Quality Of Medical Education Research Articles

The impact of a dedicated training program for oral examiners at a medical school in Germany: a survey among participants from operative and non-operative disciplines

BackgroundOral examinations have been a crucial format in ancient and modern assessment to evaluate and guarantee quality of medical education and thereby to secure patient safety. To achieve a high level of quality in the oral part of the final examination of medical students, a training program for oral examiners at the Medical Faculty of Ulm (Germany) has been established since 2007.However, little is known about the attitude of the examiners in regard to the impact of this training program and of oral examinations as instruments to ensure patient safety.MethodsAll 367 academic clinicians from operative and non-operative disciplines, attending the one-day examiner training program at the University of Ulm between 2007 and 2012 have been asked to answer an online survey (EvaSys 5.0). Focus of the survey was to find out in which respect the examiners profited from the trainings, if the training effects were discipline-dependent, and to which degree the oral examinations could contribute to patient safety. Statistical analysis was performed using the t-test for independent samples. Results were considered statistically significant when p < 0.05.ResultsA total of 63 participants answered the survey, but in 4 cases the questionnaire was not fully completed (with single items missing). More than half of the study participants (n = 34/59; 58%) have experienced (at least sometimes or rarely) candidates that they deemed incompetent and perhaps even dangerous to the patients’ health who nevertheless passed the oral exam successfully. The majority of participants were convinced that oral examinations using concrete clinical cases could significantly contribute to patient safety, if grading is based on clear criteria and if examinations as well as grading are performed more critically. The impact of the training program was rated significantly stronger by surgeons than by non-surgeons in several categories. These categories included “strengths and weaknesses of oral examinations”, “reliability”, “validity”, “competence in grading”, “critical grading”, and “departmental improvements” concerning oral examinations.ConclusionsIn respect to patient safety, it seems crucial to prevent incompetent candidates from passing the oral examination. The present study indicates the importance to continue and to develop our examiner trainings, with main emphasis on concrete clinical problems and a criteria-based critical grading system for oral examinations. Since the impact of the training was particularly high for colleagues from the operative disciplines, the training program should be offered especially in surgical departments.

Kako pripomoči k učinkovitejšemu učenju in spreminjanju življenjskega sloga oseb s kronično boleznijo

Ob pojavu kronične bolezni, ki prizadene vsakega šestega od desetih odraslih, je treba poskrbeti tako za zdravstveno urejenost bolezni kot za obvladovanje čustvenih odzivov nanjo (jeza, strah, frustracije, žalost), ne nazadnje pa je treba ohraniti oz. (pre)oblikovati (nove) vloge na delovnem mestu, v družini in med prijatelji. Na poti iskanja primernih strategij obvladovanja kronične bolezni in življenja kroničnega bolnika ima zdravstveno osebje zelo pomembno vlogo. Obolelim bi morali ponuditi kakovostne zdravstvenovzgojne programe, ki se ne osredinjajo le na značilnosti kroničnih bolezni in na možnosti zdravljenja, marveč upoštevajo tudi človeško stisko ob sprejemanju kronične bolezni, pa tudi njen vpliv na preostala področja posameznikovega življenja. Raziskave kažejo, da ima pri vseh teh nalogah za obolele- ga zelo veliko vlogo sposobnost empatičnega komuniciranja zdravstvenega osebja.

Students’ view upon graduation: a survey of medical education in Taiwan

BackgroundImproving the quality of medical education is a key goal of government policy in Taiwan. The aim of this study was to reflect the responses of medical education from the perspective of graduating medical students in Taiwan. This is the first survey study of medical education in Taiwan.MethodsUsing the Medical School Graduation Questionnaire from the Association of American Medical Colleges (AAMC), we distributed 406 questionnaires to medical students of four medical schools in their last semester, and received 270 back (response rate, 66.5%). There were 11 medical schools in Taiwan. Most questions were assessed on a 5-point Likert scale.ResultsStudents identified genetics, biochemistry, and ethics as the three most important premedical subjects preparing them for medical education and gross anatomy, physiology, and pharmacology as the three most helpful basic science subjects preparing them for clinical clerkships and electives. Most Taiwanese students were satisfied with their learning experience in internal medicine. Only 55.9% of students were confident that they had acquired the clinical skills required to become a resident, and 70.7% were satisfied with the quality of their medical education.ConclusionThe study offers preliminary results on the views of graduating students on the medical education system in Taiwan. In particular, our government and medical educators need to continuously put more effort into building students’ confidence in their clinical skills.

In Urban And Rural India, A Standardized Patient Study Showed Low Levels Of Provider Training And Huge Quality Gaps

This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. What's more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. Our results suggest an urgent need to measure the quality of health care services systematically and to improve the quality of medical education and continuing education programs, among other policy changes.

Henry Walton

Henry Walton, who died on 13 July this year, aged 88 years, was an extraordinary man who made outstanding contributions to this journal and to medical education more widely. He edited the journal in its various forms for more than 30 years. It was his vision and drive that transformed the British Journal of Medical Education into the International Journal of Medical Education and then into, simply, Medical Education. The global reach and worldwide responsibilities of medical education lay at the heart of his work and his achievements. Henry grew up in South Africa and graduated from the medical school in Cape Town. After postgraduate training in London and New York, and subsequent to a short period back in South Africa, he was invited to take up a Chair in Psychiatry at the University of Edinburgh in 1963. His clinical research interests included suicidal behaviour, alcoholism and the inter-relationships of physical and mental illnesses presenting in general hospitals. From the outset of his career in Edinburgh, Henry devoted much of his time to research in higher education, completing a PhD in the teaching of psychiatry in the mid-1960s and helping to found the Society for Research in Higher Education in 1971. Within higher education, medical education was Henry’s passion. His role in creating and developing institutions devoted to improving medical education is unequalled: he was secretary and then president of the Association for the Study of Medical Education (ASME), a founder and the first president of the Association for Medical Education in Europe (AMEE), and a founder and first president of the World Federation for Medical Education (WFME). In 1986 the University of Edinburgh appointed Henry to the Chair in International Medical Education. In this role and as president of the WFME in 1988, Henry organised the World Congress in Medical Education that produced the Edinburgh Declaration. The 12 principles set out in that document have proved to be of great influence. In particular, they underpin the WFME global standards that represent a benchmark for quality in medical education and are applied directly or indirectly in countries across the world. Henry was honoured with many awards, notably the Gold Medal of the Albert Schweitzer Academy of Medicine in 2003. This list of achievements does not capture the unique style that Henry brought to all his activities. I had the privilege of working with Henry in both his clinical and educational spheres. He was gracious and charming in manner, but tenacious in the pursuit of his goal: his was a steel hand in a silk glove. Silk is an appropriate description; immaculate in his attire, Henry was never afraid to dress with an edge of flamboyance in the conservative world of medicine. Art collecting was the other enduring passion that Henry pursued with energy, determination and success. As in his dress, he was eclectic: his collection contained challenging examples of modern art, as well as drawings by various of the Old Masters and Chinese jade pieces. High quality was his only requirement for the decision to purchase. Variety and individuality attracted him in art, in psychiatry and in medical education. In his clinical work, Henry insisted on a rigorous personality description, as well as an illness diagnosis. In medical education, he was particularly interested in the learning that takes place in small groups. In all three spheres, he wished to understand the interactions of an individual with his or her specific context and environment. The quality of his art collection led to its acceptance in 2010 by the National Galleries for Scotland. Henry’s art collection is one of his legacies; the Edinburgh Declaration is another, but the third, in my view, is his greatest: Medical Education. This journal continually develops and changes because Henry set it free from the limitations and preoccupations of one country to enable it to become a forum for those interested in improving medical education, wherever they live and work.

Improving Diversity Through Strategic Planning

The Medical University of South Carolina launched a systematic plan to infuse diversity among its students, resident physicians, and faculty in 2002. The dean and stakeholders of the College of Medicine (COM) embraced the concept that a more population-representative physician workforce could contribute to the goals of providing quality medical education and addressing health care disparities in South Carolina. Diversity became a central component of the COM's strategic plan, and all departments developed diversity plans consistent with the overarching plan of the COM. Liaisons from the COM diversity committee facilitated the development of the department's diversity plans. By 2011, the efforts resulted in a doubling of the number of underrepresented-in-medicine (URM, defined as African American, Latino, Native American) students (21% of student body); matriculation of 10 African American males as first-year medical students annually for four consecutive years; more than a threefold increase in URM residents/fellows; expansion of pipeline programs; expansion of mentoring programs; almost twice as many URM faculty; integration of cultural competency throughout the medical school curriculum; advancement of women and URM individuals into leadership positions; and enhanced learning for individuals from all backgrounds. This article reports the implementation of an institutional plan to create a more racially representative workforce across the academic continuum. The authors emphasize the role of the stakeholders in promoting diversity, the value of annual assessment to evaluate outcomes, and the positive benefits for individuals of all backgrounds.

Variability of Physics Education in Radiation Oncology Medical Residency Programs

The aim of this study was to compare the quality of medical physics education for radiation oncology medical residents. An independent survey regarding physics education was carried out using e-mail. The survey contained 12 questions addressing the duration, length, and quality of education. Responses were tabulated and compared with the recommended educational scheme. Nearly 56% of institutions participated in this survey. Educational patterns were found to be significantly variable among institutions. Some have minimum physics education (10 lectures), and some have 90 lectures per year. In general, two-thirds of the institutions require residents to attend classes up to the third year. Significant variability of physics education for radiation oncology medical residents was observed, contrary to the national recommendations. With advanced treatment techniques, physics education should be given more importance, and the number of lectures should be increased to accommodate every aspect of radiation oncology practice.

A Psychometric Analysis of Research Perceptions in Osteopathic Medical Education

Background: Evidence-based medical practice demands that physicians acquire proficiency in research methods. This study psychometrically evaluates the construct of research perceptions of osteopathic medical students, interns, and residents (trainees) to inform research curricula goals. Methods: Using focus groups and literature reviews, preliminary survey items were developed, and administered as a survey to obtain a set of research perceptions construct items. The resulting items were cross examined by experts for content validity. Factor analysis and multivariate analysis of variance (MANOVA) were used. Results: A final structure of research perceptions construct has 19 items, reliability.840, and three key domains: (1) research needs/attitudes, (2) research climate, and (3) research skills. Statistically significant difference in the domain mean summative scores between students and residents was observed. Conclusion: Osteopathic medical trainees have fairly positive clinical research perceptions despite observed differences in the key research perceptions construct domains. Further exploration and validation of the research perception construct is necessary to ensure that medical research education is evidence-driven, responsive, and targeted in a manner that improves the overall quality of medical education.

National differences in quality of integrative postgraduate medical education? A survey in anthroposophic hospitals in Germany and Switzerland

National differences in quality of integrative postgraduate medical education? A survey in anthroposophic hospitals in Germany and Switzerland

Student Attitudes towards Computer Assisted Learning: Scalingup Medical Education in a Poor Setting

economic, infrastructural, and manpower challenges peculiar to poor settings pose daunting obstacles to quality medical education and healthcare delivery in those settings. The purpose of the current study therefore was to determine from the perspective of students how to effectively incorporate information communication technology (ICT) in to the medical curriculum to help improve tuition and scale - up training in a Ghanaian Medical School, and concluded that blended instructional models may be more suitable. KeywordsAssisted Instruction, Medical Education

Discussion on quality training and medical education measures for further study physicians in department of vascular surgery

The decade practical training experiences in vascular department of Xuanwu Hospital were reviewed.Quality training and medical education measures for further study physicians in department of vascular surgery were introduced and summarized from medical ethics education,professional training,theoretical knowledge training and quantitative assessment.All these measures were intended to improve the overall quality of vascular surgical further study physicians and to guarantee the most gain for trainees. Key words: Vascular surgery; Further study; Medical education

P03.10. The quality of integrative postgraduate medical education within the public health care system of Germany: the example of anthroposophic hospitals

Methods We conducted an anonymous survey among all 215 residents of the 34 departments of all 11 German hospitals providing AM and IM and regular postgraduate medical education (PME), using an instrument with 71 scaled questions developed by the ETHZ for assessing QPME in CM hospitals, complemented by 22 additional questions for AM aspects of PME. Forty-two percent responded. Data were analyzed descriptively and according to department sizes and clinical disciplines.

A Comparative Study of Knowledge and Satisfaction of Faculty Members and Students with Education Development Center Activities (Babol-2010)

Background: Educational Development Center (EDC) establishment is one of the procedures to improve quality of medical education. As positive knowledge and attitude of lecturers and students are essential factors to gain access to goals of these centers, the aim of this project was to assess knowledge and satisfaction of faculty members and students about EDC activities, Babol-2010. Methods: This project is a descriptive-analytical and crosssectional study which was done using questionnaire among 147 faculty members, 75 residents and 80 interns. Samples were collected using randomized, census and simple sampling methods, respectively. Data were analyzed using Chi square, ANOVA and T-tests. Results: According our results, mean of the knowledge score (in a scale of 0-15) among faculty members was higher than residents and interns (9.48 compare with 4.36 and 7.67). ANOVA test results showed that there was a significant difference between them (P<0.05). Also, Pearson correlation calculation revealed that there were positive and significant correlations between years of experience and teaching experience among faculty members and the knowledge score. Our results regarding satisfaction of EDC activities (in a scale of 0-5) demonstrated that faculty members had the highest mean score in comparison with residents and interns (2.86, 2 and 1.83, respectively). Conclusions: Although faculty members had a better knowledge and attitude regarding EDC activities compare with residents and interns, but continuous education, discussion session and rewarding measures are necessary in order to improve condition

Preliminary exploration of medical humanistic quality education in pathology teaching

Enhancing medical humanistic quality education is the essence of medicine and it is also a necessity of conforming to the transformation of medical model.The pathological teachers should improve their humanistic quality actively,integrate humanistic quality training into pathology teaching and focus on training the social responsibility and healthy psychological qualities in order to enhance medical students' humanistic accomplishment and to make them become high qualified medical talents. Key words: Pathology; Teaching; Humanistic quality; Medical education

Online medical education: determinants and development prospects with reference to Indian institutions

PurposeThe purpose of this paper is to present an initial discussion on issues related to imparting medical education through the e‐learning mode in India.Design/methodology/approachThe approach takes the form of the authors' observations as well as reflections on discussions with medical practitioners.FindingsOnline medical education has the potential to address the issue of shortage of medical professionals in India. This study provides insights into the receptiveness of the faculty members regarding the paradigm shift from traditional classroom to online learning environment. It describes the apprehensions, the hurdles and the probable way forward to aid e‐learning in medical education. The discussion can influence policy makers with regard to required accreditation systems for offering and acceptance of online degrees. It can also aid the cause of increasing the doctor‐population ratio, which may lower the deficiency of skilled professionals in the rural regions, thereby ensuring the availability of quality medical education and service to all strata of society at affordable options.Originality/valueThis paper draws on the knowledge, experiences and insights of medical practitioners and trainers in India who regularly interact with faculty, administrators, students and policy makers. As an initial work in this crucial area, the paper raises several questions and identifies areas in need of immediate examination.

Quality management of body donation program at the University of Padova

Quality management improvement has become a recent focus of attention in medical education. The program for the donation of bodies and body parts (Body Donation Program) at the University of Padova has recently been subjected to a global quality management standard, the ISO 9001:2008 certification. The aim of the present work is to show how the above standard is useful in enhancing the efficiency of body donation procedures and the quality and output of medical education. The program is managed by means of the following interlinked procedures: the collection of body donations, death certificates, data, and body parts from living donors; the transportation and identification of cadavers; the management of bodies, body parts, equipment, instruments, purchasing of necessary materials, and setting up anatomical training sessions; the management of preventive and corrective actions; the management of documents and registration; the management of internal and external quality audits; and the review of outcomes and improvement planning. Monitoring indicators are identified in the numbers of donors and of donated body parts per year, education sessions, and satisfaction of learners and donors, as evaluated by questionnaires. The process management approach, the integrated involvement of medical, technical, and administrative staff in defining procedures, and the application of monitoring indicators allow quality improvement in all aspects of the Body Donation Program.

Das Marburger chirurgische Curriculum - Attraktivitätssteigerung der studentischen Ausbildung in der Chirurgie durch Vermittlung von chirurgischen Kernkompetenzen

The quality of medical education is an ongoing challenge due to the continuing changes of the health-care politics and general social conditions. At many German university hospitals the dominating picture is overfilled courses, lack of hands-on practice, reduced patient contact and the dull provision of theoretical, abstract knowledge. The reformed surgical curriculum at the University of Marburg university hospital is used to demonstrate that, in spite of large student numbers, a practice-oriented, small-group training at a high didactic level is possible. The surgical training courses are organized in detail and coordinated. Course contents and structure are media availablein print and online versions for both studentsand teachers and thus fulfill not only transparency needs but also contemporary requirements. The strategy of a practice- and patient-oriented, small-group training is followed strictly in the surgical curriculum. In addition, accompanying tutorial possibilities for individual study in an up-to-date learning center are offered. Here the students have the opportunity to intensify knowledge acquired in previous or future courses with numerous attractive education means. Continuous evaluation of the individual training courses at the end of each semester not only document motivation of the students but also serve to continuously improve the training concepts.

Handoffs in the Era of Duty Hours Reform

With changes in the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements related to transitions in care effective July 1, 2011, sponsoring institutions and training programs must develop a common structure for transitions in care as well as comprehensive curricula to teach and evaluate patient handoffs. In response to these changes, within the Duke University Health System, the resident-led Graduate Medical Education Patient Safety and Quality Council performed a focused review of the handoffs literature and developed a plan for comprehensive handoff education and evaluation for residents and fellows at Duke. The authors present the results of their focused review, concentrating on the three areas of new ACGME expectations--structure, education, and evaluation--and describe how their findings informed the broader initiative to comprehensively address transitions in care managed by residents and fellows. The process of developing both institution-level and program-level initiatives is reviewed, including the development of an interdisciplinary minimal data set for handoff core content, training and education programs, and an evaluation strategy. The authors believe the final plan fully addresses both Duke's internal goals and the revised ACGME Common Program Requirements and may serve as a model for other institutions to comprehensively address transitions in care and to incorporate resident and fellow leadership into a broad, health-system-level quality improvement initiative.

Evaluating a masters of medical education program: Attaining minimum quality standards?

Background: As more Masters of Medical Education programs (MMEPs) become available, the quality of these programs will be under increased scrutiny.Aims: We applied World Federation for Medical Education (WFME) quality standards in an internal evaluation process involving participants and faculty to determine: (i) if our MMEP met minimum quality standards (ii) if WFME standards provided a useful framework to evaluate minimum standards in our context and (iii) whether the program was perceived as developing future educational leaders.Methods: A cross-sectional researcher developed survey, interviews and secondary data analysis were utilized for data collection. Quantitative data were analyzed using SPSS version 16. Descriptive statistics were generated. Fisher′s exact test determined statistically significant differences between groups. Qualitative data were analyzed using a framework analysis.Results: All students attending the MMEP 2007–2010 (n = 67) and faculty (n = 11) were invited to participate; 48% students and 91% faculty responded. Quantitative and qualitative results demonstrated positive perspectives regarding all three aspects of our enquiry. Nevertheless, needed improvements were identified in the areas of availability of human and physical resources, feedback and aspects of the research experience.Conclusions: Impact on quality of health professions education in the Kingdom and participant educational leadership development are particularly important social responsiveness features of the program. Refinement of the evaluation instrument and WFME standards to ensure clarity and relevance to local contexts as well as a future expected imperative to move beyond social responsiveness to social accountability in health professions education, are future challenges discussed.

Integrating patients into medical education.

The discussions about medical education in the public focus upon quantity. The quality of the teaching process isn’t questioned. But the professionalization of medical education should start with a close look at bedside teaching because it is the core of training medical doctors.Patient-centered teaching: German medical leicensure act (Approbationsordnung) defines the quality of medical education by standard setting for group sizes and fixing the hours of bedside teaching. Although there are some fuzzy definitions it is possible to extract some special forms of bedside teaching. The capacity act (Kapazitätsverordnung) interprets these definitions for calculating the number of students who could be enrolled each year.Types of bedside teaching: The different forms of contact with patients which are necessary for a good medical education can be transformed into distinct types of courses. Our classification of courses with specific forms of patient contact is suitable to describe each German program of medical studies. This quantitative profile offers new opportunities for comparing medical education at the different faculties.Discussion: In many German medical schools the hours of bedside teaching are allocated in a verv pragmatical way according to the medical leicensure act. A more professional curriculum planning leads to a sophisticated use of these diverse forms of patient-centered teaching. Because this professional planning is better derived from the legal basis it offers new arguments against an economically oriented hospital management.