Medical Education Initiatives Research Articles

How Medical Students Benefit from Participating in a Longitudinal Resource Stewardship Medical Education Program (STARS): An International Descriptive Evaluation.

STARS (Students and Trainees Advocating for Resource Stewardship) is a medical student leadership program that promotes integration of resource stewardship (RS) into medical education in at least seven countries. Little is known about how participation affects student leaders. To understand how partaking in STARS impacted participants' knowledge, skills, and influenced career plans, and aspirations. We conducted qualitative semi-structured interviews with STARS participants (n = 27) from seven countries. STARS was designed to facilitate grassroots efforts that embed RS principles into medical education. STARS programs globally share common features: participation from several medical schools, centralized organizing hubs and leadership summits, and support from faculty mentors. Students take lessons learnt from centralized programming to implement changes that advance RS initiatives at their schools. Students finished STARS with better RS knowledge, enhanced change management skills (leadership, advocacy, collaboration), and a commitment to incorporate RS into future practice. Nearly all respondents hoped to pursue leadership activities in medicine, but most were unclear if they would focus efforts to advance RS. STARS participants gained knowledge as it relates to RS, change management skills, and catalyzed a commitment to incorporate high-value care into future practice. Medical education initiatives should be leveraged as a key strategic approach to build RS capacity.

Literature review on Curriculum Development

Background: Curriculum development in medical education is vital at all educational levels, from undergraduate to postgraduate and professional education focused on patient care. Understanding the systematic approach to curriculum development and evaluation is essential for maximizing the potential of medical education initiatives. Objective: The objective of this review was to explore and synthesize the existing literature on curriculum development in medical education, focusing on the processes and outcomes, and to provide recommendations for effective curriculum design and implementation. Methods: A comprehensive literature review was conducted using multiple electronic databases, including PubMed, MEDLINE, ERIC, Scopus, Web of Science, and Google Scholar. The search terms included "curriculum development," "medical education," "learning outcomes," "educational strategies," "assessment tools," "curriculum implementation," and "curriculum evaluation." Articles published in peer-reviewed journals were included based on relevance and methodological rigor. Data were synthesized using a narrative approach. Results: The review identified three types of curricula: explicit, implicit, and null. The explicit curriculum is structured and publicly available with clear learning objectives. The implicit curriculum is influenced by geographical, political, and socioeconomic contexts. The null curriculum refers to aspects not covered despite being planned. Key steps in curriculum development included needs assessment, content determination, goal and objective setting, selection of educational strategies, implementation, and evaluation. Educational strategies varied, including lecture-based learning, hands-on skill delivery, flipped classroom, and case-based learning. Continuous evaluation, both formative and summative, was essential for curriculum adaptation and improvement. Conclusion: A systematic approach to curriculum development in medical education ensures comprehensive and adaptive educational programs. This process addresses the diverse and evolving needs of learners and society, ultimately enhancing the quality of medical education. Effective curricula prepare healthcare professionals with the necessary knowledge, skills, and attitudes for high-quality patient care and adaptability to changing healthcare environments.

Gauging the Awareness of Physicians in Saudi Arabia Regarding Risk Factors for Thyroid Cancer.

Background The prevalence of obesity and thyroid cancer (TC) is increasing worldwide, and obesity is a risk factor for TC. Objectives This study aimed to elucidate physicians' awareness of obesity as a risk factor for TC. Materials and methods A cross-sectional, self-report online questionnaire was distributed to physicians in all regions of Saudi Arabia. The questionnaire comprised sociodemographic data and questions concerning the risk factors for TC, including obesity. Results A total of 310 physicians participated in this study. Of the respondents, 35.8% (n = 111) were aged 30-40 years, 40.6% (n = 126) were board certified, and 52.3% (n = 162) had >10 years of experience. Only 36.8% (n = 114) of respondents were familiar with the relationship between obesity and TC risk (P < 0.001). In terms of knowledge of obesity as a risk factor for TC, a significant difference was observed for the following sociodemographic characteristics: sex, educational attainment, and years of experience. A significant difference was also observed with awareness of other risk factors for TC. Conclusions In light of the limited awareness of the correlation between obesity and TC, the most effective approach to address these misconceptions would be to implement diverse and ongoing medical education initiatives.

A Journey of Innovation: 40years of Pioneering Medical Education at the Aga Khan University Medical College in Karachi, Pakistan.

This article presents an overview of Aga Khan University's (AKU) pioneering medical education initiatives over the past 40years, exploring its impact on healthcare in the region and its commitment to advancing medical education and research in the developing world. Established in 1983 as the first private university in Pakistan, AKU has evolved into a global institution with a focus on improving healthcare standards and addressing healthcare needs in the developing world. The article also discusses the undergraduate and postgraduate medical education programs at AKU Medical College, Pakistan, highlighting their unique features and pioneering approaches to medical education. The institution's journey highlights its ability to adapt to the evolving healthcare landscape while maintaining a focus on quality and excellence, offering a model for other institutions striving to meet healthcare needs in low- and middle-income countries.

Impact of an immersive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change

BackgroundRetinal diseases, including wet or dry age-related macular degeneration, diabetic macular edema, and diabetic retinopathy (DR), are underdiagnosed and undertreated in the United States. Clinical trials support the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) therapies for several retinal conditions, but real-world data suggest underuse by clinicians, resulting in patients experiencing poorer visual outcomes over time. Continuing education (CE) has demonstrated effectiveness at changing practice behaviors, but more research is needed to understand whether CE can help address diagnostic and treatment gaps.MethodsThis test and control matched pair analysis examined pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners (i.e., retina specialists, ophthalmologists, optometrists, primary care providers, diabetes educators, pharmacists/managed care specialists, and other healthcare providers, such as registered nurses, nurse practitioners, and physician assistants) who participated in a modular, interactive CE initiative. An additional medical claims analysis provided data on practice change, evaluating use of VEGF-A inhibitors among retina specialist and ophthalmologist learners (n = 7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis.ResultsLearners significantly improved knowledge/competence scores on early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P-values = 0.003 to 0.004). Compared with matched controls, learners’ incremental total injections for anti-VEGF agents for retinal conditions increased more after the CE intervention (P < 0.001); specifically, there were 18,513 more (new) anti-VEGF injections prescribed versus non-learners (P < 0.001).ConclusionsThis modular, interactive, immersive CE initiative resulted in significant knowledge/competence gains among retinal disease care providers and changes in practice-related treatment behaviors (i.e., appropriate consideration and greater incorporation of guideline-recommended anti-VEGF therapies) among participating ophthalmologists and retina specialists compared to matched controls. Future studies will utilize medical claims data to show longitudinal impact of this CE initiative on treatment behavior among specialists and impact on diagnosis and referral rates among optometrists and primary care providers who participate in future programming.

Assessing predictors of students’ academic performance in Ethiopian new medical schools: a concurrent mixed-method study

BackgroundSince 2012 the Ethiopian Federal Ministry of Health and Education implemented a new medical curriculum in 13 institutions. The new curriculum introduced some questions on its admission policy: students can join with different educational backgrounds. Students’ performance on qualifying exams and grade point average are lower than desired. Therefore, the aim of the study was to investigate what factors predict the academic performance of students in the New Medical Education Initiative in Ethiopia.MethodsA concurrent mixed method of survey and qualitative was used; for the survey, a structured self-administered questionnaire was distributed to students of four randomly selected medical schools from December 2018 to January 2019. The questionnaire includes questions about socio-demographic and educational background of participants. Multiple linear regression analysis was used in order to identify the factors associated with academic performance. In-depth interviews were conducted with 15 key informants to explore qualitatively.ResultsIn the multiple linear regressions, stress was associated with lower academic performance. Students with prior education in the field of health science outperformed students with other bachelors. The cumulative grade point average of the previous bachelor degree and the score on the entrance exam to join medicine also significantly predicted performance. Although some more variables are identified from the qualitative interviews, its findings supported the survey results.ConclusionsOf the number of predictor variables analyzed in the model, only stress, prior educational degree, performance in the prior degree and entrance exam score were significantly correlated with the performance of students in their preclinical medical engagement.

Mastering the Patient Handoff

Mastering the Patient Handoff

The influence of patient gender on medical students' care: Evaluation during an objective structured clinical examination

ObjectivesTo assess whether men and women are evaluated and treated differently by medical students. MethodsWe evaluated patient care provided by 110 fifth-year medical students during an objective structured clinical examination (OSCE), using two clinical cases with standardized patients (SPs): generalized anxiety disorder (GAD) and ascending aortic dissection (AAD). Half of the students encountered male and half female SPs. Except for gender, the cases were identical. We compared diagnosis and treatment of male vs female SPs. ResultsStudents diagnosed GAD more often in female SPs than in male SPs (diagnosis completed, partially completed, and not completed in 47%, 16% and 36% respectively vs. 22%, 20%, and 58% for male SPs, p = 0.02). The nature of symptoms was better described for male SPs. For AAD, the emergency was more frequently identified and the examination of femoral pulses better performed in female SPs. ConclusionMedical students have a gender bias when evaluating patients with GAD and AAD. Practice implicationThe observed gender bias in the evaluation of patients, likely leads to differences in treatment between male and female patients (i.e. under-recognition of anxiety in men). Medical schools should implement gender-sensitive medical education initiatives to improve inclusive patient care.

Key elements and checklist of shared decision-making conversation on life-sustaining treatment in emergency: a multispecialty study from China.

Shared decision-making (SDM) has broad application in emergencies. Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice. This study is to investigate the optimal application of SDM to guide life-sustaining treatment (LST) in emergencies. This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education. Participants were identified based on their expertise in medicine, law, administration, medical education, or patient advocacy. All individual items and questions in the questionnaire were scored using a 5-point Likert scale, with responses ranging from "very unimportant" (a score of 1) to "extremely important" (a score of 5). The percentages of the responses that had scores of 4-5 on the 5-point Likert scale were calculated. A Kendall's W coefficient was calculated to evaluate the consensus of experts. A two-level framework consisting of 4 domains and 22 items as well as a ready-to-use checklist for the informed consent process for LST was established. An acceptable Kendall's W coefficient was achieved. A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions, research studies, medical education, and policy initiatives.

Adapting to a Pandemic: Web-Based Residency Training and Script Concordance Testing in Emergency Medicine During COVID-19.

The coronavirus disease (COVID-19) pandemic necessitated alternative methods to ensure the continuity of medical education. Our study explores the efficacy and acceptability of a digital continuous medical education initiative for medical residents during this challenging period. From September to December 2020, 47 out of 60 enrolled trainee doctors participated in this innovative digital Continuous Medical Education (CME) approach. We utilized the Script Concordance Test to bolster clinical reasoning skills. Three simulation scenarios, namely Advanced Trauma Life Support (ATLS), Advanced Life Support (ALS), and European Paediatric Life Support (EPLS), were transformed into interactive online sessions via Zoom™. Participant feedback was also collected through a survey. Consistent Script Concordance Testing (SCT) scores among participants indicated the effectiveness of the online training module. Feedback suggested a broad acceptance of this novel training approach. However, discrepancies observed between formative SCT scores, and summative Multiple-Choice Questions (MCQ) assessments highlighted areas for potential refinement. Our findings showcase the resilience and adaptability of medical education amidst challenges like the global pandemic. The success of methodologies such as SCT, endorsed by prestigious bodies like the European Resuscitation Council and the American Heart Association, suggests their potential in preparing health care professionals for emergent situations. This research offers valuable insights for shaping future online CME strategies.

32793 How can we teach clerkship medical students the multidisciplinary aspects of dermatology? A medical education initiative

Background: Canadian medical schools offer minimal clinical dermatology training for clerkship students. The limited available educational resources for them usually focus on primary skin conditions, therefore it is challenging for students to understand the multidisciplinary nature of dermatology in a clinical setting. The study objective was to develop case-based educational resources to help bridge this gap and assess their effectiveness.

32652 Using shared decision-making communication strategies to improve outcomes for patients with atopic dermatitis: Results of a national scope continuing medical education initiative

An online national-scope 1-credit continuing medical education (CME) activity targeted at primary care clinicians, pediatricians, dermatologists, and allergists focused on educating as many clinicians as possible on what shared decision-making (SDM) is and how it can improve outcomes in patients with atopic dermatitis (AD). It also encouraged providers to share National Eczema Association’s patient platform, EczemaWise, with as many patients as possible. The activity, available through three of the largest CME distribution channels in the United States, included video vignettes with examples of effective communication and SDM between real clinicians and patients with AD.

Perceptions and expectations of medical students and junior doctors in training: blended learning approach for medical education initiatives

Perceptions and expectations of medical students and junior doctors in training: blended learning approach for medical education initiatives

Randomized Controlled Trial of Interactive Spaced Education to Support Constipation Management by Pediatric Primary Care Providers.

Integrating continuing medical education and quality improvement (QI) initiatives is challenging. We aimed to compare one method, Interactive Spaced Education (ISE/QI), with standard (sTD/Qi) education embedded within a constipation management Qi initiative. We conducted a randomized, controlled study to compare ISE/QI and STD/QI education. Pediatric primary care providers (PCPs) were recruited from a network of local private practices. The QI initiative was implemented with all providers before education interventions. ISE/QI participants received questions by email weekly, provided answers, received feedback, and repeated questions over a 4-month period. The STD/QI group received a Power Point with the same educational content. Pre- and post-surveys evaluated usability, self-assessed confidence, and practice changes while quizzes evaluated knowledge. Process control charts tracked subsequent visits to gastroenterology (GI). Of the 212 eligible PCPs, 101 (48%) enrolled, with 49 PCPs in the ISE/QI arm and 52 in STD/QI education arm. Quiz scores improved in the ISE/QI arm with a strong effect size (Cohen d 1.76). Mean increase in confidence managing difficult cases was higher in the ISE/QI group (1.84 vs 1.21, P = 0.030). ISE/QI participants were more likely to rate the activity better than most online education (odds ratio [OR] 18.1, P < 0.0001) and incorporate practice changes (OR 3.35, P = 0.0152). Visits to GI decreased among the entire population, but the effect on GI visits within each education arm was mixed. ISE/QI improved knowledge and confidence managing difficult cases. ISE/QI participants reported higher likelihood to change practice, but no differences were seen in GI referrals.

Communicating Scope of Practice: An Outpatient Group Art Therapy Documentation Initiative (Communiquer le champ de pratique : une initiative de documentation sur l’art-thérapie ambulatoire de groupe)

In medical settings, art therapists face challenges of communicating their therapeutic practices to clinicians who are unfamiliar with the vernacular of art therapy. Despite growing evidence, the field of art therapy lacks a common language “scope of practice” that easily translates across fields. In this study, we piloted a novel documentation tool, The Progress Note for Group Art Therapy (PN-GAT), which aggregated frequencies of assessments and interventions within the Addiction Institute at Mount Sinai Beth Israel Hospital in New York, while identifying common practices of outpatient art therapy groups that may contribute to the development of a more communicable “scope of practice.” Our interdisciplinary documentation initiative was implemented during 18 adult outpatient art therapy groups conducted by one art therapist from August 2018 through February 2019. Analysis showed that insight-development (38.6%) and social-relational (35.9%) interventions were recorded more frequently than art-making (25.5%) interventions. The most frequently logged art therapy assessments included assessments of client response (88.9% of sessions) and mental status examinations (72.2%). The growth of art therapy within medical practices necessitates a rethinking of treatment collaboration. Our findings identified frequently used components of art therapy based in a medical setting, as well as the need for future medical education initiatives. While improving standards of collaborative care, the development of a well-defined “scope of practice” may serve to enhance interdisciplinary communication.

European Medical Education Initiative on Noonan syndrome: A clinical practice survey assessing the diagnosis and clinical management of individuals with Noonan syndrome across Europe

IntroductionNoonan syndrome (NS) is a rare genetic disorder caused by mutations in genes encoding components of the RAS/mitogen-activated protein kinase (MAPK) signalling pathway. Patients with NS exhibit certain characteristic features, including cardiac defects, short stature, distinctive facial appearance, skeletal abnormalities, cognitive deficits, and predisposition to certain cancers. Here, a clinical practice survey was developed to learn more about differences in the diagnosis and management of this disease across Europe. The aim was to identify gaps in the knowledge and management of this rare disorder. Materials and methodsThe European Medical Education Initiative on NS, which comprised a group of 10 experts, developed a 60-question clinical practice survey to gather information from European physicians on the diagnosis and clinical management of patients with diseases in the NS phenotypic spectrum. Physicians from three specialities (clinical genetics, paediatric endocrinology, paediatric cardiology) were invited to complete the survey by several national and European societies. Differences in answers provided by respondents between specialities and countries were analysed using contingency tables and the Chi-Squared test for independence. The Friedman's test was used for related samples. ResultsData were analysed from 364 respondents from 20 European countries. Most respondents came from France (21%), Spain (18%), Germany (16%), Italy (15%), United Kingdom (8%) and the Czech Republic (6%). Respondents were distributed evenly across three specialities: clinical genetics (30%), paediatric endocrinology (40%) and paediatric cardiology (30%). Care practices were generally aligned across the countries participating in the survey. Delayed diagnosis did not emerge as a critical issue, but certain unmet needs were identified, including transition of young patients to adult medical services and awareness of family support groups. ConclusionData collected from this survey provide a comprehensive summary of the diagnosis and clinical management practices for patients with NS across different European countries.

Oncology training and education initiatives in low and middle income countries: a scoping review.

BackgroundThe global cancer burden falls disproportionately on low and middle-income countries (LMICs). One significant barrier to adequate cancer control in these countries is the lack of an adequately trained oncology workforce. Oncology education and training initiatives are a critical component of building the workforce. We performed a scoping review of published training and education initiatives for health professionals in LMICs to understand the strategies used to train the global oncology workforce.MethodsWe searched Ovid MEDLINE and Embase from database inception (1947) to 4 March 2020. Articles were eligible if they described an oncology medical education initiative (with a clear intervention and outcome) within an LMIC. Articles were classified based on the target population, the level of medical education, degree of collaboration with another institution and if there was an e-learning component to the intervention.FindingsOf the 806 articles screened, 25 met criteria and were eligible for analysis. The majority of initiatives were targeted towards physicians and focused on continuing medical education. Almost all the initiatives were done in partnership with a collaborating organisation from a high-income country. Only one article described the impact of the initiative on patient outcomes. Less than half of the initiatives involved e-learning.ConclusionsThere is a paucity of oncology training and education initiatives in LMICs published in English. Initiatives for non-physicians, efforts to foster collaboration within and between LMICs, knowledge sharing initiatives and studies that measure the impact of these initiatives on developing an effective workforce are highly recommended.

How Physician Workforce Shortages Are Hampering the Response to the Opioid Crisis.

The United States is experiencing an unprecedented opioid crisis, with a record of about 93,000 opioid-involved overdose deaths in 2020, which requires rapid and substantial scaling up of access to effective treatment for opioid use disorder. Only 18% of individuals with opioid use disorder receive evidence-based treatment, and strategies to increase access are hindered by a lack of treatment providers. Using a case study from the largest municipal hospital system in the United States, the authors describe the effects of a workforce shortage on health system responses to the opioid crisis. This national problem demands a multipronged approach, including federal programs to grow and diversify the pipeline of addiction providers, medical education initiatives, and enhanced training and mentorship to increase the capacity of allied clinicians to treat patients who have an opioid use disorder. Workforce development should be combined with structural reforms for integrating addiction treatment into mainstream medical care and with new treatment models, including telehealth, which can lower patient barriers to accessing treatment.

Adapting Medical Education Initiatives Through Team-Based e-Learning, Telemedicine Objective Structured Clinical Exams, and Student-Led Community Outreach During the COVID-19 Pandemic.

Although the COVID-19 pandemic has quickly prompted medical schools and students around the world to transition from their traditional classrooms to web-based learning, the global crisis has inspired the development of innovative e-learning solutions that use existing technology and other web-based tools to continue nurturing the education of medical students while ensuring the public health and safety of both students and faculty members alike. Through the perspective of medical students, we share how the COVID-19 pandemic has impacted and transformed small team–based learning in medical education; changed objective structured clinical exam evaluations and the practice of clinical skills through telemedicine; and nurtured nationwide, web-based, student-led initiatives for community outreach, telehealth, and medical services.

Clinic-based Procedures for Headache.

Headache disorders are common and disabling, and many therapies that are effective and safe are procedural. After pivotal clinical trials, onabotulinumtoxinA has become an established preventive therapy for chronic migraine; it is better tolerated than many other treatments and may be useful for other headache disorders. Peripheral nerve blocks, especially greater occipital nerve blocks, have amassed evidence from randomized trials in the acute and short-term preventive treatment of migraine and cluster headache. Trigger point injections and sphenopalatine ganglion blocks have recent trials suggesting efficacy and safety in properly selected patients. Medical education initiatives are needed to train neurologists in these procedures to help manage the large population of patients with headache disorders who need them. Evidence exists for the efficacy and safety of procedural therapies to be incorporated into neurology practice for the management of patients with migraine, cluster headache, and other headache disorders.