Undergraduate Medicine Curriculum Research Articles

Practice makes perfect: the development of a medical student-led crowdsourced question bank for self-study in undergraduate medical education.

The development of multiple-choice questions (MCQs) for undergraduate medical education study purposes is resource intensive. Commercially available question banks are typically expensive, only available in English, and may not be aligned with medical school learning objectives. Here, we introduce The Ottawa Question Bank: a student-led, bilingual study resource curated to a Canadian undergraduate medicine curriculum (www.theottawaquestionbank.ca). In total, 205 medical students wrote and edited 4438 original MCQs linked to objectives from the University of Ottawa undergraduate medical education curriculum. The project has received positive feedback from both developers and users. Our experience suggests that involving medical students in MCQ development is feasible and can result in the rapid creation of a low-cost, high-quality study resource curated to a program's learning objectives. The platform outlined here can be used as a model for other medical schools and professional degree programs to develop their own question banks, including pharmacy, dentistry, nursing, and physiotherapy. Interested programs are encouraged to contact our team for collaborative opportunities.

MEDICAL HUMANISM. FICTION OR PARADIGM? THE ROLE OF HUMANISM IN THE TRAINING OF PHYSICIANS

There is still considerable resistance to accepting that the medical humanities could play an important role as core and integrated provision in an undergraduate medicine curriculum. Sceptics towards this curriculum innovation are usually strong proponents of “evidence-based medicine”, where what count as evidence is constrained by scientific paradigm. Arts practi­tioners and humanities scholars are not used to working within such a paradigm that appears constrictive and theoretical rationales for including the medical humanities in medical edu­cation are generally flimsy. The voiced skepticism of many basic science teachers towards the humanities may contribute to the “empathy decline” from the population to medical physicians around the world, the so called “inhumanity” of the medical doctors. Considering the value of humanities as important for the training of the new generation of professionals requires thinking medicine with the incorporation of arts and other areas of humanities. Supporters of the medical humanities point out that it is in the arena of patient-centered narrative based medicine, rather than population-centered evidence, that the medical humanities play a sig­nificant role. Rifts and tensions exist in the worlds of biomedical science and clinical practice as these apply to medical education. However,the question of impact of medical humanities interventions in medical education should be addressed and critically evaluated.

The Need to Integrate Fundamental Radiology in Undergraduate Medicine Curriculum

Dear Editor, 
 Since its advent in the early Twentieth Century, Radiology beholds capital significance in diagnostic and therapeutic medicine. Imaging techniques of the likes of X – Ray, CAT scan, MRI and the positron emission tomography (PET) have taken the world by storm over the past 20 years so much so that they have become indispensable in Medical Investigation. There is a growing school of thought with the view that basic radiological knowledge of X – Rays and Ultrasound should be imparted to medical students from the get-go.1
 As a matter of fact, until recently an overwhelming majority of Medical Institutions in Pakistan have been adherent to the orthodox Non - Modular system which was essentially based on the then transformative Flexner Report of July 1910 where Abraham Flexner vehemently advocated learning basic biomedical sciences prior to clinical sciences; thereby preferring less practical theoretical knowledge to that of empirical importance to the clinician.2 Unfortunately, that is not how patients are to be treated.3 Recently, all Medical Colleges under University of Health Sciences have adopted the Integrated Modular system4 which endorses the studying of basic and clinical subjects side by side. In addition to this much needed step, the concerned authorities are exhorted to look into the need to include fundamental radiological techniques in the under graduate Medical curriculum in order to properly integrate the modular system.

A therapeutic intervention for an ailing medical education: The values prism model as proof of concept

Purpose To articulate proof of concept in relation to a complex pedagogical values intervention for a range of medical education’s historically accumulated symptoms. Methods Using a discursive approach, symptoms that hinder development of medical education are set out. Such symptoms rest with the instrumentality of current pedagogical approaches, supressing potential. A ‘cure’ is articulated – that the dominant values complex of instrumentalism is raised in quality through embracing ethical, aesthetic, political, and transcendental (meaning) values. Key to this is the use of language in clinical encounters, where the productive metaphor count is repressed in instrumental-technical approaches but multiplied in embracing other values and qualities. This ‘Values Prism’ model shows instrumentalism passing through an expansive educational prism to create expansion in types and qualities. Results and conclusions Proof of concept is achieved. The Values Prism model can be adapted for any undergraduate medicine curriculum as a process model – a set of values that permeate the curriculum beyond the dominant instrumental. The enhanced and expanded curriculum acts in a translational capacity.

Development and Initial Assessment of a Novel Customized Deep Laceration Simulator for Suturing Training.

Suturing of different layers, such as deep lacerations, is a challenging clinical skill for residents. Currently, there is a lack of general suturing instructions and practice in undergraduate medicine curricula which would add to the education required during residency and could be impactful to patient safety. Therefore, in order to adequately prepare trainees for clinical practice, training in suturing needs to be made more robust and executable. One way to facilitate this is to provide easy access to equipment that can offer good educational value while allowing for adequate repetition of suturing deep lacerations outside of clinical settings, similar to how it has been done for superficial lacerations. Simulation-based medical education addresses this by training residents in healthcare skills in a safe and controlled environment. Our technical report aims to describe the development and initial evaluation of a deep laceration simulator designed to train residents in suturing. The simulator was made using additive manufacturing techniques such as three-dimensional printing and silicone. Feedback on the simulator was provided by Centre Hospitalier de l'Université de Montréal clinicians from various specialties and residents. The simulator was assessed mainly as being easy to use, durable, and having anatomically accurate characteristics. The main improvements suggested were to make the skin thinner, divide the epidermis and dermis, add a fascia, andcreate a looser and friable layer of fat. Overall, the respondents rated the simulator as a good educational tool with a few minor adjustments.

Unknown unknowns: can bringing patients’ lived experience of long term conditions into curriculum design help our future doctors offer more holistic, socially accountable care?

ABSTRACT Understanding the holistic impact of long-term conditions (LTCs) on a patient, due to their high prevalence, morbidity, mortality and cost, is an important part of the primary care undergraduate medicine curriculum. Increasingly, we set learning outcomes for our students anticipating what the patient would want them to know. But are our expectations congruent with what patients would want them to know? In this leading article, we propose that patient involvement in curriculum design remains inadequate. We base our argument on (1) an existing strong theoretical premise that increasing patient incorporation enhances the delivery of medical education, (2) recommendations from major health organisations, our regulator and leading healthcare educationalists and (3) a growing body of evidence that what is important to physicians may not reflect what is important to patients. We advocate that patient involvement in curriculum design will result in a better understanding of how LTCs affect their physical, psychological and social health and of their journey through health care and community support services. This learning is essential, but unfortunately often overlooked, if we are to ensure that students in their future roles plan patient care using an empathic, holistic, patient-centred and socially accountable approach.

Wilderness Medicine Simulation-Based Teaching Program for Medical Students in the UK

The UK undergraduate medicine curriculum provides insufficient opportunities for medical students to explore the field of wilderness medicine, despite interest in the area. The student-led Cambridge University Wilderness Medicine Society devised a low-cost wilderness medicine teaching weekend that can be replicated at other institutions. The weekend course consisted of small-group lessons introducing the roles of the expedition doctor and expedition leader and the assessment and management of acute conditions in remote environments. This was followed by a 3-station circuit to teach the principles of casualty triage, splinting, and construction of rope stretchers. These skills were then practiced in simulations in which participants rotated roles as care providers and patients. Participant confidence was compared before the course and immediately on course completion using the related-samples Wilcoxon signed-ranks test with significance accepted at P<0.05. Usefulness of course content and perceptions of learning were also assessed. Sixty-one medical students attended the wilderness teaching weekend and completed the structured feedback questionnaires. Participants rated the course highly in terms of usefulness of course content (mean±SD=18.3±1.9, range=12-20) and perceptions of learning (mean±SD=37.6±2.6, range=31-40), with 92% of participants "strongly agreeing" that the course was of high quality. There was an improvement in perceived confidence after course completion (P<0.001). We have demonstrated that a teaching program consisting of structured, low-cost "teaching weekends" is a potential solution to the lack of centralized national wilderness medicine teaching and can be integrated, with minimal disruption, into the undergraduate curriculum.

Very Short Answer Questions: A Novel Approach To Summative Assessments In Pathology.

BackgroundA solid understanding of the science underpinning treatment is essential for all doctors. Pathology teaching and assessment are fundamental components of the undergraduate medicine curriculum. Assessment drives learning and the choice of assessments influences students’ learning behaviours. The use of multiple-choice questions is common but is associated with significant cueing and may promote “rote learning”. Essay-type questions and Objective Structured Clinical Examinations (OSCEs) are resource-intensive in terms of delivery and marking and do not allow adequate sampling of the curriculum. To address these limitations, we used a novel online tool to administer Very Short Answer questions (VSAQs) and evaluated the utility of the VSAQs in an undergraduate summative pathology assessment.MethodsA group of 285 medical students took the summative assessment, comprising 50 VSAQs, 50 single best answer questions (SBAQs), and 75 extended matching questions (EMQs). The VSAQs were machine-marked against pre-approved responses and subsequently reviewed by a panel of pathologists, with the software remembering all new marking judgements.ResultsThe total time taken to mark all 50 VSAQs for all 285 students was 5 hours, compared to 70 hours required to manually mark an equivalent number of questions in a paper-based pathology exam. The median percentage score for the VSAQs test (72%) was significantly lower than that of the SBAQs (80%) and EMQs (84%), p <0.0001. VSAQs had a higher Cronbach alpha (0.86) than SBAQs (0.76), and EMQs (0.77). VSAQs, SBAQs and EMQs had a mean point-biserial of 0.35, 0.30 and 0.28, respectively.ConclusionVSAQs are an acceptable, reliable and discriminatory method for assessing pathology, and may enhance students’ understanding of how pathology supports clinical decision-making and clinical care by changing learning behaviour.

Redesigning the Learning Assessment Tools for Community-Based Training Program in the Undergraduate Medical Education at a University in Ethiopia

In Ethiopia, the undergraduate medical education is a six-year program, which has three major curricular components, including Pre-medical, preclinical and clinical years. Upon successful completion of every year pre-clinical and clinical courses, students are required to complete community-based training program (CBTP) courses that demand a field work in the nearby community settings. The main intent of these courses is to develop general competencies of the graduates so that they become more socially accountable at the same time ensuring opportunities for lifelong learning in the community through training and services. In a general sense, the learning assessment provides an opportunity for students to improve their skills, reduce anxiety over grading, and improve relationships between learners and teachers. The aim of this study was to evaluate the existing learning assessment tools applied in the CBTP courses and improve them so that they become aligned with the expected graduate competencies specified in the undergraduate medicine curriculum in the University studied. This study used a case study design for the in-depth analysis of the learning assessment tools of CBTP courses. Guided by this, first the study comprises an analysis of the existing assessment tools being practiced in a university studied. Then, three FGDs were held with instructors, department heads, and students who participated in CBTP course implementation of the undergraduate medicine program. This was followed by a consultative workshop with relevant experts in Community-based education (CBE), to identify essential items to be included in the redesigned assessment tools. As a result of this study, the study participants identified the learning domains that were aligned to the core competencies. The corresponding guidelines for each assessment methods were developed. The tools were piloted in the field and they were found very comprehensive and feasible for use in the university studied. The findings of this study were suggested that the redesigned assessment tools can address the basic problems of the existing assessment methods, which were found, fragmented and had higher degrees of subjectivity.

A Religiosidade/Espiritualidade dos Médicos de Família: Avaliação de Alunos da Universidade Aberta do SUS (UNA-SUS)

RESUMO Introdução Muitas universidades ao redor do mundo têm incluído o tema religiosidade/espiritualidade (R/E) no currículo médico no período de graduação, especialmente nos Estados Unidos e Reino Unido. Este artigo objetiva apresentar a opinião de médicos, especializandos em Saúde da Família da Universidade Aberta do SUS (UNA-SUS) na Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) sobre o ensino do tema R/E na graduação em Medicina, as percepções dos profissionais sobre essa temática na prática clínica e os índices de religiosidade/espiritualidade dos estudantes. Metodologia Estudo transversal, em que um instrumento de pesquisa eletrônica foi disponibilizado aos alunos na plataforma virtual da UNA-SUS/UFCSPA, tendo sido convidados a participar voluntariamente todos os médicos de nacionalidade brasileira inscritos no curso de especialização em Saúde da Família entre os meses de junho e agosto de 2016. Resultados Foram obtidas 73 respostas (17,2%) de um total de 423 médicos. Foram encontrados 61,4% de católicos, 18,5% de evangélicos e 8,6% de espíritas, sendo 52,1% de não praticantes; 86,3% acreditam em Deus; 89% consideram importante ou muito importante o cuidado espiritual nas práticas em saúde e 94,6% consideram que a espiritualidade contribui para a saúde física. Constatou-se que 60,3% consideram a coleta da história espiritual como a habilidade mais importante a ser aprendida e 72,2% concordam em que o tema R/E deve ser abordado na graduação, enquanto 13,7% relataram contato prévio com o tema na faculdade. A relevância conferida à R/E no cuidado médico não parece ter sido mediada pela religiosidade intrínseca dos estudantes, pois não houve correlação estatisticamente significativa entre essa variável e a atribuição de importância à R/E na prática clínica (p = 0,585). Os médicos avaliados parecem reconhecer a importância da espiritualidade para os pacientes e para a saúde, mas são menos fortemente propensos a considerar o seu papel como cuidadores dessa dimensão. Conclusões A aceitação do tema R/E pelos médicos especializandos em Saúde da Família pela UNA-SUS/UFCSPA foi considerada bastante satisfatória. É necessário desenvolver propostas pedagógicas inovadoras, metodologicamente eficazes e apropriadas ao contexto da atuação médica no Sistema Único de Saúde, tanto na graduação, quanto nos programas de pós-graduação.

Medical students' palliative care education in a Latin American university: a three-year experience at Austral University in Buenos Aires, Argentina.

The School of Medicine of Austral University incorporated palliative care as an elective in undergraduate medicine curriculum during 2010. We analyzed the experience and results after 3 years of teaching palliative care. We compared students who chose palliative care as an elective subject (PC Group) with students who did not (Non-PC Group). We focused on the experience of contact with palliative care patients and self-perceived attitudes. Additionally, the impact produced by palliative care education in knowledge, self-perceived attitudes, and comfort was evaluated. All the students tested completed a questionnaire on their attitude when exposed to dying patients. Students in the PC Group completed an additional questionnaire to assess their level of knowledge and their self-perceived comfort when interacting with patients. We tested 146 students. All students in the PC Group and 95.2% in the Non-PC Group considered that specific death issues ought to be part of the curriculum. Some students indicated that they could be present in a mandatory course. Before taking their elective, students in the PC Group confirmed a lack of technical training to understand palliative care patients, as did those students in the Non-PC Group. After taking a palliative care elective students expressed an improvement in self-perceived attitudes toward suffering and there was a significant increase (p<0.0001-0.0045) in knowledge. They also expressed an improvement in comfort levels in evaluation and treatment of pain. More than 95% of the students in the PC Group rated the experience as valuable and perceived the content as not available elsewhere in their training. Our results show that palliative care education provides opportunities to improve attitudes not specific to this discipline: interprofessional collaboration, holistic care, patient-centered care, self-awareness, and humanism. We conclude that an exposure to palliative care improved student's perception about the complexities of dying patients and their care.

RAP Sessions ‐ interdisciplinary delivery of anatomy, radiology, and procedural skills (343.2)

The McMaster University Michael G. DeGroote School of Medicine’s undergraduate medicine curriculum is a concepts‐based curriculum with anatomy sessions, lectures and small group tutorials. Curriculum review revealed a paucity of radiology and procedural skills in the pre‐clerkship training. An interdisciplinary program of anatomy, radiology, and procedural skills was developed. Method: A 3‐hour curriculum was developed that integrated chest anatomy taught by an anatomist, radiology related to the chest taught by a radiologist, and the procedural skill of placing a chest tube by a general surgeon. The session revolved around a case that was part of their regular small group tutorials. Students rated their knowledge of chest anatomy, knowledge of placing a chest tube and their comfort with placing a chest tube pre and post session using a 10‐point Likert rating scale. Students were also asked to rate the experience on a number of dimensions. Results: 23 students participated in this workshop. All completed the pre and post questionnaires. Students reported an increase in self‐rated knowledge of chest anatomy (4.3 vs 6.4), knowledge in placing a chest tube (1.8 vs 7.7), and in comfort with placing a chest tube (1.4 vs 6.3 post. These results were analyzed using Wilcoxon Signed‐Rank Test and the differences were all statistically significant (p&lt;0.001). The sessions were highly rated, with the mean value for organization/venue scale being 9.4 out of 10 (SD=0.6) and educational value scale (effective, appropriate) being 9.3 out of 10 (SD=0.07). Conclusion: RAP sessions are an innovative interdisciplinary curriculum integrating radiology, anatomy and procedural skills within the context of a concept based medical curriculum. Students reported an increase in knowledge and skills and highly rated the experience as a valuable teaching session for concept integration.

Can the science of communication inform the art of the medical humanities?

There is increasing interest in establishing the medical humanities as core integrated provision in undergraduate medicine curricula, but sceptics point to the lack of evidence for their impact upon patient care. Further, the medical humanities culture has often failed to provide a convincing theoretical rationale for the inclusion of the arts and humanities in medical education. Poor communication with colleagues and patients is the main factor in creating the conditions for medical error; this is grounded in a historically determined refusal of democracy within medical work. The medical humanities may play a critical role in educating for democracy in medical culture generally, and in improving communication in medical students specifically, as both demand high levels of empathy. Studies in the science of communication can provide a valuable evidence base justifying the inclusion of the medical humanities in the core curriculum. A case is made for the potential of the medical humanities--as a form of 'adult play'--to educate for collaboration and tolerance of ambiguity or uncertainty, providing a key element of the longer-term democratising force necessary to change medical culture and promote safer practice. The arts and humanities can provide important contextual media through which the lessons learned from the science of communication in medicine can be translated and promoted as forms of medical education.

Ethics Education in Research Involving Human Beings in Undergraduate Medicine Curriculum in Brazil

The Brazilian national curriculum guidelines for undergraduate medicine courses inspired and influenced the groundwork for knowledge acquisition, skills development and the perception of ethical values in the context of professional conduct. The evaluation of ethics education in research involving human beings in undergraduate medicine curriculum in Brazil, both in courses with active learning processes and in those with traditional lecture learning methodologies. Curricula and teaching projects of 175 Brazilian medical schools were analyzed using a retrospective historical and descriptive exploratory cohort study. Thirty one medical schools were excluded from the study because of incomplete information or a refusal to participate. Active research for information from institutional sites and documents was guided by terms based on 69 DeCS/MeSH descriptors. Curriculum information was correlated with educational models of learning such as active learning methodologies, tutorial discussions with integrated curriculum into core modules, and traditional lecture learning methodologies for large classes organized by disciplines and reviewed by occurrence frequency of ethical themes and average hourly load per semester. Ninety-five medical schools used traditional learning methodologies. The ten most frequent ethical themes were: 1--ethics in research (26); 2--ethical procedures and advanced technology (46); 3--ethic-professional conduct (413). Over 80% of schools using active learning methodologies had between 50 and 100 hours of scheduled curriculum time devoted to ethical themes whereas more than 60% of traditional learning methodology schools devoted less than 50 hours in curriculum time to ethical themes. The data indicates that medical schools that employ more active learning methodologies provide more attention and time to ethical themes than schools with traditional discipline-based methodologies. Given the importance of ethical issues in contemporary medical education, these findings are significant for curriculum change and modification plans in the future of Brazilian medical education.

Integration of Community Health Teaching in the Undergraduate Medicine Curriculum at the University of Toronto

BackgroundIn 1999, Determinants of Community Health was introduced at the Faculty of Medicine, University of Toronto. The course spanned all 4 years of the undergraduate curriculum and focused on addressing individual patient and community needs, prevention and population health, and diverse learning contexts.PurposeTo demonstrate the value of an integrated, longitudinal approach to the efficiency of delivering a public health curriculum.DesignTime-series comparing the curricular change over two periods of time.Setting/participantsUndergraduate medical students from 1993 to 2009.InterventionUsing a spiral curriculum, the educational materials are integrated across all 4 years, based on the concept of medical decision making in a community context.Main outcome measuresThis study compares measures of student satisfaction and national rankings of the University of Toronto with the other 16 Canadian medical schools for the “Population Health, Ethical, Legal, and Organizational aspects of the practice of medicine” component of the Medical Council of Canada Qualifying Examination Part 1.ResultsThe University of Toronto has been ranked either first or second place nationally, in comparison to lower rankings in previous years (p<0.02 on the Kruskal–Wallis test). Student ratings indicated the course was comparable to others in the curriculum.ConclusionsFor the same amount of curricular time, an integrated spiral curriculum for teaching public health appears to be more effective than traditional approaches.

Does undergraduate curriculum design make a difference to readiness to practice as a junior doctor?

Background: Undergraduate medicine curricula can be designed to enable smoother transition to work as a junior doctor. Evaluations should improve curriculum design.Aim: To compare a graduate cohort from one medical school with a cohort from other medical schools in the same Foundation Year 1 (FY1) programme in terms of retrospective perceptions of readiness for practice.Method: A Likert-scale questionnaire measured self-perception of readiness to practice, including general capabilities and specific clinical skills.Results: Response rate was 74% (n = 146). The Peninsula Medical School cohort reported readiness for practice at a significantly higher level than the comparison cohort in 14 out of 58 items (24%), particularly for ‘coping with uncertainty’. In only one item (2%) does the comparison cohort report at a significantly higher level.Conclusions: Significant differences between cohorts may be explained by undergraduate curriculum design, where the opportunity for early, structured work-based, experiential learning as students, with patient contact at the core of the experience, may promote smoother transition to work as a junior doctor. Evaluation informs continuous quality improvement of the curriculum.

Toward an Aesthetic Medicine: Developing a Core Medical Humanities Undergraduate Curriculum

The medical humanities are often implemented in the undergraduate medicine curriculum through injection of discrete option courses as compensation for an overdose of science. The medical humanities may be reformulated as process and perspective, rather than content, where the curriculum is viewed as an aesthetic text and learning as aesthetic and ethical identity formation. This article suggests that a "humanities" perspective may be inherent to the life sciences required for study of medicine. The medical humanities emerge as a revelation of value inherent to an aesthetic medicine taught and learned imaginatively.

Integrating prevention into obstetrics/gynecology.

Obstetricians and gynecologists play an important role in preventive medicine. A great deal of obstetrics and gynecology is dependent on the principles of preventive medicine, such as understanding populations, risk profiling, epidemiology, and statistics as they pertain to screening programs and prevention. Thus, it is reasonable that an ob-gyn clerkship be an integral part of a program to teach preventive medicine in a medical school. This article presents information about formats used to teach preventive medicine in ob-gyn, illustrated by specific programs at medical schools across the country. It also provides information about publications that are useful for designing and creating programs in introduce and/or integrate preventive medicine into ob-gyn clerkships and other parts of the undergraduate medicine curriculum. Obstetricians and gynecologists spend the majority of their time in the office, and most of their patient visits can be classified as preventive medicine visits. Medical students' education needs to reflect that focus. Among other things, ob-gyn must develop training directed toward students who do not intend to become obstetricians. A rotation in ob-gyn may be the only exposure a student has to health care that is specifically for women. Therefore, that clerkship must focus on preventive medicine for women as well as on treatment.