Medical Education Resources Research Articles

A spaced-repetition approach to enhance medical student learning and engagement in medical pharmacology

BackgroundPharmacology is a cornerstone of medical education as it underlies safe prescribing practices. However, medical students have reported unease regarding their perceived proficiency in medical pharmacology. Despite the significant impetus to improve student outcomes, there is little analysis available of the techniques used by medical students to learn, retain and apply medical pharmacology knowledge.MethodsA mixed-methods, student-focused approach was conducted to design and evaluate specific resources developed to address gaps in pharmacology education. This methodology comprised an anonymised scoping survey, followed by semi-structured focus group interviews. We then developed a flashcard resource as an intervention to support long-term revision for academic and clinical success. This resource was released to a cohort of 100 graduate entry preclinical medical students who were invited at the end of year to evaluate the intervention via a subsequent anonymous survey.ResultsThe scoping survey received 103 complete responses. Surveys and focus group interviews revealed that only 50% of students engage in ongoing revision. Amongst our cohort, we identified that the evidence-based technique of spaced-repetition was particularly well regarded. Hence, we developed and evaluated a bespoke resource utilising Anki™, an open-source, spaced-repetition flashcard program. A total of 1208 flashcards spanning 156 distinct classes of drugs with supplementary summary tables, diagrams and explanatory video and summary guides were created. Designed as a strategic revision tool to reinforce learning, evaluation showed students greatly appreciated the “comprehensive” and “well formatted” Anki™ resource that supported existing teaching modalities, with a global rating of 3.8 out of 5.ConclusionsStrategic and personalised resources for medical pharmacology education that assist with in-semester revision and long-term retention are highly valued amongst students for examination preparation and preparedness for practice. Collectively, these results reflect a novel approach to identifying and addressing weaknesses in existing learning resources in a manner that is inclusive of, and acceptable to, medical students.

COVID-19 and Virtual Medical Student Education.

COVID-19 and Virtual Medical Student Education.

Scalp laceration repair with hair apposition technique in the maritime environment under telemedicine guidance using free open-access medical resources

Requests for medical advice to evaluate injuries sustained on board a shipping vessel make up a significant number of calls to Telemedical Maritime Assistance Services. As the maritime setting is an austere environment with regards to resources such as equipment and availability of medically trained personnel, it is important to have a set of skills and techniques to treat all manner of common injuries with the tools at hand. Here we discuss a case report of using telemedicine and free open-access medical education resources to teach the hair apposition technique to an on-board medical provider for the treatment of a scalp laceration with good outcome.

Medical Education Blog and Podcast Utilization During the COVID-19 Pandemic.

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic disrupted traditional in-person learning models. Free Open Access Medical (FOAM) education resources naturally filled this void, so we evaluated how medical blog and podcast utilization changed during the early months of the pandemic.MethodsAcademic medical podcast and blog producers were surveyed on blog and podcast utilization immediately before (January-March 2020) and after (April-May 2020) the COVID-19 pandemic declaration and subsequent lockdown. Utilization is quantified in terms of blog post pageviews and podcast downloads. Linear regression was used to estimate the effect of publication during the COVID-19 period on 30-day downloads or pageviews. A linear mixed model was developed to confirm this relationship after adjustment for independent predictors of higher 30-day downloads or pageviews, using the podcast or blog as a random intercept.ResultsCompared to the pre-pandemic period, downloads and pageviews per unique blog and podcast publication significantly increased for blogs (median 30-day pageviews 802 to 1860, p<0.0001) but not for podcasts (median 30-day downloads 2726 to 1781, p=0.27). Publications that contained COVID-19 content were strongly associated with higher monthly utilization (β=7.21, 95% CI 6.29-8.14 p<0.001), and even non-COVID-19 material had higher utilization in the early pandemic (median 30-day downloads/pageviews 868 to 1380, p<0.0001).DiscussionThe increased blog pageviews during the early months of the COVID-19 pandemic demonstrated the important role of blogs in rapid knowledge translation. Podcasts did not experience a similar increase in utilization.

Review article: E-learning in emergency medicine: A systematic review.

E‐learning (EL) has been developing as a medical education resource since the arrival of the internet. The COVID‐19 pandemic has minimised clinical exposure for medical trainees and forced educators to use EL to replace traditional learning (TL) resources. The aim of this review was to determine the impact of EL versus TL on emergency medicine (EM) learning outcomes of medical trainees. A systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta‐analysis statement using articles sourced from CINAHL, Embase, OVID Medline and PubMed. Articles were independently reviewed by two reviewers following strict inclusion and exclusion criteria. Bias was assessed using the Cochrane Risk of Bias tool. The search yielded a total of 1586 non‐duplicate studies. A total of 19 studies were included for data extraction. Fifteen of the included studies assessed knowledge gain of participants using multiple‐choice questions as an outcome measure. Eleven of the 15 demonstrated no statistically significant difference while two studies favoured EL with statistical significance and two favoured TL with statistical significance. Six of the included studies assessed practical skill gain of participants. Five of the six demonstrated no statistical significance while one study favoured EL with statistical significance. This systematic review suggests that EL may be comparable to TL for the teaching of EM. The authors encourage the integration of EL as an adjunct to face‐to‐face teaching where possible in EM curricula; however, the overall low quality of evidence precludes definitive conclusions from being drawn.

Understanding Distribution of Gender and Race across Consultation Liaison Psychiatry in USA

The United States of America (USA) has a culturally and ethnically diverse population. Various gender and racial minorities in the healthcare system are not represented adequately when compared to their ratios in the general population. This study reviewed the gender and racial distribution and its temporal trends among fellows in Consultation-Liaison Psychiatry (CLP) within the USA. A retrospective analysis was performed to evaluate the gender and race of fellows in CLP fellowship programs in the USA from 2007 to 2019. Data was retrieved from publicly available Accreditation Council for Graduate Medical Education (ACGME) Resource Books. According to ACGME data, races were categorized as White (non-Hispanic), Asian/Pacific Islander, Hispanic, Black (non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was self-reported as male, female, and not reported. Among fellows in CLP, the White (Non-Hispanic) race remained the most represented and increased by 7.3% from 2011 to 2019, with an 18.6% increase in relative change. In contrast, the Asian/Pacific Islander, African American/Black (Non-Hispanic), and others decreased by 6.2%, 4.0%, and 4.6%, respectively. Gender distribution trends showed an increase in male representation with a relative increase of 14.7% and an absolute increase of 5.5%. Similar trends were seen in female representation with a relative and absolute increase of 5.2% and 2.8%, respectively. However, women remained the most represented throughout the period. Considering the ongoing globalization & rapidly evolving US demographics, it is crucial to analyze the gender and racial disparities within psychiatry. Racial concordance and a diversified culturally competent physician workforce is imperative for the effective delivery of mental health services.

A qualitative study of an undergraduate online emergency medicine education program at a teaching Hospital in Kampala, Uganda

BackgroundGlobally, half of all years of life lost is due to emergency medical conditions, with low- and middle-income countries (LMICs) facing a disproportionate burden of these conditions. There is an urgent need to train the future physicians in LMICs in the identification and stabilization of patients with emergency medical conditions. Little research focuses on the development of effective emergency medicine (EM) medical education resources in LMICs and the perspectives of the students themselves. One emerging tool is the use of electronic learning (e-learning) and blended learning courses. We aimed to understand Uganda medical trainees’ use of learning materials, perception of current e-learning resources, and perceived needs regarding EM skills acquisition during participation in an app-based EM course.MethodsWe conducted semi-structured interviews and focus groups of medical students and EM residents. Participants were recruited using convenience sampling. All sessions were audio recorded and transcribed verbatim. The final codebook was approved by three separate investigators, transcripts were coded after reaching consensus by all members of the coding team, and coded data were thematically analyzed.ResultsTwenty-six medical trainees were included in the study. Analysis of the transcripts revealed three major themes: [1] medical trainees want education in EM and actively seek EM training opportunities; [2] although the e-learning course supplements knowledge acquisition, medical students are most interested in hands-on EM-related training experiences; and [3] medical students want increased time with local physician educators that blended courses provide.ConclusionsOur findings show that while students lack access to structured EM education, they actively seek EM knowledge and practice experiences through self-identified, unstructured learning opportunities. Students value high quality, easily accessible EM education resources and employ e-learning resources to bridge gaps in their learning opportunities. However, students desire that these resources be complemented by in-person educational sessions and executed in collaboration with local EM experts who are able to contextualize materials, offer mentorship, and help students develop their interest in EM to continue the growth of the EM specialty.

Gender and Racial Disparity among Addiction Psychiatry Fellows in the United States.

The United States (US) has a culturally diverse population. However, the percentage of underrepresented minorities (URMs) and women in healthcare does not fully reflect their current and future demographics. Our objective was to explore and forecast the gender and racial trends in the US addiction psychiatry fellowship programs. A retrospective analysis was performed using data from Accreditation Council for Graduate Medical Education (ACGME) Resource Books which encompassed US addiction psychiatry fellows from 2007 to 2020. Simple linear and multiple regression were used to predict the 2030 addiction psychiatry workforce. White (Non-Hispanic) and Asian/Pacific Islander had a relative change of -2.8% and -26.1% from 2011 to 2020, respectively. Black (non-Hispanic) had a relative change of + 5.2%. Hispanic and Native American/Alaskan had no relative change during this time. From 2007 to 2020, women's representation relatively decreased by 10.9%. Statistically, these dynamic trends of the addiction psychiatry workforce will continue to exist in 2030. Women and URM addiction psychiatrists play an effective role in addressing substance use disorders (SUD). Unfortunately, the current gender and racial disparities in addiction psychiatry will exist in the future. Understanding the continued gender and racial bias in addiction psychiatry fellowships and devising appropriate recommendations can help mitigate the existing disparities.

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Single-centre study surveying neurology trainees’ and faculty’s perceptions of the impact of the COVID-19 pandemic on residents’ medical education

ObjectiveTo assess perceptions of our neurology residents and faculty regarding training experience and medical education during the early COVID-19 pandemic.MethodsWe distributed two online, voluntary and anonymous surveys to trainees and...

Histomorphological assessment of non-neoplastic renal diseases at autopsy: an institutional experience in Southwestern Nigeria.

Autopsy remains an invaluable resource for medical education and establishing diagnosis of diseases that were missed prior to death. Many patients on admission in hospitals suffer kidney diseases that may contribute to their morbidity and/or mortality. The kidneys from autopsies provide opportunity to diagnose and understand some of these non-neoplastic renal lesions. This study aimed to present the frequency of non-neoplastic renal diseases at autopsy. We conducted a five-year retrospective review of post-mortem records of deceased who had autopsy. Data such as age, sex, cause of death, and kidney lesions were extracted from the post-mortem records and clinical details were gotten from the clinical summaries in the autopsy reports. The kidneys were examined for pathological findings that were then classified into glomerular, tubulointerstitial (tubulointerstitial nephritis and other tubular lesions such as tubular necrosis, casts and fibrosis) and vascular lesions. A total of seventy (70) cases met the inclusion criteria with 91.4% having significant non-neoplastic renal lesions. The mean age of the deceased was 57.7years (18years - 91years). Males accounted for 65.7% of the cases. Glomerular lesions were seen in 84.3% of the cases, tubulointerstitial nephritis in 41.6% of cases, vascular lesions were seen in 30% of the cases and other tubular lesions (such as stones, casts and tubular necrosis) were seen in 52.9% of the cases. Cardiovascular diseases and infections were the major causes of death in these patients, accounting for 40% and 27% respectively. Renal diseases were attributed to immediate cause of death in 10% of the cases. The kidney at autopsy provides a valuable renal pathology educational tool, as a wide range of medical renal lesions can be seen from kidneys examined at post mortem.

Hurdles for adopting mobile learning devices at the outset of clinical courses

BackgroundMobile devices provide medical students with easy access to medical information and educational resources. Since 2013, we have followed the study use of iPads among medical students. In 2016, we observed a notable drop in the mobile device usage in the first cohort of medical students entering their clinical courses.MethodsThe aim of the study was to identify the hurdles for adopting mobile devices at the beginning of the clinical courses. We examined how students evaluated their own and the clinical teachers’ ability to use the iPad, how the study assignments fit into digital learning, and how students used the mobile device with patients. The data were collected with online surveys among three consecutive student cohorts and the distributions of closed-ended questions analyzed.ResultsResponse rates ranged from 67.5 to 90.8%. Students evaluated their own ability to use the iPad as good or excellent and teachers’ skills as relatively poor and wanted more digitally tailored assignments. They reported negative attitudes towards mobile device use in the clinical setting and were hesitant to use them in patient contact. Teachers seldom communicated suitable quality medical applications to students.ConclusionsClinical teachers need support and training to implement a learning environment and assignments appropriate for mobile devices. Both students and teachers were concerned about using these devices with patients. To achieve the full potential of digitalisation in clinical courses, their use should be developed collectively with students.

Top resources and tools for physician management of chronic pain in the Canadian Armed Forces

LAY SUMMARYDiagnosis and management of chronic pain in Canada by primary care clinicians is a challenging and changing field with new approaches, evidence, and tools emerging in the past few years. For a busy clinician, it is vital to integrate and become aware of new tools that can improve the care delivered to patients. This article summarizes new evidence-based tools, key guidelines and research, algorithms, and simplified prescription practices, in addition to continuous medical education resources that will allow busy clinicians to rapidly be brought up to speed on the latest in chronic pain management in the Canadian military context.

Creating Open and Free Medical Education Resources.

Purpose: Open Educational Resources (OERs) are published in public domains or permissively licensed (i.e., Creative Commons [CC]) materials that allow for open sharing and free accessibility. 1 The absence of a common structure for OER materials has been identified as a barrier to collaboration among educators and a source of inefficiency. 2 Both MedEdPORTAL and the Association of American Medical Colleges (AAMC)’s Clinical Teaching and Learning Experiences 3 collection of educational materials lack a standard format that would allow resources to be directly integrated into medical school curricula without significant modification. The rise of virtual education with COVID-19 has made OERs more pertinent and accessible. Transition to Residency (TTR) courses have become increasingly popular as they seek to improve skills just before the increase in responsibility seen when students become first-year residents. 4 TTR courses should work toward common content between institutions because most students matriculate to residency programs outside of their medical school alma mater. Approach: We sought to create an OER collection specific to TTR courses containing standard formats, allowing course directors to interchangeably use materials and more easily share materials between institutions. Keywords of “Transition to Residency,” “bootcamp,” “internship preparation,” and “capstone” were used in multiple searchable collections of OERs (BCcampus, Oasis, OpenStax, MERLOT, and MedEdPORTAL) to search for existing TTR-related materials. Few resources were identified and either required significant modification to be used in a TTR course or were specific to 1 specialty. 5 A 12-participant convenience sample from 8 different medical schools and the AAMC MedBiquitous program used consensus discussion to draft a set of standards for faculty guides and teaching materials. A website (www.ttreducators.com) was created as a hub for collaboration and a platform for future distribution of materials. A pilot conversion of 10 existing materials from our local TTR course uncovered key considerations and process steps needed to create TTR OERs. Results: A standard structure for faculty guides (i.e., title structure, learning objectives, MESH terms, etc.) was identified. Five specialty groupings were selected for specialty-specific material: Emergency Medicine, Internal Medicine, Obstetrics–Gynecology, Pediatrics, and Surgery. Ten different educational delivery formats were identified as commonly adopted in TTR courses: “long-case” and “short-case” case-based learning, lecture, panel discussion, game, workshop/procedural skills training, peer role-play, simulation – standardized patient role-play, simulation – manikin/low-fidelity, and simulation – manikin/high fidelity. Each type was assigned a standard duration (1 or 2 hours), ideal group size (3, 4, 10, or infinite), a facilitator/student ratio (1/4, 1/6, 1/10, 1/infinite), and an ideal learning setting (classroom, virtual, simulation center). The “game” delivery format was not assigned standards due to the variability and complexity of games being delivered in TTR courses. Pilot conversion of local materials identified numerous key steps for ensuring compliance with CC licensing and OER best practices: ensuring web accessibility for the disabled, reverse image searching to ensure embedded content from external sources is open access, and documenting a CC license. 1 Additionally, an author consent was created and reviewed by our institution’s legal team. Discussion: A draft set of standards was created for TTR course curricular materials that will help ensure OERs are more easily usable by courses from different medical schools. We feel this approach was successful due in part to similar TTR course goals across schools, ensuring OERs can be freely modified after dissemination, and openness of educators to relinquish some personal control for the greater good. Our approach could be adapted by other educational domains in both undergraduate and graduate medical education, potentially saving a significant amount of time from teaching faculty. Significance: Creating standardized formatting of TTR course materials will make OER distribution, implementation, and exchange easier and more widely adopted.

Systematic online academic resource (SOAR) review: Endocrine, metabolic, and nutritional disorders.

Free open-access medical education (FOAM) has become an integral resource for medical school and residency education. However, questions of quality and inconsistent coverage of core topics remain. In this second entry of the SAEM Systematic Online Academic Resource (SOAR) series, we describe the application of a systematic methodology to identify, curate, and describe FOAM topics specific to endocrine, metabolic, and nutritional disorders as defined by the 2016Model of the Clinical Practice of Emergency Medicine (MCPEM). We developed an automated algorithm to search 264keywords derived from ninesubtopics within the MCPEM category in the FOAM Search (a customized FOAM search tool) and the Social Media index. The top 100 results were extracted for each keyword. Resources underwent a manual iterative screening process, and those relevant to endocrine, metabolic, or nutritional disorders and EM were evaluated with the revised Medical Education Translational Resources: Impact and Quality (rMETRIQ) tool. The search yielded 36,346 resources, of which 756met the criteria for quality assessment. After rMETRIQ tool training, four raters demonstrated an average measured intraclass correlation coefficient of 0.94 (95% confidence interval= 0.88 to 0.97, p<0.001). A total of 121 posts (16% of posts) covering 25subtopics were identified as high quality (rMETRIQ ≥16). The most covered subtopic was potassium disorders, representing 15% of all posts. Subtopics that did not have a high-quality resource identified include metabolic alkalosis, respiratory alkalosis, fluid overload, phosphorus metabolism, hyperglycemia, malabsorption, malnutrition, and thyroiditis. From most to least common, the overall target audience was junior resident (91%), PGY-1 resident (88%), senior resident (81%), clerk (64%), attending (50%), and preclerkship (9%). We systematically identified, described, and curated FOAM resources for EM learners on the topic of endocrine, metabolic, and nutritional disorders. A final list of high-quality resources can guide trainees, educator recommendations, and FOAM authors.

Novel Education Modules Addressing the Underrepresentation of Skin of Color in Dermatology Training.

Representative images of pathology in patients with skin of color are lacking in most medical education resources. This particularly affects training in dermatology, which relies heavily on the use of images to teach pattern recognition. The presentation of skin pathology can vary greatly among different skin tones, and this lack of representation of dark skin phototypes challenges providers' abilities to provide quality care to patients of color.In Botswana and other countries in sub-Saharan Africa, this challenge is further compounded by limited resources and access to dermatologists. There is a need for improved and accessible educational resources to train medical students and local medical providers in basic skin lesion description and diagnosis. We examined whether online Perceptual and Adaptive Learning Modules (PALMs) composed of representative dark skin images could efficiently train University of Botswana medical students to more accurately describe and diagnose common skin conditions in their community. Year 4 and 5 medical students voluntarily completed PALMs that teach skin morphology, configuration, and distribution terminology and diagnosis of the most common dermatologic conditions in their community. Pre-tests, post-tests and delayed-tests assessed knowledge acquisition and retention. PALMs training produced statistically significant (P < .0001) improvements in accuracy and fluency with large effect sizes (1.5, 3.7) and good retention after a 12.5-21-week median delay. Limitations were a self-selected group of students, a single institution, slow internet connections, and high drop-out rates. Overall, population-specific PALMs are a useful tool for efficient development of pattern recognition in skin disease description and diagnosis.

Variable trajectory: a systematic review, analytic synthesis and construct domain consolidation of international measures of competence in doctors and medical students

BackgroundCompetence is assessed throughout a doctor’s career. Failure to identify and manage impaired competence can have critical consequences. Consistent conceptualisation and accurate measurement of this construct is imperative. Therefore, the...

An Overview of Online Resources for Medical Spanish Education for Effective Communication with Spanish-Speaking Patients

Phenomenon Despite the rapid development of virtual medical Spanish educational materials, online resources lack transparency and a peer-review process. The purpose of this interdisciplinary study was to provide a critical inventory of virtual resources for medical Spanish education, thereby providing a panorama of the current state of online medical Spanish. Approach Research team members conducted iterative searches to identify medical Spanish online resources, which were then screened for predetermined inclusion/exclusion criteria. Between June and August 2020, a panel of medical and language experts then adapted and applied a previously published evaluation tool to determine whether resources that met study criteria would help learners achieve medical Spanish core competencies and to what extent each resource incorporated communicative language activities. Consensus meetings were conducted to resolve disagreements and identify gaps in online education. Findings Out of 465 resources, 127 were further screened, and eight were selected for evaluation. Medical and language specialists independently scored each resource and, following discussions, achieved consensus. Overall, no resource met suitability criteria for all five medical Spanish learner competencies or cultural elements, and only one was suitable for achieving the self-assessment competency. Insights Interdisciplinary consensus meetings provide an important avenue for resolving differences of opinion and for integrating both language and medical perspectives into the evaluation process. Existing online resources should be used in conjunction with other materials to ensure that all core competencies for medical Spanish education are addressed. This study revealed important gaps in online resources, including a need to target advanced Spanish learners, apply authentic communicative activities, include assessment opportunities, and integrate culture in the learning program. Based on the current state of online medical Spanish, we offer recommendations for future resources.

Creating Models of Serious Educational Games for the Purpose of Medical Training

The report presents the serious educational games in the field of medicine and their advantages in the medical education of the scientific community, medical professionals, teachers, researchers, trainers, decision makers, training companies, students, gamers and others. Research and analysis of innovative, technological methods and tools for creating semantically based knowledge for the purposes of training in medicine has been conducted. Research and analysis of innovative methods and tools for modeling and creating computer-based medical educational resources have been made. Attention is paid to the methods for creating computer-based resources in the field of medical education. The report presents videos and a serious educational game that are used in medical universities in medical education.

Training pediatric residents in point-of-care ultrasound: An assessment of the needs and barriers to acquire the skill.

IntroductionThe use of point-of-care ultrasound (POCU) is increasing globally. However, owing to the epidemiology of diseases and local management strategies, POCU may not be universally applicable. Before developing a POCU training program, because of limited resources for medical education, it was pivotal to conduct a needs assessment and identify the training barriers.MethodsThis study used a validated paper questionnaire. The survey instrument was distributed to 120 pediatric residents (male 60, female 60) training at our institution to assess their self-reported level of skill in POCU, and their perceptions with regard to the applicability of POCU, measured with a 5-point Likert scale. The skills deficit was measured by subtracting the self-reported level of skills in lung, cardiac, and abdominal POCU from the perceived applicability of POCU.ResultsFifty-nine residents participated, resulting in a response rate of 50 and 48% (n = 29) for the male group, and 50% (n = 30) for the female group. The level of knowledge and proficiency was low. Scanning for free abdominal fluid was deemed the most applicable (mean 4.2 ± SD 1.1); however, the use of POCU to detect consolidation was considered least applicable (mean 2.7 ± SD 1.3). The skills deficit was highest for an abdominal POCU (mean 2.4 ± SD 1.6) and lowest for lung ultrasound (mean 1.4 ± SD 1.6). Although the majority (n = 48) agreed that this skill was essential, 3 (5%) had no interest, and 39% (n = 23) indicated a lack of time to acquire the skill.ConclusionsThough pediatric residents in Saudi Arabia agree that POCU is an essential skill, large skill deficits exist, supporting the necessity to provide POCU training. However, there are several barriers to overcome to achieve this.