Undergraduate Medical Program Research Articles

A qualitative study exploring how students’ conceptualisations of lifelong learning develop in an undergraduate medical training programme

ABSTRACT There is currently a paucity of evidence regarding how medical undergraduate training influences students’ attitudes and skills for lifelong learning (LL). This study describes medical graduates’ conceptualisations of LL at the University of Dundee and proposes a provisional theory regarding related curriculum influences. Using a methodology informed by scientific realism, semi-structured interviews were employed to explore six graduating medical students’ conceptualisations of and preparedness for LL. Findings were thematically analysed and aligned with existing educational theories. Graduates characterised LL as a continual process which emphases reflection, responsibility for learning, and maintaining motivation. Their conceptualisations did not translate readily beyond professional medical practice. The strongest curriculum influences were experiences in the authentic clinical environment, use of learning portfolios, and the intercalation of a medical science degree. In the absence of formal teaching, medical students’ conceptualisations of LL develop in accordance with both the implicit prevailing professional narrative and from curriculum interventions which: increase their sense of relatedness with their community of practice; provide autonomy in learning; and engender a sense of responsibility to learn. This provisional theory could be valuable in guiding the teaching and assessment of LL in-line with contemporary graduate outcome frameworks.

COVID-19 Pandemic Experiences of Residents: A Qualitative Study

Aim: The COVID-19 pandemic has had an unprecedented impact on the healthcare system and professionals worldwide. This study aims to explore the residents' experiences working in medical and surgical fields in Hacettepe University hospitals during the early months of the COVID-19 pandemic and investigate the effects of the pandemic on their lives and education.Methods: The research is designed as a Qualitative research. We obtained the data through in-depth interviews with nine residents working at the forefront of the pandemic, maintaining their postgraduate education at Hacettepe University Faculty of Medicine. We used content analysis to analyze the data.Results: Residents discussed the effects of the COVID-19 epidemic on their professional, psychosocial and educational lives with a broad perspective. They defined the modifications in working conditions, professional and institutional approaches, the professional conflicts caused by the pandemic, the effects of the pandemic on patient treatment/care, and the gains from experience as the effects of the COVID-19 epidemic on their professional lives. Besides family and friends' support, faculty members have an essential role in supporting residents. The residents stressed the importance of society's cooperation in managing the pandemic. They stated that the decision-makers and their institutions did not meet their expectations. They explained the pandemic's main psychosocial effect: the fear of infecting family members, social adaptation, and social stigma. The residents stated that the pandemic caused disruptions and changes in medical education. They indicated that undergraduate medical education was insufficient to prepare health professionals for extraordinary conditions. The residents suggested that the management of exceptional conditions topics such as epidemics, pandemics, and disasters should be included in medical education.Conclusions: COVID-19 has affected many aspects of residents' lives. Although this experience provided some gains, the pandemic experience revealed the weaknesses of medical education, university, hospital management and government. The pandemic caused changes in professional life, tensions in work environments, and psychosocial difficulties. It is worrying that undergraduate medical education programs are insufficient to prepare health professionals for crises in the health system. The pandemic caused disruptions in residency education. Academic, professional, and psychological support of faculty members has been critical in ensuring the residents' motivation during the pandemic. Stakeholders should consider the suggestions and needs of residents, and medical education programs should be reviewed to achieve competencies related to disaster/crisis management. This effort is the responsibility of all partners to the young physicians who witnessed the most memorable period of history and society, which is the subject of health service delivery.

Virtual Care in Undergraduate Medical Education: perspectives beyond the pandemic. How medical education can support a change of culture towards virtual care delivery in Canada.

The pandemic has led to further the importance of telemedicine, teleconsultation, and technology as essential components for delivering of care in all settings. Prior to the pandemic, the instruction surrounding the safe delivery of virtual care in undergraduate medical education was sparse and informal. For care to be delivered to the high standards expected of Canadian physicians, the University of Ottawa undergraduate medical program (UGME) made the decision to define virtual care as a series of tools to facilitate and support the safe delivery of care. By focusing on virtual care as a set of tools, it provides the framework for skill development for future clinicians early in their careers and provides a critical thinking pathway to support the ever-evolving landscape of digital technology in the provision of safe, effective, timely and patient-centered care. This white paper shares our experience creating a virtual care curriculum and the possible implications for medical education.

Recent medical graduates’ attitudes towards nutrition education and its role in medical practice

The objective of this study was to investigate recent Dalhousie Medical School graduates’ perceptions of nutrition in three domains: attitudes towards its use in medical practice generally, learned body of knowledge in medical school and residency, and satisfaction with how undergraduate and postgraduate medical education aligned their attitudes and knowledge of nutrition in medicine. Graduates of Dalhousie University’s undergraduate medical program from 2013 to 2018 were contacted to complete an internet-based questionnaire of 13 five-point Likert scale questions about attitudes, knowledge, and satisfaction with nutrition education in their undergraduate medical studies and medical practice. Responses ranged from one, “strongly disagree” to five, “strongly agree”. Most respondents (90.2%) agreed that ‘nutrition counseling can make a positive difference to patient outcomes’ and 80.5% agreed that ‘physicians can influence patient behavior related to nutrition’. However, fewer (61.0%) agreed that ‘physicians play a key role in improving patients’ nutritional habits.’ Even fewer participants agreed that nutritional assessment (34.1%) and nutritional counselling (41.5%) should be a routine part of care, regardless of specialty. The mean (standard deviation) overall score of participants with regards to their attitudes about nutrition assessment, counselling, and role in patient health, was 3.60 (0.633). Scores ranged from 1 to 5 with higher score indicating morepositive attitude. Mean overall knowledge and satisfaction scores were 3.76 (0.702) and 2.70 (0.898), respectively. There is a lack of consensus regarding the role of physicians in delivering nutrition care to patients, despite its perceived importance to patient health, requiring further exploration.

Types of exams used in medical education in Norway.

No overview exists of the types of exams used in medical education in Norway. In this study, we have identified these and analysed the reasons why directors of studies choose a particular type of exam. The aim has been to form an overview and to frame the reasoning behind assessment practices in Norwegian undergraduate medical education in an international and research-based perspective. We gathered information about the types of exams used in the four undergraduate medical education programmes in Norway. We also conducted semi-structured interviews with a director of studies at each university. The strengths and weaknesses of the types of exams used were discussed in the interviews. The number of exams, the types of exams and their position in the study programme varied considerably across the four study programmes. Multiple-choice exams were the most common, supplemented with various oral exams and practical assessments. Arguments for choosing the various types of exam were largely related to the need for standardisation, objectivity and resource availability. Assessment seems to be largely intended to measure and control, while the opportunities to foster learning that examination affords are not well exploited. Systems thinking in relation to the different intentions of the types of assessment, which is touched on in international guidelines, seems to be a low priority.

Reflective writing in undergraduate medical education: A qualitative review from the field of psychiatry

The aim of this study was to identify the types of reflective writing produced by a cohort of medical students undertaking a clinical psychiatry module as part of their undergraduate medical programme at a University in the Republic of Ireland. A random sample of 80 reflective essays were selected for review. These assignments were evaluated using a comprehensive content analysis process with a pre-determined reflective writing coding instrument and coding protocol. Dialogic reflection was the most common type of reflective writing identified, with 56.3% (n = 45) of the summative assignments categorised as such. Twenty five percent (n = 20) of the assignments were classified as descriptive reflection, while 18.8% (n = 15) of the assignments demonstrated critical reflection. Overall, the findings of the study indicate that this innovative programme was successful in fostering and developing reflective writing in medical students to quite an advanced level. The paper concludes with specific recommendations for facilitating reflective writing in professional and higher education.

A Generalizable Approach to Predicting Performance on USMLE Step 2 CK.

IntroductionThe elimination of the USMLE Step 1 three-digit score has created a deficit in standardized performance metrics for undergraduate medical educators and residency program directors. It is likely that there will be greater emphasis on USMLE Step 2 CK, an exam found to be associated with later clinical performance in residents and physicians. Because many previous models relied on Step 1 scores to predict student performance on Step 2 CK, we developed a model using other metrics.Materials and MethodsAssessment data for 228 students in three cohorts (classes of 2018, 2019, and 2020) were collected, including the Medical College Admission Test (MCAT), NBME Customized Assessment Service (CAS) exams and NBME Subject exams. A linear regression model was conducted to predict Step 2 CK scores at five time-points: at the end of years one and two and at three trimester intervals in year three. An additional cohort (class of 2021) was used to validate the model.ResultsSignificant models were found at 5 time-points in the curriculum and increased in predictability as students progressed: end of year 1 (adj R2 = 0.29), end of year 2 (adj R2 = 0.34), clerkship trimester 1 (adj R2 = 0.52), clerkship trimester 2 (adj R2 = 0.58), clerkship trimester 3 (adj R2 = 0.62). Including Step 1 scores did not significantly improve the final model. Using metrics from the class of 2021, the model predicted Step 2 CK performance within a mean square error (MSE) of 8.3 points (SD = 6.8) at the end of year 1 increasing predictability incrementally to within a mean of 5.4 points (SD = 4.1) by the end of year 3.ConclusionThis model is highly generalizable and enables medical educators to predict student performance on Step 2 CK in the absence of Step 1 quantitative data as early as the end of the first year of medical education with increasingly stronger predictions as students progressed through the clerkship year.

Assessment as Learning in Medical Education: Feasibility and Perceived Impact of Student-Generated Formative Assessments.

BackgroundSelf-regulated learning (SRL) is gaining widespread recognition as a vital competency that is desirable to sustain lifelong learning, especially relevant to health professions education. Contemporary educational practices emphasize this aspect of undergraduate medical education through innovative designs of teaching and learning, such as the flipped classroom and team-based learning. Assessment practices are less commonly deployed to build capacity for SRL. Assessment as learning (AaL) can be a unique way of inculcating SRL by enabling active learning habits. It charges students to create formative assessments, reinforcing student-centered in-depth learning and critical thinking.ObjectiveThis study aimed to explore, from the learners’ perspectives, the feasibility and perceived learning impact of student-generated formative assessments.MethodsThis study relied on a convergent mixed methods approach. An educational intervention was deployed on a cohort of 54 students in the second year of a 6-year undergraduate medical program as part of a single-course curriculum. The AaL intervention engaged students in generating assessments using peer collaboration, tutor facilitation, and feedback. The outcomes of the intervention were measured through quantitative and qualitative data on student perceptions, which were collected through an anonymized web-based survey and in-person focus groups, respectively. Quantitative survey data were analyzed using SPSS (IBM), and qualitative inputs underwent thematic analysis.ResultsThe students’ overall score of agreement with the AaL educational intervention was 84%, which was strongly correlated with scores for ease and impact on a 5-point Likert-type scale. The themes that emerged from the qualitative analysis included prominent characteristics, immediate gains, and expected long-term benefits of engagement. The prominent characteristics included individuals’ engagement, effective interdependencies, novelty, and time requirements. The identified immediate gains highlighted increased motivation and acquisition of knowledge and skills. The expected long-term benefits included critical thinking, problem solving, and clinical reasoning.ConclusionsAs a form of AaL, student-generated assessments were perceived as viable, constructive, and stimulating educational exercises by the student authors. In the short term, the activity provided students with a fun and challenging opportunity to dive deeply into the content, be creative in designing questions, and improve exam-taking skills. In the long term, students expected an enhancement of critical thinking and the inculcation of student-centered attributes of self-regulated lifelong learning and peer collaboration, which are vital to the practice of medicine.

Global Perceptions on Social Accountability and Outcomes: A Survey of Medical Schools

Phenomenon : Social accountability has become a universal component in medical education. However, medical schools have little guidance for operationalizing and applying this concept in practice. This study explored institutional practices and administrative perceptions of social accountability in medical education. Approach : An online survey was distributed to a purposeful sample of English-speaking undergraduate medical school deans and program directors/leads from 245 institutions in 14 countries. The survey comprised of 38-items related to program mission statements, admission processes, curricular content, and educational outcomes. Survey items were developed using previous literature and categorized using a context-input-process-products (CIPP) evaluation model. Exploratory Factor Analysis (EFA) was used to assess the inter-relationship among survey items. Reliability and internal consistency of items were evaluated using McDonald’s Omega. Findings : Results from 81 medical schools in 14 countries collected between February and June 2020 are presented. Institutional commonalities of social accountability were observed. However, our findings suggest programs focus predominately on educational inputs and processes, and not necessarily on outcomes. Findings from our EFA demonstrated excellent internal consistency and reliability. Four-factors were extracted: (1) selection and recruitment; (2) institutional mandates; (3) institutional activities; and (4) community awareness, accounting for 71% of the variance. McDonald’s Omega reliability estimates for subscales ranged from 0.80-0.87. Insights : This study identified common practices of social accountability. While many medical schools expressed an institutional commitment to social accountability, their effects on the community remain unknown and not evaluated. Overall, this paper offers programs and educators a psychometrically supported tool to aid in the operationalization and reliability of evaluating social accountability.

Position paper on undergraduate Palliative Medicine education for doctors in South Africa.

BackgroundBasic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality.AimThis joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor.SettingPalliative Medicine programme leads and teachers from eight medical schools in South Africa.MethodsA survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers.ResultsResponses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the pre-clinical and clinical components of the curriculum.ConclusionThrough mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC).

Applied Theatre and Drama in Undergraduate Medical Education: A Scoping Review

Background: Thematic arts have been integrated throughout various undergraduate medical education programs to improve students’ clinical skills, knowledge, and behaviours to be clinically competent physicians. Applied theatre and drama use theatrical performances and exercises respectively to guide education. Several medical schools across Canada and the United States have incorporated applied theatre and drama within their curriculums, but there is currently no compilation of these initiatives. Methods: Using Arksey and O’Malley’s methodological framework for scoping reviews, the two authors searched journal databases for articles pertaining to theatre/drama activities being used in undergraduate medical education in Canada and the United States; search terms revolved around applied theatre and undergraduate medical education. Twenty articles were read in full, 14 were included in this review. The articles were subjected to content analysis to understand how these studies connected with the CanMEDS framework to understand the impacts and merits of applied theatre and drama in undergraduate medical education. Results: Content analyses generated three parent-categories of how theatre and drama can help medical students improve their communication skills, creative medical learning, and aid their professional development. These three categories touched upon all seven aspects of the CanMEDS framework, indicating the values of drama being included in medical education. Conclusion: This scoping review illustrates the intersections of thematic arts in undergraduate medical education by highlighting how applied theatre or drama activities connect to the entire CanMEDS framework. This review provides insights to current theatre and drama initiatives to aid medical faculty with their undergraduate medical curricula developments.

Development of a list of core clinical topics suitable for a shared primary care curriculum for medical undergraduates in Malaysia: A Delphi study

ABSTRACT In the last few decades, primary care medicine (PCM) is increasingly recognised as a cornerstone of an efficient and effective healthcare system. However, the PCM discipline is now facing challenges such as a shortage of doctors. One of the possible reasons could be the lack of comprehensive PCM curricular components in the undergraduate medical programmes. This study aimed to develop a list of core clinical topics suitable to be used as a shared PCM curriculum for undergraduate education in Malaysia. A Delphi survey that consisted of three iterative rounds with feedback was used in this research. The participants included PCM experts involved in the undergraduate level of PCM teaching. These experts were selected based on the criteria developed by two senior academicians in PCM medical education. The final developed list contained 34 core clinical topics that should be incorporated into the undergraduate PCM curriculum. The findings will be useful in establishing the policies and guidelines of PCM education for undergraduates in various medical schools. This study may also promote the field of PCM and encourage more doctors to take up the speciality. Lastly, it provides essential information to address the knowledge gap in PCM education among undergraduate medical students in Malaysia.

Taking the Big Leap: A Case Study on Implementing Programmatic Assessment in an Undergraduate Medical Program

The concept of programmatic assessment (PA) is well described in the literature; however, studies on implementing and operationalizing this systemic assessment approach are lacking. The present case study developed a local instantiation of PA, referred to as Assessment System Fribourg (ASF), which was inspired by an existing program. ASF was utilized for a new competency-based undergraduate Master of Medicine program at the State University of Fribourg. ASF relies on the interplay of four key principles and nine main program elements based on concepts of PA, formative assessment, and evaluative judgment. We started our journey in 2019 with the first cohort of 40 students who graduated in 2022. This paper describes our journey implementing ASF, including the enabling factors and hindrances that we encountered, and reflects on our experience and the path that is still in front of us. This case illustrates one possibility for implementing PA.

Morte e morrer na formação médica brasileira: revisão integrativa

Abstract To describe how death and dying are approached in the medical undergraduate programs in Brazil and their repercussions for students, an integrative review of publications from 2008 to 2019 was carried out, resulting in a selection of 36 articles. The difficulties in approaching the theme related to the biomedical model of training, the organization of the curriculum, and the training of teacher were identified. Those affect students, causing psychic suffering and hindering the training process. Few curriculums approach psychosocial aspects related to death and dying, which are often approached for insufficient credit hours, inadequate methods, or as extracurricular activities. Solution proposals point to the necessity of investments in palliative care in the undergraduate programs. In conclusion, these themes need to be more thoroughly included in the National Curricular Directives of medicine programs, to foster a more humanitarian training, based on ethical principles, and which prepares students and professionals to deal with end-of-life situations

Near-Peers First, Physician Tutors Last. Interim Report of a Mixed-Methods Study Exploring Optimal Timing in Undergraduate Ultrasound Teaching

Near-Peers First, Physician Tutors Last. Interim Report of a Mixed-Methods Study Exploring Optimal Timing in Undergraduate Ultrasound Teaching Abstract. While many medical undergraduate ultrasound teaching programmes combine teaching from both physician and student ('near-peer') tutors, there has been little research on how these can be optimally combined. In this study, four groups of 16 medical undergraduates each received twelve lessons from student tutors and four lessons from physician tutors as part of their basic ultrasound course. Each group's physician tutor lessons took place in a different quarter of the course timetable. Quantitative and qualitative data were then collected through an online questionnaire, and 15 participants had 1:1 interviews. This interim analysis shows that, when designing combined ultrasound teaching for medical undergraduates, student tutors should be used at the start and physician tutors in the second half of the programme.

Study of effect of induction programme among phase I MBBS students

In India, students enter medical profession at the age of 17-19 years. At such tender age, this cohort of students has dissimilar psychological characteristics such as fear of ragging, feeling of homesickness, peer pressure, parental pressures, language problems, and adjustments to hostel life and food. In such a psychological state, they are expected to understand and appreciate the medical subjects. The health professional will understand their responsibilities with regards to quality service delivery in their work station. The aim and objective of the study was to evaluate the feedback of Induction Programme in newly entered medical undergraduate programme. 199 students participated in this one day program held on 1/10/2018.Their feedback was obtained by a pre-designed and pre-validated questionnaire on a five-point Likert scale. 199 students responded in feedback on induction on varied criterias of induction programme. It is therefore important to give newly appointed lecturers the best possible start in the teaching profession since their input is vital for promoting learning. A study in 2017 was done by Patel J on 107 students with the feedback about orientation program, whereas all the 112 students gave feedback on foundation course.

"New" medical education: perception of professor of an undergraduate program implemented from Mais Médicos Program

Introduction: Medical education is constantly changing in order to train medical professionals capable of intervening in the current needs of Brazilian health. In Brazil, this changing process was driven by Mais Médicos Program and the new National Curriculum Guidelines for medicine undergraduate. Objective: This study aimed to describe the perception of professors acting in an undergraduate medical program aligned with the Mais Médicos Program with regard to the "new" medical education in Brazil. Methods: This is a qualitative study, in which 18 medical educators of the aforementioned course. Data collection occurred through individual narrative interviews based on a guiding script. Data analysis was conducted by Hermeneutic-Dialectic. The following categories of analysis emerged: the course Pedagogical Course Project (PCP) and learning methodologies. Results: Among the difficulties for its curriculum implementation, there are cited the professionalization of the teaching role, the complexity of the activities, the scarceness of literature sources, and insecurity. These characteristics are added to the overcoming of the traditional undergraduate formation, which together diverge with the implementation of active teaching strategies, requiring medical trainers to be open to the changes that have been occurring in medical education. Conclusion: With this study, it was possible to identify professors' concerns and perceptions regarding the format of the course and its implementation process.

Injury prevention in medical education: a Canadian medical school survey

BackgroundInjury has a major societal impact. In Canada, injury is the leading cause of death among those aged 1–44 years, the fifth-leading cause of death among those of all ages...

It took a pandemic: Enduring lessons for improving accessibility in medical education

In March of 2020, the rapid onset of the COVID‐19 pandemic halted the gears of undergraduate medical education programs in the U.S. and in many locations across the globe. Disruptions to usual practice provided the impetus for educators to creatively re‐envision medical education with approaches that shared a common feature: flexibility. Out of the chaos of the pandemic rose a collective willingness to think creatively and adapt (see https://bit.ly/3x91Y8H). Although this type of creativity had been used prior to the pandemic to develop accommodations for individual students with disabilities, these changes occurred on a larger scale and increased flexibility for entire cohorts and programs.

Supplementing Gross Anatomy Pelvis and Perineum Content with Video Modules: Effects on Student Learning

Human gross anatomy and embryology (GAE) remains an integral piece in the first‐year medical student's education, even as medical schools across the United States condense their foundational phase curricula. In the setting of undergraduate medical programs that are making this transition, supplemental video modules are more frequently being utilized in gross anatomy learning. At Brody School of Medicine (BSOM) at East Carolina University (ECU), the GAE course is a 16‐week long course taught during the first block of the first‐year of medical school at BSOM. In addition to human gross anatomy (lecture and donor‐cadaver dissection), faculty also lecture on human embryology and radiology. In this project, we generated video modules focused on the genetic male pelvis and perineum and genetic female; these were then incorporated into the GAE course at BSOM. The videos included recordings of relevant anatomical features of donor‐cadaver prosections generated by BSOM anatomy faculty, as well as author generated illustrations highlighting key structural relationship, high‐yield embryology concepts, and voice‐over narration. The videos were uploaded to the BSOM learning management system, and learners instructed to watch the videos in preparation for the upcoming sessions focused on the pelvis and perineum (prosection demonstration and flipped‐classroom session). The aim of this study was to ascertain student self‐perception of comprehension of pelvis and perineum material with the incorporation of the video modules into the prosection laboratory and active‐learning session. The learners sampled were first‐year medical students enrolled in GAE at BSOM in Fall 2019 (n=87). In prior years, the pelvis and perineum unit included a three‐hour dissection followed by a flipped‐classroom session. Data analysis of survey results (n=86, 99% response rate) indicate that prior to reviewing the modules, 12% of respondents felt moderately or very comfortable with the content. After viewing the videos, 80% of respondents felt moderately or very comfortable with the content. Interestingly, all respondents (100%) agreed that it would be beneficial to their learning for similar videos to be included in future flipped‐classroom sessions. Collectively, these results provide insight into the positive effects of supplemental video modules in supporting student comprehension and retention of anatomical sciences knowledge when time constraints may require faculty to modify laboratory activities and active‐learning classroom sessions. Additional scholarship opportunities focus on evaluating the correlation between the use of video modules in GAE and learners' exam performance.