Quality Of Medical Training Research Articles

Formação na Residência Médica: visão dos preceptores

Abstract: Introduction: Medical residency is a specialization established as the gold standard for the training of specialists. It is a transformative professional phase for the young physician, aimed at improving the quality of medical training. By fostering the resident’s training while providing assistance to the users, the preceptor becomes a type of interlocutor between teaching and assistance. This professional needs to encourage their residents to develop their clinical and ethical sense, and it is generally reported that the preceptors are not trained for their teaching duties. Objective: to analyze the preceptors’ experiences and understandings related to the teaching activity in medical residencies. Method: Descriptive and quantitative study, consisting of 300 preceptors, of all age groups and genders, from Maceió, Alagoas. A questionnaire created and validated by Girotto was applied, containing 35 statements, divided into five factors, with emphasis on the preceptors’ opinions on several topics involving their activities. The percentages of positive and negative perceptions about each statement were analyzed. Results: There was a predominance of positive perceptions about the aptitude for educational activities (88.67%), development of theoretical-practical correlations in preceptorship (96%), perception of the need for learning (98.33%) and updating (87%). There was also a positive perception related to the presence of essential resources for teaching activities (71%); additionally, 91% of the preceptors reported that preceptorship integrates the resident into their team. However, it is noteworthy the fact that preceptorship constitutes non-remunerated work (75.34%), as well as the non-performance of pedagogical training (72%). Conclusion: The preceptors are part of an adequate environment for their teaching activities, with appropriate physical structure, in addition to support from the management and the institution. They feel able to teach, but in general they have not received teaching training. The residents are adequately incorporated into the residency environment, improving the service. However, overall, the preceptors are not paid for this work.

Simulation Based Training in Internal Medicine as an Essential Adjunct to Conventional Medical Education in a Developing World Setting

Medical training has over time significantly evolved globally. Plausibly, this may have been motivated by the need to produce qualified human resource in order to match the ever increasing demand on health services in the face of population growth and the associated rise in disease burden. The growing number of medical training institutions coupled with the increasing number of students enrolled in these institutions in the face of limited qualified human resource, infrastructure, equipment and patient subjects may pose a threat to the quality of medical training expected to be delivered and the caliber of graduates to be produced. However, this may also be an opportunity for the affected medical training institutions to come up with ways of supplementing the traditional methods of teaching in order to overcome the challenges met with delivering to huge numbers of students using the traditional approach alone. In this case simulation based training can be considered and applied in medical schools in the hope of enhancing training in clinical skills. The simulation based approach in training has been commonly used in faculties such as nursing, surgery, obstetrics and gynecology but less so, though now increasingly becoming the practice in Internal Medicine and Pediatrics training. Medical simulation can be defined as the use of a device or series of devices to emulate a real patient care situation or environment for the purposes of training, evaluation and/ or research. It is a mode of medical training that can enhance clinical skills in the students while also promoting patient safety. This paper will seek to examine the various simulation based methods and there applicability in medical training. The paper will further seek to analyze the role of simulation based training in the setting of medical education in Internal Medicine.

ROLE OF INDEPENDENT WORK IN DEVELOPMENT OF PROFESSIONAL COMPETENCE OF MEDICAL SPECIALISTS

Current global trends in the medical services market are creating new requirements for the quality of medical training. First of all, graduates of medical educational institutions should be guided in the latest technologies of medical science, be prepared to develop and implement scientific achievements in the system of practical health care. The assistance and quidance of future specialists in acquiring a high level of professional competencies, along with the fostering moral, emotional, and volitional qualities, life values and professional orientation, clinical thinking, are priority tasks of a modern higher medical school. The educational and scientific environment of a medical university provides great opportunities for successful professional and personal growth of specialists, however, the ever-increasing amount of knowledge and information requires the intensification of the learning process, and well-planned and organized tasks for students’ independent work is one of the forms of the effective learning strategy. In the context of the ECTS implementation, this form of learning is able to provide an independent search for the necessary information, creative perception and comprehension of educational material in the classroom and extracurricular time, the development of analytical skills and critical thinking. The effectiveness of independent work depends both on the organization of classes and the nature of the teacher’s influence, and on the self-organization of the student. The key to the success of this learning form also consists in a reasonable ratio between the volumes of class work and independent work, providing the student with the necessary methodological materials for independent work, conducting individual consultations, maintaining motivation among students. The tasks for independent work should include two levels of tasks: basic tasks, which are obligatory for everyone, and more advanced tasks, which based on deep understanding and mastering the basics. The article provides a theoretical justification and some aspects of the practical implementation of students' independent work at the Department of Histology, Cytology and Embryology, Ivano-Frankivsk National Medical University as one of the sources for improving the medical training quality.

Organization Decisions in Clinical Oncology Based on the Statistics of Malignant Neoplasms

Cancer service parameters in St.-Petersburg, Russia, were studied in relation to patients with urological malignant neoplasms (uMN) in 2014-2018. Material and methods. We studied a number of medical and statistical indicators obtained from the state reporting forms (ff. 7 and 35). Results. The exponential growth of absolute and “crude” indicators of morbidity and morphological verification of the MN of prostate, kidney and bladder in the early stages of the tumor is presented. An increase in the active detection of MN of the prostate gland (by 3.36) and kidney (by 2.26) were observed, due to the increase in oncological alertness at general practitioners. The number of bladder cancer patients who died within a year increased by 37.5%, indirectly indicates potentially aggressive forms of the tumor and the problem of early diagnostics of cancer. The maximum age of patients with newly diagnosed MN of the prostate/urinary bladder was 64-70 years, according to world statistics, kidney cancer diagnosed in patients of any age. Testicular MN was most often founded in patients 25-39 years old with an exponent in 2014-2016, penile MN – was verified at the age of 55-69 years, with a stable rate of increase in incidence. However, defects in the collection of primary medical information were identified, which made it difficult to evaluate cancer indicators. Conclusion. Original directions for the development of information collection medical systems and the provision of specialized medical care to the population of St-Petersburg are proposed - improving the system of registration of tumors and the quality of medical training and studies for stuff of statistical department, conducting research for prevention of the development of malignancies.

Medical education in Nigeria and migration: a mixed-methods study of how the perception of quality influences migration decision making

This article was migrated. The article was marked as recommended. Medical education in Nigeria faces numerous challenges and problems; a lack of a coherent admission policy, inadequate funding, poor planning, and erosion of values have led to a general perception of low standards and quality. In the face of these, questions arise as to their influence on medical students' aspirations and intentions to migrate after graduation. This study uses a sequential mixed-method design to examine the extent to which the perceptions of the quality of medical education in Nigeria affect the aspirations and plans of Nigerian medical students to migrate after graduation. 211 final year students (out of a potential 580) participated in a survey; aged between 20 and 45. While the survey showed that the students perceived medical education to be of sufficiently good quality across a spectrum of variables, interview respondents described a dysfunctional medical education that failed to meet their aspirations. The perception of a declining standard in medical training is a major issue for Nigerian medical students and graduates. The inability to halt the decline in the quality of medical training in Nigeria, therefore, leaves many medical students and graduates feeling inadequately trained, and inadvertently feeds their desires and aspirations to migrate abroad after graduation.

Biomechanical profiles of tracheal intubation: a mannequin-based study to make an objective assessment of clinical skills by expert anesthesiologists and novice residents

BackgroundTracheal intubation (TI) is a key medical skill used by anesthesiologists and critical care physicians in airway management in operating rooms and critical care units. An objective assessment of dexterity in TI procedures would greatly enhance the quality of medical training. This study aims to investigate whether any biomechanical parameters obtained by 3D-motion analysis of body movements during TI procedures can objectively distinguish expert anesthesiologists from novice residents.MethodsThirteen expert anesthesiologists and thirteen residents attempted TI procedures on an airway mannequin using a Macintosh laryngoscope. Motion capturing technology was utilized to digitally record movements during TI procedures. The skill with which experts and novices measured biomechanical parameters of body motions were comparatively examined.ResultsThe two groups showed similar outcomes (success rates and mean time needed to complete the TI procedures) as well as similar mean absolute velocity values in all 21 body parts examined. However, the experts exhibited significantly lower mean absolute acceleration values at the head and the left hand than the residents. In addition, the mean-absolute-jerk measurement revealed that the experts commanded potentially smoother motions at the head and the left hand. The Receiver Operating Characteristic (ROC) curves analysis demonstrated that mean-absolute-acceleration and -jerk measurements provide excellent measures for discriminating between experts and novices.ConclusionsBiomechanical parameter measurements could be used as a means to objectively assess dexterity in TI procedures. Compared with novice residents, expert anesthesiologists possess a better ability to control their body movements during TI procedures, displaying smoother motions at the selected body parts.

The Educational and Clinical Benefits of a “Consultant-Speciality Trainee” ENT Shared Clinic

Introduction and Aims. The European Working Time Regulations (EWTR) of 48-hour working week limit have raised concerns regarding the quality of medical training for junior doctors. Our study has looked to improve junior doctors training without impairing patients’ care with the introduction of one-to-one “consultant with specialty trainee” doctor teaching in the outpatient clinic setting. Methodology. In this study, an ENT specialty trainee conducted a 3-month block of solo clinics seeing new patients. After that, the same specialty trainee shared the clinic with an ENT consultant for 3 months and subsequently the same trainee reconducted solo clinics. Outcomes of the specialty trainee performance were measured clinically by completed patient episodes (CPE) (i.e., patient discharged from clinic or placed on surgical operation waiting list) and ongoing patient episodes (OPE) (i.e., patient given follow-up appointment to ENT clinic) and educationally by workplace based assessments (WBA) completed in the trainee’s e-portfolio. Results. 271 patients were recruited in this research: 24% being in the preintervention group, 47% during the intervention, and 29% in the postintervention. The intervention of one-to-one outpatient clinic teaching increased the specialty trainees CPE rate (60% to 67.5%, p>0.1) and reduced their OPE rate (40% to 32.5%, p=0.001). Educationally these trainees completed with the consultant statistically significant WBA (17 assessments) during the one-to-one clinics compared to solo clinics (2.3 on average). Discussion and Conclusion. In this study, a positive trend in the clinical outcomes was obtained in terms of CPE, while a statistically significant reduction of the total OPE was achieved giving an indicator to consider this concept for further research in terms of patient’s clinical outcomes. Nevertheless, it showed a new way of supporting the trainee’s education supported by more WBA being filled.

Does the Stress of Exams Period Influence Medical Students Blood Pressure? A Longitudinal Study

Background: Based on relation of pathological effects of stress on the body and its reflex on blood pressure, the high level of stress undergone by medical students becomes a concern about quality of medical training and its health. The aim is to verify the possible influence of stress during exam periods on the blood pressure of medical students.Method: The systemic arterial pressure (SAP) of 109 medical students of an institution was measured and analyzed in the period from March to September 2016, using the standardization recommended by the American Heart Association, in 3 time intervals: school holidays, classes without exams, and classes with exams.Results: The authors verified that the systolic arterial pressure and cardiac frequency values checked on exam days were statistically higher (mean of 121.60 mmHg and 85 bpm, respectively) than when measured on class days or during vacations. Whereas the systolic arterial pressure and cardiac frequency values measured on class days were significantly lower than those on the other days (mean of 112.75 mmHg and 74.86 bpm, respectively).Conclusion: The authors statistically verified that stress during exam periods had an influence on the arterial blood pressure of medical students, bringing into focus the need for teaching institutions to provide these students with psychosocial and pedagogical support.

The Enduring Legacy of 250 Years of Pharmacology in Edinburgh.

In 1768, 250 years ago, the University of Edinburgh appointed Francis Home to the first chair of materia medica, the accumulated knowledge of materials used in healing. Francis Home and his colleagues were determined to improve the quality of medical training in Edinburgh by introducing a final examination and compiling a catalog of medicines validated by the Royal College of Physicians of Edinburgh. The catalog, known as the Edinburgh Pharmacopoeia, was a great success, partly due to the orderly nature of its contents, its routine editing to eliminate worthless entries, and the introduction of new treatments whose preparation was precisely documented. In a relatively short time, the worth of the Edinburgh Pharmacopoeia was recognized throughout Europe, America, and the British Empire. Today, the British and European Pharmacopoeias are catalogs of publicly available, legally enforceable standards for active pharmaceutical ingredients and finished dosage forms of pharmaceutical products and medical devices. Home and the many luminaries who succeeded him would surely take pleasure and pride in the fact that the mantra of today's medicines regulators worldwide is little different from that of these early visionaries: "To take better advantage of the best possible science in the service of the public health and our health-care systems" ( 1 , p. 492).

Steps towards Updating the Curriculum and Teaching Methods in Obstetrics, Gynaecology and Neonatology in Mongolia

Background: Medical education in Mongolia faces many challenges in terms of staff capacity, large student numbers, and limited access to clinical experience. The Government of Mongolia has placed a high priority on reducing maternal and infant mortality, necessitating improvements to the quality of medical training, ensuring a highly skilled health workforce is produced and maintained. In 2014, a team of academic staff from Sydney Medical School were appointed by United Nations Population Fund (UNFPA) to assist in reviewing and updating the medical student curriculum in obstetrics, gynaecology and neonatology in accordance with international best practice. The first phase involved a visit from a senior delegation from Mongolia, including representatives from the Mongolian National University of Medical Sciences (MNUMS), UNFPA and the Mongolian Ministry of Health to Sydney. The week long programme was designed to demonstrate best practice in obstetrics, gynaecology and neonatology undergraduate medical education; and display modern teaching practices. Methods: Course design included demonstration and participation in a four station Structured, Clinical, Objective, Reference, problem-oriented, Integrated, and Organised (SCORPIO); observation of a Clinical Reasoning Session (CRS); demonstration and participation in a four station OSCE, and teaching of best practice in writing single-best answer multiple choice questions. Participants also took part in a teacher training session. The programme was implemented at a large teaching hospital in Sydney, Australia. We employed mixed-methods to evaluate the programme, using pre- and post-questionnaires and a focus group. Results: The programme increased participants’ perceived understanding and ability to apply educational principles, plan learning activities, and provide feedback. In particular, participants perceived that their understanding how to implement SCORPIO, CRS and OSCE had increased. However, participants would have liked greater opportunity to observe bedside teaching. Participants foresaw challenges to the implementation of educational changes in Mongolia, including the anticipated difficulty of engaging hospital staff in teaching; implementing a student-centred approach to teaching; and providing a large number of students with adequate clinical experience. Conclusion: Changes in educational strategy in Mongolia may assist medical schools to produce clinically competent graduates. Our programme provided an effective means to introduce Mongolian leaders in health and education to modern student-centred medical education teaching and assessment methods; and to highlight the importance of teacher training and evaluation as a strategy to engage both university and hospital staff in medical education. Additionally, programme outcomes assisted in subsequent phases of the project, including in-country needs assessment, curriculum development and delivery.

Professional Competencies of Cuban Specialists in Intensive Care and Emergency Medicine.

INTRODUCTION The quality of medical training and practice reflects the competency level of the professionals involved. The intensive care and emergency medicine specialty in Cuba has not defined its competencies. OBJECTIVE Identify the competencies required for specialty practice in intensive care and emergency medicine. METHODS The study was conducted from January 2014 to December 2015, using qualitative techniques; 48 professionals participated. We undertook functional occupational analysis, based on functions defined in a previous study. Three expert groups were utilized: the first used various group techniques; the second, the Delphi method; and the third, the Delphi method and a Likert questionnaire. RESULTS A total of 73 specific competencies were defined, grouped in 11 units: 44 in the patient care function, 16 in management, 7 in teaching and 6 in research. A competency map is provided. CONCLUSIONS The intensive care and emergency medicine specialty competencies identified will help improve professional standards, ensure health workforce quality, improve patient care and academic performance, and enable objective evaluation of specialists' competence and performance. KEYWORDS Clinical competency, competency-based education, professional education, intensive care, emergency medicine, urgent care, continuing medical education, curriculum, medical residency, Cuba.

Integrating the Learner's Perspective in the Refinement of Competency-Based Assessments

Beginning with the Accreditation Council for Graduate Medical Education's (ACGME) Outcomes Project, which introduced the core competency domains within medical practice,1 there has been a shift in graduate medical education towards competency-based training.2 Ideally, this framework aligns the medical needs of patients with ensuring that the outcomes of training prepare graduates to meet those needs3—a goal consistent with ongoing efforts to improve the quality and safety of patient care.4,5 Educators have responded to concerns about the frequency of medical errors and the quality of medical training by focusing assessment strategies on the transparent, accurate documentation of trainee performance within key clinical competency domains.

Medical education in Vietnam

Background: Vietnam is one of the most populous countries in Southeast Asia, yet it displays an unsettling lack of doctors.Aims: Medical education is an important factor contributing to this issue, yet little is known about the system currently in place in Vietnam.Methods: Through an extensive literary search of medical schools’ and Ministry of Health's data, we have examined the current medical education system in Vietnam.Results: At present, there are 12 medical universities, and the general curriculum at each university follows a national framework but tends to vary from university to university. Medical training lasts either 4 or 6 years, with competitive graduates attending residency programs following graduation. While examinations are required to graduate, the lack of a national licensing exam makes it difficult to ensure that a nation-wide standard of quality exists, both at the medical universities themselves as well as amongst the doctors graduating from them.Conclusions: The development and institution of a national exam would introduce a standard of training throughout Vietnam's medical education system. Further, a substantial portion of a doctor's education is in subjects that are loosely related to medicine. When looking forward it will be important to evaluate whether or not these non-medical subjects detract from the quality of medical training.

Impact of EWTD on patient:doctor ratios and working practices for junior doctors in England and Wales 2009

The European Working Time Directive (EWTD) has resulted in large changes in the working patterns of junior doctors in the U.K. All consultant physicians in England and Wales were invited to anonymously submit data on their teams for 11 am and 11 pm on 5 November 2009. Data on doctor number, grade, location and patient number were collected. Data were available on 887 hospital teams at 11 am and on 670 teams at 11 pm. At 11 am, the average number of patients per ward doctor was 11 (2-65). At 11 pm the average number of patients per doctor was 61 (1-400). Consultants were present overnight in 6.1% of teams. Doctors in the first two years of training were the most senior medical cover in 63 teams. Sickness rates varied between 1.5% and 3.5% for junior doctors, and were significantly higher in the second foundation year. Vacancy rates at the specialist registrar level were 8.6%. Trainees were available for training 66-80% of the time. These findings have significant implications for patient safety and quality of medical training in the U.K.

Quality of medical training and emigration of physicians from India.

BackgroundPhysician 'brain drain' negatively impacts health care delivery. Interventions to address physician emigration have been constrained by lack of research on systematic factors that influence physician migration. We examined the relationship between the quality of medical training and rate of migration to the United States and the United Kingdom among Indian medical graduates (1955–2002).MethodsWe calculated the fraction of medical graduates who emigrated to the United States and the United Kingdom, based on rankings of medical colleges and universities according to three indicators of the quality of medical education (a) student choice, (b) academic publications, and (c) the availability of specialty medical training.ResultsPhysicians from the top quintile medical colleges and of universities were 2 to 4 times more likely to emigrate to the United States and the United Kingdom than graduates from the bottom quintile colleges and universities.ConclusionGraduates of institutions with better quality medical training have a greater likelihood of emigrating. Interventions designed to counter loss of physicians should focus on graduates from top quality institutions.

Medical education in Nigeria

Nigeria is the most populated black African nation, with a population of 140 million from the 2006 population census. Medical education began with the establishment of the University College Hospital, Ibadan as a College branch of the University of London in 1948. Since then four generations of medical schools have evolved. The newer medical schools adopted the curriculum of the older schools with little modification. The subsequent introduction of changes and modification in the curriculum of medical education worldwide did not seem to affect Nigerian medical schools. Teacher training in educational methods for medical educators has not been introduced, nor has there been any curriculum planning or review. Efforts made regionally and nationally to change the medical curriculum and improve quality of medical training has not yielded the desired results. The regulatory bodies, the National Universities Commission and the Medical and Dental Council of Nigeria introduced separate curricula for medical schools, as a guide to minimum standards, but there has been so far a varying degree of compliance by the Universities. There is an urgent need to bring Medical Education and teacher training issues to the fore. Needs assessment of medical school faculty to determine their training would be seen to be a good starting point, as well as curriculum transformation and the introduction of newer assessment methods. It is suggested that the Medical and Dental Council of Nigeria (MDCN) should take a leading role by collaborating with outside bodies concerned with medical education.

Disponibilidad de médicos en Chile y su proyección a mediano plazo. Cinco años después

According to a prospective study performed in 1993, Chile had 14,400 active physicians (excluding those over 70 years of age) and a physician/inhabitant ratio of 1:960. The estimated projection for 1998 was of 16,244 physicians and a ratio of 1:921. However, during the present decade, the number of medical schools in Chile has duplicated, increasing by 38.4% the number of available posts in Medical schools. Also, 1,297 physicians graduated abroad, have been incorporated. Therefore, previous projections must be revisited. The present study shows that in 1998, Chile has 17,441 physicians (1:850), will have 20,610 (1:765) in 2003 and 24,449 in 2008. This last figure means a physician/inhabitant ratio of 1:679, similar to that of countries with a consolidated market economy. The foreseen medical population increase rate of 3.5% doubles the general population increase rate. To assure the quality of medical training, a Medical School accreditation process is being held. This study highlights the need to review bilateral agreements subscribed with five countries, that recognize the physician degree without assessing the medical skills of foreign graduates.

Medical Education and Instructional Design

The rising costs of medical care and the training of medical professionals has brought about circumstances which threatens the acceptable quality of medical care in the United States. Fewer medical schools and a drop in the rate of enrolled medical students are but two indicators reflecting the issue between cost versus quality of medical training. One of the medical communities responses to this crisis has been the introduction of educational technology and instructional design processes in the training of medical professionals. This paper discusses the background of the problem and offers an instructional design model which has applied success.