Quality Of Undergraduate Medical Education Research Articles

Quality of Teaching-learning in Undergraduate Medical Education in Bangladesh - Views of Stakeholders

This descriptive type of cross-sectional study was carried out in 4 government and 4 non-government medical colleges of Bangladesh to assess the quality of undergraduate medical education. The study was conducted during the period of July 2018 to June 2019. The total sample size was 576, out of which there were 440 fifth year medical students, 114 clinical teachers and 22 Key informants. Convenience sampling technique was adopted. Two self - administered semi- structured questionnaires and one in-depth-interview schedule were utilized for the study. The study revealed that there was shortage of teaching staffs and infrastructure facilities. However numbers of hospital beds, indoor and outdoor patients were found to be sufficient. Study revealed that most of the students learned to take history, examine the patients; but had difficulties to make a provisional diagnosis. The clinical teaching in evening session was found to be neglected. Teachers could not ensure students’ learning of optimum skills and attitude. The study recommended reviewing the curriculum. Course burden should be reduced by removing redundant contents. The subjects namely Pathology, Microbiology and Pharmacology need to be rearranged to shift those to second phase. Emphasis is required to be given on behavioural science, communication skills and medical ethics.
 Bangladesh Journal of Medical Education Vol.11(2) 2020: 34-42

COVID-19 impact on medical education and the future post-pandemic era for medical students

The COVID-19 global emergency has brought about unexpected changes in the format and quality of undergraduate medical education in a short period of time. The impact of remote delivery on medical students learning, satisfaction, confidence, social relationships, communications and emotional wellbeing has been significant. The lack of direct patient and teacher contact is generating anxiety about their future competence. The ambivalence about urge to help without sufficient clinical skills and the fear of being either infected or becoming an asymptomatic carrier that puts patient safety at risk is of concern to them. Suggestions for enhancing pandemic or global emergency preparedness for the future are made. Strategies to manage the way in which remote learning is delivered need to be implemented as a matter of urgency should social distancing and quarantine regulations keep medical students away from hands-on clinical practice for long periods. Actions to maintain motivation and trust in the medical schools to meet their learning needs now and in the future are warranted.

Current Issues and Future Considerations in Undergraduate Medical Education from the Perspective of the Korean Medical Doctor Development System

Observation of the current Korean medical education and training system shows that certain negative traits of unchangeable solidification engraft themselves so deeply into the overarching system that they are now hampering the state of the national health welfare. Focusing only on undergraduate medical education, we can point out some glaring side-effects that should be of concern to any stakeholder. For instance, a graduate can legally begin his career as an independent practitioner immediately after passing the licensing exam and return to the old stuck school-year system of 2-year-premedical and 4-year-medical programs where outcome-based and integrated curricula are incomplete and unsatisfactory. In terms of learning opportunities, the balance between patient care and public health, as well as that between in-hospital highly specialized practice and community-based general practice, has worsened. Every stakeholder should be aware of these considerations in order to obtain the insight to forge a new direction. Moreover, our medical schools must prepare our students to take on the global roles of patient care within the Fourth Industrial Revolution, health advocacy for the imminent super-aged society, and education and research in the bio-health industry, by building and applying the concept of academic medicine. We will need to invest more resources, including educational specialists, into the current undergraduate medical education system in order to produce proper outcomes, smart curriculum, innovative methods of teaching and learning, and valid and reliable monitoring and evaluation. The improved quality of undergraduate medical education is the starting point for the success of the national system for public health and medical care as a whole, and therefore its urgency and significance should be emphasized to the public. The medical society should go beyond fixing what is broken and usher in a new era of cooperation and collaboration that invites other health professionals, governmental partners, law-makers, opinion leaders, and the general public in its steps toward the future.

Association Between Learning Environment Interventions and Medical Student Well-being

Concerns exist about the current quality of undergraduate medical education and its effect on students' well-being. To identify best practices for undergraduate medical education learning environment interventions that are associated with improved emotional well-being of students. Learning environment interventions were identified by searching the biomedical electronic databases Ovid MEDLINE, EMBASE, the Cochrane Library, and ERIC from database inception dates to October 2016. Studies examined any intervention designed to promote medical students' emotional well-being in the setting of a US academic medical school, with an outcome defined as students' reports of well-being as assessed by surveys, semistructured interviews, or other quantitative methods. Two investigators independently reviewed abstracts and full-text articles. Data were extracted into tables to summarize results. Study quality was assessed by the Medical Education Research Study Quality Instrument (MERQSI), which has a possible range of 5 to 18; higher scores indicate higher design and methods quality and a score of 14 or higher indicates a high-quality study. Twenty-eight articles including at least 8224 participants met eligibility criteria. Study designs included single-group cross-sectional or posttest only (n = 10), single-group pretest/posttest (n = 2), nonrandomized 2-group (n = 13), and randomized clinical trial (n = 3); 89.2% were conducted at a single site, and the mean MERSQI score for all studies was 10.3 (SD, 2.11; range, 5-13). Studies encompassed a variety of interventions, including those focused on pass/fail grading systems (n = 3; mean MERSQI score, 12.0), mental health programs (n = 4; mean MERSQI score, 11.9), mind-body skills programs (n = 7; mean MERSQI score, 11.3), curriculum structure (n = 3; mean MERSQI score, 9.5), multicomponent program reform (n = 5; mean MERSQI score, 9.4), wellness programs (n = 4; mean MERSQI score, 9.0), and advising/mentoring programs (n = 3; mean MERSQI score, 8.2). In this systematic review, limited evidence suggested that some specific learning environment interventions were associated with improved emotional well-being among medical students. However, the overall quality of the evidence was low, highlighting the need for high-quality medical education research.

ISQUA16-3009UNDERGRADUATE STUDENTS PERCEPTIONS AND SATISFACTION WITH THE QUALITY OF THE INTEGRATED MEDICAL CURRICULUM

The College of Medicine in the University of Dammam has implemented an innovative integrated undergraduate medical curriculum since 2014 in order to reform the quality of undergraduate medical education, to achieve Saudi-NCAAA accreditation for the college of medicine and to support quality improvement in Saudi Healthcare system. Like any innovative curriculum it needs to be evaluated for proper implementation. The main objective of this study is to evaluate student perceptions and satisfaction with the quality of the integrated medical curriculum. A cross-sectional survey was conducted during December 2015 among the two cohorts of medical students studying the integrated medical curriculum in the college of medicine. A sample of …

Medical training in Greece: A crisis in progress

Objectives. We sought to evaluate the opinions of medical students and graduates regarding the quality of medical education in Greece. Methods. Two online questionnaires concerning the undergraduate medical education and specialty training respectively were distributed. Results. Regarding the quality of undergraduate medical education, 52.1% of participants replied favorably while clinical training was found satisfactory by 45.1. Dissatisfaction rates with research opportunities and support from tutors reached 88.4 and 83.3%, respectively. The majority (75.3%) supported the introduction of examinations for commencing specialty training. 52.3% of physicians were satisfied with the quality of specialty training. The most common complaint was the absence of a formal educational program. 67.2% of participants were dissatisfied with working conditions during their specialty training, with 70.1% working >60 h per week. Physicians practicing medical specialties were more satisfied with the quality of specialty training than those practicing surgical specialties (odds ratio: 1.43; 95% confidence limits: 1.09–1.87) and were less likely to work for >60 h per week (odds ratio: 0.66; 95% confidence limits: 0.48–0.9). Conclusion. Opinions expressed in this survey highlight the need for reforming medical education in Greece.

Accreditation and culture of quality in medical schools in Saudi Arabia

Saudi Arabia (SA), the largest country in the Gulf Region, has witnessed unprecedented expansion in undergraduate medical education (UME) with more than 200% increase in medical schools over the last five years. Such rapid expansion creates major challenges in relation to quality of outcomes to the extent that some authors argue that SA needs reform similar to Abraham Flexner. This may explain the strong movement towards accreditation of UME in SA but it is important to reflect on purpose of accreditation and learn from the experience of developed countries. In USA, more than 100 years ago Flexner used a predetermined gold standard to judge all medical schools and resulted in closing more than 50% of the medical schools at that time. For accreditation to fulfill its promises in ensuring quality of UME, it has to reassure stakeholders of its contribution to their culture of quality rather than an external judge of their quality. Recently, the World Federation for Medical Education recognizes that the presence of accreditation systems “does not provide a guarantee that the system is working and resulting in trustworthy decisions on the quality of programs in medical education”. However, there must be a way of introducing quality management that maintain recent needed quantity development of UME in SA while ensuring the quality of products of medical schools. This paper describes accreditation development in SA and suggests a strategy for creating a culture of quality in medical schools in preparation for meaningful accreditation systems that ensure proper participation of all stakeholders in quality management on basis of evidence.

The importance of medical education accreditation standards

Introduction: The purpose of this study was to evaluate the relative and absolute importance of individual standards used by accreditation agencies throughout the world.Method: We developed a 150-item survey that consisted of all World Federation for Medical Education standards, supplemented with additional standards used around the world. International accreditation experts rated the standards based on the importance of each standard for ensuring the quality of undergraduate medical education. A 3-point scale was employed: 1 = not important, 2 = important but not essential, 3 = essential.Results: Thirteen of 22 chosen experts anonymously completed the survey (59%). The mean values, over raters, across individual standards ranged from 2.32 to 2.87, indicating that most of the 150 standards are at least important, and often essential, for ensuring program quality. Fourteen standards received the highest rating of 3 (“Essential”) from all experts, and four standards received mean ratings ≤2.00. Variability in the ratings across the experts for individual standards ranged from 0.00 (unanimous agreement) to 0.76 (moderate disagreement).Conclusions: While there is some global variation in experts’ opinions of accreditation standards, certain standards are considered essential. Our summary data are useful for determining best practices for medical education accreditation systems.

Overview of accreditation of undergraduate medical education programmes worldwide

There is significant variation in the structure and quality of undergraduate medical education around the world. Accreditation processes can encourage institutional improvement and help promote high-quality education experiences. To investigate the overseeing of medical education from an international perspective, the Foundation for Advancement of International Medical Education and Research (FAIMER) has developed, and continues to update, the Directory of Organizations that Recognize/Accredit Medical Schools (DORA). The directory includes information on the presence of national accrediting bodies and related data. Medical education accreditation information was pooled by World Health Organization (WHO) regions. Although over half of all countries with medical schools indicate that they have a national process for accrediting medical education programmes, the nature of the various authorities and levels of enforcement vary considerably. Despite global trends indicating an increasing focus on the quality of education programmes, data linking accreditation processes to the production of more highly skilled doctors and, ultimately, better patient care are lacking. Investigating current accreditation practices is a necessary step for further research. To this end, we will continue to gather data on medical education around the world and will explore opportunities for relating these processes to outcomes.

On the importance and validity of medical accreditation standards.

In late 1997, the authors conducted a national survey of communities of interest about the importance and clarity of 44 accreditation standards applied to teaching, learning, and evaluation in medical schools by the Liaison Committee on Medical Education (LCME). Questionnaires were mailed to deans and educational administrators at U.S. medical schools; current LCME members and surveyors and those who had served during the preceding five years; a random selection of residency program directors drawn from both general practice and speciality disciplines; sample groups of medical students and residents; and a cohort of practicing physicians not affiliated with academic medical institutions. Altogether 1,659 questionnaires were mailed, and 701 responses were received (42%). The recipients were asked to use a five-point Likert scale to rate each of the 44 standards both for its perceived importance as an indicator of the quality of undergraduate medical education and for the clarity with which the standard's intent was conveyed. Although the mean ratings of importance all fell in the "moderately important" and "highly important" areas across the respondent groups, the ratings divided into three groups, semantically and statistically. At the high end for importance are standards dealing with fundamental qualities of students, instruction, and the structuring of resources. At the low end of the importance scale are standards dealing largely with matters of process. The ratings for clarity were systematically lower than the ratings for importance, and in some cases the rating for clarity were even more widely discrepant with the ratings for importance. Individual comments by respondents about certain standards were critical of their complicated construction and of confusion about their meaning and measures of compliance. One or more of these hallmarks--being rated of lower importance or clarity, and being the target of criticism by survey respondents--distinguished most of the standards that earlier study had shown are often neglected by surveyors. The predictive validity of each of a number of standards was examined by testing the association between the standard (or its derivative) and outcomes expressed in annual student and school questionnaires and compiled in databases of the Association of American Medical Colleges and the American Medical Association. The result was a mixed bag, confounded by the absence of specific dimensions of many accreditation standards (independent variables) and the lack of discriminating measures of outcome (dependent variables). Nevertheless, the LCME's accreditation standards are believed to be important by those most affected by them. And beyond validating that medical accreditation is guided by relevant standards for teaching, learning, and evaluation, the results of this study point to ways by which the process can be made more precise and useful.