Postgraduate Medical Curricula Research Articles

Knowledge and awareness about dentistry among medical students, residents, and medical practitioners in Bhairahawa city, Nepal.

Introduction:Oral health is considered to be a mirror of systemic health and vice-versa. Medical professionals are considered to be the primary caregivers in a given population and as such a vast majority of the population visits them for health-related problems. Therefore, this study aimed to evaluate the level of knowledge and awareness of dentistry among first-year medical students, residents, and medical practitioners.Methods:A cross-sectional questionnaire survey was carried out to assess the knowledge and awareness of dentistry among MBBS first-year students, medical residents, and medical practitioners of Bhairahawa city, Nepal. Data analysis was done with SPSS version 11.Results:As per the demographic characteristics out of 147 subjects 82 (55.8%) were male and 65 (44.2%) were female. Most of the participants were from the age group of 21–30 years, 66 (44.9%) and 115 (78.2%) of them were married. Among 147 subjects every respondent (100%) knew about the profession of dentistry giving statistically significant results.Conclusion:The present study shows that medical professionals had better knowledge of dentistry as compared to medical students and residents. This unnecessary gap between dental and medical professionals can only be fulfilled by including dental education in both undergraduate and postgraduate medical curriculum.

"When in Doubt, Ask the Patient": A Quantitative, Patient-Oriented Approach to Formative Assessment of CanMEDS Roles.

IntroductionSince the introduction of competency-based frameworks into postgraduate medical curricula, educators have struggled to implement robust assessment tools that document the progression of necessary skills. The global movement towards competency-based medical education demands validated assessment tools. Our objective was to provide validity evidence for the Ottawa CanMEDS Competency Assessment Tool (OCCAT), designed to assess clinical performance in the communicator, professional, and health advocate CanMEDS roles.MethodsWe developed the OCCAT, a 29-item questionnaire informed by specialty-specific Entrustable Professional Activities and consultation with stakeholders, including patients. Our sample included nine neonatal-perinatal medicine and maternal fetal medicine fellows rotating through antenatal high-risk clinics at the Ottawa Hospital. Following 70 unique encounters, the OCCAT was completed by patients and learners. Generalizability theory was used to determine overall reliability of scores. Differences in self and patient ratings were assessed using analyses of variance.ResultsGeneralizability analysis demonstrated that both questionnaires produced reliable scores (G-coefficient > 0.9). Self-scores were significantly lower than patient scores across all competencies, F(1, 6) = 13.9, p = .007. Variability analysis demonstrated that trainee scores varied across all competencies, suggesting both groups were able to recognize competencies as distinct and discriminate favorable behaviors belonging to each.DiscussionOur findings lend support to the movement to integrate self-assessment and patient feedback in formal evaluations for the purpose of enriched learner experiences and improved patient outcomes. We anticipate that the OCCAT will facilitate bridging to competency-based medical education.

Practice, Perception, and Associations of Peer Learning Among Resident Doctors in Nigeria: Charting Study

Abstract Introduction: Peer learning is an important component of the postgraduate medical curriculum, and it is considered as an integral part of learning in some countries. The practice of peer learning among postgraduate trainees, especially the resident doctors, is an area that has not been explored in Nigeria and other third world countries. This study aims to examine the practice, perception, and drivers of peer-to-peer training in Nigeria. Methodology: This study was a national multi-centre and multi-disciplinary cross-sectional survey, conducted among resident doctors in Nigeria. Semi-structured questionnaires were used to obtain respondents’ biodata, perception and practice on peer learning. Data were analysed using SPSS version 23 software. Results were presented as frequency table and proportion, means, and standard deviation. Inferential statistics such as bivariate analysis was performed. Results: Majority, 287 (73.2%), considered the peer education programme as an appropriate learning practice, 173 (45.9%) considered peer education programme integrated part of the training, while 350/383 (88.2%) engaged in a peer education programme. Statistically, a significant association was found between those who considered peer training as appropriate (p = 0.038) and those who considered peer education as an integral part of postgraduate medical training curriculum (p =0.009). Conclusion: Peer learning is popular among resident doctors in Nigeria. Concerted efforts are needed to re-structure the residency training curriculum in order to maximize the benefits of this learning approach for an effective training programme.

Development and evaluation of an evidence-based medicine module in the undergraduate medical curriculum

BackgroundEvidence-based medicine (EBM) is a core competence in both undergraduate and postgraduate medical curricula. However, its integration into curricula varies widely. Our study will help medical colleges develop, implement and evaluate their EBM courses. We assessed the effectiveness of workshops in improving critical appraisal skills among medical students.MethodsA before-and-after study design without a control group was used. A 5-week short EBM module including lectures, workshops, and online search sessions was conducted with 52 fourth-year medical students during their primary healthcare course at the College of Medicine, Princess Nourah bint Abdulrahman University. Statistical analysis was performed using SPSS statistical software (version 20, SPSS Inc., Chicago, US). Parametric tests as well as Student’s paired t-test for pre- and post-test comparisons were used.ResultsForty-nine (49) participants completed the pre- and post-training Fresno tests, and 44.9% of the participants had a GPA of 4.0 or higher. The mean Fresno test score increased from 45.63 (SD 21.89) on the pre-test to 64.49 (SD 33.31) on the post-test, with significant improvements in the following items: search strategies, relevance, internal validity, magnitude and significance of results, statistical values of diagnosis studies (sensitivity, specificity, and LR), statistical values of therapy studies (ARR, RRR, and NNT), and best study design for diagnosis and prognosis (P < 0.05).ConclusionThis study supports that a short course in EBM that is incorporated into the undergraduate curriculum, especially in the clinical years, might be effective in improving medical students’ knowledge and skills in EBM. However, prospective studies are necessary to assess the long-term impact of these interventions and ultimately their effectiveness for clinical decision making.

Current provision of myelopathy education in medical schools in the UK: protocol for a national medical student survey

IntroductionDegenerative cervical myelopathy (DCM) is a common, disabling and progressive neurological condition triggered by chronic compression of the cervical spinal cord by surrounding degenerative changes. Early diagnosis and specialist management...

Assessment of Infant and Young Child Feeding Content in Physicians’ Postgraduate Textbooks in Croatia

Objectives − Physicians who care for mother-baby dyads should receive training in infant and young child feeding. This should be reflected in the official postgraduate medical curriculum and in the relevant textbooks. The aims of this study were to: 1) determine if infant and young child feeding is part of physician postgraduate training programs in Croatia; 2) assess the infant and young child feeding content of relevant textbooks. Methods − Post-graduate training programs in obstetrics/gynaecology, paediatrics and family medicine, available online, for the academic year 2016/7 were analysed. Eight relevant textbooks were assessed by two independent authors. Topics covered in World Health Organisation’s Infant and young child feeding Model Chapter for textbooks for medical students and allied health professionals were used as a ˝gold standard˝. Results − Infant and young child feeding is part of family medicine and paediatric postgraduate training programs in Croatia, with one and four subjects dedicated to this topic, respectively. Six percent (range: 3.3 – 10.0) of infant and young child feeding content was found to be inaccurate, and 72% of topics were omitted. The topic Animal milks and infant formula was thoroughly covered, whereas Twins, Oversupply of breast milk, Relactation, Kangaroo Mother Care and Fostering breastfeeding support groups was omitted in all textbooks. Conclusion − A thorough revision of infant and young child feeding content in Croatian physician postgraduate training programs is required if family physicians, paediatricians and obstetricians/gynaecologists are to provide appropriate advice and support to mother-infant dyads.

Global Needs-Assessment for a Postgraduate Program on Nonsurgical Facial Aesthetics.

Standardizing training and education in nonsurgical facial aesthetic procedures during residency training has long been challenging because majority of the procedures are performed outside the usual teaching hospital settings. Several areas of refinement have been suggested and an increased need for more hands-on training identified in the available literature. Despite the growing demand for nonsurgical facial aesthetics (NSFA), it is yet to be fully integrated into standard postgraduate medical or surgical curriculum. The objective of this study was to explore the current state and the need for medical education and training of aesthetic clinicians across specialties in a formal postgraduate curriculum. A mixed-method, cross-sectional, online research was conducted among physicians involved in training and practicing NSFA between July 2018 and December 2018. Focus group discussion was conducted to ensure the face and content validity of the survey items. The total responses collected in the trainer's group was 179 and 496 in the trainee's group. The majority of trainers (95%) and trainees (93.8%) across specialties expressed their opinion for the need of a standard postgraduate course in NSFA. Moreover, more than 55% of them felt that 12 months, with a work-based, blended learning approach, would be most suitable for training and education. The survey results have underlined the need for specialized training in NSFA to enable clinicians to pursue independent practice with confidence. The authors recommend the inclusion of evidence-based postgraduate programs on NSFA in higher academic institutions as per their educational curriculum.

A mixed-methods review of how quality improvement is represent in the UK postgraduate medical curricula

Today's medical curricula shape the institutional culture of tomorrow. There is an opportunity within the medical curricula to embed improvement methodology at the heart of practice, and ignite meaningful change throughout the health service. Therefore, it is imperative that quality improvement (QI) is well-characterised in the medical curricula. To determine how QI is represented in postgraduate medical curricula. Sixty postgraduates’ medical curricula and decision aides were reviewed. Text related to audit or quality improvement was extracted and coded …

Evaluation of knowledge and awareness of invasive fungal infections amongst resident doctors in Nigeria.

Introductionit has been estimated that about 11.8% of the Nigerians suffer serious fungal infections annually. A high index of suspicion with early diagnosis and institution of appropriate therapy significantly impacts on the morbidity and mortality of invasive fungal infections (IFIs).Methodswe conducted a cross-sectional multicentre survey across 7 tertiary hospitals in 5 geopolitical zones of Nigeria between June 2013 and March 2015. Knowledge, awareness and practice of Nigerian resident doctors about the diagnosis and management of invasive fungal infections were evaluated using a semi-structured, self-administered questionnaire. Assessment was categorized as poor, fair and good.Results834(79.7%) of the 1046 participants had some knowledge of IFIs, 338(32.3%) from undergraduate medical training and 191(18.3%) during post-graduate (specialty) residency training. Number of years spent in clinical practice was positively related to knowledge of management of IFIs, which was statistically significant (p < 0.001). Only 2 (0.002%) out of the 1046 respondents had a good level of awareness of IFIs. Only 4(0.4%) of respondents had seen > 10 cases of IFIs; while 10(1%) had seen between 5-10 cases, 180(17.2%) less than 5 cases and the rest had never seen or managed any cases of IFIs. There were statistically significant differences in knowledge about IFIs among the various cadres of doctors (p < 0.001) as level of knowledge increased with rank/seniority.Conclusionknowledge gaps exist that could militate against optimal management of IFIs in Nigeria. Targeted continuing medical education (CME) programmes and a revision of the postgraduate medical education curriculum is recommended.

Impact of faculty development programme on self-efficacy, competency and attitude towards medical education in Bhutan: a mixed-methods study

BackgroundSoon after Bhutan’s first medical university was established in 2012, Faculty Development Programmes (FDPs) were adopted for efficient delivery of postgraduate medical curriculum. Medical education was an additional responsibility for the clinicians who already had multi-dimensional roles in the healthcare system where there is acute shortage of healthcare professionals. We studied the impact of FDPs on postgraduate medical education in Bhutan.MethodsThis was a mixed-methods study with a quantitative (cohort study – quasi-experimental with 18 participants) and concurrent explanatory qualitative component (focused group discussion (FGD) with 11 teaching faculty members). The 18 participants were given a structured FDP designed by the University. The FGD assessed teacher self-efficacy and competency using standard tools before and after the FDP. Thematic analysis of the FGD explored the impact of FDPs in the delivery of postgraduate residency programmes.ResultsThere were significant increase in the teacher self-efficacy (31 vs 34, p = 0.009) and competency scores (56 vs 64, p = 0.011). There were significant improvements in self-efficacy in the domain of the teaching relevant subject contents and developing creative ways to cope with system constraints. In teaching-learning assessments, there was a significant appreciation of the effectiveness of lectures and tutorials and the use of essay questions. The FGD demonstrated the acceptance of FDPs and its importance in quality improvement of postgraduate medical education, professional development of teachers and improvement of their communication skills. The teachers have now migrated from the conventional methods of teaching to workplace-based teaching and assessment. The FDPs also resulted in review and revision of postgraduate medical curriculum soon after the first batch graduated in 2018. Lack of adequate support from relevant stakeholders and lack of a medical education centre in the University were seen as major challenges.ConclusionsThe FDPs have brought tangible professionalization of postgraduate medical education at an early stage of the medical university. There is a need for continued efforts to strengthen, sustain and consolidate the gains made thus far.

Dual Use Research of Concern: Perspective of Clinicians from a Training Viewpoint.

The field of Dual use research of concern (DURC) has been rapidly expanding in the last decade. Though this has led to unprecedented breakthroughs in Life sciences and Technology, it is also associated with significant risks. These risks are enormous, transcend local and national boundaries and have the potential of catastrophic effects. Some of these include the release of highly infectious pathogens capable of sparking unnatural outbreaks, with resultant widespread illness and deaths. Yet Clinicians who are significant first responders involved in the management of cases in outbreaks, often lack relevant training on DURC and its associated risks. We propose that the World Health Organization (WHO) should develop global guidelines on the integration of relevant DURC training into undergraduate and postgraduate medical curricula. In addition, country-level national policy should be developed by each member country in line with their specific context.

Does Curriculum Analysis in Clinical Residency Training Need to be Different?

Objectives:Curriculum analysis is an essential process in exploring the validity of assumptions behind the curriculum and judging its perspectives, goals, and objectives. This study analysed the curriculum of the Internal Medicine Residency Programme at the Sudan Medical Specialisation Board, exploring the programme’s strengths, weaknesses, and areas for improvement.Materials and Methods:A qualitative descriptive analysis method using Harden Ten Questions framework was used, implemented through document analysis. Thematic analysis was used to categorise the findings following the Harden Ten Questions framework.Results:The analysis of this curriculum using Harden Ten Questions framework revealed that it is built on needs assessment, with clear objectives and contents, good organisation of the contents and a precise management process. However, there is a need to improve the areas related to training strategies, training methods, assessment methods and the learning environment.Conclusions:This study showed that the curriculum is built to meet the needs of the Sudanese community. The contents fit for internal medicine clinical residency and the methods of training are likely to foster long-life learning. The curriculum needs some improvement particularly in the following areas such as clinical teaching, trainee assessments, and learning environments. Harden Ten Questions framework for curricula was practical to some degree in analysing the postgraduate curriculum. However, some suggestions have been made regarding the original framework to make it more adaptable to curriculum analysis at postgraduate level. The systematic analysis is transferable to the analysis of other undergraduate or postgraduate medical curricula in Sudan.

Teaching human factors: a near-peer approach.

An understanding of human factors and ergonomics (HFE) is critical for optimal team performance, and is an important component of the postgraduate medical curriculum. This training is often delivered by senior clinicians with experience of using and teaching HFE concepts. A lack of availability of these experienced tutors can be a constraint on training provision. A near-peer tutor (NPT) approach was used to deliver a classroom-based HFE course to postgraduate doctors, supported by a tutor handbook. We aimed to compare feedback from this course with a previous course taught by experienced tutors. Learners (n=21) attending this course were divided into small groups, with one NPT per group. Each group viewed three video reconstructions of incidents from health care and other industries, followed by a structured discussion. Learners were encouraged to recognise concepts from HFE, and to develop changes to their own practice. The NPTs were guided through the session by a tutor handbook, which they received in advance. Human factors and ergonomics training is associated with a significant decrease in error RESULTS: Initial and 2-month feedback was extremely positive, with Likert scores of 5/5 for Organisation, Content, Teaching Methods and Overall Impression. This was significantly (p<0.05) better than feedback from a previous HFE course with senior tutors. Median NPT confidence ratings before and after receiving the handbook were 4/10 and 8/10, respectively. These results support the use of NPTs in delivering HFE training to postgraduate doctors. Self-reported confidence is increased by providing a handbook with discussion prompts. Training in HFE does not require senior tutors with significant clinical commitments, and can be provided to a high standard by NPTs.

Gaps in Developmental Pediatrics training: A Canadian resident physician perspective.

This article was migrated. The article was marked as recommended. Introduction: Postgraduate medical training worldwide has recently experienced a transition to Competency-Based Medical Education (CBME). This provides a timely opportunity to critically evaluate the postgraduate medical curriculum, particularly from a trainee perspective. Studies reveal that Canadian residents and recent graduates in pediatrics and family medicine are uncomfortable with their proficiency in child development. However, little is known about residents' perceptions of their training, nor where specific needs lie. We therefore sought to identify gaps in developmental pediatrics training, with the goal of informing the development of a new CBME curriculum. Methods: An online cross sectional needs assessment survey was administered to current pediatrics and family medicine residents at our institution. A total of 63 residents participated, 43 pediatrics and 20 family medicine. Results: Four key themes emerged from analysis of survey results: 1. Residents agree that developmental pediatrics is relevant to future practice and competency; 2. Residents feel they lack competency in the assessment and management of patients with developmental issues; 3. Residents' feelings of insufficient and inadequate training increase over time; 4. Residents recommend changes to developmental pediatrics training. Conclusion: As we prepare to transition to CBME, curriculum should be purposefully developed to meet resident identified need and reflect appropriate competencies required for clinical practice.

Aspiring Pain Practitioners in India: Assessing Challenges and Building Opportunities.

Background:Pain medicine is a developing specialty, aimed at relieving pain and suffering, enhancing function, and improving the quality of life of patients. Pain is often ignored, under-reported and mismanaged by health-care providers. Aspiring pain physicians in India face many challenges and barriers in advancing their specialty.Objectives:The objective of this study is to determine the challenges in establishing a pain practice in India and to discuss the opportunities and strategies to overcome these barriers.Subjects and Methods:Face-to-face interactive sessions were held with 60 aspiring pain physicians of India who were chosen as registrants to an International Association for the Study of Pain-Indian Society for Study of Pain multidisciplinary evidence-based pain management program conducted at Delhi and Mumbai. The available opportunities, practical issues and the hurdles in becoming a pain specialist were analyzed and summarized in this commentary.Results:The major barriers identified were: (1) Inadequate knowledge and absence of structured, educational and training courses, (2) bureaucratic hurdles, and (3) concerns of opioid misuse and addiction. The opportunities for personal growth and that of the specialty that could be utilized include the creation of a pain resource team, increasing community awareness, changing attitudes of other physicians toward pain specialty, and research and evidence building of the effectiveness of pain management strategies.Conclusion:India needs a structured teaching and training program in the area of pain medicine that is affiliated by the Medical Council of India or other reputed boards of medical education and certification. There is an urgent need to include pain management in the undergraduate and postgraduate medical curriculum. Enhancing community level awareness by public health education campaigns, developing networks of pain physicians, and appropriate marketing of the specialty is needed to make pain medicine recognized and utilized as a valuable specialty.

Integrating medical biostatistics into postgraduate medical curriculum.

Knowledge of biostatistics is important for a health professional to understand research methods, analyse new information presented in scientific journals and to assess its relevance for their clinical practice. We discuss the implementation of biostatistics in medical curricula, give perspectives on medical education in India, and narrate our own experience of integration of biostatistics into the medical curriculum. Biostatistics is still not a part of all postgraduate curricula in spite of its growing importance for all medical practitioners in the 21st century. The need for a reliable tool in research and evidence-based medicine is recognized in most postgraduate medical curricula in developed countries to improve teaching-learning outcomes.

Preventive psychiatry in medical curriculum

Mental and behavioral disorders are responsible for 7.4% of the total disease burden. Even with optimal care and service delivery, <30% of the burden of disease attributable to mental disorders can be averted, making a strong case for an increase in preventive efforts in psychiatry and mental health promotion. Clinicians can play an important role in implementation of preventive interventions. To carry out these important preventive skills, the training of the future physicians and psychiatrists should incorporate mental health prevention and promotion in the medical curriculum. Although preventive aspects of mental health have been included in the medical curriculum for undergraduates and postgraduates, most of the emphasis during training is on the curative aspects. In this article, various ways of enhancing mental health prevention and promotion component in the undergraduate and postgraduate medical curriculum have been discussed.

Essential Skills in Postgraduate Medical Curriculum of Community Medicine

Introduction: Community-based education has been considered a suitable approach for health promotion and for requisite skill development regarding primary health care. In the current perspective, public health training and research, being two important aspects require immediate attention. Objective: To assess the skills of Postgraduate Students in the Department of Community Medicine in four Medical Colleges of Delhi. Materials and Methods: It was a cross-sectional study conducted among 70 Postgraduate Medical Students of 4 Medical Colleges in Delhi. The data were collected through a self administered, pretested questionnaire containing items assessing socio-demographic profile and skills essential for Postgraduate Students of Community Medicine. Results: There were 58.6% male and 29% female students. A large proportion of participants were having age range between 25-29 years. Ability 'to resolve conflict among the nurse at Primary Health Centre (PHC)', 'generate community participation', 'making thick and thin smear in case of fever', 'making a chart showing month-wise distribution of CuT', and 'calculating Chi-square of data', were found to significantly higher in 2nd and 3rd year PG students than first year PG students (p&lt;0.01). Only 27.1% of students felt that they could test water sample for microbiological aspects while only 47.1% said that they could examine an industrial worker for pre-placement examination. Conclusions: PG students assessed themselves to possess necessary skills on communication, counselling and health education. However, many students lacked skills pertaining to occupational health and epidemiology.

Methods and frequency of sharing of learning resources by medical students

AbstractUniversity students have ready access to quality learning resources through learning management systems (LMS), online library collections and generic search tools. However, anecdotal evidence suggests they sometimes turn to peer‐based sharing rather than sourcing resources directly. We know little about this practice—how common it is, what sort of resources are involved and what impact it is likely to have on students' learning. This paper reports on an exploratory investigation of students' resource sharing habits, involving 338 respondents from the first 3 years of a 4‐year postgraduate medical curriculum. On average, students reported sharing learning resources with other students two or more times per week. They were most likely to share non‐curriculum resources (not available through their LMS) although curriculum and physical resources (eg, printed or handwritten notes and textbooks) were also often shared. Students employed a range of sharing technologies including email (most frequent), social media tools and cloud‐based file services. A cluster analysis revealed four distinct groups of students based on the frequency with which they share, the range of technologies they employ and whether they share both online and physical resources.

Acquiring surgical skills: the history of surgical teaching at the University of Sydney 1883-2014.

There have been at least 10 major revisions of the medical curriculum since the inauguration of the Faculty of Medicine at the University of Sydney in 1883. This study traced the evolution of the teaching of surgery at our institution by examination of the set curriculum of each period; the expectations of student knowledge in the final examination as well as examining some of the insights provided by past students of their surgical experience through their writings. In the early years, medical graduates were qualified to perform operative surgery without any further training, whereas the modern postgraduate medical curriculum provides students with the basis for further surgical training.