Traditional Medical Curriculum Research Articles

Action in Healthcare Sustainability is a Surgical Imperative: This is a Novel Way to Do It

The healthcare system accounts for 8%-10% of all greenhouse gas emissions in the United States and hospital buildings are significant contributors. Operating rooms account for 20%-33% of all hospital waste. This may contribute to significant climate change and negatively affect public health. Physicians and surgeons must act to reduce our collective carbon footprint to improve the health of our patients. The traditional graduate medical education curriculum does not routinely train future generations of physicians in healthcare sustainability. We describes a fellowship program designed to change this. The Cleveland Clinic surgical residency has implemented a unique educational program. Here we describe the 5-year results of our novel fellowship program in health care sustainability, primarily focused on greening the operating room. Selected General Surgery residents interested in healthcare sustainability and greening the operating room. We have successfully implemented a novel resident focused fellowship program in healthcare sustainability. Fellowship projects have led to significant reductions in our hospitals' collective carbon footprint. Surgeons have a unique responsibility to reduce the carbon footprint of the Operating Room. Implementing a dedicated fellowship program or similar intensive educational experience in healthcare sustainability within the framework of a graduate medical education curriculum will help to ensure future generations of surgeons are thoughtful leaders in environmental stewardship.

COMPARISON OF FIRST YEAR MEDICAL UNDERGRADUATES’ PERCEPTIONS REGARDING THEIR RESPECTIVE INSTITUTIONAL EDUCATIONAL ENVIRONMENT IN INTEGRATED VS TRADITIONAL MEDICAL CURRICULUM BY USING DREEM INVENTORY

OBJECTIVE: To compare the first-year medical undergraduates’ perceptions regarding their institutional educational environment in traditional and integrated medical curricula by using the Dundee Ready Educational Environment Measure (DREEM) inventory. METHODS: This cross-sectional comparative study was conducted in 2017-18 at two medical institutions of Rawalpindi and Islamabad labeled as Institution A (with integrated curriculum) and B (with traditional curriculum). After seeking written informed consent, paper format DREEM questionnaire was administered to 100 first year MBBS students. Data was analyzed using SPSS version 24. Descriptive and inferential statistics were applied. RESULTS: Mean global DREEM score for institution A was 131.09±19.94 with minimum score of 87 and maximum score of 175. Mean global DREEM score for institution B was 117.11±21.02 with minimum score of 65 and maximum score of 167. These scores reveal a “more positive” environment (scores of 101-150), with no statistically significant difference (p-value >0.05) between them. DREEM subscales scores for both institutions indicated room for improvement at both institutions in all five domains. CONCLUSION: We concluded that there were no statistically significant differences between first year medical students’ perceptions of their respective institutional educational environment in integrated versus traditional medical curriculum by using DREEM. However, students in integrated medical curriculum perceived their educational environment more positively than their counterparts in traditional medical curriculum.

Student-Led Efforts to Advance Anti-Racist Medical Education.

Over the past decade, medical schools across the United States have increasingly dedicated resources to advancing racial and social justice, such as by supporting diversity and inclusion efforts and by incorporating social medicine into the traditional medical curricula. While these changes are promising, the academic medicine community must apply an anti-racist lens to every aspect of medical education to equip trainees to recognize and address structural inequities. Notably, organizing and scholarly work led by medical students has been critical in advancing anti-racist curricula. In this article, the authors illustrate how student activism has reshaped medical education by highlighting examples of student-led efforts to advance anti-racist curricula at Harvard Medical School (HMS) and at the University of California, San Francisco (UCSF) School of Medicine. HMS students collaborated with faculty to address aspects of existing clinical practice that perpetuate racism, such as the racial correction factor in determining kidney function. They also responded to the existing curricula by noting missed opportunities to discuss structural racism, and they planned supplemental sessions to address these gaps. At UCSF, students identified specific avenues to improve the rigor of social medicine courses and developed new curricula to equip students with skills to confront and work to dismantle racism. The authors describe how HMS students, in an effort to improve the learning environment, developed a workshop to assist students in navigating microaggressions and discrimination in the clinical setting. At UCSF, students partnered with faculty and administration to advocate pass/fail grading for clerkships after university data revealed racial disparities in students' clerkship assessments. In reviewing these examples of students' advocacy to improve their own curricula and learning environments, the authors aim to provide support for students and faculty pursuing anti-racist curricular changes at their own institutions.

THE INFLUENCE OF EARLY CLINICAL EXPOSURE MODULE IN UNDERGRADUATE MEDICAL EDUCATION

Introduction: In traditional medical curriculum basic science subjects were taught in isolation from clinical subjects. Students would thereby find it difficult to retain concepts in basic sciences, recall and co-relate it when clinical setting was encountered. Early clinical exposure is early authentic patient contact in clinical or social setting which helps to enhance the understanding of health or illness/disease and the role of medical professional. The objective of this study was to study the influence of early clinical exposure for a module on jaundice on undergraduate students and faculty perception.
 Materials and Methods: ECE module on jaundice was introduced for study in first MBBS students. Pre-validated questionnaire was used for data collection and student and faculty perception about the module was evaluated.
 Results: Participating students got better score in post-test (6. 03 + 1.701) as compared with pre-test (5.82+1.701) although the results were not statistically significant. 92% students and faculty positively rated and appraised ECE as a teaching learning tool.
 Conclusion: ECE module on jaundice generated interest in students and could help students co-relate basic science concepts with cases. This could lead to improvement in academic performance and better patient care.
 Keywords: Early clinical exposure; student, faculty perception

English

BACKGROUND Basic life support (BLS) although a lifesaving skill, is seldom taught in the first year of traditional Indian undergraduate medical curriculum resulting in lack of competence and confidence. Medical Council of India’s new competency based undergraduate curriculum stresses on early skill acquisition. Basic life support hands-on workshop can be a simple yet effective educational intervention in achieving the goal. The aim of the study is to determine the effectiveness of introduction of BLS training workshop to first year MBBS curriculum as a part of foundation course skills development. METHODS An interventional study in the form of BLS workshop consisting of lecture, demonstration and hands on practice on mannequins was conducted on first MBBS students. Assessment was done by standardized pre- and post-test questionnaire and direct observation of procedural skills (DOPS). Student’s perception was qualitatively explored by conducting focus group discussions (FGD) followed by thematic analysis. RESULTS Analysis of median pre- and post-test scores using Wilcoxon test matched pairs signed rank test revealed highly significant gain in knowledge and confidence (P value = 0.000). Thirty three percent students could perform all the seven steps of cardiopulmonary resuscitation (CPR) correctly, meeting all six quality indicators indicating satisfactory skill acquisition. Six overarching themes emerged from the focus group responses viz. importance of clinical skill acquisition in first year, suggested methods to improve skill training, effectiveness of BLS workshop, usefulness of learning BLS skill, readiness to perform CPR in real life scenario and need for curriculum reformation. CONCLUSIONS Simulation-based hands-on workshop can serve as an effective teaching learning strategy for foundation course BLS skills development under new competencybased first MBBS curriculum by Medical Council of India (MCI). KEYWORDS Basic Life Support, Cardiopulmonary Resuscitation, MBBS, Curriculum, Competency, Qualitative Analysis, Medical Education

A sex and gender medicine in emergency medicine course: a novel elective for trainees

ABSTRACT Evidence-based sex and gender differences in Emergency Medicine (EM) affect every aspect of patient care. Unfortunately, these important differences are not yet routinely incorporated into traditional medical curricula, leaving most EM trainees bereft of this knowledge, potentially resulting in suboptimal patient care. In an effort to close this knowledge and curricular gap, a unique introductory ‘Sex and Gender in Emergency Medicine’ (SGEM) course was created and offered to medical students and EM residents as an elective course. Pre- and post-course surveys were obtained. Surveys were designed to assess awareness, knowledge, and attitudes regarding Sex- and Gender-based Medicine (SGM). Pre-surveys demonstrate that less than half (44%) were familiar with the topic of SGM and none reported receiving any prior instruction or medical education regarding SGM. Despite this relative unfamiliarity with SGM, the majority (91.6%) felt that SGM knowledge was important and would improve one’s ability to care for patients. Post-survey responses consistently reflected that participants were now more familiar with SGM and additionally felt that SGM knowledge would affect their future clinical practice. All respondents felt that medical education should routinely incorporate SGM. An SGM/SGEM elective is feasible and an effective curricular addition to introduce SGM to medical students and residents.

A Strategy for Undergraduate Medical Education in Urology During the COVID-19 Pandemic

OBJECTIVETo provide a framework for a virtual curriculum during the COVID-19 pandemic for medical student educators that introduces and teaches clinical concepts important in urology and surgical specialties in general.METHODSWe created a 1-week virtual urology course utilizing interactive lectures, case-based exercises, and faculty-proctored surgical video reviews. Students were assigned self-study modules and participated in case-based discussions and presentations on a topic of their choice. Students’ perceptions of urology as a specialty and the utility of the course was evaluated through pre- and postcourse surveys. Understanding of urologic content was evaluated with a multiple-choice exam.RESULTSA total of nine students were enrolled in the course. All students reported increased understanding of the common urologic diagnoses and of urology as a specialty by an average of 2.5 points on a 10-point Likert scale (Cohen's measure of effect size: 3.2). Additionally, 56% of students reported increased interest, 22% reported no change and 22% reported a decreased interest in pursuing urology as a specialty following the course. Students self-reported increased knowledge of a variety of urologic topics on a 10-point Likert scale. The average exam score on the multiple-choice exam improved from 50% before the course to 89% after the course.CONCLUSIONSVarious teaching techniques can be employed through a virtual platform to introduce medical students to the specialty of urology and increase clinical knowledge surrounding common urologic conditions. As the longevity of the COVID-19 pandemic becomes increasingly apparent and virtual teaching is normalized, these techniques can have far-reaching utility within the traditional medical student surgical curriculum.

Democratizing Access to Neurosurgical Medical Education: National Efforts in a Medical Student Training Camp During Coronavirus Disease 2019

BackgroundNational medical student surveys amidst the coronavirus disease 2019 (COVID-19)–driven subinternship cancellations have demonstrated the need for supplemental, standardized subspecialty medical education, mentorship, and career planning nationally. We have presented the first live, cross-institutional virtual medical student subspecialty training camp to deliver standardized neurosurgical educational content to medical students during the COVID-19 pandemic, and its results on medical student anxiety and perceptions of neurosurgery.MethodsThe online training camp used a video conferencing platform that was open to all medical students. A post-training camp survey was administered.ResultsA total of 305 medical students registered for the event from 107 unique U.S. medical schools. Of the 305 medical students, 108 reported intending to apply to neurosurgery residency in 2021. The top medical student objectives for the training camp were program networking and mentorship. Of the 305 participants, 121 (39.7%) completed the post-training survey. Of the respondents, 65.0% reported improved neurosurgical knowledge, 79.8% reported decreased anxiety about subinternships and interviews, 82.5% reported increased enthusiasm about neurosurgery, and 100% desired a future annual virtual training camp because of the increased accessibility and decreased cost. This was especially important for students at institutions without home subspecialty programs and those with financial burdens.ConclusionsCOVID-19–driven innovations in medical education have accelerated changes that may have long been necessary. This virtual structure improved resource usage and scalability compared with in-person training, maintained social distancing, and democratized access to standardized, specialized content not often available through traditional medical curricula. Even as a supplement to in-person events, the virtual training camp model could be implemented by national medical societies, which might significantly increase medical students' preparedness for, and education in, neurosurgery and other subspecialties.

Scaling Up a Global Health and Disparities Path of Excellence Pilot Program at the University of Michigan Medical School.

Transforming medical school curricula to train physicians to better address society's needs is a complex task, as students must develop expertise in areas other than clinical medicine. In 2010, the University of Michigan Medical School (UMMS) launched the Global Health and Disparities (GHD) Path of Excellence as part of a larger curriculum transformation. The GHD Path is a co-curriculum with the goal of ameliorating health disparities in the United States and abroad. It was developed iteratively based on student and faculty feedback. Student feedback emphasized the value of the relationships with faculty and other students, the capstone project, and exposure to role models and professional networks. Faculty described the joy of interacting with students and the desire for recognition by their departments for their role as an advisor. Informed by the GHD Path experience, UMMS embraced the Path model, which emphasized professional relationships, career development, and high-impact scholarly work, making it different from the traditional medical curriculum, and the school implemented 7 other Paths between 2013 and 2018. Elements common to all Paths include a capstone project, a longitudinal advisor separate from the capstone advisor, exposure to role models and leaders, and the dissemination of scholarly work to promote networking. Next steps for the Paths of Excellence include developing methods to systematically monitor students' progress, facilitating mentoring skills in and recognizing faculty advisors, and measuring the long-term impact of the Paths on students and society.

Effect of linguistic strategies in traditional Chinese medicine English teaching courses for foreign students

It's important that the university teachers apply proper linguistic strategies in the Traditional Chinese medicine courses for foreign students, which can reduce the non-native language ability limitation to teaching effect to a certain extent, which can let students better understand and grasp the contents. This paper summarize the influence of linguistic strategies on teaching effect, such as signposting, signalling importance, back channeling, repetition, questioning, commenting, which is the important foundation and powerful guarantee of ideal teaching effects of EMI. Key words: Traditional Chinese medical curriculum; Students, international (TCMP); English as medium of instruction (EMI); Linguistic strategies

The impact of a simulation-based approach to teaching crisis resource management for medical emergencies on neonatal intensive care units in the UK, India, Nepal and Saudi Arabia

Effective communication, team working and human factors are given little attention in traditional medical curricula. However, these skills are fundamentally important during crisis resource management (CRM) in healthcare. These skills can be learnt and can be taught very effectively within a simulated environment. Thus simulation-based training on CRM can positively impact patient safety. One such course which focuses on the management of common neonatal emergencies is the ‘Neonatal Emergencies Simulation Team training’ (NEST) program. This one day multiprofessional educational program, originally designed by the London Neonatal Transfer Service, aims to develop multidisciplinary confidence and competence in the management of common neonatal emergencies. This program has been evaluated positively in India, Nepal, Saudi Arabia and the UK and shows promise for wider implementation in high-, middle- and lowincome countries. Here we give an overview of the program and its implications. Citation: Mohinuddin S, Rajkumar Rajendram R, Swamy S. The impact of a simulationbased approach to teaching crisis resource management for medical emergencies on neonatal intensive care units in the UK, India, Nepal and Saudi Arabia. Anaesth Pain & Intensive Care 2018;22(3 Suppl1):S124-S128

Best practices to impart clinical skills during preclinical years of medical curriculum.

Globally, health is regarded as a booming industry with greater stress being laid on high quality, accountability, and transparency. Traditional medical curricula rely primarily on clerkships during the clinical period of study to train clinical skills, while the preclinical period is mainly used to teach the basic sciences. In recent years, the early introduction of clinical skills training has received increased attention. This review aims to identify and summarize teaching approaches of clinical skills for medical students during preclinical years, namely, (1) framing objectives (2) learning activities, and (3) evaluation strategies. Although the clinical tutor's role is to ensure that students receive effective preclinical skills through different modes of learning (lectures, presentations, and problem-based learning), the role of advanced technologies, namely, simulation-based learning platforms and gamification are found to be very successful. To improve the communication skills, there is strong evidence in support of role plays, and similarly, for enhancing observation skills, an introduction of fine arts in clinical skills training was found to be very useful. Medical schools worldwide should give high priority to conduct faculty development programs on various aspects of training and teaching modalities, evaluation strategies, and improving the evaluation of various clinical skills. Students should be provided with sufficient learning opportunities including a well-equipped clinical skills laboratory and individual attention, and constructive feedback should be given to students for building their confidence level during their learning process.

Learning experience of undergraduate medical students during 'model preparation' of physiological concepts.

PurposeLearning physiological concepts and their practical applications in the appropriate contexts remains a great challenge for undergraduate medical students. Hence the present study aimed to analyze the learning experience of undergraduate medical students during an active learning process of ‘preparation of models’ depicting physiological concepts.MethodsA total of 13 groups, involving 55 undergraduate medical students with three to five individuals in each group, were involved in model preparation. A total of 13 models were exhibited by the students. The students shared their learning experiences as responses to an open-ended questionnaire. The students’ responses were analyzed and generalized comments were generated.ResultsAnalysis of the results showed that the act of ‘model preparation’ improved concept understanding, retention of knowledge, analytical skills, and referral habits. Further, the process of ‘model preparation’ could satisfy all types of sensory modality learners.ConclusionThis novel active method of learning could be highly significant in students’ understanding and learning physiology concepts. This approach could be incorporated in the traditional instructor-centered undergraduate medical curriculum as a way to innovate it.

Multidisciplinary Neonatal Emergencies Simulation Team-Training (NEST) Improves Participant’s Confidence in Dealing With Simulated Neonatal Emergencies

Background: A traditional medical curriculum has limited emphasis on communication skills, teamworking, and human factors. Simulation-based training emphasizes these skills and positively impacts patient safety. A group of Indian neonatologists in collaboration with their UK colleagues conducted adapted Neonatal Emergencies Simulation Team-training (NEST) courses in India. Aim: To evaluate the effectiveness of NEST courses in India and analyze the participant’s feedback Methods: A total of 16 NEST courses were conducted between November 2014 and February 2016. Structured pre- and postcourse feedback from participants was analyzed. Key domains studied included structured approach, human factors, situation-background-assessment-recommendation tool, and teamwork in an emergency. Each category was rated from 1 to 5, indicating a low to high scale. Pre- and posttraining scores and scores between centers were compared using the Wilcoxon signed-rank test and Kruskal-Wallis test, respectively. Results: A total of 191 feedbacks from 58 nurses and 133 doctors from 4 centers were analyzed. The comparison of self-reported pre- and postcourses showed a significant improvement across all domains. There was no statistical difference between scores from different centers showing consistent course results. Conclusions: We have demonstrated that the NEST multiprofessional course can be collaboratively delivered. The analysis of feedback shows a significant improvement in the candidate’s self-reported ability across all domains related to the application of the course principles to simulated neonatal emergencies.

Problem Based Learning for Fourth Year Medical Students in Fayoum Governorate, Egypt

Background: Problem based learning (PBL) consider that the most significant development in education over the past five decades. It has been boosted by the curriculum of choice, and since its introduction in the 1960's, has been vastly adopted by many medical and dental schools. Objectives: The aim of this research was to compare the development and recollection of knowledge in the medical sciences between students on the traditional and reformed undergraduate medical curricula, respectively.Methods: For each medical student has taken, The Progress Test Medizin (PTM), relative frequencies of correct answers were computed for basic sciences items only and for the whole curriculum. Frequencies were averaged and grouped by semester and curriculum. Analyses of variance (ANOVAs) were performed at all measurement points with a Bonferroni-corrected p-value at the level of p < 0.005. Eta-squared (g2) was used to classify effect size.Results: The current study occurs on 80 fourth year medical students divided into two rounds. First round study by the traditional medical curriculum (lecture group) whiles the second round study by the reformed medical curriculum (problem learning group). The present study shows that there is statistically significant difference with p-value <0.05 between different topics among lecture teaching method with the lowest score given for identification topic and the highest core for death topic; which indicated that lecture methods not suits some topics as identification topicConclusion: Proceed testing as a longitudinal method allows us to better understand the development of knowledge during formal undergraduate education. The main difference between traditional and problem-based medical education demonstrate to be induced by the high-stakes national examination undertaken in the traditional course.

Perception of Ghanaian Medical Students of Cadaveric Dissection in a Problem-Based Learning Curriculum

There is a drastic shift in medical curriculum from the traditional medical curriculum where various basic science disciplines are taught separately in the preclinical years to integrated problem-based learning (PBL) in many medical schools across the world. In the integrated PBL, the time for classical anatomy dissection is significantly reduced. There are varying views across the world about the perception of medical students to cadaveric dissection. There is however no research on student's perception of cadaveric dissection in Ghana. The present study was to assess Ghanaian medical student's perception of cadaveric dissection under the PBL curriculum and to assess which educational tool students rely on to study anatomy. An anonymous self-administered, Likert-style questionnaire consisting of 24 questions was administered to 132 second- and third-year students after they had completed the dissection schedules for the musculoskeletal system. Participation was voluntary. In all, 89.5% of the students indicated that they had attended all the dissection sessions. The students generally agreed that dissection deepens their understanding of anatomy (87.9%), provides better understanding of clinical skill examination (66.7%), enhances their respect towards the human body (66.6%), provides better understanding of the effect of trauma (69.7%), and makes learning interesting (90.9). However, 57.5% of them agreed or strongly agreed that dissection was stressful. Majority of the students also disagreed that dissection should be eliminated from the curriculum (100%). This study has shown a strong positive perception towards the use of cadaveric dissections in teaching and learning anatomy regardless of the fact that SMHS/UDS uses the integrated PBL curriculum.

Reform and thinking of physiological techniques teaching

The traditional medical physiology curriculum is difficult to meet the training requirements for biotechnology specialty. Aiming at the goal of professional training, we carried out the reform for the curriculum of physiological techniques, including changing the physiology curriculum system, carrying out patch-clamp recording, multiple-channel recording, behavioral experiments and self-directed experiments and using PBL and microclass teaching methods. Through these processes, the aim is to enable students to master the basic theoretical knowledge of physiology and keep up with the frontier research technology. Key words: Research experiments; Biotechnology; Physiological techniques curriculum; Whole-cell clamp recording

Simulation-Based medical teaching and learning in human anatomy

Modern medical education faces a problem of combining the latest technology with classic teaching methods. Simulation is a technique, which replaces or amplifies experiences in controlled conditions and therefore evokes or replicates substantial aspects of the real world in a fully interactive manner. The basic course of human anatomy in medical education could be recognised as the best example of implementing new educational techniques such as simulation, into the traditional medical curriculum. Modern medical education faces a problem of combining the latest technology, procedures and information with classic teaching methods. The goal is to prepare students to become physicians equipped with the latest conceptions in medicine. Another challenge is the linking of theoretical and practical knowledge without forgetting the socio-practical aspect of medical care. Training, from the very beginning, taking place in a reality-reflected environment (e.g. simulation-based training) seems to be a beneficial solution. Simulation is a technique, which replaces or amplifies doctor–patient experiences in controlled conditions and therefore evokes or replicates substantial aspects of the real world in a fully interactive manner [1]. Simulation techniques improve both cognitive and practical aspects of the education process in predictable and stress free conditions. The basic course of anatomy in medical education could be recognised as the best example of implementing new educational techniques such as simulation, into the traditional medical curriculum.

Medical students utilization of e-learning re-sources; is it an informal curriculum?

Background: E-learning refers to the use of Internet technologies to deliver a broad range of solutions that enhance knowledge and per-formance of learners. This mode of learning can be used by institutions to improve the efficiency and effectiveness of educational inter-ventions in the face of the social, scientific, and pedagogical challenges. Worldwide, it has gained popularity in the past few decades; however, its use is highly variable among the medical schools of Pakistan. Currently, a very few number of institutions have adopted it officially in their curriculum. Despite this, many students use different E Learning resources to enhance their learning.Objective: To find out about the online resources utilized by the medical students in addition to their traditional medical curriculum to enhance their learning.Method: In this cross-sectional study, 300 participants from Dow Medical College and Jinnah Sindh Medical Universities were included after taking informed consent. A self-administered questionnaire which consists of demographic information, years of study and online resources with their usage details by the students for different subjects of basic and clinical sciences were documented.Results: Almost all the students reported to use some form of eLearning to enhance their medical understanding. The most frequently used electronic resources were Google images (61.7%) and Wikipedia (50.3%). Mostly, the students used YouTube (25.7%) for animations; Kaplan (27%) and Dr. Najeeb (15.6%) for video lectures. However, Audio lecture by Goljan (17.7%) was the only resource for podcast learning. Among discussion forums, Facebook groups (16.3%) were most popular and among static websites, Medscape (4.3%), PubMed (2.5%), WebMD (1.3%) were the most commonly used ones.Conclusion: All of the medical students used some form of eLearning in medical education in addition to their formal curriculum. This way of learning should be further implemented in the form of formal curriculum as e-learning modules for basic and clinical sciences to make learning easier, engaging and innovative for the 21st century learners.

The reform of pediatric teaching course with multidisciplinary integration

In order to optimize the curriculum structure, improve the quality of the traditional medical curriculum which separates the theory teaching and clinical teaching in medical education; give full play to the advantages of the multiple disciplines application to guide students to establish a holistic view of medicine; cultivate students' independent thinking and team cooperation ability, we explore the reform model of the pediatric teaching courses from the following five aspects: curriculum design, class hour arran-gement, teaching team building, teaching carrier production and application of problem-based learning (PBL) teaching method. Preliminarily establish the teaching mode in multi disciplines integration which is characterized by taking a certain symptom or sign as leading clue. Key words: Multi disciplines; Problem-based learning (PBL); Pediatric teaching courses