Multiple-choice Questions Scores Research Articles

Enhancing the learning experience by empowering medical students to co-create learning tools and classroom activities.

This study aimed to enhance the learning experience among medical students by empowering them to co-create learning tools and classroom activities. A cross-sectional study was conducted with 10 participants from Year 2 of the new curriculum volunteering to participate in this study. Five were selected based on their diversities and empowered to design learning tools and class activities. Student satisfaction was presented as mean scores. A comparison of self-confidence scores in subjects learned before and after the class was analyzed using the paired t-test. Comparisons of multiple-choice question (MCQ) scores before and after the class between Years 2 (n = 96) and Year 3 of the previous curriculum attending inclass teaching (n = 98) were analyzed using the independent sample t-test. A high level of satisfaction (M=87.5, SD=15.7%) and significant improvements in student self-confidence in subjects learned between before (M=46.4, SD=20.8%) and after (M=82.7, SD=16.9%) the class were noted (t (223) = -23.73, p<.001). Additionally, Year 2 students achieved significantly higher MCQ scores after the class (M=85.6, SD=19.0%) compared with the scores from Year 3 (M=77.3, SD=23.6%) (t (190) = 3.32, p<.001). Empowering medical students to co-create learning tools and class activities could positively enhance their learning experience. The result of this study addressed the importance of student empowerment with well-designed student-centered learning strategies based on their learning environment. Additional qualitative research is required to better understanding the "why" and "how" behind the findings of this study.

Effectiveness of video making to enhance infection control skills by undergraduate MBBS students

Background: Competency-based medical education (CBME) Microbiology second MBBS curriculum, infection control practices are core competencies for certification of the second MBBS student. E-learning through video making can help students to achieve these infection control skills upto certifiable level. Educational videos which are of short duration, created in a step wise manner have shown to improve skill acquisition and augment observational learning. The aim and objectives were to study the effectiveness of video making as a teaching learning tool, to enhance infection control skills in undergraduate second MBBS students through video making and to evaluate the students’ infection control skills by giving them a prior checklist. Methods: Second MBBS students after taking informed consent were enrolled for the study. Ten infection control and prevention topics were included in the study for video making. All the 100 second MBBS students in 5 groups of 20 students had made all the 10 videos of duration 2 minutes. A self-administered, validated pre-test and post-test, multiple choice question (MCQ) test and objective structured practical examination (OSPE) checklist were used. Results: Mean post-test marks improved by a mean of 5.91 with significant p value (&lt;0.001, using statistical package for the social sciences (SPSS) software version 29). Mean MCQ and OSPE scores also improved. In almost all the questions on feedback of student’s perception and assessment feedback, percentage of students who agreed and strongly agreed were far more than those who disagreed. Conclusions: Second phase MBBS students learning and performance of infection control skills greatly improved when they created their own videos.

A Case of Painful Visual Loss - Managing Orbital Compartment Syndrome in the Emergency Department.

Emergency medicine (EM) residents. This simulation curriculum may also be utilized for senior medical students conducting EM rotations. Ophthalmologic education represents only a small portion of medical school curriculums and continues to decrease over time, leaving physicians poorly equipped to diagnose and manage eye complaints.1 Of emergency physicians (EPs) surveyed, 72.5% felt that they could diagnose orbital compartment syndrome (OCS), yet only 40.3% felt comfortable performing a necessary lateral canthotomy and cantholysis (LCC).2 These survey results demonstrate the urgent need for improved ophthalmology education in EM residency to help us diagnose and manage potentially vision-threatening pathology. By the end of this simulation, learners will be able to: 1) demonstrate the major components and a systematic approach to the emergency ophthalmologic examination, 2) develop a differential diagnosis of sight-threatening etiologies that could cause eye pain or vision loss, 3) demonstrate proficiency in performing potentially vision-saving procedures within the scope of EM practice. Low-fidelity simulation was conducted using a novel model adapted from that used by Phillips et al. during their ophthalmology day in the Department of Emergency Medicine at Vanderbilt University.3 The simulation case was developed by an interdepartmental team of ophthalmologists and EPs at our institution. To evaluate for statistically significant changes in self-efficacy, knowledge, and performance after an educational intervention. Our primary outcome was defined as a checklist-based performance on a simulated case of orbital compartment syndrome necessitating LCC. We conducted a single-center prospective pre- and post-interventional study evaluating the impact of an educational intervention on EM resident management of a simulated case of OCS. Our two-part study intervention consisted of a lecture on OCS followed by a four and a half hour ophthalmology education day (OED). Residents were evaluated using self-efficacy scales (SES), multiple-choice questions (MCQ), and a performance checklist (developed via a modified Delphi process) at three timepoints: Pre-intervention, immediate post-intervention, and three months post-intervention. Post-graduate year (PGY)-1 through PGY-4 EM residents at an Urban Level 1 Trauma Center participated. Initial recruitment consisted of 18 residents (PGY-1 through PGY-4), and 16 residents (PGY-1 through PGY-3) completed the study. Nine residents participated in the OED and seven residents did not. There were no pre-existing differences in median checklist-based performance, MCQ, or SES scores prior to the intervention. At three months post-OED, the OED attendees scored statistically significantly higher on checklist-based performance than non-attendees (lecture only). Ophthalmology education in physician training is limited, and EP comfort with performing vision-saving procedures is poor. We developed a simulation case involving such a vision-saving procedure as well as an ophthalmology curriculum that increased skill retention surrounding management of ophthalmologic emergencies. Emergency medicine (EM), ophthalmology, orbital compartment syndrome (OCS), retrobulbar hematoma, vision loss, eye pain.

The Effectiveness of Gamebook Teaching-Learning Approach in Undergraduate MBBS Course in Comparison with the Conventional Teaching-Learning Approach

Among various methods of learning and teaching, educational games are tools that engage students for both educational purposes and entertainment. This study aimed to evaluate the effectiveness of game-based learning (GBL) for undergraduate obstetrics and gynecology students in the form of a gamebook. A quasi-experimental study was conducted to compare the outcomes of two different teaching methods, conventional case-based learning (CBL) and GBL, on undergraduate medical students from Taylor’s University, Malaysia. A statistical analysis was performed to compare the performance between the control and intervention groups. Single-best-answer multiple-choice questions (MCQs) were used to assess students’ knowledge and understanding of the clinical subject content, and a 5-point Likert scale was used to assess students’ perception of the new teaching method. Chi-squared tests were used to compare the mean academic performance of the two groups of 128 participants. There was no significant difference in the post-intervention MCQ scores. Students in the GBL group found that learning is more enjoyable and felt more confident in managing patients both theoretically and in real world situations. In conclusion, GBL is comparable to conventional CBL in achieving the desired knowledge and understanding of the topics with a more positive perception towards GBL.

Development and validation of immediate self-feedback very short answer questions for medical students: practical implementation of generalizability theory to estimate reliability in formative examination designs

BackgroundVery Short Answer Questions (VSAQs) reduce cueing and simulate better real-clinical practice compared with multiple-choice questions (MCQs). While integrating them into formative exams has potential, addressing marking time and ideal occasions and items is crucial. This study gathers validity evidence of novel immediate self-feedback VSAQ (ISF-VSAQ) format and determines the optimal number of items and occasions for reliable assessment.MethodsNinety-four third-year pre-clinical students took two ten-item ISF-VSAQ exams on cardiovascular drugs. Each question comprised two sections: (1) Questions with space for student responses and (2) a list of possible correct answers offering partial-credit scores ranging from 0.00 to 1.00, along with self-marking and self-feedback options to indicate whether they fully, partially, or did not understand the possible answers. Messick’s validity framework guided the collection of validity evidence.ResultsValidity evidence included five sources: (1) Content: The expert reviewed the ISF-VSAQ format, and the question was aligned with a standard examination blueprint. (2) Response process: Before starting, students received an example and guide to the ISF-VSAQ, and the teacher detailed the steps in the initial session to aid self-assessment. Unexpected answers were comprehensively reviewed by experts. (3) Internal structure: The Cronbach alphas are good for both occasions (≥ 0.70). A generalizability study revealed Phi-coefficients of 0.60, 0.71, 0.76, and 0.79 for one to four occasions with ten items, respectively. One occasion requires twenty-five items for acceptable reliability (Phi-coefficient = 0.72). (4) Relations to other variables: Inter-rater reliability between self-marking and teacher is excellent for each item (rs(186) = 0.87–0.98,p = 0.001). (5) Consequences: Path analysis revealed that the self-reflected understanding score in the second attempt directly affected the final MCQ score (β = 0.25,p = 0.033). However, the VSAQ score did not. Regarding perceptions, over 80% of students strongly agreed/agreed that the ISF-VSAQ format enhances problem analysis, presents realistic scenarios, develops knowledge, offers feedback, and supports electronic usability.ConclusionElectronic ISF-VSAQs enhanced understanding elevates learning outcomes, rendering them suitable for formative assessments with clinical scenarios. Increasing the number of occasions effectively enhances reliability. While self-marking is reliable and may reduce grading efforts, instructors should review answers to identify common student errors.

Multiple choice as formative assessment in dental education.

The effectiveness of multiple-choice questions (MCQs) in dental education is pivotal to student performance and knowledge advancement. However, their optimal implementation requires exploration to enhance the benefits. An educational tool incorporating MCQs was administered from the 5th to the 10th semester in a dental curriculum. The students filled out a questionnaire after the MCQ, which was linked to the learning management system. Four cohorts of four semesters generated 2300 data points analysed by Spearmen correlation and mixed model regression analysis. Demonstrated a significant correlation between early exam preparation and improved student performance. Independent study hours and lecture attendance emerged as significant predictors, accounting for approximately 10.27% of the variance in student performance on MCQs. While the number of MCQs taken showed an inverse relationship with study hours, the perceived clarity of these questions positively correlated with academic achievement. MCQs have proven effective in enhancing student learning and knowledge within the discipline. Our analysis underscores the important role of independent study and consistent lecture attendance in positively influencing MCQ scores. The study provides valuable insights into using MCQs as a practical tool for dental student learning. Moreover, the clarity of assessment tools, such as MCQs, remains pivotal in influencing student outcomes. This study underscores the multifaceted nature of learning experiences in dental education and the importance of bridging the gap between student expectations and actual performance.

Instructional Video of a Standardized Interprofessional Postsimulation Facilitator-guided Debriefing of a Fatality in Plastic Surgery

Background: Postsimulation facilitator-guided debriefing (PSFGD) is the process of intentional discussion of thoughts, actions, and events that took place during simulation amongst the facilitator(s) and trainees. Despite the significance of delivering high-quality debriefings, there is a lack of evidence-based guidelines. Our study aimed to provide an instructional video demonstration of a PSFGD of a fatality. Methods: Fifty surgical interns participated in a burn simulation scenario in two groups. Group 1 (control, or “no exposure,” n = 25) consisted of residents who received oral postsimulation debriefing from an independent faculty member who had no exposure to our instructional video on how to debrief effectively. Group 2 (intervention, or “exposure,” n = 25) consisted of interns who were debriefed by the second faculty member who did watch our instructional video before the simulation and learned about “advocacy and inquiry” techniques. The outcome measures were the Debriefing Assessment for Simulation in Healthcare score and the postdebrief multiple-choice question (MCQ) quiz scores to assess debriefers’ performance and interns’ knowledge consolidation, respectively. Results: The “exposure” group presented statistically significantly higher values for the Debriefing Assessment for Simulation in Healthcare score (P &lt; 0.001) and MCQ score (P &lt; 0.001) compared with the “no exposure” group. Conclusions: Debriefers who followed the methodology as demonstrated in our instructional video were considered more competent, and the residents achieved higher MCQ scores. The quality of the debriefing ensures improved critical thinking and problem-solving skills. Safer practice and better patient outcomes are achieved by developing debriefing programs for educators.

Impact of blunder lecture on deep learning of pharmacology concepts by cognitive conflict strategy: A new standard in teaching

Background: Small group discussion (SGD) is an established teaching-learning tools in medical colleges to impart a better understanding of the topics. Blunder lecture (BL) is an innovative approach to teaching and learning, placing students at the center and encouraging collaborative, peer-assisted learning. Aims and Objectives: The objectives of the study were to assess the combined effect of BL and SGDs on multiple-choice questions (MCQs) score in pharmacology by comparing the MCQs score after the traditional SGDs approach and after a combined session of BL and SGDs. Materials and Methods: One hundred and two Phase II MBBS students participated in an educational interventional study in the Department of Pharmacology. Two sessions were conducted: First, SGD only; second, integrated BL and SGD on previously covered pharmacology topics in didactic lectures. Twenty deliberate mistakes (blunders) were incorporated in BL that span the hierarchy of bloom’s taxonomy’s cognitive domain. Theory and MCQs tests were performed after each session to assess the impact on scores. Results: There was a statistically significant difference between the means of MCQs test scores of SGD alone and combined SGD + BL session (P &lt; 0.05) after data analysis using a paired t-test. The mean difference of theory test scores of SGD alone and combined SGD + BL session was not statistically significant except cardiovascular system BL session. Conclusion: Combined session of BL and SGD was found to be an effective supplementing method in enhancing MCQs score that can be utilised to support undergraduate students’ learning.

‘SurgTalk’: The Educational Outcomes Associated With Development of a Surgical Podcast for Undergraduate Medical Students

Educational podcast series are becoming increasingly popular as free open access medical education (FOAMed) resources, however, the educational benefit associated with their use is unclear. The aim of this study was to assess the educational outcomes associated with the implementation of a surgical podcast series for undergraduate medical students. Two conversational case-based podcast episodes were recorded covering 2 common surgical presentations. Final-year medical students were recruited prospectively in January 2023 and underwent a baseline multiple choice question (MCQ) test covering the material within the podcast episodes. Participants were then provided with the episode files through encrypted Google Drive links. Two weeks following baseline assessment, students repeated the initial MCQ test and completed a postpodcast reaction survey. Data were analyzed using a paired t-test, multivariable regression analyses, and simple descriptive statistics. Fifty students were enrolled in the study. All participants undertook the baseline assessment. About 98% completed the postpodcast MCQ, while 94% completed the postpodcast reaction survey. All participants who undertook the reaction survey (n = 47) found the podcast helpful in explaining surgical concepts, 92% of participants found the podcast enjoyable to listen to. The most commonly reported activity undertaken while listening was "commuting/driving" (n = 24, 48%). The mean baseline MCQ score was 44.6%. The mean postpodcast MCQ score was 65.51%. There was a mean absolute increase in test score of 20.2% from baseline which was statistically significant (95%CI 14.67-25.6, p < 0.001). Implementation of this podcast series was associated with a statistically significant improvement in mean test score from baseline, reflecting knowledge acquisition. There was a positive user reaction and students were able to listen while performing other activities. Further evaluation of the educational outcomes associated with podcast use, particularly the effects on knowledge retention and clinical competence, is required.

Exploring the impact of online and offline teaching methods on the cognitive abilities of medical students: a comparative study

BackgroundOnline education has become increasingly popular, but research on the effectiveness of different teaching models in developing cognitive skills is limited. This study investigated the relationship between different teaching models (online and offline) and the development of cognitive skills in clinical medicine students.MethodsSurvey data were collected from 2018 entry students who participated in online teaching and 2019 entry students in offline teaching at Xiangya School of Medicine, Central South University. National Quality Open Courses (NQROC) were provided to both groups of students. The study examined the total score of physiology final exam, score of each type of question, and NQROC learning engagement in different score segments under the two teaching models. Non-parametric statistical methods were utilized to analyze the total score of physiology final exam, score of each type of question, and the NQROC learning engagement. Spearman’s rank correlation was utilized to analyze the relationship between the score of physiology final exam and the students’ NQROC learning engagement.ResultsThe study found no statistically significant difference in the total score, short-answer questions (SAQs) score, and case study questions (CSQs) score between online and offline teaching models. However, the multiple-choice questions (MCQs) score was higher in the online teaching model (Z=-4.249, P < 0.001), suggesting that online teaching may be an effective way to improve lower-order cognitive skills among students. In contrast, low-achieving students had higher total scores (Z=-3.223, P = 0.001) and scores in both MCQs (Z=-6.263, P < 0.001) and CSQs (Z=-6.877, P < 0.001) in the online teaching model. High-achieving students in the online teaching model had higher total scores (Z=-3.001, P = 0.003) and MCQs scores (Z=-5.706, P < 0.001) but lower scores in CSQs (Z=-2.775, P = 0.006). Furthermore, students’ NQROC learning engagement was greater in the online teaching model.ConclusionsThe results of this study suggested that online teaching was not statistically significantly different from offline in cognitive domains and was more desirable than offline in strengthening lower-order cognitive skills. However, it was important to note that offline teaching may be more effective in reinforcing higher-order cognitive skills among high-achieving students. In conclusion, this study provided important insights into the effectiveness of different teaching models in developing cognitive skills among medical students and highlighted the potential benefits of online teaching in enhancing students’ lower-order cognitive skills.

Mechanical Ventilation Training Curriculum for Pulmonary Critical Care Fellows during the COVID-19 Pandemic.

Mechanical ventilation (MV) management is an essential skill for pulmonary and critical care medicine (PCCM) fellows to master during training. The unprecedented emergence of the coronavirus disease (COVID-19) pandemic highlighted the need for advanced operator competency in MV to improve patients' outcomes. We aimed to create a standardized case-based curriculum using a blended approach of high-fidelity simulation, rapid-cycle deliberate practice, video didactics, and hands-on small group sessions for rapid accumulation of knowledge and hands-on skills for PCCM fellows before caring for critically ill patients during the COVID-19 pandemic. The MV curriculum consisted of the following steps: 1) baseline written knowledge test with 15 multiple-choice questions covering MV, the latest evidence-based practices, and pathophysiology of COVID-19; 2) baseline confidence survey using a 5-point Likert scale; 3) a one-on-one session using a high-fidelity simulation manikin, a lung simulator, and a mechanical ventilator to test baseline competencies; 4) a structured debriefing tailored per fellow's 50-point competency assessment checklist from the simulation using rapid-cycle deliberate practice; 5) video didactics; 6) a hands-on session in small groups for basic knobology, waveforms, and modes of MV; 7) a one-on-one simulation reassessment session; 8) a written knowledge posttest; and 9) a post-training confidence survey using a 5-point Likert scale. Eight PCCM fellows completed the training. The mean multiple-choice question score increased from 7.4 ± 2.9 to 10.4 ± 2.4 (P < 0.05), and the simulation scores increased from 17.1 ± 4.4 to 30.8 ± 3.7 (P < 0.05). Comparing the simulation reassessment to the baseline, fellows showed significant improvement (P < 0.05) in assessing indications for MV; implementing rapid sequence intubation for patients with COVID-19; initiating MV and ventilator bundle per best practices; recognizing and managing mucous plugging, ventilator dyssynchrony, and evidence-based treatments for acute respiratory distress syndrome; and developing a care plan for proning. The post-training survey revealed improved learner confidence in all competencies. This pilot MV curriculum using a blended approach was feasible and allowed PCCM fellows to significantly improve their knowledge and hands-on skills, allowing for the appropriate use of MV during the pandemic. Self-reported improvement scores further reinforced this. The emergent need for novice learners may again be necessary for future pandemic settings where standard training models requiring extensive training time are limited.

A randomised control trial study on the efficacy of high-fidelity simulation in enhancing knowledge

Introduction: The practice of high-fidelity simulation-based medical education has become a popular small-group teaching modality across all spheres of clinical medicine. High-fidelity simulation (HFS) is now being increasingly used in the context of undergraduate medical education, but its superiority over traditional teaching methods is still not established. The main objective of this study was to analyse the effectiveness of HFS-based teaching over video-assisted lecture (VAL)-based teaching in the enhancement of knowledge for the management of tension pneumothorax among undergraduate medical students. Methods: A cohort of 111 final-year undergraduate medical students were randomised for this study. The efficacy of HFS-based teaching (intervention group) and VAL-based teaching (control group), on the acquisition of knowledge, was assessed by single-best answer multiple choice questions (MCQ) tests in the first and eighth week of their surgery posting. Mean and standard deviation (SD) for the total score of MCQ assessments were used as outcome measures. ANCOVA was used to determine the difference in post-test MCQ marks between groups. The intragroup comparison of the pre-test and post-test MCQ scores was done by using paired t-test. The P-value was set at 0.05. Results: The mean of post-test MCQ scores were significantly higher than the mean of pre-test MCQ scores in both groups. The mean pre-test and post-test MCQ scores in the intervention group were slightly more than those of the control group but not statistically significant. Conclusion: There was a statistically significant enhancement of knowledge in both groups but the difference in knowledge enhancement between the groups was insignificant.

A comparative study of students’ performance in flipped classroom and structured interactive session teaching learning method in Conservative Dentistry and Endodontics

Introduction: Flipped classroom is an element of blended learning, integrating both face-to-face learning in the class through group discussion and distance learning outside the class by watching video lessons and online collaboration. The objective of the study was to introduce and assess the effectiveness of flipped classroom in teaching and learning of Conservative Dentistry and Endodontics and to understand the perspective of students about the same. Methods: Third year undergraduate dental students were randomly divided into two groups: structured interactive session group and flipped classroom group. Structured interactive session group had their class taken in the traditional manner while the flipped classroom group was given power point presentation and videos beforehand so that students came to class being prepared. The in class time was utilized for group discussions and peer exercises. Same set of questions including multiple choice questions (MCQs) and problem based questions (PBQs) validated by the faculties involved in the research was used for assessment. A questionnaire was then provided to students regarding their perception of flipped classroom method. Results: Among the 41 students, 19 students were in structured interactive session group and 22 were in flipped classroom group. The mean MCQ and PBQ score in structured interactive session group was 69.47 and 59.39 respectively whereas it was 73.17 and 66.55 respectively in flipped classroom group. Conclusions: The performance of flipped classroom group was better in both MCQs and PBQs. Students preferred flipped classroom method and were ready to accept it as their teaching learning modality.

A serious video game—EmergenCSim™—for novice anesthesia trainees to learn how to perform general anesthesia for emergency cesarean delivery: a randomized controlled trial

PurposeWe developed EmergenCSim™, a serious game (SG) with an embedded assessment, to teach and assess performing general anesthesia for cesarean delivery. We hypothesized that first-year anesthesiology trainees (CA-1) playing EmergenCSim™ would yield superior knowledge scores versus controls, and EmergenCSim™ and high-fidelity simulation (HFS) assessments would correlate.MethodsThis was a single-blinded, longitudinal randomized experiment. Following a lecture (week 3), trainees took a multiple-choice question (MCQ) test (week 4) and were randomized to play EmergenCSim™ (N = 26) or a non-content specific SG (N = 23). Participants repeated the MCQ test (week 8). Between month 3 and 12, all repeated the MCQ test, played EmergenCSim™ and participated in HFS of an identical scenario. HFS performance was rated using a behavior checklist.ResultsThere was no significant change in mean MCQ scores over time between groups F (2, 94) = 0.870, p = 0.42, and no main effect on MCQ scores, F (1, 47) = 1.110, p = 0.20. There was significant three-way interaction between time, gender and group, F (2, 90) = 3.042, p = 0.053, and significant two-way interaction between gender and time on MCQ scores, F (2, 94) = 107.77, p = 0.036; outcomes improved over time among males. There was no group difference in HFS checklist and SG scores. Both instruments demonstrated good internal consistency reliability but non-significant score correlation.ConclusionsPlaying EmergenCSim™ once did not improve MCQ scores; nonetheless scores slightly improved among males over time, suggesting gender may impact learning outcomes with SGs.

Aligning orthodontic education: Investigating the use of a digital app to improve the performance in managing orthodontic problems.

General dentists are qualified to manage orthodontic emergencies within their scope of practice. This may involve advice, hands-on intervention or referral to a specialist orthodontist. This study aimed to assess the effect of an orthodontic app on dental undergraduates' ability to manage common orthodontic issues. In addition, this study aimed to determine the confidence of dental students in finding information related to orthodontic emergencies (CFI) as well as their confidence in managing orthodontic emergencies (CMOE). Students were randomised into one-of-three groups, an app group, an internet group and a closed-book, exam-style group. All participants self-reported their CFI and CMOE. Following this, all participants were asked to complete a multiple-choice question (MCQ) paper based on clinical orthodontic scenarios. In addition, the app group were instructed to complete an app usability questionnaire (MAUQ). Approximately, 91.40% of students (n = 84) had not received clinical training in managing orthodontic emergencies, and 97.85% (n = 91) had not managed an orthodontic emergency clinically within the last 6 months of their training. The mean score for CFI was 0.10 out of 1.0 (SD 0.11) and CMOE was 0.28 out of 1.0 (SD 0.23). Statistically significant better MCQ scores were found in the app group, and no statistically significant difference was found between the internet and exam-style group. This study is the first to consider the use of an orthodontic app to aid in the management of orthodontic issues. It has practical implications for how mobile apps can aid in learning and can be incorporated into the wider dental field.

Early Clinical Exposure – Effectiveness and Attitude among MBBS Students

Background: In the traditional method, students learn theory without contacting patients in the initial part of MBBS. Early clinical exposure creates a scope for students to correlate basic science and clinical application. Hence, there is a need to study the effectiveness of different forms of early clinical exposure (ECE). The objectives of the study were to compare the knowledge acquired and attitude toward ECE by the students after different forms of ECE. Methodology: An observational study was done with 1st-year MBBS (n = 150) students. Based on the National Medical Council (Then Medical Council of India) II ECE document for undergraduate medical education programs, 10 topics were selected. The first six ECE sessions were conducted in the classroom, the next two at the hospital, and the last two virtually. Phase-validated structured multiple-choice questions (MCQs) and feedback were given to students before and after every ECE. The MCQ scores and feedback conducted in three forms were statistically analyzed. Results: There was a notable disparity in the mean between pre- and posttest. The mean scores of the virtual mode were better than the other two forms. As per the feedback analysis, most of the students observed ECE aid to clear conceptualization, critical thinking, and correlate anatomical basis in clinical cases. However, students also felt that it is too early to understand the topic in such detail in 1st year. Conclusion: This longitudinal study on ECE showed there is an increase in the knowledge and analytical skills of students. Hence, we recommend continuing ECE and to have a blended learning environment along with limited content to be included for a better outcome.

Mechanical life support algorithm for emergency management of patient receiving extracorporeal membrane oxygenation.

There are limited practical advanced life support algorithms to aid teams in the management of cardiac arrest in patients on extracorporeal membrane oxygenation (ECMO). In our specialist tertiary referral centre we developed, by iteration, a novel resuscitation algorithm for ECMO emergencies which we validated through simulation and assessment of our multi-disciplinary team. A Mechanical Life Support course was established to provide theoretical and practical education combined with simulation to consolidate knowledge and confidence in algorithm use. We assessed these measures using confidence scoring, a key performance indicator (the time taken to resolve gas line disconnection) and a multiple choice question (MCQ) examination. Following this intervention the median confidence scores increased from 2 (Interquartile range IQR 2, 3) to 4 (IQR 4, 4) out of maximum 5 (n = 53, p < 0.0001). Theoretical knowledge assessed by median MCQ score increased from 8 (6, 9) to 9 (7, 10) out of maximum 11 (n = 53, p0.0001). The use of the ECMO algorithm reduced the time taken by teams in a simulated emergency to identify a gas line disconnection and resolve the problem from median 128s (65, 180) to 44s (31, 59) (n = 36, p 0.001) and by a mean of 81.5s (CI 34, 116, p = 0.001). We present an evidence based practical ECMO resuscitation algorithm that provides guidance to clinical teams responding to cardiac arrest in ECMO patients covering both patient and ECMO troubleshooting.

Comparability of Objective Structured Clinical Examinations (OSCEs) and Written Tests for Assessing Medical School Students' Competencies: A Scoping Review.

Objective Structured Clinical Examinations (OSCEs) and written tests are commonly used to assess health professional students, but it remains unclear whether the additional human resources and expenses required for OSCEs, both in-person and online, are worthwhile for assessing competencies. This scoping review summarized literature identified by searching MEDLINE and EMBASE comparing 1) OSCEs and written tests and 2) in-person and online OSCEs, for assessing health professional trainees' competencies. For Q1, 21 studies satisfied inclusion criteria. The most examined health profession was medical trainees (19, 90.5%), the comparison was most frequently OSCEs versus multiple-choice questions (MCQs) (18, 85.7%), and 18 (87.5%) examined the same competency domain. Most (77.5%) total score correlation coefficients between testing methods were weak (r < 0.40). For Q2, 13 articles were included. In-person and online OSCEs were most used for medical trainees (9, 69.2%), checklists were the most prevalent evaluation scheme (7, 63.6%), and 14/17 overall score comparisons were not statistically significantly different. Generally low correlations exist between MCQ and OSCE scores, providing insufficient evidence as to whether OSCEs provide sufficient value to be worth their additional cost. Online OSCEs may be a viable alternative to in-person OSCEs for certain competencies where technical challenges can be met.

The Efficacy of High-fidelity Simulation-based Education in Enhancing Knowledge among Undergraduate Medical Students

Background: Medical education has experienced important changes in recent times. The concern for patient's safety is one of the key reasons for the change in medical curricula. Innovative instructional methods like simulation-based medical education (SBME) has evolved to address this problem. SBME has become an essential part of education and training for health professionals in many parts of the world. There are evidences that support that high-fidelity simulation (HPS) training has enhanced clinical knowledge among medical students.&#x0D; Aims: The objective of this study was to note the differences in the knowledge made by high-fidelity simulation-based medical education among undergraduate medical education.&#x0D; Study Design: It was a quasi-experimental time series study with Pre-test and Post-test interventions.&#x0D; Place and Duration of Study: Clinical Skills Lab, Faculty of Medicine, Manipal University College Malaysia, Melaka, between October 2015 and September 2017.&#x0D; Methodology: The study involved 347 final year undergraduate medical students. The participants were divided into groups during the simulation sessions and their knowledge was assessed individually with Multiple Choice Questions (MCQ) and also self-reported Pre-test and Post-tests. Paired t-test was used to determine the difference of MCQ scores between pre and post simulation sessions. One-way repeated measure ANOVA was performed to determine the significant difference in knowledge assessment of self-reported Pre-test and Post-test scores. P value &lt; .001 was taken to be of statistical significance.&#x0D; Results: In the unpaired t-test, Post-test MCQ scores were higher than Pre-test scores but not statistically significant (P = .013). A one-way repeated measured ANOVA with Bonferroni post hoc analysis demonstrated that the total scores of the self-reported knowledge tests were significantly increased over time (P &lt; .001).&#x0D; Conclusion: There is enhancement of knowledge as perceived by the students with self-reported knowledge tests but not statistically significant as revealed by the MCQ scores.

Cross sectional study on the competence and confidence of dental students and graduates in the management of medically compromised patients and acute medical emergencies.

A rapidly aging population means many people have multiple health issues leading to an increased risk of acute medical emergencies. The objective of this study was to evaluate how essential experiential learning is in developing dental graduates' ability to manage medically compromised patients. Three hundred and twenty-seven students and graduates were invited to participate in an online survey to rate their confidence in managing medically compromised patients and acute medical emergencies using a 5-point Likert scale. Competence of knowledge was evaluated using 30 multiple choice questions (MCQs) across six domains. The respondents were also asked whether a theory-only training adequately prepared them to manage medically compromised patients, or whether it must be supplemented with clinical training. Two-hundred and sixty-four responses were collected from 75 undergraduates (UG), 96 junior dental officers (JDO) and 93 senior dental officers (SDO). The UG reported that they infrequently managed medically compromised patients, whereas both the JDO and SDO reported having frequent encounters with these patients. The mean confidence scale in the management of medically compromised patients were 2.62, 3.50 and 3.69 (out of 5), respectively. In contrast, their confidence scale in the management of acute medical emergencies was 2.05, 2.33 and 2.50 (out of 5), respectively. The MCQ scores were 25.51, 26.44 and 26.86 out of 30, respectively. The outcomes of the JDO and SDO were significantly better than the UG (t-tests, p<0.05). All three groups responded that a theory-only training in dental school did not adequately prepare them to manage medically compromised patients. Both the JDO and SDO felt that their clinical work experience better prepared them to manage these patients. Experiential learning from "real-life" clinical experience is an essential component in developing graduates' confidence and competence in the management of medically compromised patients. A dental curriculum with theory-only training in this aspect is inadequate.