Medical Education Resources Research Articles

Sharing is caring: How EM Sim Cases (EMSimCases.com) has created a collaborative simulation education culture in Canada.

ABSTRACTFree open access medical education (FOAM) resources in emergency medicine (EM) have grown exponentially in recent years. Within this movement, there are relatively few resources dedicated to simulation in EM. EM Sim Cases is a FOAM resource that was started in 2015 with the goal of creating a central database of simulation cases and scholarly articles that could be shared worldwide and thus reduce needless duplication of effort. Since 2015, EM Sim Cases has grown to have an annual average of 8,148 views per month from a total of 161 countries. It has an editorial team of 18 members as well as a leadership team of three. There is a robust, peer-reviewed case bank ranging in topic from neonatal resuscitation to end-of-life care as well as a number of simulation-relevant educational posts.

Trends in e-literature on cardiovascular diseases: A bibliometric analysis with reference to ClinicalKey (2015 -2019)

ClinicalKey is a clinical search engine that helps doctors and other health professionals to make better decisions anywhere, anytime, in any patient scenario. ClinicalKey database provides access to thousands of online resources such as online medical books, e-journals, drug monographs, guidelines, patient education, clinical overviews and multimedia resources. This paper aims to describe the bibliometric study published in ClinicalKey from 2015 to 2019 on e-literature on cardiovascular diseases (CVDs) and to explore publishing trends in the relevant field. For the study, the literature was extracted in terms of full-text research articles from ClinicalKey covering the period from January 2015 to December 2019. This quantitative study includes the bibliometric methods to analyze original articles and the data has been analyzed using statistical techniques in MS Excel and SPSS. During the period of study, a total of 8193 research articles were published, giving an average of 1639 pieces of literature per year. Results of this study revealed that the year-wise distribution of articles has a mean relative growth rate of 0.90 articles per annum and a doubling time of 2.27 years for the publications at the aggregate level. In the same way, month-wise results for the year 2015 and 2019 are, mean relative growth rate 0.45 and 0.41 articles per month and the doubling time 10.34 and 10.49 months respectively. Relative growth rate and doubling time of retrieved literature from 2015 to 2019 is stable and indicates an exponential growth of literature in the field. The analysis shows that there is a nucleus zone of journals (core journals) publishing cardiovascular diseases research output which is scattered among journals in cardiovascular diseases literature confirm to the Bradford’s law of scattering.

Change of accreditation standards of medical schools by the Korean Institute of Medical Education and Evaluation from 2000 to 2019.

This review presents information on changes in the accreditation standards of medical schools in Korea by the Korean Institute of Medical Education and Evaluation (KIMEE) from 2000 to 2019. Specifically, the following aspects are explained: the development process, setting principles and directions, evaluation items, characteristics of the standards, and validity testing over the course of 4 cycles. The first cycle of accreditation (2000–2005) focused on ensuring the minimum requirements for the educational environment. The evaluation criteria emphasized the core elements of medical education, including facilities and human resources. The second cycle of accreditation (2007–2010) emphasized universities’ commitment to social accountability and the pursuit of excellence in medical education. It raised the importance of qualitative standards for judging the content and quality of education. In the post-second accreditation cycle (2012–2018) which means third accreditation cycle, accreditation criteria were developed to standardize the educational environment and programs and to be used for curriculum development in order to continually improve the quality of basic medical education. Most recently, the ASK 2019 (Accreditation Standards of KIMEE 2019) accreditation cycle focused on qualitative evaluations in accordance with the World Federation of Medical Education’s accreditation criteria to reach the international level of basic medical education, which emphasizes the need for a student-centered curriculum, communication with society, and evaluation through a comprehensive basic medical education course. The KIMEE has developed a basic medical education evaluation and accreditation system in a step-by-step manner, as outlined above. Understanding previous processes will be helpful for the future development of accreditation criteria for medical schools in Korea.

Construction of Medical Teaching Network Based on Information Technology

Purpose: In order to facilitate students’ systematic learning on the base of the existing resources. Proposed Methods: School managers should systematize the accumulated medical teaching resources into medical teaching network, according to the training requirements of medical students. Information technology has promoted the reform of medical education in teaching education concept, including teaching management, teaching reform and clinical ability training. The establishment of large clinical simulation teaching system based on the network includes digital course platform, digital resource platform, information portal, clinical simulation teaching system, remote operation teaching and remote teaching system. Results: The change of the traditional teaching structure, the expansion of the traditional teaching environment, the innovation of education and teaching ideas, the realization of the transformation of passive learning to active learning. Conclusion: Information technology has improved the information literacy of the majority of medical teachers and students.

The knowledge needs for Canadian paediatric emergency physicians in the diagnosis and management of tropical diseases: A national physician survey.

To assess the knowledge gaps and need for continuing medical education (CME) resources for Canadian paediatric emergency department (PED) physician management of common tropical diseases. A cross-sectional survey study of Canadian PED was performed from May to July 2017 using the Pediatric Emergency Research Canada (PERC) database. The response rate was 56.4% (133/236). The mean performance on the case-based vignettes identifying clinical presentation of tropical illnesses ranged from 59.9% to 76.0%, with only 15.8% (n=21) to 31.1% (n=42) of participants scoring maximum points. Those who 'always' asked about fever performed better than those who only 'sometimes' asked (40.4% versus 23.8%). For management cases, the majority of the participants (59.4% to 89.5%) were able to interpret investigations; however, many were unsure of subsequent actions relating to initial treatment, discharge instructions, and reporting requirements. Many would consult infectious diseases (87.8% to 99.3%). Fifty-three per cent of the participants reported a low comfort level in diagnosing or managing these patients. They rated the importance of CME materials with a median of 50/100, via various modalities such as case studies (71.9%), emphasizing a need for PED-specific content. This study identified a knowledge gap in the recognition and management of pediatric tropical diseases by Canadian PED physicians. There is a need for formal CME materials to supplement physician practice.

Review of Published Curriculum on Sex Trafficking for Undergraduate Medical Trainees

Educational councils and medical societies recommend that medical students learn to recognize and care for victims of sex trafficking. Previous research has found that healthcare providers are one of the few professionals to interact with sex trafficking victims during exploitation. This review evaluates currently published curricular and extracurricular U.S. medical education resources. A literature review of MEDLINE, PubMed, Embase, MedEdPORTAL, Google Scholar, and Google was conducted in December 2018 to January 2019 using the search terms: human trafficking OR sex traffic OR sex violence OR sex work OR sex exploitation OR child prostitution AND education, medical, undergraduate OR students, medical OR medical student or medical education OR education, medical. The inclusion criteria included informational educational materials for medical students on sex trafficking. Studies were excluded for: non-English language, empirical research on sex trafficking, nonhealth or nonundergraduate medical students, and resources focused on other sexual health topics. The database literature search uncovered 64 scholarly articles. Inclusion criteria were met by 4 articles; 2 articles were added from a reference review, and an additional 5 articles were found from an Internet search. These 11 resources provided educational materials relevant to medical students on sex trafficking themes, including scope, consequences, identification, treatment, referral, legal, security, and prevention. The curricula demonstrated a wide variability in delivery method, length, and scope. A limited published sex trafficking curriculum exists for medical student learners. Future research evaluating unpublished curricula within U.S. medical schools is necessary to coordinate efforts for standardized and robust sex trafficking education.

A Study on Perception of Students Regarding Newer Teaching Methods in Medical Education

Introduction: Learning is a complex and multifaceted phenomenon. Research findings suggest that a deep, integrated understanding of the basic sciences is important for solving clinically relevant tasks. Evidence suggests that students today may be more engaged and learn better when there are different teaching approaches incorporated into the educational environment. Crossword Puzzle (CWP) is a form of active learning which is helpful to review and summarise concepts. Mind Map (MM) is a powerful graphic technique that can be applied to improve learning and clearer thinking. E-learning is an innovative modern technology which can support and enrich medical education. Aim: To assess the perceptions of students regarding newer teaching methods like CWPs, MMs and online resources in medical education. Materials and Methods: This was a cross sectional study conducted in the Department of Pathology for 2nd year Medical, Physiotherapy and Nursing students for a period of one year from October 2018 to September 2019. A total of 206 students participated in the study, of which 90 were MBBS students, 30 were Physiotherapy students and 86 were Nursing students. Newer teaching methods like CWPs and MMs were introduced in the classes. A feedback form was given at the end of the class and their responses were collected regarding newer methods. Perceptions of students regarding newer teaching methods were represented using descriptive statistics in frequencies and percentages. Results: Female students were more compared to male students across all the branches with 63.3% female students in MBBS, 80% in Physiotherapy and 82.6% in Nursing. 84.4% of MBBS students, 86.7% of Physiotherapy students and 97.7% of nursing students were interested in filling CWPs. 94.4% of MBBS students, 93.3% of Physiotherapy students and 100% of nursing students opined that MMs help in memory retention. 93.3% of MBBS students, 96.7% of Physiotherapy students and 91.9% of nursing students wanted newer teaching methods to be part of the curriculum. Conclusion: Educators need to constantly change their teaching methods in order to hold the attention of students. CWP’s and MM’s created interest among the students in learning subject. CWPs enhanced group interaction among peers whereas MMs helped in retaining the key points and also bringing out the creative talent.

Pores, Pimples and Pathologies: 3D Capture and Detailing of the Human Skin for 3D Medical Visualisation and Fabrication.

Three-dimensional (3D) scanning of the human skin for 3D medical visualisation and printing does not often produce the desired results due to a number of factors including the specularity of human skin, difficulties in scanning fine structures such as the hair and the capabilities of the scanning technologies utilised. Some additional 3D modelling may be required to make the surfaces more suitable for use in the production of anatomical and medical teaching resources, computerised facial depiction and design of bespoke prostheses. Three-dimensional scanned surfaces can be enhanced through digital sculpting and embossing of high-resolution photographs of the human skin.

Investigation and Analysis on the Management Standard of Blood Glucose Monitoring for Clinical Nurses in Nyingchi Region of Tibet

Background: In participating in the medical support work in the Nyingchi area of Tibet, the author found that the medical education resources in this area are scarce, and the clinical nurses in this area have relatively insufficient knowledge about blood glucose monitoring and management. Accurately understanding the knowledge-attitude/belief-practice (KAP) level of nurses in Nyingchi area on blood glucose management is of great significance to the development of blood glucose monitoring management guidance for nurses in this area. Therefore, this study investigated the current status of the management of blood glucose monitoring management standards for clinical nurses in Nyingchi, Tibet. Objective: To investigate and analyze the current situation of clinical nurses in Nyingchi region of Tibet to grasp the regulation of blood glucose monitoring and guide the implementation of the norm of blood glucose monitoring for clinical nurses. Methods: The research survey was carried out from March to April 2020. Random sampling method was used to select 134 clinical in-service nurses in Nyingchii, Tibet. The self-designed knowledge-attitude/belief-practice survey questionnaire for clinical nurses’ blood glucose monitoring and management in Tibet was used. Nurses’ blood glucose monitoring management “KAP” scores and related influencing factors are analyzed. Results: Blood sugar monitoring and management knowledge score is (36.78 ± 6.80), attitude dimension is (42.48 ± 6.42), practice dimension is (61.87 ± 10.24) and total score is (304.73 ± 36.24). The nurse’s department and whether to participate in diabetes training are the main influencing factors of the blood glucose monitoring management norms, knowledge and behavior (both P < 0.05). Conclusion: The standard knowledge of blood glucose monitoring and management of clinical nurses in Nyingchi region of Tibet is at the middle level, positive attitude and unsatisfactory behavior. Nursing managers should conduct standardized training for clinical nurses in blood glucose monitoring, develop the training mode of diabetes specialty nursing talents in Nyingchi area, and construct a complete management system of diabetes specialty nursing.

Analysing the literature: A research primer for low- and middle-income countries.

Effective critical appraisal of medical research requires training and practice. Evidence-based medicine provides a framework for standardised review of manuscripts of nearly any research design. Online resources and communities exist to provide free access to electronic search engines and critical appraisal of emergency medicine and non-emergency medicine research. An emerging array of Free Online Open Access medical education (FOAMed) resources also provide opportunities to observe Evidence-based medicine critical appraisal in written or audio format and to actively participate as a learner. This chapter will highlight accessible resources that provide both methodological background and virtual mentoring for readers to develop EBM skills.

FOAM Impact: The Influence of Open-access Medical Education on Practice Uptake.

The FOAM Impact study sought to examine baseline rates of intravenous (IV) lidocaine usage for the treatment of renal colic and to compare rates of use between FOAM utilizers and nonutilizers. We sought to measure the effect of FOAM resources on clinical practice by timing the release of FOAM content with publication of the LIDOKET trial. A cross-sectional before-and-after survey was conducted and disseminated on two social media platforms. The 13-question, anonymous survey was posted for 1week prior following the release of the LIDOKET study. Descriptive statistics, Mann-Whitney t-test, and chi-square test statistics were used to describe survey respondent characteristics and Likert responses. There were a total of 472 survey respondents. A total of 321 physicians (75.7% of total respondents) provided pre- and postpublication survey answers. There was no significant change in the use of analgesics before and after publication of LIDOKET and concurrent REBEL EM blog post. A total of 197 (42%) survey respondents reported using lidocaine for renal colic, of which 60 respondents (13%) reported frequent or occasional use. The mean difference in perceived efficacy of lidocaine before and after publication was -0.30 (95% confidence interval [CI]= -0.80 to 0.19, p=0.15). Being a FOAM user was not associated with changes in mean difference in perception of lidocaine efficacy (F=0.127, p=0.72); however, there was a significant difference in perception of lidocaine's efficacy following LIDOKET and REBEL EM publication (F=4.718, p=0.03). Using an online survey-based technique, no appreciable impact of FOAM resources was immediately apparent; however, engagement with FOAM was associated with a change in perception of IV lidocaine's efficacy. To our knowledge, this is the first study of its kind to evaluate the impact of FOAM on clinical practice. The unique method of coordinating FOAM distribution with traditional medical publication may provide future opportunities for measuring the impact of asynchronous medical education resources on medical practice.

The Revised METRIQ Score: A Quality Evaluation Tool for Online Educational Resources.

With the rapid proliferation of online medical education resources, quality evaluation is increasingly critical. The Medical Education Translational Resources: Impact and Quality (METRIQ) study evaluated the METRIQ-8 quality assessment instrument for blogs and collected feedback to improve it. As part of the larger METRIQ study, participants rated the quality of five blog posts on clinical emergency medicine topics using the eight-item METRIQ-8 score. Next, participants used a 7-point Likert scale and free-text comments to evaluate the METRIQ-8 score on ease of use, clarity of items, and likelihood of recommending it to others. Descriptive statistics were calculated and comments were thematically analyzed to guide the development of a revised METRIQ (rMETRIQ) score. A total of 309 emergency medicine attendings, residents, and medical students completed the survey. The majority of participants felt the METRIQ-8 score was easy to use (mean± SD= 2.7±1.1 out of 7, with 1 indicating strong agreement) and would recommend it to others (2.7±1.3 out of 7, with 1 indicating strong agreement). The thematic analysis suggested clarifying ambiguous questions, shortening the 7-point scale, specifying scoring anchors for the questions, eliminating the "unsure" option, and grouping-related questions. This analysis guided changes that resulted in the rMETRIQ score. Feedback on the METRIQ-8 score contributed to the development of the rMETRIQ score, which has improved clarity and usability. Further validity evidence on the rMETRIQ score is required.

Enlightenment of the training model of orthopedic residents in the US to orthopedics education in China

This article reviews the training model of orthopedic residents in the world's top orthopedic hospitals, such as Hospital for Special Surgery Affiliated to Cornell University and The Affiliated Hospital of Harvard University Medical School, and it is found that there are differences between China and the US in the training of orthopedic residents in the aspects of the admittance system of physicians, the setting of training contents, and the training model of orthopedic residents. The training of orthopedic residents in the US adheres to the concept of elite education and pays attention to the construction of tutors and learning atmosphere. The enlightenment to the training of orthopedic residents in China includes further clarification of the training objectives of orthopedic residents, improvement of the stage-based training system, integration of excellent medical teaching resources, and improvement of teaching methods and assessment systems. Key words: The US; Orthopedics; Resident; Training

Learning from mistakes on social media

BackgroundClinicians in the emergency care specialties often access information via social media (SM) to supplement their learning. The rapid and user-centred dissemination of information via SM speeds knowledge translation and...

Current status and future development of higher medical education in Chongqing, China

Great achievements have been made in higher medical education in Chongqing, China. Among the western provinces and cities, Chongqing has relatively high quantity and quality indicators of medical education institutions. Within the whole country, Chongqing has a medium level of the key indicators of medical education, and there is still a gap between Chongqing and the economically developed provinces such as Zhejiang and Guangdong. Among the four centrally administered municipalities, Beijing and Shanghai have rich medical education resources, and there is a large gap between Chongqing and Beijing/Shanghai in the level of medical education, the number of academicians, and the number of hospitals included in the top hundred hospitals in China. Recently, Chongqing University started to establish a medical school, and University of Chinese Academy of Sciences started to construct an affiliated hospital named Chongqing Hospital in cooperation with Chongqing Municipal Health Planning Commission, which provided valuable opportunities for the development of higher medical education in Chongqing. Chongqing should increase the investment in basic research and development of medical science and technology, seize the strategic opportunity of Internet + medicine , and gather the talents in medical science and technology, so as to promote the integration and development of military-civilian medical education and improve the level of higher medical education. Key words: Medical education; Chongqing; Current status analysis

1471-P: Visceral and Subcutaneous Adipose Tissue Attenuation Differs by Type 1 and Type 2 Diabetes Status

Adipose tissue (AT) volume and quality may contribute to cardiovascular risk. AT volume and attenuation can be derived from computed tomography (CT) scans, with greater attenuation indicating poor AT quality and increased fibrosis. We examined whether AT quantity and quality were associated with coronary artery calcium (CAC) in a sample of adults without diabetes (non-DM), with type 1 diabetes (T1D), and with type 2 diabetes (T2D). 294 non-DM adults (mean age±SD 55±9 years), 226 adults with T1D (mean age±SD 52±9 years), and 52 adults with T2D (mean age±SD 53±9 years) completed CT scans for CAC measurement and abdominal CT scans at lumbar 4-5 for visceral (VAT) and subcutaneous (SAT) AT volume and attenuation measurement. Adults with T2D had significantly more VAT and SAT when adjusting for age and sex compared with T1D and non-DM adults, but after adjusting for BMI there was no difference in VAT volume by diabetes status. Adults with T2D had significantly lower SAT volume when adjusted for BMI as compared with both non-DM and T1D adults (157 cm3 vs. 177 cm3 and 183 cm3, p=0.0008). Adults with T1D had significantly higher SAT attenuation as compared with non-DM and T2D adults (p&amp;lt;0.0001 for both). Square root-transformed CAC volume was significantly higher in both T1D (mean volume±SD 10.4±14.7) and T2D (mean volume±SD 9.6±15.9) compared to non-DM adults (mean volume±SD 4.5±8.2). Greater attenuation of VAT and SAT was associated with increased CAC (p=0.03 for both), but there was no association between AT volume and CAC in this sample. AT attenuation was significantly higher in T1D and independently associated with subclinical atherosclerosis in a sample of non-DM, T1D, and T2D adults. AT fibrosis is associated with metabolic dysfunction, decreased angiogenesis, and increased inflammation; our results suggest that despite similar AT volume, T1D adults have adverse fat quality that may indicate fibrosis. This may be a mechanism through which T1D is associated with greater levels of CAC. Disclosure A. Keshawarz: None. A.C. Alman: None. C.C. Low Wang: Advisory Panel; Spouse/Partner; Bayer Healthcare, LLC, CSL Behring, Genentech/Roche, Hema Biologics, Novo Nordisk Pharmaceuticals, Inc, Octapharma Pharmazeutika, Shire. Speaker's Bureau; Self; Medical Education Resources. S. Mitchell: None. I.E. Schauer: Other Relationship; Spouse/Partner; Kestrel Labs. J.E.B. Reusch: Board Member; Self; American Diabetes Association. Other Relationship; Self; Merck &amp; Co., Inc. J.G. Regensteiner: None. J.K. Snell-Bergeon: None. Funding American Diabetes Association (7-13-CD-10 to J.K.S-B.)

Strategies for Residents to Explore Careers in Medical Education.

Strategies for Residents to Explore Careers in Medical Education.

Development a national minimum data set (MDS) of the information management system for disability in Iran

BackgroundDisability management and policymaking require complete and valid data on disability. ObjectiveDevelopment of a minimum data set (MDS) of the information management system for disability in Iran. MethodsThis descriptive, cross-sectional study was performed in 2017. Data were collected from the documents of persons with disabilities data bank of the State Welfare Organization of Iran available at “payment.behzisti.net”, and data elements of the Ministry of Health and Medical Education (MOHME) resources, in addition to the Internet and library. A checklist was used for data collection. The Delphi technique was applied to reach a consensus about the data elements using a questionnaire. The content validity and reliability of the questionnaire were assessed by experts’ opinions and the test-retest method, respectively. ResultsAn MDS of disability was developed including administrative and clinical categories with 130 and 345 data elements, respectively. Two hundred and thirty eight data elements were mandatory elements (administrative: 60, clinical: 178) and the rest were optional elements. ConclusionsAn MDS can be a starting point for standardizing the disability data. A minimum data set has the potential to standardize the data and overcome the problem of low-quality disability data in Iran through providing consistent, complete and uniform data elements. Thus, the use of this MDS is useful in determination of the level of disability and its benefits, and in policy-making and effective planning for providing persons with disabilities with more efficient and cost-effective services.

MP16: Which PoCUS skills are retained over time for medical students?

Introduction: Point-of-care ultrasonography (PoCUS) is being incorporated into Canadian undergraduate medical school curricula. The purpose of this study was to evaluate novel PoCUS education sessions to determine what aspects of the sessions benefitted from hands-on training and which PoCUS skills were retained over time. Methods: Second year medical students voluntarily received three different PoCUS training sessions, each lasting three hours. Prior to the sessions, participants prepared independently with pre-circulated online learning materials. After a 15-minute lecture, experienced PoCUS providers led small group (1 instructor: 5 students), live scanning sessions. Evaluations were conducted before and after each session using expert validated multiple choice questions testing general and procedural knowledge, image recognition and interpretation. Volunteer students were evaluated via direct observation of live scanning using an objective structured assessment of technical skills (OSAT) based on the O-score and then re-evaluated at 2 months post-training to assess PoCUS skills retention. Results: 40 second year medical students participated in extended Focused Assessment with Sonography for Trauma (eFAST), cardiac, and gallbladder PoCUS sessions. The live-training sessions significantly improved student PoCUS knowledge beyond what they learned independently for eFAST (p &amp;lt; 0.001), cardiac (p &amp;lt; 0.001), and gallbladder (p = 0.02). The largest improvement was noted in procedural knowledge test scores improving from 44.0% to 84.0% (n = 38). 16 students were evaluated after each session with a mean O-score of 2.37. 8 students returned two months later to be re-evaluated demonstrating a change in O-scores for eFAST (2.00 to 2.38, p = 0.15), cardiac (2.28 to 2.00, p = 0.32), and gallbladder (2.91 to 1.88, p &amp;lt; 0.001). Conclusion: Procedural PoCUS knowledge benefited the most with hands-on training. eFAST and cardiac PoCUS competency was maintained over time while gallbladder PoCUS competency degraded suggesting that targeted PoCUS skills training may be possible. Further study is required to determine the best use of PoCUS resources in undergraduate medical education.

Feedback learning opportunities from medical student logs of paediatric patients

BackgroundFeedback can alter medical student logging practices, although most learners feel feedback is inadequate. A varied case mix in rural and urban contexts offers diverse clinical encounters. Logs are an indicator of these clinical experiences, and contain opportunities for feedback, which can greatly influence learning: we labelled these ‘feedback learning opportunities’ (FLOs).We asked:How often do FLOs occur?What are the case complexities of rural compared to urban paediatric logs?Do more complex cases result in more FLOs?MethodsIn Western Australia, 25% of medical students are dispersed in a Rural Clinical School (RCSWA) up to 2175 miles (3500 km) from the city. Urban students logged 20 written cases; rural students logged a minimum of 25 paediatric cases electronically. These were reviewed to identify FLOs, using a coding convention. FLO categories provided a structure for feedback: medical, professionalism, insufficient, clinical reasoning, student wellbeing, quality and safety, and sociocultural. Each log was assigned an overall primary, secondary or tertiary case complexity.ResultsThere were 76 consenting students in each urban and rural group, providing 3034 logs for analysis after exclusions. FLOs occurred in more than half the logs, with significantly more rural (OR 1.35 95% CI 1.17, 1.56; p < 0.0001). Major FLOs occurred in over a third of logs, but with no significant difference between rural and urban (OR 1.10 95% CI 0.94, 1.28; p = 0.24). Medical FLOs were the most common, accounting for 64.0% of rural and 75.2% of urban FLOs (OR 1.71 95% CI 1.37, 2.12; p < 0.0001). Students logged cases with a variety of complexities. Most cases logged by urban students in a tertiary healthcare setting were of primary and secondary complexity. Major medical FLOs increased with increasing patient complexity, occurring in 32.1% of tertiary complexity cases logged by urban students (p < 0.001).ConclusionsCase logs are a valuable resource for medical educators to enhance students’ learning by providing meaningful feedback. FLOs occurred often, particularly in paediatric cases with multiple medical problems. This study strengthens recommendations for regular review and timely feedback on student logs. We recommend the FLOs categories as a framework for medical educators to identify FLOs.