Standard Medical Curriculum Research Articles

Electives as a Pedagogical Strategy for Fostering Medical Student Engagement and Exploration beyond the Standard Medical Curriculum

Electives as a Pedagogical Strategy for Fostering Medical Student Engagement and Exploration beyond the Standard Medical Curriculum

Disseminated Melioidosis Presenting as Sepsis, Neurological Melioidosis, Liver and Prostate Abscess in United Arab Emirates.

Melioidosis is an infection caused by Burkholderia pseudomallei, a Gram-negative bacterium. It is a disease endemic to Southeast Asia and northern Australia although its global incidence has been rising. It most commonly infects people with certain identified risk factors such as diabetes, alcoholism, thalassemia, and underlying chronic disease involving lungs, kidney and liver. This bacterium is capable of producing a wide array of clinical manifestations ranging from asymptomatic disease to localised infections such as in the lung, bone or skin to disseminated infection. This is a case, from United Arab Emirates, of a 40-year-old male recently diagnosed with diabetes who presented with multiple abscesses and was eventually diagnosed with disseminated melioidosis. He was treated successfully with antibiotics and drainage of abscesses. In non-endemic regions, melioidosis can be easily missed in common diagnostic approaches. This gap of awareness could delay the diagnosis and allow further deterioration of the patient due to complications. Thus, case reports like this can enlighten internists about changing incidences and complexity of clinical presentations, thus preparing them to better handle such patients in the future. Owing to its considerably rare incidence in non-endemic regions including the United Arab Emirates, melioidosis can easily be overlooked or misdiagnosed.Moreover, due to similarity with multiple other diseases and infections as well as significant absence from standard medical curricula, melioidosis is rarely on the differential list of an internist.This report aims to enhance awareness and alertness to aid earlier detection and avoid severe complications.

Difficult conversations: Navigating intimate partner violence with standardized patients

BackgroundOne in three women in the US experience intimate partner violence (IPV) in their lifetime. There are minimal opportunities for medical students to learn about responding to IPV. MethodsStudents participated in a learning intervention about recognizing and addressing IPV, followed by a standardized patient session. Students filled out a seven-question survey before and after the session, which assessed comfort addressing IPV, discussing resources, and practicing trauma-informed care. Responses were compared using the Mann-Whitney U test. ResultsSixteen medical students participated, response rate of 100%. The median score for comfort recognizing signs of IPV increased from 2 to 3 (p < 0.01); for asking patients about IPV, from 1 to 3.5 (p < 0.01); in knowledge of IPV resources, from 1 to 3 (p < 0.01); in preparedness to practice trauma informed care, from 2 to 3.5 (ns). Comfort addressing IPV improved from 1 to 3 (p < 0.01). ConclusionAfter the session, student preparedness and comfort addressing IPV increased. The learning intervention addressed information not in standard medical curricula. This module can be easily adapted to any medical school curricula.

How to Internationalize Medical Education using Concepts in Internationalization of Higher Education.

This article was migrated. The article was marked as recommended. Internationalization of higher education is a well-researched area with a long history. At a time of increasing globalization, particularly in light of recent global health events, the internationalization of medical education may play an important role in medical school teaching - increasing future medical collaboration and building a global medical community. Internationalization of medical education is a less researched discipline and often limited to areas of Global Health. It is typically not part of the standard medical curriculum. While internationalization of medical education has overlapping themes with Global Health education, it has a much wider scope (i.e., preparation of global citizen physicians, international employability, collaboration, cultural and international understanding). Lessons learned from concepts in internationalization of higher education can aid in the realization of internationalization of medical education programs and establish IoME as a distinct area of educational research. This paper suggests elements to consider when implementing programs in internationalization of medical education. Guided by the analysis of an existing program in internationalization of medical education, important components are highlighted from the perspective of concepts found in internationalization of higher education. Several elements that are important features in internationalization of higher education are emphasized - institutional partnerships, goal setting, variety of internationalization at home concepts, international classroom features, multi-directional student mobility, and sustainability. The authors aim to shed light on the area of internationalization of medical education, widen its scope from Global Health education, and introduce it as a field of study for educational research. Adapting models and concepts of international higher education can help with establishing this field.

Impact of nutrition education on nutritional knowledge and intentions towards nutritional counselling in Dutch medical students: an intervention study

ObjectiveManagement of diet-related chronic diseases may benefit from improved nutrition education of medical students. This study aims to investigate the effects of a nutrition education course on nutritional knowledge and...

A nationwide peer-assisted learning program in disaster medicine for medical students

The Sendai Framework advocates the importance of training in disaster medicine as a way to improve health system resilience. In Italy, despite the official recognition of disaster medicine as a mandatory discipline in the standard curriculum, most students are never exposed to its basic concepts. DisasterSISM is a nationwide educational program in disaster medicine developed in 2008. Given the scarcity of experienced instructors, in 2013, the course adopted a peer-assisted learning (PAL) approach to correct the omission identified in the national curriculum. The new approach involved a training of trainers (ToT) and a basic course organized and delivered by certified student teachers. The authors gathered and analyzed data from demographic questionnaires, pretest and posttests, and satisfaction questionnaires. From 2013 to 2018, 42 medical students attended the ToT becoming student teachers. From 2014 to 2018, 2316 medical students attended the basic course delivered by the student teachers across Italy. Thirty-six out of 41 medical schools were reached. Participation in the program improved students' knowledge in disaster medicine. Participants were satisfied with both the course structure and its PAL approach and considered disaster medicine to be highly relevant for their future professional career. By presenting this nationwide program and its outcomes, the authors hope to strengthen the case for including disaster medicine education in the standard medical curriculum. Because the course relies on medical students and PAL, the authors trust that it could be adapted to other countries worldwide.

A Five-Year Review of Enhanced Learning through Integration: Anatomy and Clinical Practice

Many medical schools have undergone curricula revisions and attempted to integrate basic and clinical sciences. In 2012, our program at the University of Florida College of Medicine underwent significant curricular reform, transitioning from the standard medical curriculum to a systems-based approach. The teaching of anatomy, clinical skills, radiology, ethics, population health, human behavior, and evidence-based medicine was integrated into one class, “Introduction to Clinical Medicine”, which spans 68 weeks in the pre-clerk- ship curriculum. As a result, there was a reduction of anatomy teaching from 166 to 120 hours. Our curriculum integration demonstrates opportunities for enhanced teaching including increasing peer learning, incorporating multidisciplinary case presentations, and allowing for a deliberate overlap and layering of anatomy education across two years of medical school. This paper describes our reflection on the effect of the curriculum change on student learning. Five years after implementation of these changes shows that our efforts also illustrate the challenges inherent to curricular integration including scheduling constraints, unclear sources of financial support, apprehension about the effect on future National Board of Medical Examiners (NBME) scores, and difficulty assessing which areas a student needs to remediate within a failed integrated course. Overall, the integration of anatomy with other classes into a revised course at our College of Medicine has been well received and successful.

Training the next generation of doctors in palliative care is the key to the new era of value-based care.

There is a common misperception that palliative care is just another term for hospice care. Although it includes hospice, palliative care is also the long-term coordinated care of the chronically ill, which is delivered at a cost savings. Why does it matter that the average American understand what palliative care means? Because the evidence shows that U.S. patients near the end of life are spending exorbitant amounts of money on health care they do not want and the country cannot afford. To better understand why palliative care is an important issue in the current debate about health care reform, the authors first briefly review landmark legal cases in the area of end-of-life care. They then discuss the role of palliative care in conversations in the current health care climate and conclude by emphasizing the importance of integrating palliative care into the standard medical curriculum. The authors predict that palliative care will be accepted in the United States as a much-needed and desirable field of medicine. Getting there, however, will require a multifaceted approach including payment reform, encouraging an open conversation among the U.S. public, and training physicians to offer the best possible care and guidance until a patient's last breath.

Italian medical students and disaster medicine: Awareness and formative needs

Over the last century, the number of disasters has increased. Many governments and scientific institutions agree that disaster medicine education should be included in the standard medical curriculum. Italian medical students' perceptions of mass casualty incidents and disasters and whether-and if so to what extent-such topics are part of their academic program were investigated. A Web-based survey was disseminated to all students registered with the national medical students' association (Segretariato Italiano Studenti Medicina), a member of the International Federation of Medical Students' Associations. The survey consisted of 14 questions divided into four sections. Six hundred thirty-nine medical students completed the survey; 38.7 percent had never heard about disaster medicine; 90.9 percent had never attended elective academic courses on disaster medicine; 87.6 percent had never attended non-academic courses on disaster medicine; 91.4 percent would welcome the introduction of a course on disaster medicine in their core curriculum; and 94.1 percent considered a knowledge of disaster medicine important for their future career. Most of the students surveyed had never attended courses on disaster medicine during their medical school program. However, respondents would like to increase their knowledge in this area and would welcome the introduction of specific courses into the standard medical curriculum.

‘Thinking on my feet’: an improvisation course to enhance students’ confidence and responsiveness in the medical interview

Effective patient-centred communication requires physicians to respond 'in the moment' to comments and questions. It is a valuable skill to be able to react to unexpected patient utterances with empathy and support, and these surprises may be most common in general practice where patients are encouraged to speak to their doctor about anything. We developed an elective for medical students to learn and practise improvisational skills that would optimise their communications with patients during medical encounters. Nineteen second-year medical students during two consecutive years (n =38) participated in a four-session elective that introduced and allowed them to practise the principles and skills of improvisation, and reflect on the role of those skills in their communication with patients. Specific skills that were practised and emphasised included listening, affirmation, vocal tone modulation, nonverbal communication, agreement, collaboration, acceptance and validation. In addition to previously developed 'Improv' exercises, students created their own improvisation exercises targeted at specific communication skills. Twenty-seven (71%) of all participating students completed the post-curriculum assessment survey. Twenty-two (81%) rated their enjoyment as 'tremendous'. The desire to experience something new and different from the standard medical curriculum served as the motivation for many of the students (67%) to sign up for the course. Most students (23/27; 85%) thought that the concepts that were addressed were either 'very much' or 'tremendously' relevant to the care of patients. We have found that an improvisational workshop geared towards enhancing medical student communication skills has the potential to impart valuable skills that are essential to providing empathic, supportive patient-centred care. Communication skills training programmes have become a cornerstone in medical student and postgraduate medical education over the past 20 years. Both national accreditation and expert panel consensus guidelines have stressed the importance and framed the structure for best communication practices. Exemplary curricula for teaching medical trainees in core communication strategies to use with patients have been published; many emphasise patient-centred and/or relationshipcentred strategies. Simulated patient technologies with video review can allow learners to practise their skills through both self-assessment and feedback from others. However, despite these newer learning resources, frameworks and behavioural checklists, learners naïve to clinical patient encounters must still learn how to function and adapt within the interpersonal communicative space that is created by the learner and patient. At its core, this is an iterative, spontaneous process created by the dyad and yielding, from moment to moment, to unique and unanticipated outcomes. Thus, repetitive practice will improve confidence but may miss the mark in learning the essential skills of intuitive and improvised interpersonal responsiveness. One could argue that existing approaches in teaching medical learners communication skills may promote rigid and stereotyped responses. Haidet proposes that there are significant parallels between the patient-physician dialogue (when a physician attempts to learn details about a patient and their illness) and improvisational jazz. 11 He contends that effective clinicians who are committed to relationship-centred practice depart from overarching principles of biomedical inquiry when necessary to respond spontaneously and without script to the particular circumstances of each encounter. It is believed that successful doctor-patient relationships are founded upon trusting and open communication, as well as genuine respect that can be shown by a willingness to listen or respond to the issues raised by patients. 12 The nature of the comprehensive care in family medicine makes it likely that GPs will regularly be surprised by concerns raised by patients such that they must be adept at improvising. Because of the gap that currently exists in interview skills training programmes, we hypothesised that the field of improvisational theatre would effectively supplement the traditional curriculum. Improvisation relies on listening, confidence and responding instinctively and spontaneously. 13,14 In this paper, we describe our efforts to develop a brief curriculum for medical students providing training in the art of theatre improvisation, with the goal of enhancing students' confidence and performance in clinical encounters. We hoped that this innovative curricular experience would establish a venue where secondyear medical students could learn and practise improvisational skills that might prove helpful in their communications with patients during medical encounters.

Medical educators: the new generalists identifying the core traditions of the profession to create the next generation of doctors.

Medical educators: the new generalists identifying the core traditions of the profession to create the next generation of doctors.

Concerns about substandard training for prescription privileges for psychologists

This Commentary on the Muse and McGrath study (this issue, pp. 96-103) refutes its conclusion that the amount of training for prescription privileges for psychologists (RxP) is equal to or greater than that for psychiatric nurse practitioners and physicians. First, the sample failed to include only training programs for nurses and psychologists that lead to independent prescribing. Second, training was defined by an arbitrary, nonvalidated list of "key content areas" that excluded much of the standard medical curricula for nurses and physicians to prescribe. Third, the levels of training for which the "key content areas" were assessed omitted undergraduate prerequisites, apprenticeships, supervised practice, and residencies that are a standard part of the nursing and physician programs studied. RxP training remains substandard.

Out of the Shadows: It is Time to Mainstream Treatment for Transgender Patients

bed nucleus of the stria terminalis

An innovative community medicine curriculum: the La Mesa housecleaning cooperative.

Even after several years of learning medicine from an individual, disease-oriented approach, senior medical students may be unprepared to learn about community issues. Residents, who encounter additional time demands and the responsibilities of patient care, may be even more resistant to learning about the principles of health care in the community. The standard medical curriculum often fails to address community medicine in a way that residents find constructive and engaging. The Community Health Partnerships program at the University of New Mexico Health Sciences Center, Albuquerque, tries to involve medical residents in community-oriented primary care projects in local communities. Major goals of the program are for the residents to interact with a community and to allow community members to define the objectives of the project.

The Broader View of Medical Ethics

To the Editor.— Mr Cousins' view of medical ethics is intriguing and even compelling, but I wonder if it automatically invests the doctor with undeserved wisdom. Of course, any is free to influence any aspect of public life or policy as long as he does so in the role of a private citizen, but when he uses the mantle of physician to give his views special authority, especially as a moral or ethical champion, he may be misleading the public. Our country is full of self-anointed prophets, all too ready to advise the public on matters of national policy, international politics, and philosophical and religious matters. There is nothing in the standard medical curriculum that gives physicians a special insight into philosophy, religion, economics, or international politics. If he steps outside of the medical arena to argue such matters of public policy or national defense, he should not drag