Undergraduate Medical School Research Articles

Ten practical tips for integration of biochemistry topics into systems-based medical school curriculum

Biochemistry is implemented in undergraduate medical school from the very beginning of the curriculum. Achieving a high level of competence in this area strongly influences academic success throughout the entire program. Due to the evaporating nature of this subject, medical students struggle to retain biochemistry concepts across the two years of their preclinical courses, especially while preparing for their board examinations. Therefore, the curriculum should be designed strategically to effectively implement the ever-growing field of biochemistry and metabolic pathways across the preclinical years of medical education. We propose a broadened integration of biochemistry by providing clinically correlated metabolic concepts which spiral across multiple domains, thus deepening and solidifying students’ understanding of pathology and etiology. This approach may help medical students retain their subject expertise and understand the complex material in the clinical context to minimize rote memorization. We hope to encourage medical educators, course directors, and curriculum administrators to utilize these tips to augment their biochemistry instruction in medical education.

Can the medical educator speak? The next frontier of globalisation research in medical education.

Can the medical educator speak? The next frontier of globalisation research in medical education.

Where in the world: Mapping medical student learning using the Social and Structural Determinants of Health Curriculum Assessment Tool (SSDH CAT)

ABSTRACT Introduction Addressing the Social and Structural Determinants of Health (SSDH) is a primary strategy for attaining health equity. Teaching and learning about SSDH has increased across medical schools throughout the world; however, the published literature describing these efforts continues to be limited and many unknowns persist including what should be taught and by whom, what teaching methods and settings should be used, and how medical learners should be assessed. Materials and Methods Based on published studies, input from experts in the field, and elements from the framework developed by the National Academy of Medicine, we created a universal Social and Structural Determinants of Health Curriculum Assessment Tool (SSDH CAT) to assist medical educators to assess existing SSDH curricular content, ascertain critical gaps, and categorize educational methods, delivery, and assessment techniques and tools that could help inform curricular enhancements to advance the goal of training a health care workforce focused on taking action to achieve health equity. To test the usefulness of the tool, we applied the SSDH CAT to map SSDH-related curriculum at a US-based medical school. Results By applying the SSDH CAT to our undergraduate medical school curriculum, we recognized that our SSDH curriculum relied too heavily on lectures, emphasized knowledge without sufficient skill building, and lacked objective assessment measures. As a result of our curricular review, we added more skill-based activities such as using evidence-based tools for screening patients for social needs, and created and implemented a universal, longitudinal, experiential community health curriculum. Discussion We created a universal SSDH CAT and applied it to assess and improve our medical school’s SSDH curriculum. The SSDH CAT provides a starting point for other medical schools to assess their SSDH content as a strategy to improve teaching and learning about health equity, and to inspire students to act on the SSDH.

“You’re actually part of the team”: a qualitative study of a novel transitional role from medical student to doctor

BackgroundOptimizing transitions from final year of medical school and into first post graduate year has important implications for students, patients and the health care system. Student experiences during novel transitional roles can provide insights into potential opportunities for final year curricula. We explored the experiences of medical students in a novel transitional role and their ability to continue learning whilst working as part of a medical team.MethodsNovel transitional role for final year medical students were created in partnership by medical schools and state health departments in 2020 in response to the COVID-19 pandemic and the need for a medical surge workforce. Final year medical students from an undergraduate entry medical school were employed as Assistants in Medicine (AiMs) in urban and regional hospitals. A qualitative study with semi-structured interviews at two time points was used to obtain experiences of the role from 26 AiMs. Transcripts were analyzed using deductive thematic analysis with Activity theory as a conceptual lens.ResultsThis unique role was defined by the objective of supporting the hospital team. Experiential learning opportunities in patient management were optimized when AiMs had opportunities to contribute meaningfully. Team structure and access to the key instrument, the electronic medical record, enabled participants to contribute meaningfully, whilst contractual arrangements and payments formalized the obligations to contribute.ConclusionsThe experiential nature of the role was facilitated by organizational factors. Structuring teams to involve a dedicated medical assistant position with specific duties and access to the electronic medical record sufficient to complete duties are key to successful transitional roles. Both should be considered when designing transitional roles as placements for final year medical students.

Teaching, learning and assessment of professionalism in medical education: A citation-based systematic review of literature

Background: Professionalism is an important competence in medical practice, yet a complex area. We describe the landscape of published articles on teaching, learning and assessment of professionalism in medical schools. This study aims to review the temporal trend of literature published and cited on the subject, and includes frequently publishing authors, journals, and network analysis. The study further aims to present the themes of the most commonly cited articles. Methods: A systematic review of peer-reviewed literature was carried out to describe the current patterns of research in professionalism using the terms “professionalism” AND "medical education" OR "medical college" OR "medical school". The title and abstract of the selected documents were skimmed to include only relevant articles. ‘Relevant’ articles were defined as articles describing teaching, learning or assessment of professionalism in undergraduate medical curricula. Articles describing professionalism, but not directly related to teaching, learning and assessment were excluded. Results: Over the study period spanning from 1973 to 2020, a total of 1053 articles were identified as relevant. A surge in the number of publications was observed from the year 2000. Over 400 articles were published in 5 leading journals in medical education. Of the 50 top-cited papers, 18 (36%) articles explored opinions of stake holders through questionnaires and surveys about different aspects of professionalism, there were 13 (26%) ‘Commentary’ and 7 (14%) review articles. The primary objectives of more than 50% of the top-cited articles were assessment methods (14%), teaching by humiliation (14%), personal identity formation (8%), barriers to professionalism (8%), and teaching ethics (8%) and empathy (8%). Conclusions: We describe the landscape of published articles on teaching, learning and assessment of professionalism in undergraduate medical schools. The surge in publications since 2000, top publishing journals and frequently publishing authors were identified. Of the most cited articles, assessment methods, personal identity formation, and teaching empathy and ethics predominate as the main themes.

Undergraduate courses of evidence-based medicine in Peruvian medical schools: Characteristics and addressed topics

BackgroundMedical schools are increasingly including evidence-based medicine (EBM) courses in their curricula. However, little is known about the characteristics of these courses in Peru. Therefore, the present study aimed to describe the characteristics and topics addressed by undergraduate courses on EBM in Peruvian medical schools, and to compare the content of these courses with predefined EBM competencies. MethodsWe conducted a cross-sectional study. We obtained the syllabi of undergraduate EBM courses from all medical schools for the latest year available. We extracted their characteristics and categorized the topics they included according to the five steps necessary to apply EBM, divided into 22 competencies. ResultsIn 2021, Peru had 47 universities with active undergraduate medical schools, of which 9 (19.1%) had EBM courses. These courses were not mandatory in three of the universities, and were typically offered between the 2nd and 5th year of the degree program. When analysing the topics covered in the syllabi, we found that they addressed 7 to 13 of the 22 core competencies evaluated. The least addressed topics belonged to steps 4 (apply) and 5 (evaluate) of the EBM process. ConclusionWe found that few Peruvian universities offer EBM courses, and that these courses have heterogeneous characteristics, with syllabi that do not include all essential topics for applying the five steps of EBM.

INTEGRATION OF PALLIATIVE CARE INTO MEDICAL SCHOOL CURRICULUM IN NEPAL – An analytical study among medical students in Nepal

Introduction The holistic approach of palliative care aims at improving the life of patients with life-threatening diseases and their families through early identification, assessment, and treatment of physical, psychological, or spiritual pain. Despite the recognition of palliative care as a human right and essential for the improvement of the quality of life of patients – and their families, many low-income countries either lack palliative care services or have limited access to it. The WHO suggests that one of the steps that countries can take to eliminate these barriers is to include palliative care into the core curricula of all new health professionals. A study in 2019 showed that 58,000 adults required palliative care in Nepal in 2012, and most of them lived in rural areas. Palliative care in Nepal is still new and training programs for doctors and nurses are not fully developed and in place in undergraduate medical schools. This study evaluates the working knowledge of palliative care among undergraduate medical students, and the presence of it in their academic curriculum. Methods This analytical study was designed during an internship at the Binaytara Foundation Cancer Center in Nepal. The study was conducted among undergraduate medical students between March 6th, 2020 to July 6th, 2020. The questionnaire results were entered on Microsoft Excel and then analyzed. Results Results showed that 63.2% of the respondents had heard of “Palliative Medicine”, but 68.4% did not know the WHO definition of Palliative Care (Table 2 (135189)). Among all the students from the different universities, 33.3% said that palliative care is part of their curriculum, while 66.6% said it is not (Table 5 (135192)). Conclusions The results from the study demonstrated inadequate knowledge and perception of palliative care among undergraduate medical students in Nepali institutions. The EAPC indications on a palliative care curriculum could be taken as a blueprint for developing a tailored one for medical schools in Nepal to set a strong base for the next generation of doctors to be able to appropriately meet the needs of patients and their families.

Facilitação da iniciação científica na graduação em Medicina - entendendo inúmeras siglas, abreviaturas e acrônimos

Facilitação da iniciação científica na graduação em Medicina - entendendo inúmeras siglas, abreviaturas e acrônimos

Abordagem da morte na graduação médica: percepções de estudantes à luz de contribuições freudianas

Abstract: Introduction: In western contemporary society, attempts to prevent death and suffering promote a medical training focused on dealing mostly with the biological aspects of illness and death, to the detriment of the psychosocial aspects related to those issues. Objective: The authors intended to identify medical students’ perceptions about the approach to death and dying in the light of Freudian theory about death. Method: This was a qualitative study with an exploratory approach, developed based on six focal groups consisting of 55 students from all the undergraduate medical school semesters from a federal university in the interior of the state Minas Gerais. The data produced was analyzed according to the thematic or category-based content analysis, from which the following categories emerged: 1- The death topic in undergraduate medical school; 2- The medical professional facing death. Results: To discuss death and dying in the formative process is to talk about the anguish in the face of human finitude. The students identified the approach to death and dying in undergraduate school, but in a limited and insufficient way. They indicated the need to increase contact with the topic in the curriculum, and to include, in a mandatory way, the contents on Palliative Care. The medical role encompasses both the care focused on healing and the assistance in moments when healing is not possible. The preparation to deal with death throughout undergraduate training involves personal conceptions and experiences, undergraduate practice, access to theoretical contents, specificities and subjective aspects related to each situation. The mentioned resources to deal with death, in addition to the studies, were religiosity and psychotherapy. Conclusion: To approach death in undergraduate medical curricula involves great complexity and challenges. From the viewpoint of psychological reality, human beings try to deny death and avoid suffering. Thus, the challenges in medical formation and practices consist in assuming the indissociable articulation between the biological, cultural and psychosocial aspects. To take care of life is also to take care of death and avoiding it may cause greater suffering to the patients, family members, students and medical professionals.

Scientific mentoring in undergraduate medical school: impacts on student satisfaction, engagement and production

Resumo: Introdução: A mentoria é uma estratégia acadêmica que está cada vez mais presente no curso de Medicina por promover benefícios, como a criação de ambientes de acolhimento e afetividade, e discussão de conteúdos médicos e de temas relacionados à formação profissional. Entretanto, pouco se discute acerca dessa estratégia com finalidades científicas. Objetivo: Este estudo teve como objetivos descrever a implementação do programa de mentorias científicas, investigar a percepção dos estudantes sobre a sua implantação e execução, além de mensurar indicadores de êxito. Método: Trata-se de estudo seccional descritivo, realizado em um curso de graduação em Medicina, localizado em Salvador/Bahia. Foram incluídos estudantes do terceiro ao quarto ano da graduação. Aplicou-se um questionário virtual, estruturado, anônimo, com perguntas objetivas relacionadas ao perfil discente, às percepções sobre o programa de mentorias científicas e à publicação dos trabalhos de conclusão de curso (TCC). Resultado: Dos 143 estudantes participantes, houve predominância de solteiros (90,9%), pardos (46,2%), do sexo feminino (72,0%), com idade de 25,3 ± 5,54 anos, que não participaram de programas de iniciação científica (88,8%). Dentre aqueles que participaram das mentorias (n = 101), 97,1% afirmaram que elas contribuíram para o desenvolvimento do TCC, 98,0% se mostraram favoráveis à manutenção de sua oferta e 85,0% consideraram a estratégia inovadora. No recorte temporal de dois semestres letivos, apresentaram-se 131 TCC, dos quais 27,5% foram publicados contando com a participação de 19 professores, com média de 1,89 produção/professor. Conclusão: Os estudantes de Medicina são favoráveis à implementação do sistema de mentorias científicas, tendo essa estratégia se mostrado factível e eficaz.

HISTOPATHOLOGY PRACTICAL SESSIONS AND THE THEORETICAL KNOWLEDGE OF PATHOLOGY: CORRELATION AND STUDENTS’ PERCEPTION

Background: Histopathology practical sessions constitute a substantial bulk of pathology teaching in undergraduate medical school. This study aimed to assess the correlation between students’ scores in histopathology practical and pathology theoretical examinations and to explore the students’ perception. Methods: It was a prospective observational study conducted amongst 109 third year medical students at Shifa College of Medicine from 1st June 2019 to 30th March 2020. The histopathology practical were conducted through traditional microscopy sessions. Mean histopathology summative scores of 9 modules were correlated with the respective block integrated practical examination (IPE) scores. The perception of students regarding histopathology practical was explored through a questionnaire which comprised of eight items to be rated on a three-point Likert scale. Results: Correlation between the mean summative score with their respective IPE scores showed weak positive correlation (Block I: r=0.489, p<0.0001; Block II: r=0.468, p<0.0001; Block III: r=0.445, p<0.0001). Performance in IPE was found to be a weak predictor of performance in summative examination with an adjusted R2 of 0.194 in block I, 0.199 in block II and 0.201 in block III (p<0.0001). The questionnaire responses showed that students have difficulty in understanding the microscopic findings and they find it difficult to correlate them with the theoretical knowledge. Conclusion: There was no significant correlation between the students’ scores in histopathology practical and pathology theoretical examinations. The practical sessions need to be consigned and innovated with theoretical/clinical relevance in demonstration to augment basic pathological theory concepts and learning. Pak J Physiol 2022;18(4):27–30

The current status of interventional radiology in the undergraduate medical curriculum and the way forward.

Interventional radiology (IR) is underrepresented in undergraduate medical school curricula. Despite the introduction of a suggested undergraduate curriculum for IR by the British Society of Interventional Radiology (BSIR), current evidence suggests there is inadequate knowledge and awareness of IR amongst medical students. As a result of this, there is a lack of visibility of the subspeciality amongst medical students and junior doctors contributing to the shortage of IR trainees resulting in an IR workforce crisis in the UK. The uptake of the proposed undergraduate IR curriculum remains unclear, highlighting the need for a thorough audit and improvement of IR teaching in undergraduate medical education. In this commentary, we discuss the importance of including IR in the undergraduate curriculum, the evidence surrounding undergraduate IR education, the reasons for the potential lack of interest in IR from medical students and future steps to ensure optimal IR exposure in undergraduate medical school curricula.

Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives

BackgroundDoctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors’ working conditions and, thus, their mental health.MethodsWe interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors’ working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations.ResultsJunior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork.ConclusionWe suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.

Development of an assessment technique for basic science retention using the NBME subject exam data

IntroductionOne of the challenges in medical education is effectively assessing basic science knowledge retention. National Board of Medical Examiners (NBME) clerkship subject exam performance is reflective of the basic science knowledge accrued during preclinical education. The aim of this study was to determine if students’ retention of basic science knowledge during the clerkship years can be analyzed using a cognitive diagnostic assessment (CDA) of the NBME subject exam data.MethodsWe acquired a customized NBME item analysis report of our institution’s pediatric clerkship subject exams for the period of 2017–2020 and developed a question-by-content Q-matrix by identifying skills necessary to master content. As a pilot study, students’ content mastery in 12 major basic science content areas was analyzed using a CDA model called DINA (deterministic input, noisy “and” gate).ResultsThe results allowed us to identify strong and weak basic science content areas for students in the pediatric clerkship. For example: “Reproductive systems” and “Skin and subcutaneous tissue” showed a student mastery of 83.8 ± 2.2% and 60.7 ± 3.2%, respectively.ConclusionsOur pilot study demonstrates how this new technique can be applicable in quantitatively measuring students’ basic science knowledge retention during any clerkship. Combined data from all the clerkships will allow comparisons of specific content areas and identification of individual variations between different clerkships. In addition, the same technique can be used to analyze internal assessments thereby creating an opportunity for the longitudinal tracking of student performances. Detailed analyses like this can guide specific curricular changes and drive continuous quality improvement in the undergraduate medical school curriculum.

Medical students’ perceptions of the impact of artificial intelligence in radiology

ObjectivesTo analyse medical students’ perceptions of the impact of artificial intelligence in radiology. Material and methodsA structured questionnaire comprising 28 items organised into six sections was distributed to students of medicine in Spain in December 2019. ResultsA total of 341 students responded. Of these, 27 (7.9%) included radiology among their three main choices for specialization, and 51.9% considered that they clearly understood what artificial intelligence is. The overall rate of correct answers to the objective true-or-false questions about artificial intelligence was 70.7%. Whereas 75.9% expressed their disagreement with the hypothesis that artificial intelligence would replace radiologists, only 41.9% disagreed with the hypothesis that the demand for radiologists would decrease in the future. Only 36.7% expressed concerns about the role of artificial intelligence related to choosing radiology as a specialty. A greater proportion of students in the early years of medical school agreed with statements that radiologists accept artificial-intelligence-related technological changes and work with the industry to apply them as well as with statements about the need to include basic training about artificial intelligence in the medical school curriculum. ConclusionsThe students surveyed are aware of the impact of artificial intelligence in daily life, but not of the current debate about its potential applications in radiology. In general, they think that artificial intelligence will revolutionise radiology without having an alarming effect on the employability of radiologists. The students surveyed think that it is necessary to provide basic training about artificial intelligence in undergraduate medical school programs.

Digital MD: A Novel Undergraduate Medical School Elective for Social Media and Digital Scholarship.

An outcomes-based novel curriculum integrating digital literacy, social media, and digital scholarship was implemented into an undergraduate medical education elective for first- and second-year medical students. Learners engaged in asynchronous discussion boards, live didactics and seminars, and a capstone project with peer feedback throughout the 7-week course.

Establishing and promoting an ‘out-of-area’ programme for GP placements as a strategy to expand undergraduate experience in primary care

Recruiting placements in undergraduate general practice is increasingly challenging. Here we describe our experience over the past decade of establishing an out-of-area programme for clinical medical students undertaking a four-week placement in general practice. Out-of-area programmes are run by at least five undergraduate medical schools in England and are founded upon two pillars. First, is the large pool (c60%) of GP practices nationwide not routinely teaching medical students, even for their local school. Through a personal approach (from either the student or via medical school staff contacts) these GPs often prove keen to start teaching, sometimes year on year. Second, is the NHS bursary. This reimburses student expenses (not GP teacher payment) and is eligible to most students in their fifth year of the medical course (or fourth if they have completed an intercalated one year degree). Running a successful out-of-area programme requires preparation/guidance for students, opportunistic outreach (direct approaches by students and engaging alumni and hospital colleagues’ contacts who are GPs), promotion through diverse media (university alumni/staff publications, social media and the school website), offering a range of rotation dates, quality assurance and online meetings/support. Growing the programme requires nurturing of personal relationships with GP teachers and keeping up a database of surgeries offering to teach going forward. Positive feedback helps to ‘sell’ these placements as an exciting ‘elective’ opportunity to students. We have encountered no objection from other medical schools about our programme. Strong administrative support is critical.

Online academic satisfaction during the COVID-19 pandemic in medical students: role of sleep, psychological issues, college adjustment, and digital skills

Background: The measures taken to contain the COVID-19 pandemic, led to significant changes in university education, resulting in the new normal standard of virtual teaching in many undergraduate medical schools worldwide. Therefore, the aim of this paper was to determine the factors related to academic satisfaction with virtual teaching in medical students during the COVID-19 pandemic. Methods: A cross-sectional-analytical study was conducted on medical students at a private university in Peru, through self-reported questionnaires divided into sociodemographic data and variables of interest that could influence academic satisfaction during the pandemic. To evaluate possible factors related to academic satisfaction, stepwise regression models were performed for both sexes. Results: In total, data from 310 medical students, 117 males and 193 females, were analyzed. Academic satisfaction reached a score of 11.2 ± 2.9, which was similar in both sexes. The best regression model for males (AIC: 544.32; RMSE: 2.42; R 2: 0.30) showed that adaptation to university life (favorable change) and depression (unfavorable change) explained 30% of changes in students' academic satisfaction. While in females (AIC: 907.59; RMSE: 2.49; R 2: 0.22) the model integrated favorable factors such as adjustment to college life and anxiety; while depression and poor sleep quality were unfavorable factors. Conclusion: Factors that contributed to academic satisfaction in medical students were determined in this study, which differed by gender. Thus, it is important to take into account the particularities of male and female medical students in order to improve their academic satisfaction during their university careers.

Putting nutrition education on the table: development of a curriculum to meet future doctors' needs.

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training.With this imperative, the Association for Nutrition established an Interprofessional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service (NHS), royal colleges, medical schools and universities, government public health departments, learned societies, medical students, and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors.Through an iterative and transparent consultative process, thirteen key nutritional competencies, to be achieved through mastery of eleven graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skill acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council (GMC) Outcome for Graduates.As nutrition is an integrative science, the AfN IPG recommends that the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden for teaching staff.The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip frontline staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered associate nutritionist/registered nutritionist (ANutr/RNutr) or registered dietitian (RD) where this is likely to be beneficial.

Putting nutrition education on the table: development of a curriculum to meet future doctors’ needs

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between...