management, and knowledge retention in block learning were considered lacking in flipped classroom block implementation. The management of time delays, a stage for students to be ready, a step to lessen psychological stress, and the use of media to generate different learning experiences are particular areas that need improvement.

Early clinical exposure as a highly interesting educational program for undergraduate medical students: an interventional study

BackgroundTraining professional medical experts is so much dependent on the efficacy of the medical curriculum. Bearing this in mind, we aimed to evaluate the attitude of the undergraduate medical students toward the Early clinical exposure (ECE) program as a facilitator transition to the clinical phase.MethodsThis quasi-experimental study was conducted on undergraduate medical students at the Mashhad University of Medical Sciences, Mashhad, Iran who were transferring from the pre-clinical course to the externship course from 2021 to 2022 by census method (i.e. all eligible students were included and no sampling was performed). An eight-session ECE intervention was performed on the participants by two professors of the Internal medicine department of Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. The participants’ attitude toward the program and the program quality was assessed with the valid and reliable scale developed by Mirzazadeh et al. (Cronbach’s alpha = 0.72). Statistical analyses were performed by SPSS software (version.16) with a statistically significant level of less than 0.05.ResultsA total of 118 undergraduate medical students were enrolled in the study. Our results revealed that this program could familiarize (n = 95,81.2%)the students with the role of basic sciences knowledge in clinical settings, and 104(88.9%) participants believed that this intervention could motivate them toward learning more. The data revealed that this program was highly interesting for international students. There was a significant differentiation between Iranian and international students in familiarity with doctoring skills in medicine(P < 0.001), familiarity with the roles and responsibilities of clinical students(P < 0.001), and utility of early clinical exposure and providing more experiences(P < 0.001). According to the students’ reports, the major strengths of the program were familiarizing themselves with the clinical fields, having excellent instructors, and performing admirable training. On the other hand, the major weakness of the program was the short duration and the high population of participants in each group.ConclusionsThe ECE program had a positive impact on the students’ satisfaction with medical education, and it also enhanced their understanding of the role they will play as future physicians. Therefore, we recommend that this program be implemented as a part of the medical education curriculum in medical universities.

Pathways and Patients: building an innovative collaborative medical education curriculum between Valparaiso and Boston (P4-8.002)

<h3>Objective:</h3> To construct a neurometabolism curriculum for residents from the Universidad de Valparaiso and Boston Children’s Hospital, furthering a longstanding international partnership. <h3>Background:</h3> The current project arose from a symmetric collaboration between the Universidad de Valparaiso and Boston Children’s Hospital existing since 2006. Recognizing pediatric neurologists must identify and initiate treatment for neurometabolic diseases despite limited clinical exposure, we aimed to improve management of these rare conditions through an innovative curriculum. <h3>Design/Methods:</h3> The Pathways and Patients Neurometabolic Curriculum was designed according to Kern’s Six Step Curriculum Design with learning objectives designed based on Bloom’s taxonomy. <h3>Results:</h3> Twelve sessions were completed (02/22–6/22), with post-curriculum anonymous survey completed by 15 US and 7 Chilean trainees (76% completion rate) and 10/12 participants (83%) with neurometabolic conditions. Trainees reported low pre-session self-efficacy (US trainees mean 2.2-points on 7-point scale, SD 1.1; Chilean trainees 3.5/7, SD 1.6). For each neurometabolic conditions, Chilean residents had seen average 1–2 patients, and US trainees 0 patients. Residents had increased post-session self-efficacy (increase 2 or greater/7, n=17/22, 77%). All Chilean trainees and 73% of US trainees reported patient interviews were very helpful in knowledge retention. All respondents reported improved understanding of alternant healthcare system. Qualitative data from residents and patient participants reported value in normalizing day-to-day of patients with rare disease and intercultural exchange, as well as area for growth in translation quality. <h3>Conclusions:</h3> Symmetric, longitudinal global collaborations allow for burgeoning of creative initiatives to address training gaps. Trainees overall had low exposure and self-efficacy ratings for neurometabolic diseases, which improved with the curriculum. Patient interviews were helpful in retention of content (88%), understanding health systems, and lived reality of rare disease. In addition, the curriculum furthered secondary aims of improving intercultural exchange and awareness for resident physicians. <b>Disclosure:</b> The institution of Dr. BriscoeAbath has received research support from Boston Children’s Hospital. Dr. BriscoeAbath has a non-compensated relationship as a Board of Trustees Member with Brother’s Brother Foundation that is relevant to AAN interests or activities. Dr. Huff has nothing to disclose. Dr. Gutierrez has nothing to disclose. Dr. Aguilera has nothing to disclose. Dr. Urion has nothing to disclose. Mr. Cabello has nothing to disclose.

Incorporating ultrasound training into undergraduate medical education in a faculty-limited setting

BackgroundPoint of care ultrasound (POCUS) is becoming a major extension of patient care. From diagnostic efficacy to its widespread accessibility, POCUS has expanded beyond emergency departments to be a tool utilized by many specialties. With the expansion of its use, medical education has begun to implement ultrasound education earlier in curricula. However, at institutions without a formal ultrasound fellowship or curriculum, these students lack the fundamental knowledge of ultrasound. At our institution, we set out to incorporate an ultrasound curriculum, into undergraduate medical education utilizing a single faculty member and minimal curricular time.MethodsOur stepwise implementation began with the development of a 3-hour fourth-year (M4) Emergency Medicine clerkship ultrasound teaching session, which included pre- and post-tests as well as a survey. The success with this session progressed to the development of a designated fourth-year ultrasound elective, which was evaluated with narrative feedback. Finally, we developed six 1-hour ultrasound sessions that correlated with first-year (M1) gross anatomy and physiology. A single faculty member was responsible for this curriculum and other instructors included residents, M4 students, and second-year (M2) near-peer tutors. These sessions also included pre- and post-tests and a survey. Due to curricular time limitations, all but the M4 Emergency Medicine clerkship session were optional.Results87 students participated in the emergency medicine clerkship ultrasound session and 166 M1 students participated in the voluntary anatomy and physiology ultrasound sessions. All participants agreed or strongly agreed that they would like more ultrasound training, that ultrasound training should be integrated into all four years of undergraduate medical education. Students were in strong agreement that the ultrasound sessions helped increase understanding of anatomy and anatomical identification with ultrasound.ConclusionWe describe the stepwise addition of ultrasound into the undergraduate medical education curriculum of an institution with limited faculty and curricular time.

Global Health in Undergraduate Education: Knowledge, Attitude, and Practice of Sudanese Medical Students towards Global Health Education: a cross-sectional study

IntroductionGlobalization and other relevant phenomena such as healthcare workforce, ageing of the population, brain drain etc. all necessitate medical curricula to transcend national medicine and encompass a more global approach. This is especially true in the context of developing countries which currently act as passive recipients of ongoing global decisions, health inequities or pandemics. The aim of this research was to study the Knowledge, Attitude, and Practice of Sudanese medical students towards global health education and the impact of extra-curricular activities on their knowledge and attitudes.MethodsThis was a descriptive cross-sectional institutional based study. The study was conducted in five Sudanese Universities and participants were selected using systematic random sampling. An online-based, self-administered questionnaire was used, samples were collected between November 2019 until April 2020 and data was analyzed using SPSS version 25.Results1176 medical students were involved. The study revealed a poor level of knowledge among 72.4%, and only 2.3% of respondents revealed a good level of knowledge. Mean knowledge scores between Universities slightly vary and have shown positive correlation according to the grade of the medical student. Regarding attitude, the results demonstrated the high level of interest of medical students in global health, their agreement in including global health in their official medical education curriculum (64.8%) and their consideration of including global health as part of their future career (46.8%).ConclusionThe study concluded that there is a knowledge gap among Sudanese medical students regarding global health education, although students showed good attitudes and willingness to include global health in their official curriculum.RecommendationsGlobal health education should be implemented in the official curriculums of Sudanese Universities, and Universities should do global partnerships and increase the learning and teaching opportunities in this interesting field.

Breathing, Obstruction, Restriction, and Gas Exchange: A Pulmonary Function Testing Interpretation Framework for Novice Learners.

Pulmonary function testing (PFT) is a common method of assessing patients with respiratory symptoms, yet exposure to PFT is variable throughout medical training. Therefore, incorporating a dedicated approach to teaching PFT into the formal medical education curriculum can ensure that trainees become familiar with both the relevant physiologic principles involved in interpreting PFT results and the indications for performing PFT in clinical practice. In this "How I Teach" article, we present breathing, obstruction, restriction, and gas exchange (BORG), a novel, small-group workshop designed to teach novice learners a sequential framework for PFT interpretation. The BORG workshop comprises two segments: a whiteboard minilecture that illustrates the BORG framework and a case-based worksheet whereby learners apply this approach to sets of PFTs with increasing difficulty. Our workshop is grounded in two cognitive psychology frameworks: the cognitive theory of multimedia learning and the dual-process theory. We provide three figures and four supplementary videos to illustrate our workshop's design and delivery, as well as both learner and instructor versions of our BORG worksheet. Last, we address three PFT concepts that have challenged us as instructors and provide evidence-based teaching scripts. The BORG workshop can be used by medical educators working with medical students and residents as a means of helping learners progress along the continuum from a basic understanding of spirometry to independent analysis and interpretation of PFTs to application of PFT results to medical decision making.

Understanding Academic Self-Concept and Performance in Medical Education.

Medical students' academic self-concept (ASC) is an important factor in better understanding noncognitive mediators of performance in medical school. However, research is limited on ASC in medical students across multiple phases of undergraduate medical education curriculum. This pilot study explored the relationship between ASC and academic performance across different phases of a U.S. medical school curriculum, specifically at the end of the second (preclinical) and third (clinical) years. Medical students across 2 cohorts at Virginia Commonwealth University School of Medicine, Richmond, Virginia, were surveyed using an ASC confidence subscale in 2019. Multiple linear regression analysis was conducted using medical student ASC scores in preclinical (n = 190) and clinical (n = 149) phases and performance data. Clinical performance was calculated through a weighted mean of clerkship grades based on the number of weeks for each clerkship. Preclinical performance was related to ASC, gender, and performance after year 1. ASC scores varied significantly by gender in the preclinical cohort ( P < .01), with men reporting higher ASC than women (mean [SD], 2.94 [0.41] vs 2.78 [0.38]). Significant gender differences in performance were found at the end of year 3 ( P < .01), with women performing more favorably compared with men (mean [SD], 94.1 [59.04] vs 124.24 [64.54]). The relationship between ASC and performance at the end of year 2 suggested students with higher ASC perform better during their preclinical phase. This pilot study supports future scholarship in 2 areas: (1) identification and assessment of additional factors that influence the relationship between ASC and academic performance across the entire undergraduate medical education curriculum and (2) development and implementation of evidence-based interventions to support student ASC and performance and enhance the learning environment. Analyzing longitudinal trends across multiple cohorts will drive evidence-based interventions at learner and programmatic levels.

Evaluating ChatGPT's Ability to Solve Higher-Order Questions on the Competency-Based Medical Education Curriculum in Medical Biochemistry.

Background Healthcare-related artificial intelligence (AI) is developing. The capacity of the system to carry out sophisticated cognitive processes, such as problem-solving, decision-making, reasoning, and perceiving, is referred to as higher cognitive thinking in AI. This kind of thinking requires more than just processing facts; it also entails comprehending and working with abstract ideas, evaluating and applying data relevant to the context, and producing new insights based on prior learning and experience. ChatGPT is an artificial intelligence-based conversational software that can engage with people to answer questions and uses natural languageprocessing models. The platform has created a worldwide buzz and keeps setting an ongoing trend in solving many complex problems in various dimensions. Nevertheless, ChatGPT's capacity to correctly respond to queries requiring higher-level thinking in medical biochemistry has not yet been investigated. So, this research aimed to evaluate ChatGPT's aptitude for responding to higher-order questions on medical biochemistry. Objective In this study, our objective was to determine whether ChatGPT can address higher-order problems related to medical biochemistry.​​​​​​ Methods​​​ This cross-sectional study was done online by conversing with the current version of ChatGPT (14 March 2023, which is presently free for registered users).It was presented with 200 medical biochemistry reasoning questions that require higher-order thinking. These questions were randomly picked from the institution's question bank and classified according to the Competency-Based Medical Education (CBME) curriculum's competency modules. The responses were collected and archived for subsequent research. Two expert biochemistry academicians examined the replies on a zero to five scale. The score's accuracy was determined by a one-sample Wilcoxon signed rank test using hypothetical values. Result The AI software answered 200 questions requiring higher-order thinking with a median score of 4.0(Q1=3.50, Q3=4.50). Using a single sample Wilcoxon signed rank test, the result was less than the hypothetical maximum of five (p=0.001) and comparable to four (p=0.16). There was no difference in the replies to questions from different CBME modules in medical biochemistry (Kruskal-Wallis p=0.39). The inter-rater reliability of the scores scored by two biochemistry faculty members was outstanding (ICC=0.926 (95% CI: 0.814-0.971); F=19; p=0.001)​​​​​​ Conclusion The results of this research indicate that ChatGPT has the potential to be a successful tool for answering questions requiring higher-order thinking in medical biochemistry, with a median score of four out of five. However, continuous training and development with data of recent advances are essential to improve performance and make it functional for the ever-growing field of academic medical usage.

Substance Abuse Among Medical Students of a Nigerian University

Background: Substance abuse is simply the use of illegal drugs, prescription/over-the-counter drugs as well as alcohol for purposes other than they are designated for, or in excessive amounts. Indulgence in these is high among students, with attendant negative consequences. Objectives: The objectives of this study were to determine the prevalence of substance use among the students, factors influencing use and the effect on academic performance. Materials and Methods: It was a cross-sectional descriptive study with respondents selected by simple random sampling. Structured questionnaires were self-administered and data analyzed using Statistical Package for Social Sciences (SPSS). Results: Caffeine (170/300, 56.7%) happened to be the substance mostly abused and cannabis least abused (6/300, 2%). The major reason for the excessive usage of caffeine was for alertness (215/300, 71.7%) during exams period. There was no significant association between drug use prevalence and improvement in respondents reading pattern/ability to effectively concentrate at lectures. However, there existed a significant association between respondents’ sociodemographics (age, sex) and prevalence of substance use (p &lt; 0.05). Conclusions: Substance abuse is common among medical students and it is influenced by some sociodemographic factors. Substance use had no significant effect on the academics of the study participants. Stress management strategies/courses should be included in the medical education curriculum.

Educational strategies for general medicine education in accordance with the model core curriculum for medical education in Japan.

In Japan, the Model Core Curriculum for Medical Education, which is the National Model COre CUrriculum for Undergraduate Medical Education, was first published in 2001 and has since been revised to meet the needs of an aged society and the global standardization of medical education. A new quality and ability "Generalism," which is a comprehensive attitude toward patients, has been added to this revision of the model core curriculum. In this letter, we propose an educational strategy for generalism.

Exploratory Factor Analysis of a French Adapted Version of the Substance Abuse Attitude Survey among Medical Students in Belgium

To evaluate the impact of a new Substance Use Disorder (SUD) education program on medical students' attitudes, we selected the Substance Abuse Attitude Survey (SAAS) questionnaire, which we adapted to our curriculum and cultural context. To validate this adapted version, we conducted an exploratory factor analysis following the administration of our 29-item bSAAS questionnaire to 657 medical students in Belgium (response rate: 71.1%). Twenty-three items correlated to three factors; namely, "Stereotypes and moralism", "Treatment optimism" and "Specialized treatment" were retained (70% of total variance explained, Cronbach's alpha = 0.80) and constituted the new questionnaire called beSAAS. The factor "Specialized treatment" stood out from previous studies, which could be explained by our target population and the impact of the formal, informal and hidden curricula in medical education. This study was able to highlight certain factors influencing stereotypical representations such as age, gender, origin, personal or professional experience with substance use. Our study allowed us to retain the beSAAS as a good questionnaire to evaluate SUD stigma and highlighted interesting findings to improve SUD training in medicine. Further studies are needed to complete its validity and reliability.

Perspectives of Teachers at Medical Colleges Across India regarding the Competency based Medical Education Curriculum – A Qualitative, Manual, Theoretical Thematic Content Analysis

Background: Competency-based medical education (CBME) curriculum has been implemented in India since 2019 with a goal to create an “Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness. Objectives: To explore teachers’ perceptions across India at medical colleges on the newly implemented competency-based medical education curriculum. Methods: This was a qualitative cross?sectional study conducted among teachers working at medical colleges across India, between February and April 2022 (n = 192). The data collection was done using Google forms online survey platform on teachers’ perception regarding CBME, its specific components, and perceived bottlenecks. We analyzed this qualitative data using manual, theoretical thematic content analysis following the steps endorsed in Braun and Clarke’s six-phase framework. Results: The majority of the teachers (64.1%) have positively responded to the CBME curriculum’s implementation. However, it came with a caution that the curriculum should continuously evolve and adapt to regional demands. The foundation course, early clinical exposure, and the family adoption program were the specific components of CBME curriculum over which the teachers raised concerns. The need for additional teachers in each department (department-specific teacher or faculty per hundred students ratio to be worked out) and the need for enabling faculty preparedness through adequate training was highlighted. Concerns were also raised regarding implementing CBME with teachers without a medical background (especially in preclinical departments). Conclusion: It is the need of the hour for the curriculum to incorporate a systematic feedback mechanism built into the system, though which such critical appraisals can be meaning collated and acted upon, to ultimately evolve, thereby creating an “Indian Medical Graduate” for the needs of todays’ society.

Development of a Novel Web-Based Tool to Enhance Clinical Skills in Medical Education.

A significant component of Canadian medical education is the development of clinical skills. The medical educational curriculum assesses these skills through an objective structured clinical examination (OSCE). This OSCE assesses skills imperative to good clinical practice, such as patient communication, clinical decision-making, and medical knowledge. Despite the widespread implementation of this examination across all academic settings, few preparatory resources exist that cater specifically to Canadian medical students. MonkeyJacket is a novel, open-access, web-based application, built with the goal of providing medical students with an accessible and representative tool for clinical skill development for the OSCE and clinical settings. This viewpoint paper presents the development of the MonkeyJacket application and its potential to assist medical students in preparation for clinical examinations and practical settings. Limited resources exist that are web-based; accessible in terms of cost; specific to the Medical Council of Canada (MCC); and, most importantly, scalable in nature. The goal of this research study was to thoroughly describe the potential utility of the application, particularly its capacity to provide practice and scalable formative feedback to medical students. MonkeyJacket was developed to provide Canadian medical students with the opportunity to practice their clinical examination skills and receive peer feedback by using a centralized platform. The OSCE cases included in the application were developed by using the MCC guidelines to ensure their applicability to a Canadian setting. There are currently 75 cases covering 5 specialties, including cardiology, respirology, gastroenterology, neurology, and psychiatry. The MonkeyJacket application is a web-based platform that allows medical students to practice clinical decision-making skills in real time with their peers through a synchronous platform. Through this application, students can practice patient interviewing, clinical reasoning, developing differential diagnoses, and formulating a management plan, and they can receive both qualitative feedback and quantitative feedback. Each clinical case is associated with an assessment checklist that is accessible to students after practice sessions are complete; the checklist promotes personal improvement through peer feedback. This tool provides students with relevant case stems, follow-up questions that probe for differential diagnoses and management plans, assessment checklists, and the ability to review the trend in their performance. The MonkeyJacket application provides medical students with a valuable tool that promotes clinical skill development for OSCEs and clinical settings. MonkeyJacket introduces a way for medical learners to receive feedback regarding patient interviewing and clinical reasoning skills that is both formative and scalable in nature, in addition to promoting interinstitutional learning. The widespread use of this application can increase the practice of and feedback on clinical skills among medical learners. This will not only benefit the learner; more importantly, it can provide downstream benefits for the most valuable stakeholder in medicine-the patient.

Novel Osteo Refurbishment Method and Choice of Colouring Materials for Anatomy Specimens.

The introduction of competency-based medical education curriculum and a shifted focus towards self-directed learning (SDL) in medical schools across the world has necessitated a reduction of didactic teaching hours. Museum specimens are an indispensable tool in anatomy teaching and can play a pivotal role in fostering and reinforcing SDL. Coloring of specimens makes it attractive and facilitates understanding anatomy. The aims of this study were: (1) weigh up the two commonly used coloring materials in anatomy viz. acrylic paint and nail polish; and (2) to assess the perception of anatomy students towards a Novel Osteo Refurbishment Method (NORM) for restoration of partially damaged osteology specimens. Undergraduate and postgraduate students of anatomy were recruited in the study. Participants responded to a 5-point Likert scale questionnaire. Obtained data were analyzed using Microsoft Excel version 2019. For a comparison of the two coloring agents Mann-Whitney U test was applied to the responses toward the Likert scale-based questionnaire. P-value <0.05 was considered significant. Out of 318 study participants, 63.7% and 36.3% of the respondents were male and female, respectively. 90.5 % were new entrants to university and the remainder 9.5% had a prior university degree. Students found the acrylic paint to be a better coloring agent and they also opined that NORM generated refurbished osteology specimens could serve as a useful self-learning tool. Acrylic paint was found to be more suitable as compared to nail polish with significant p-value in most of the parameters tested. Acrylic colour holds a good place in coloring both specimens and models in anatomy. Nail polish can be an alternative but with some noted disadvantages. The initial experience with NORM yielded encouraging results with potential practical utility.

Clinical Clerkships in General Medicine Enable Students to Acquire Basic Medical Competencies and Experience in Community-Based Integrated Care: A Descriptive Questionnaire-Based Study.

Background No previous research has targeted educators regarding educational practice and the achievements of students in terms of the learning objectives of clinical clerkships in university general medicine departments of Japan. We aimed to clarify the characteristics of clinical clerkships in Japanese general medicine departments using a questionnaire administered to chairpersons of university general medicine departments. Methods This was a descriptive questionnaire-based study using Google Forms (Google, Inc., Mountain View, CA, USA). We asked the chairpersons of general medicine departments in Japanese universities the following questions, with responses given on a 5-point Likert scale: Question 1: How well are primary symptoms in the national model core curriculum for undergraduate medical education taught in clinical clerkships in university general medicine departments? Question 2: How successfully can students achieve the learning objectives of the national model core curriculum for undergraduate medical education through clinical clerkships in general medicine departments of university hospitals? Question 3: How successfully can students achieve the learning objectives of the national model core curriculum for undergraduate medical education through clinical clerkships in other community clinics or hospitals?The results of the questionnaire responses are described as mean±standard deviation. Results Of the 71 Japanese universities with general medicine departments, 43 were included in the analysis. For Question 1, the symptoms and pathophysiologies with a mean score of 4 points or higher were fever, general malaise, anorexia, weight loss or gain, edema, abdominal pain, lymphadenopathy, and headache. All those symptoms require basic medical competencies. For Questions 2 and 3, the intramural clinical clerkship of general medicine departments had a higher mean score than the extramural clinical clerkship for diagnostic reasoning that emphasizes medical history and physical examination and a comprehensive approach to patients with multiple health problems.In contrast, the extramural clinical clerkship, in which medical students can build experience with community-integrated care, had a mean score of 3 points or higher for all items. Conclusions The clinical clerkship in general medicine departments of Japanese universities provides students with chances to acquire clinical competencies regarding primary symptoms and pathophysiologies. Additionally, the extramural clinical clerkship provides experience in community-based integrated care, including home medical care, collaboration, health and welfare, and long-term care.

Impact of Experiential Learning of Nutrition Therapy on Medical Students.

Despite the recognition that nutrition is a critical component of health and disease, many medical schools struggle to incorporate nutrition education into their dense curriculum. We designed this study to determine whether a brief, experiential learning project would be an effective option for teaching this content. Medical students voluntarily enrolled in the study, agreeing to (1) attempt a 2-week "medically prescribed" diet and (2) participate in small group lunch discussions related to their diet experience. Data on student perception of nutrition in medicine was collected through validated surveys. Custom surveys were designed to capture student confidence in using nutrition counseling, while qualitative analysis of lunch discussions revealed themes of experiential learning. Participants reported an overall positive sentiment and named the most impactful learning component as actively attempting the diet. Student participants showed a variety of adherence to their assigned diet, yet as a cohort demonstrated increased confidence over their non-participant peers in the use of nutrition counseling in a clinical setting. In addition, diet participants demonstrated an increased perception of the importance of physician efficacy and the physician-patient relationship in the broader landscape of nutrition in patient care (compared to the control group). This study demonstrates the educational value of a short, immersive, extracurricular opportunity in bolstering an already demanding undergraduate medical education curriculum.

Keep thinking about unanswered questions in primary care: Cultivating negative capability.

Negative capability or tolerance for uncertainty is important for primary care physicians. The 2022 edition of the Model Core Curriculum for Medical Education also states that the content of professionalism is to "keep thinking about unanswerable questions."

Assessing the Capability of ChatGPT in Answering First- and Second-Order Knowledge Questions on Microbiology as per Competency-Based Medical Education Curriculum.

Background and objective ChatGPT is anartificial intelligence (AI) language model that has been trained to process and respond to questions across a wide range of topics. It is also capable of solving problems in medical educational topics. However, the capability of ChatGPT to accurately answer first- and second-order knowledge questions in the field of microbiology has not been explored so far. Hence, in this study, we aimed to analyze the capability of ChatGPT in answering first- and second-order questions on the subject of microbiology. Materials and methods Based on the competency-based medical education (CBME) curriculum of the subject of microbiology, we prepared a set of first-order and second-order questions. For the total of eight modules in the CBME curriculum for microbiology, we prepared six first-order and six second-order knowledge questions according to the National Medical Commission-recommended CBME curriculum, amounting to a total of (8 x 12) 96 questions. The questions were checked for content validity by three expert microbiologists. These questions were used to converse with ChatGPT by a single user and responses were recorded for further analysis. The answers were scored by three microbiologists on a rating scale of 0-5. The average of three scores was taken as the final score for analysis. As the data were not normally distributed, we used a non-parametric statistical test. The overall scores were tested by a one-sample median test withhypothetical values of 4 and 5. The scores of answers to first-order and second-order questions were compared by the Mann-Whitney U test. Module-wise responses were tested by the Kruskall-Wallis test followed by the post hoc test for pairwise comparisons. Results The overall score of 96 answers was 4.04 ±0.37 (median: 4.17, Q1-Q3: 3.88-4.33) with the mean score ofanswers to first-order knowledge questions being 4.07 ±0.32 (median: 4.17, Q1-Q3: 4-4.33) and that of answers to second-order knowledge questions being 3.99 ±0.43 (median: 4, Q1-Q3: 3.67-4.33) (Mann-Whitney p=0.4). The score was significantly below the score of 5 (one-sample median test p<0.0001) and similar to 4 (one-sample median test p=0.09). Overall, there was a variation in median scores obtained in eight categories of topics in microbiology, indicating inconsistent performance in different topics. Conclusion The results of the study indicate that ChatGPT is capable of answering both first- and second-order knowledge questions related to the subject of microbiology. The model achieved an accuracy of approximately 80% and there was no difference between the model's capability of answering first-order questions and second-order knowledge questions. The findings of this study suggest that ChatGPT has the potential to be an effective tool for automated question-answering in the field of microbiology. However, continued improvement in the training and development of language models is necessary to enhance their performance and make them suitable for academic use.