Medical Learning Environment Research Articles

Strategies to recognize and mitigate mistreatment of medical students

Mistreatment of learners in medical education is a significant problem affecting more than half of all trainees worldwide. This mistreatment can lead to severe consequences, including burnout, posttraumatic stress disorder symptoms, substance misuse, and decreased self-esteem, impacting not only future physicians but also the broader educational community. Despite increased awareness of such harms associated with mistreating medical learners, these behaviors have continued to persist over the years. We aim to equip medical educators and learners with practical strategies to recognize and mitigate mistreatment in the educational setting. We offer examples and concrete advice to help educators and institutional leaders classify mistreatment, navigate various scenarios, and create optimal reporting structures. Additionally, we provide recommendations for dismantling toxic environments and enhancing reporting transparency to build learner trust. Addressing mistreatment will require multifaceted collaboration between learners, educators, and institutions. This advice will help foster a shared commitment to establishing a culture of respect and support among all in the medical learning environment.

Raising Awareness of Mistreatment Policies and Reporting Procedures Using a Novel Medical Student Mobile Application.

Reports of mistreatment are an important first step to improving medical students' learning environment. Students may not report mistreatment due to a lack of awareness of institutional policies, reporting procedures, or for fear of reprisal. We sought to determine if a medical school cross-platform mobile application (app) could be used to improve students' awareness of mistreatment policies and procedures. Participants in this intervention included Drexel University College of Medicine (DUCOM) medical students, faculty, and Student Affairs Deans. We created the DUCOMpass© app to make mistreatment policies and procedures more readily available and to ease mistreatment reporting for medical students. To determine the efficacy of the app at raising mistreatment awareness, we analyzed our institutional GraduationQuestionnaire data before and after the introduction of the app (from 2016 to 2023) as compared with the national average. We verified our students' self-reported data with app usage data. To our knowledge, this is the first instance of a medical school mobile app being implemented to successfully address medical student mistreatment awareness and reporting. We found that reaching students in a familiar and easily accessible mode(s) of communication is a catalyst for lasting change. Not applicable.

Mindfulness in the Medical Learning Environment: An Opportunity for the Struggling Learner?

Mindfulness in the Medical Learning Environment: An Opportunity for the Struggling Learner?

Study of Deep Learning in Medical Education: Opportunities, Achievements and Future Challenges.

In this era of progress, interest has developed regarding advancing deep learning (DL) in medicine. However, there has been reluctance to use deep learning, particularly among medical educators. The limitations of previous research were examined in this study, along with the extent to which DL can be used in medical education and its potential impact on educational quality. We were interested in discussing DL's prospects, and determining whether we could benefit from it in medical education. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was used to manage this review procedure. Six databases were searched carefully to obtain relevant studies. Our search identified 981 articles from the database based on our standards. After filtering the duplicated articles, 11 studies were included in the systematic review. The results showed that DL applications attracted researchers' attention in the medical and education technology owing to their effectiveness to provide the personalized assistance and feedback. Furthermore, the majority of research concentrated on teaching medical students how to utilize DL applications in the classroom, and all of them tried to improve medical students' proficiency with DL instruments in practical applications. Deep learning components in medical learning environments have two segments-in the educational settings like speech recognition or Video content analysis for affecting students' learning, and in the medical settings, applying deep learning from diagnosis to prevention. An integration of them can work better in medical education. Medical education uses DL to improve the students' education. DL is a powerful instrument which has become more famous in terms of superb outcomes. Besides, using DL in medical education is likely to continue as a hotly debated area of research and a well-known classroom strategy.

The Rights of Physicians and Future Physicians Who Are Lactating, Breastfeeding, or Chestfeeding: An American Medical Women's Association Position Article.

Breastfeeding is a fundamental and biologically normal function with well-established benefits for both lactating parents and infants. Despite these benefits, physicians, particularly those in training, often face significant obstacles when attempting to meet their breastfeeding and pumping goals. In response to these challenges, the American Medical Women's Association (AMWA) and a diverse group of health care professionals have come together to advocate for comprehensive lactation support policies in medical learning environments and workplaces. This position article highlights the ethical necessity of comprehensive lactation support in medical educational and workplace settings, emphasizing the importance of not only providing physical accommodations but also fostering a cultural shift, educational initiatives, and policy reforms to empower lactating parents. It offers an examination of the difficulties encountered by lactating parents within medical environments and proposes guidelines for the formulation and enhancement of supportive policies. The position article envisions a future where medical professionals can thrive in both their careers and parenthood through collaborative efforts and a commitment to the key elements of Effective Lactation Support Programs in medical workplaces based on the following: (1) well-equipped lactation facilities, (2) customized work schedules, (3) mentorship and support networks, (4) lactation support in clinical settings, and (5) research and advocacy.

Graduating Medical Students' Perceptions of the COVID-19 Pandemic's Impact on Their Medical School Experiences and Preparation for Careers as Physicians: A National Study.

The COVID-19 pandemic resulted in unprecedented changes to the medical education learning environment. The graduating class of 2021 was particularly affected. To better understand how students were affected, the authors explored positive and negative experiences described by graduating U.S. medical students. Using the conceptual framework of affordances, the authors examined narrative responses to 2 new open-ended questions on the Association of American Medical Colleges 2021 Graduation Questionnaire in which graduating students described the pandemic's positive and negative effects on their medical school experiences and career preparation. Conventional content analysis was used to identify affordances and themes in responses. Of 16,611 Graduation Questionnaire respondents, 8,926 (54%) provided narrative responses. Of these 8,926 respondents, responses from 2,408 students (27%) were analyzed. Students described positive and negative perceptions of affordances, centering around virtual learning, social connection, and transition to residency. Fewer in-person and increased virtual clinical rotations offered students flexible scheduling, allowing them greater opportunity to explore academic and professional interests. Additionally, students' sense of isolation from their medical school was alleviated when schools exercised intentional open communication and student involvement in decision-making. Although many described a diminished sense of preparedness for residency due to limited access to in-person clinical experiences and to assessing residencies largely through virtual away rotations and interviews, the sense of community, adaptability, and resiliency gained through varied activities reinforced students' professional identity and commitment to medicine during a time of much uncertainty. This national exploration of students' pandemic experiences highlights what students value as fundamental elements of medical education and student support and describes how innovation can improve long-standing practices. These findings, guided by students' insights, can help inform the work of educational leaders as they consider which innovations should remain to continue enhancing student learning, engagement, and well-being.

Postgraduate medical trainees at a Ugandan university perceive their clinical learning environment positively but differentially despite challenging circumstances: a cross-sectional study

PurposeThe clinical learning environment is an essential component in health professions’ education. Data are scant on how postgraduate trainees in sub-Saharan Africa perceive their medical school learning environments, and how those perceptions contribute to their engagement during training, their emotional wellbeing, and career aspirations. This study examined perceptions of postgraduate medical trainees (residents) in a resource-limited setting, regarding their learning environment and explored perceptual contributions to their career engagement during training. The data reported contribute to understanding how clinical learning environments can be improved in low-resource settings in Uganda and elsewhere.MethodsThis study was done at the Faculty of Medicine of Mbarara University of Science and Technology in Uganda. We used a descriptive cross-sectional design involving sequential mixed methods. Quantitative data were collected using the Postgraduate Hospital Educational Environment Measure (PHEEM). Qualitative data were collected using focus group discussions.ResultsNinety of the 113 eligible residents responded (79.6%). Of these, 62 (68.9%) were males, 51 (56.7%) were third-year trainees, and the majority (40%) of the residents were aged between 30 and 34 years. Overall PHEEM scored 98.22 ± 38.09; Role Autonomy scored 34.25 ± 13.69, Teaching scored 39.7 ± 13.81, and Social Support scored 24.27 ± 10.59. Gender differences occurred in the perceptions of teaching and social support. Cronbach’s alpha coefficient was 0.94 for the overall PHEEM. Five major themes were identified from the qualitative data (trainee support, supervision environment, engagement with overall learning environment, preparation for future practice, and challenges that impede training).ConclusionsOverall, this study suggests that postgraduate trainees at the institution perceived the clinical learning environment positively amidst challenges of limited resources. Trainees’ insights provided data that propose improvements on a number of domains in the learning environment.

Differences between international medical graduates and Canadian medical graduates in a medical learning environment: From matching to residency and beyond.

To determine the differences between international medical graduates (IMG) and canadian medical graduates (CMG) in the medical learning environment (MLE) as there is progression from matching to residency and beyond. A narrative literature review was done using the search engines pubmed, medline and embase on publications from 2000 to 2021 comparing IMG to CMG and those that compared IMG to non IMG in international publications were also considered. The IMGs are offered less residency program positions compared to CMGs during the CaRMS selection process and specifically less in specialty programs. Amongst the article, 66% of IMGs compared to 90% of CMG were successful in the certification examination of the college of family physicians of Canada. A US article on the other hand found similarities in performance of USMGs and IMGs in a surgical residency program. A lot of IMG face several challenges including perceived systemic and individual discrimination, lack of mentorship and poor ability to navigate after immigration even after they are matched into a Canadian residency program. These are significant issues that should be dealt with to enable increase success and survival of IMGs in the MLE.

Observational Study of Conformity in Yet Another Medical Learning Environment: Conformity to Preceptors During High-Fidelity Simulation.

Altering one's behavior to comply with inaccurate suggestions made by others (i.e., conformity) has been studied since the 1950s. Although several studies have documented its occurrence in medical education, it has yet to be examined in a high-fidelity simulation environment. It was hypothesized that a large majority of learners would conform to a preceptor. A total of 42 student dyads (a medical student paired with a resident) participated in one of four clinical scenarios to manage the diagnosis and treatment of a simulated patient encounter. Once the learners became familiar with the patient's case, a preceptor entered the simulation, offered an equivocal suggestion about diagnosis or management, and then left. Two raters observed the video recordings of how the learners managed the case after this suggestion was made. The nature of these interactions was also documented. Sixteen (38.10%) of the 42 medical student dyads conformed to the equivocal information presented by the preceptors. Observations of these interactions showed that all of the medical students conformed to the residents, but not all of the medical students conformed to the preceptors. Many learners conform to preceptors by acting on their equivocal suggestion when managing a patient case during high-fidelity simulation.

Physician Resilience and the Little Way

Many triggers for shame that lead to physician burnout occur during patient care or the medical learning environment. Many resilience programs are available to medical students and physicians, yet incorporate non-faith principles. The Little Way as developed by St. Thérèse of the Child Jesus would be a most effective way to incorporate spirituality into our daily duties. This article will explain the need for physician resilience and virtue ethics within our profession. Then, the article will describe the Little Way and apply its principles to healthcare to implement a faith-based approach to physician resilience.

Prevalence of Psychological Stress, Tension Type Headache and Altered Quality of Life in Medical Students: A Brief Review

Defining health entails a wide and integrated view of individuals that incorporates numerous interconnected social, psychological, and physical elements. Without a doubt, medical schools ensure that graduates are competent, skilled, and professional enough to meet society's expectations; nonetheless, numerous previous research have revealed a significant prevalence of self-reported psychological suffering among medical students. Although an ideal degree of stress is beneficial for pupils during academic tests, psychological suffering can impair academic achievement. Because psychological and physical pressures grow during the medical schedule, medical students get tension type headache at a higher rate than the general population. A few studies have also discovered a link between medical students' QoL and an increased risk of depression, burnout, and suicidal thoughts. The process of medical education in the medical learning environment can have negative effects on students' well-being in terms of physical and mental suffering, development of social relationships, and loss of energy. Keywords: psychological stress, tension type headache, sleep quality, medical students

Improving the Experiences of Sexual and Gender Minority-Identifying Trainees in Gastroenterology and Hepatology

Improving the Experiences of Sexual and Gender Minority-Identifying Trainees in Gastroenterology and Hepatology

Underrepresented in medicine students’ perspectives on impactful medical education

BackgroundExploring the perceptions of underrepresented in medicine (URiM) students about the medical education curriculum and learning environment could optimize their education outcomes. The current study delineated perceptions of URiM medical students about the unique elements and characteristics of an impactful medical education program that create a positive, supportive learning environment culture.MethodsWe conducted in-depth interviews with 15 URiM students between January 2018 and April 2018. Interviewees were recruited from an accredited medical education program in Historically Black Colleges and Universities (HBCUs). The University is also a member of the Hispanic Association of Colleges and Universities in the U.S. The main question that guided the study was, “What do URiM students at a Historically Black Colleges and Universities (HBCU) medical school believe would make a medical education program (MEP) impactful?” We used the grounded theory analytical approach and performed content analysis via qualitative thematic evaluation.ResultsOf 112 enrolled medical students (MS), 15 verbally consented to participation. We identified four general themes and several subthemes. The themes include 1) Grounding learning in the community; 2) Progressive system-based practice competency; 3) Social justice competency and 4) Trauma-informed medical education delivery. Theme 1 included the following subthemes (a) community engagement, and (b) student-run clinic, mobile clinic, and homeless clinic rotations. Theme 2 includes (a) interprofessional learning and (b) multidisciplinary medicine for cultivating a ‘just’ healthcare system. Theme 3 includes (a) longitudinal social justice curriculum, (b) advocacy, and (c) health disparity research. Theme 4 had the following subdomains (a) early and ongoing mentoring and (b) provision of supportive policies, services and practices to maximize learning and mental health.ConclusionOur learners found that social justice, trauma-informed, community-based curricula are impactful for URiM learners. These findings highlight the need for further research to assess the impact of permeating the championship culture, community cultural wealth, and transformational education in all aspects of the MEP in providing a supporting and positive learning environment for URiM students.

Medical student surgical proficiency and confidence on the core surgical clerkship

We investigated how students’ surgical self-proficiency and self-confidence changed during the core surgical clerkship to better understand how students learn in the operating room (OR), which receives mixed reviews as a medical student learning environment. Student demographics, self-rated ability to perform a set of core proficiencies for a common operation, and self-confidence in the OR were assessed at three clinical sites at the beginning and end of the core surgical clerkship. Self-proficiency and self-confidence metrics were created with maximum scores of 72 and 45, respectively. Pre- and post-clerkship scores were compared and analyzed for associations with student demographics. 103 (89%) students completed the pre-clerkship survey and 74 (64%) completed the post-clerkship survey. Mean self-proficiency and confidence scores significantly increased by the end of the clerkship (p < 0.001). Before the clerkship, female students (n = 46) had lower mean proficiency (20.9 ± 7.6 vs. 28.3 ± 13.1, p = 0.001) and confidence (22.5 ± 5.1 vs. 27.5 ± 5.4, p < 0.001) scores, were less likely to feel comfortable in the OR [adjusted odds ratio (95% confidence interval) 0.19 (0.07–0.54)] and to view the OR as a supportive learning environment [0.18 (0.06–0.59)], and more likely to feel anxious [3.17 (1.33–7.53)]. No significant post-clerkship gender-based differences were observed. Students with more pre-clerkship surgical experiences had higher mean proficiency (29.5 ± 11.6 vs. 19.9 ± 9.4, p < 0.0001) and confidence (27.0 ± 6.0 vs. 22.9 ± 4.9, p = 0.0003) scores, as well as a higher likelihood of feeling comfortable in the OR [adjusted odds ratio (95% CI) 7.14 (2.53–20.14)] and a lower likelihood of feeling anxious [0.32 (0.10–0.98)]. Students’ self-rated proficiency and confidence increased significantly throughout the clerkship, though various factors such as gender and prior OR experience influence baseline levels and may represent important targets for intervention.

Open problems in medical federated learning

PurposeThis study aims to summarize the critical issues in medical federated learning and applicable solutions. Also, detailed explanations of how federated learning techniques can be applied to the medical field are presented. About 80 reference studies described in the field were reviewed, and the federated learning framework currently being developed by the research team is provided. This paper will help researchers to build an actual medical federated learning environment.Design/methodology/approachSince machine learning techniques emerged, more efficient analysis was possible with a large amount of data. However, data regulations have been tightened worldwide, and the usage of centralized machine learning methods has become almost infeasible. Federated learning techniques have been introduced as a solution. Even with its powerful structural advantages, there still exist unsolved challenges in federated learning in a real medical data environment. This paper aims to summarize those by category and presents possible solutions.FindingsThis paper provides four critical categorized issues to be aware of when applying the federated learning technique to the actual medical data environment, then provides general guidelines for building a federated learning environment as a solution.Originality/valueExisting studies have dealt with issues such as heterogeneity problems in the federated learning environment itself, but those were lacking on how these issues incur problems in actual working tasks. Therefore, this paper helps researchers understand the federated learning issues through examples of actual medical machine learning environments.

Innovation and Missed Opportunities in Internal Medicine Undergraduate Education During COVID-19: Results from a National Survey.

BackgroundCOVID-19 disrupted undergraduate clinical education when medical schools removed students from clinical rotations following AAMC recommendations. Clerkship directors (CDs) had to adapt rapidly and modify clerkship curricula. However, the scope and effects of these modifications are unknown.ObjectiveTo examine the effects of the initial phase of COVID-19 on the internal medicine (IM) undergraduate clinical education.DesignA nationally representative web survey.ParticipantsIM CDs from 137 LCME-accredited US medical schools in 2020.Main MeasuresItems (80) assessed clerkship structure and curriculum, assessment in clerkships, post-clerkship IM clinical experiences, and CD roles and support. The framework of Understanding Crisis Response (Royal Society for Encouragement of Arts, Manufactures, and Commerce) was used to determine whether curricular modifications were “amplified,” “restarted,” “let go,” or “ended.”Key ResultsResponse rate was 74%. In response to COVID-19, 32% (32/101) of clerkships suspended all clinical activities and 66% (67/101) only in-person. Prior to clinical disruption, students spent a median of 8.0 weeks (IQR: 2) on inpatient and 2.0 weeks (IQR: 4) on ambulatory rotations; during clinical re-entry, students were spending 5.0 (IQR: 3) and 1.0 (IQR: 2) weeks, respectively. Bedside teaching and physical exam instruction were “let go” during the early phase. Students were removed from direct patient care for a median of 85.5 days. The sub-internship curriculum remained largely unaffected. Before the pandemic, 11% of schools were using a pass/fail grading system; at clinical re-entry 47% and during the survey period 23% were using it. Due to the pandemic, 78.2% of CDs assumed new roles or had expanded responsibilities; 51% reported decreased scholarly productivity.ConclusionsCurricular adaptations occurred in IM clerkships across US medical schools as a result of COVID-19. More research is needed to explore the long-term implications of these changes on medical student education and clinical learning environments.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07490-9.

Enhancing the Interprofessional Learning Environment: An Orientation of ICU Nurses to Effective Team Building and Their Impact on the Professional Development of the Young Physician

Purpose: Effective interprofessional teams are critical to resident physicians’ learning and patient safety. 1 How medical trainees function in the clinical learning environment is impacted by interaction with colleagues who may feel they have no “official” role in education, and as a result, often do not recognize their important role in the professional development of the medical trainee. Through a brief educational intervention for ICU nurses orienting to our institution targeted at effective teamwork and acknowledging the role of nurses as educators, we aim to improve the learning environment in this targeted setting. We chose to focus on the ICU as it has historically been a challenging, high-acuity working and learning environment and one that may not as readily espouse a learning culture for a trainee underperforming relative to peers. We elected to implement this intervention for new nurses with the hypothesis that they are still developing their style as regards interprofessional relationships and teamwork and may not recognize the importance of their role in the learning environment. Approach/Methods: In this pilot study, we enrolled 8 nurses participating in an established nurse residency program at Massachusetts General Hospital designed to prepare them for becoming independent ICU nurses. These nurses were surveyed using a Team Assessment tool, 2 followed by two 45- to 60-minute educational sessions roughly 4 months apart centered on elements of effective teamwork, the important role of nurses in physician trainee education, and the approach to a struggling trainee. One “booster” was sent by email summarizing the content of the first session. They were subsequently surveyed again using the same Team Assessment tool at the start of the second session. Results/Outcomes: These educational interventions were easy to incorporate into a previously established ICU nurse orientation program. The program was well received by both nursing leadership and participants. When surveyed, the nurse trainees reported that their teams were functioning moderately well (7–8/10). There was no significant difference in Team Assessment scores after this intervention, as anticipated. However, the nurses-in-training responded positively to the elements of the intervention that emphasized their role in medical trainee education, particularly with the struggling trainee. Discussion: Support for this educational intervention among nursing leadership and participants demonstrates interprofessional interest in improving teamwork and the learning environment in our ICUs. Many institutions have internship/orientation programs for new nurses; these forums are well suited to this type of educational intervention. We discovered that in this pilot program, orienting ICU nurses at our institution felt that teams function moderately well at baseline. However, nurses involved in our intervention did report benefit from clear discussion regarding their potential impact in their role as educators and techniques for managing a trainee who may be underperforming. Significance: Medical trainee learning environment is shaped by an interdependent system of interprofessional colleagues, who are frequently unaware of their important role in the professional development of such a colleague. Prioritizing effective programs during orientation to educate nurses on their role in trainee education has the potential to significantly improve physician-in-training learning, particularly for the underperforming trainee. This pilot program represents 1 feasible mechanism by which to achieve this goal. To significantly alter the culture surrounding medical education at our institution, long-term investment in these programs will likely be required. Further study is needed to understand best practices for implementation and impact on trainee professional development and well-being over time.

Patient-present teaching in the clinic: Effect on agency and professional behaviour.

Background/PurposeAlthough much has been written about the medical learning environment, the patient, who is the focus of care, is rarely the focus in this literature. The purpose of this study was to explore the role of the patient as an active participant with agency in the medical learning environment from the standpoint of the learner, the attending physician, and most importantly, the patient. We hoped to gain insights into the mechanisms that can reinforce professional values such as patient‐centred and respectful behaviours in a patient‐present learning environment.MethodsWe conducted this study in an ambulatory internal medicine clinic using ‘patient‐present’ clinic visits. All case presentations occurred in examination rooms with the patient. We invited participants (attending physicians, undergraduate and postgraduate learners, patients and family members) to participate in semistructured interviews after each clinic visit to explore the impact of the patient‐present learning environment. We recruited 34 participants in the study; 10 attending physicians, 12 learners, 10 patients and 2 family members. We analysed the data deductively using a conceptual framework of agency.Summary/ResultsWe identified three major insights: (1) Patients felt engaged and valued opportunities to be heard; (2) Attending physicians and learners reported a more respectful learning environment and a positive though challenging teaching and learning experience; and (3) A hidden curriculum emerged in a performance‐based view of professional behaviour.ConclusionsPatient‐present teaching engaged patients and enhanced their agency by recasting the patient as the central focus within the healthcare encounter. We identified a tension between performing and learning. This study adds new insights to the concept of patient centredness and professionalism from the perspectives of all participants in the medical teaching and learning environment.

A comprehensive literature review on the medical learning systems in the developing countries

PurposeMany people have been dying as a result of medical errors. Offering clinical learning can lead to better medical care. Clinics have conventionally incorporated direct modality to teach personnel. However, they are now starting to take electronic learning (e-learning) mechanisms to facilitate training at work or other suitable places. The objective of this study is to identify and prioritize the medical learning system in developing countries. Therefore, this paper aims at describing a line of research for developing medical learning systems.Design/methodology/approachNowadays, organizations face fast markets' changing, competition strategies, technological innovations and accessibility of medical information. However, the developing world faces a series of health crises that threaten millions of people's lives. Lack of infrastructure and trained, experienced staff are considered essential barriers to scaling up treatment for these diseases. Promoting medical learning systems in developing countries can meet these challenges. This study identifies multiple factors that influence the success of e-learning systems from the literature. The authors have presented a systematic literature review (SLR) up to 2019 on medical learning systems in developing countries. The authors have identified 109 articles and finally selected 17 of them via article choosing procedures.FindingsThe paper has shown that e-learning systems offer significant advantages for the medical sector of developing countries. The authors have found that executive, administrative and technological parameters have substantial effects on implementing e-learning in the medical field. Learning management systems offer a virtual method of augmented and quicker interactions between the learners and teachers and fast efficient instructive procedures, using computer and Internet technologies in learning procedures and presenting several teaching-learning devices.Research limitations/implicationsThe authors have limited the search to Scopus, Google Scholar, Emerald, Science Direct, IEEE, PLoS, BMC and ABI/Inform. Many academic journals probably provide a good picture of the related articles, too. This study has only reviewed the articles extracted based on some keywords such as “medical learning systems,” “medical learning environment” and “developing countries.” Medical learning systems might not have been published with those specific keywords. Also, there is a requirement for more research with the use of other methodologies. Lastly, non-English publications have been removed. There could be more potential related papers published in languages other than English.Practical implicationsThis paper helps physicians and scholars better understand the clinical learning systems in developing countries. Also, the outcomes can aid hospital managers to speed up the implementation of e-learning mechanisms. This research might also enable the authors to have a role in the body of knowledge and experience, so weakening the picture of the developing country's begging bowl is constantly requesting help. The authors hoped that their recommendations aid clinical educators, particularly in developing countries, adopt the trends in clinical education in a changing world.Originality/valueThis paper is of the pioneers systematically reviewing the adoption of medical learning, specifically in developing countries.

Fast-track flipping: flipped classroom framework development with open-source H5P interactive tools

BackgroundThe availability and popularity of laptops, tablet PCs and smartphones in private and work environments offers considerable potential for reasonably integrating blended learning formats into structured medical learning environments. The promising educational principle of the flipped classroom (FC) provides the opportunity to effectively combine e-learning and face-to-face teaching within a single framework. However, similar to most blended learning formats, the FC requires a solid groundwork of structured digitized learning content. As rearranging a whole curriculum is intense and time consuming, physicians occupied simultaneously in clinical practice and teaching may be confronted with a lack of time during this process.MethodsWe developed two straightforward approaches to transforming a pre-existing, lecture-based otolaryngology curriculum into interactive videos within a Moodle learning management system. Special attention was given to reducing individual working time for medical professionals. Thus, while one approach was mainly guided by a medical professional to control the content-related quality of video processing, we investigated an alternative approach outsourcing work to a technician. Afterwards, the working time was analysed and compared. The resulting videos were revised with the H5P plugin for moodle to adjust the content where necessary.ResultsWe identified a fast-track approach for creating structured e-learning content suitable for flipped-classroom-based lectures, other blended learning formats, or even providing a whole curriculum online. The alternative approach significantly reduced working time for medical professionals but did not impair the content-related quality significantly.ConclusionsThe use of H5P interactive tools via Moodle LMS provides a major procedural benefit by allowing the easy adjustment of pre-existing video material into suitable online content. Reasonably outsourcing work to technicians can significantly reduce the working time of medical professionals without decreasing the quality of learning content. The presented workflow can be used as a flexible approach for flipped classroom frameworks or other blended learning strategies where interactive videos are applicable.