What can medical education learn from the neurobiology of learning?

Enhancing medical education: The crucial role of sensory processing - Insights from occupational therapy

The processing of sensory information is crucial for academic success, socialization, and emotional well-being. Students who struggle with sensory processing (SP) may have difficulty concentrating, forming relationships with peers, and getting adequate sleep. These challenges are especially prevalent among college students with neurodevelopmental conditions like autism spectrum disorder and attention deficit hyperactivity disorder. To provide a comprehensive analysis of SP findings in medical education, this review examines prior research in the field of occupational therapy. To gather relevant studies, we conducted a literature search using various databases including PubMed, ISI Web of Science, and SCOPUS. Our search utilized keywords such as "sensory processing," "university students," and "college students". We have classified the outcomes into eight distinct subheadings, which we elaborated in detail. "Managing educational settings with senses into account," "managing relationships with senses into account," "SP affects medical education in various ways," "challenges that learners with SP difficulties may face in medical education," "misconceptions that medical educators have about learners with SP difficulties," "learning more about SP difficulties in medical learners," "techniques that can support medical learners with SP difficulties," and "challenges related to incorporate sensory experiences into medical education" are explained in the result section. Understanding different personality types and their preferences according to the Dunn model of SP can help create a more productive and satisfying university setting for everyone. Therefore, it is essential for universities to recognize the impact of SP difficulties and provide appropriate support and accommodations to help students succeed both academically and socially.

Assessment IS learning: developing a student-centred approach for assessment in Higher Education

Assessment and the associated feedback from those assessments are powerful factors in the development of students' learning. We have seen a shift within the Higher Education sector to conceptualise assessment as being more than summative assessment 'of' learning. Instead, there has been a greater emphasis on assessment 'as' learning, or assessment 'for' learning, through the enhanced use of formative assessments. Centralising assessment within the learning process highlights that assessment IS learning and cannot be separated from other elements of the learning process. In particular, assessment has a vital role to play in the development of students' self-regulated learning skills and the development of independence in learners. However, for assessments to effectively support learning, they need to be meaningful, engaging, well-integrated into the learning activities and 'student-focused'. Placing student skills development and personal development at the centre of assessment design has the potential to empower students through assessment. This review focuses on the potential of assessment to support student learning and development, using the 'Equity, Agency, Transparency' ('EAT') framework as a lens for effective assessment and feedback practices. We suggest ways in which we can make our assessment and feedback practices more inclusive, meaningful and authentic to the students' learning needs.

A Spaced Repetition Approach to Presenting Autonomic Nervous System Pharmacology Curricula in Medical Education

Future physicians require a strong foundational knowledge of autonomic nervous system (ANS) pharmacology to safely prescribe many medications. Spaced repetition in medical education has previously been examined in the literature. However, we have yet to elucidate the perception of spaced repetition integration into pharmacology curricula across multiple organ systems from a cohort of medical students. Preclinical students were surveyed to quantify their perceptions of ANS pharmacology curricular delivery via Qualtrics XM (Qualtrics, Provost, UT). The survey consisted of statements ranked by students on a Likert scale and then one free-response question. Free response questions underwent a narrative analysis by two members of the research team who reviewed responses to extract key themes. 95.4% of participants agreed that "revisiting the ANS curriculum in relevant Foundation Phase blocks has helped [them] remember it." More than 75% of respondents agreed with statements such as "The ANS curriculum comprehensively covered the relevant material" and "The ANS curriculum prepared me for in-house non-NBME quizzes and exams." We conclude that revisiting core concepts in ANS pharmacology across multiple organ system blocks effectively sets a solid foundation for ANS pharmacology and pathophysiology.

Use of an Asynchronous Discussion Platform During the Pre-clerkship Curriculum: A Multiyear Retrospective Study

Introduction

Asynchronous online message boards (OMBs) allow users to write questions or comments and share them with an online group. While the use of OMBs has been associated with positive outcomes in several educational settings, their use has not been studied in pre-clerkship undergraduate medical education (UME).

Methods

This multiyear, observational, longitudinal study examined patterns of OMB use in pre-clerkship UME. Descriptive statistics were used to report the number of students and instructors who logged on and contributed, the number of posts, instructor answers, post views, and the average time to answer. Patterns of use by first- and second-year medical students as well as students undergoing remote versus in-person learning were compared using Wilcoxon signed-rank tests.

Results

A total of 9870 posts were made to OMBs, initiated by 3869 student questions. There were 3078 total posts made by instructors and academic support staff and 1024 student answers to student questions. First-year medical students posted significantly more questions (149.83 vs. 83.7, p < 0.001), which resulted in significantly more instructor answers (125.0 vs. 59.1, p < 0.001). Modules during the remote learning period received more student questions (152.0 vs. 96.7, p < 0.001) and produced more instructor answers (123.8 vs. 74.7, p < 0.001) as compared to modules that took place during in-person learning.

Discussion

Online message boards represent a readily available tool to stimulate asynchronous discussion in pre-clerkship UME. First-year medical students and students during remote learning were more active on OMBs.

Teaching Philosophy in a Teaching Portfolio: Domain Knowledge and Guidance

Background

Teaching philosophy defines the beliefs and ideas that guide practices in teaching and learning. Writing teaching philosophy statements for promotion or employment is daunting for inexperienced new faculty members.

Aim

This article aims to discuss the principles of relevant educational domains that academics need to know to be well informed when writing their teaching philosophy. It also provides a new perspective on how to write the personal statements.

Methods

Journal articles published in English language between 2018 and 2023 (as well as important older ones) in electronic databases (Google Scholar, MEDLINE, PubMed, and SCOPUS) were searched, sifted, reviewed and used for this narrative literature review. Additionally, the websites of educational organisations such as higher education institutions were selected using convenience sampling method and searched to ascertain practices.

Results

Educators need to link teaching philosophy statements to the literature about teaching. However, there is a scarcity of literature that provides a comprehensive overview of the required domain knowledge. These domains are Supervision, Curriculum development, Assessment, Mentorship, Pedagogy, and Scholarship of teaching and learning (S-CAMPS domains).

Conclusion

Using various teaching practices and models to achieve the best quality learning and valued transformation is crucial in achieving a comprehensive Scholarship of Teaching and Learning. Therefore, developing a personal philosophy provides the opportunity for reflection on utilizing the theory-practice-philosophy perspective best to serve the students, academic institution, and society.

Differentiated Instruction as a Viable Framework for Meeting the Needs of Diverse Adult Learners in Health Professions Education

Health professions education (HPE) instructors are often challenged with simultaneously teaching adult learners of varying educational levels, needs, and backgrounds. With an increased focus on interprofessional education, instructors may be tasked with teaching extremely diverse audiences during a single educational session. While some aspects of differentiated instruction (DI) have been implemented within HPE contexts, the DI framework appears to be relatively unknown in many fields. Evidence from a range of educational fields outside of HPE supports the use of DI as a framework to enhance fairness, diversity and inclusion while meeting core instructional needs. In this Monograph, we explore DI and offer strategies for implementation amenable to many HPE settings.

Project CARPE Diem: Curriculum and Assessment for Residents on Pediatric Epilepsy

BACKGROUND

Pediatric residencies are not preparing trainees well to manage patients with seizures and epilepsy. To address this, we implemented a six-session curriculum using active learning techniques with the goals of improving the knowledge and attitudes needed to effectively identify and treat seizures and epilepsy, and increase residents' comfort with counseling families about these topics.

METHODS

A structured curriculum was implemented over the course of one month for the pediatric resident learner using andragogical methods such as didactic presentation, small-group sessions, role play, and simulation. A 15 multiple-choice question (MCQ) assessment and 13-statement attitudes inventory (AI) using Likert scales were given before the start of the curriculum and after its completion. Pretest and post-test scores were compared for the residents who attended at least three of the six sessions.

RESULTS

Fifty residents completed the pretest, 34 residents completed the post-test, and 24 residents completed both. Of the 24, only 19 residents attended at least half the sessions. There was a significant improvement in scores for the MCQ assessment, for each grouped AI domain, and in the proportion of residents who reported comfort with 11 of 13 AI statements.

CONCLUSION

The findings of this study demonstrate that given quality high-impact educational content, pediatric residents' knowledge about seizures and epilepsy improves significantly. It is feasible to implement active learning techniques during structured didactic time. The importance of closing the knowledge gap and improving pediatric comfort with seizures and epilepsy is essential and may translate to the much needed improvement in access to care for the patients with these disorders.

The development and validation of the assessment engagement scale

Introduction

The quality of student engagement in assessment within higher education affects learning outcomes. However, variations in conceptions of what quality in engagement looks like impacts assessment design and the way that students and lecturers engage with each other in the assessment process. Given that assessment is an important driver of student engagement in higher education, it is surprising that no specific measures to support understanding of this measure exist. To address this significant gap, we outline the evolution of an assessment engagement scale derived from a research-informed conceptual framework utilizing best practice in assessment and feedback.

Methods

We consider the validity and utility of the assessment engagement scale in supporting students' understanding of assessment and their role within it using exploratory and confirmatory factor analyses.

Results

The resultant nine-item assessment engagement scale's underpinning two factors included: (i) Understanding of the Assessment Context (UAC) including one's role within it, and confidence in navigating assessment requirement, and (ii) Realising Engagement Opportunities (REO) (i.e., willingness to engage and ability to utilise the assessment context effectively to support one's understanding). Construct, criterion, and convergent validity of the scale were established.

Discussion

The AES is a powerful tool in promoting dialogue between lecturers and students about what high quality engagement in assessment looks like, and the respective roles of all parties in realising this. Implications for assessment practices are discussed along with the potential of the scale as a predictive and developmental tool to support enhancements in assessment design and student learning outcomes in higher education.

Transforming musculoskeletal anatomy learning with haptic surface painting

Anatomical body painting has traditionally been utilized to support learner engagement and understanding of surface anatomy. Learners apply two-dimensional representations of surface markings directly on to the skin, based on the identification of key landmarks. Esthetically satisfying representations of musculature and viscera can also be created. However, established body painting approaches do not typically address three-dimensional spatial anatomical concepts. Haptic Surface Painting (HSP) is a novel activity, distinct from traditional body painting, and aims to develop learner spatial awareness. The HSP process is underpinned by previous work describing how a Haptico-visual observation and drawing method can support spatial, holistic, and collaborative anatomy learning. In HSP, superficial and underlying musculoskeletal and vascular structures are located haptically by palpation. Transparent colors are then immediately applied to the skin using purposive and cross-contour drawing techniques to produce corresponding visual representations of learner observation and cognition. Undergraduate students at a United Kingdom medical school (n = 7) participated in remote HSP workshops and focus groups. A phenomenological study of learner perspectives identified four themes from semantic qualitative analysis of transcripts: Three-dimensional haptico-visual exploration relating to learner spatial awareness of their own anatomy; cognitive freedom and accessibility provided by a flexible and empowering learning process; altered perspectives of anatomical detail, relationships, and clinical relevance; and delivery and context, relating to curricular integration, session format, and educator guidance. This work expands the pedagogic repertoire of anatomical body painting and has implications for anatomy educators seeking to integrate innovative, engaging, and effective learning approaches for transforming student learning.

Perception of challenges in management of neurological cases in the emergency room

OBJECTIVE

To investigate emergency clinicians' comfort level in assessing neurological emergencies and to identify opportunities to foster enhanced training of clinical neurology in the emergency room.

DESIGN

Internet-based survey.

SETTING

University teaching hospitals and private referral centers.

SUBJECTS

One hundred and ninety-two emergency and critical care specialists and resident trainees (ECC) and 104 neurology specialists and resident trainees (NEUR) in clinical practice.

INTERVENTIONS

An internet-based survey was distributed via veterinary professional organizations' listserves and message boards and responses were collected between March and April 2020. ECC completed a survey evaluating stress levels associated with neurological emergencies, confidence with neurological examinations, and neuroanatomical localization. NEUR completed a similar survey to report their perception of their ECC colleagues' confidence in the assessment of neurological cases. Chi-square and Mann-Whitney U-tests were used to compare categorical responses and confidence scores between groups. P < 0.002 was considered significant.

MEASUREMENTS AND MAIN RESULTS

Fifty-two percent of ECC found neurological emergencies slightly challenging, whereas 85% of NEUR found them moderately to extremely challenging for ECC (P < 0.0001). ECC's median self-reported confidence score in performing a neurologic examination on a scale of 0-100 was 75 (interquartile range [IQR], 27), while NEUR reported a median ECC confidence of 44 (IQR, 25; P < 0.0001). Median self-reported ECC confidence in localizing intracranial, spinal, and neuromuscular disease was 67 (IQR, 40), 88 (IQR, 21), and 60 (IQR, 37), respectively, which was significantly higher than median NEUR-reported ECC confidence of 35 (IQR, 38), 51 (IQR, 31), and 18 (IQR, 20), respectively (all P < 0.0001). Following case transfer, 34% of ECC received NEUR feedback in >75% of cases.

CONCLUSIONS

Noticeable discrepancies between ECC and NEUR perceptions of ECC clinical confidence were seen, while no firm evidence of neurophobia could be inferred. Improvements in interdepartmental communication and teaching of clinical neurology may be warranted.

Comparison of Class Room Lectures with Fishbowl-Snowball Activity for Dental Undergraduate Students: An Observational Study

Background Traditional classroom lectures have been the backbone of the education system for a long time although this method is most effective but it may not always permit active engagement with the matter and learn it. In contrast, active teaching formats such as fishbowl and snowball techniques allow students to participate in the task of attaining knowledge by shifting the target from preceptor to student, thereby allowing a better understanding of the concepts.

Methodology A total of 80 final-year undergraduate dental students were included in this study. Each student was informed regarding study design and protocol. A lecture on the principles of Pediatric Endodontics was delivered to the students in small groups using the routine virtual method, following which a pre-test activity questionnaire and formal thinking questionnaire were given to the students for scoring. Following this, the class of 80 was divided into smaller groups of four each and the Fishbowl–snowball activity was performed. A post-test activity questionnaire and formal thinking questionnaire were given once again to the students for scoring. The mean pre and post-test scores were statistically analyzed using paired t-test by statistical software SPSS version 20. A p-value of < 0.05 was considered significant.

Results The overall mean difference between pre and post-test activity and formal thinking scores was seen to be statistically significant (p < 0.001).

Conclusion It was seen that a combination of fishbowl and snowball method of teaching led to more satisfactory results as compared with the routine classroom teaching method.

[The cross-sectional field "pain medicine" in medical studies at the University of Leipzig-What has been achieved? : An analysis of self-estimation of students before, during and 5 years after establishment of the cross-sectional field]

BACKGROUND

The field of pain medicine was established as an obligatory subject area of medical schools in Germany in 2016. No prior study has evaluated the effects of this curricular change on students' competences in the field of pain medicine.

OBJECTIVE

The aim of this study was to find out to what extent the introduction of the additional subject "pain medicine" positively influenced the students' acquisition of competences measured via a self-assessment.

MATERIAL AND METHODS

A longitudinal and interdisciplinary curriculum for pain medicine was developed according to the current recommendations for curriculum development for medical education. In parallel, a questionnaire was created for the students' self-assessment of their own level of knowledge and the importance of pain medicine teaching content on a 5-stage Likert scale. The surveys were conducted before the implementation of the curriculum (2014), directly after the first cohort finished (2016) and 5 years after the implementation (2019) and compared by Kruskal-Wallis test.

RESULTS

The implementation of the curriculum has led to significant improvement in relevant aspects. For example, students now feel better prepared overall for the treatment of pain patients (2.67 in 2014 vs. 3.18 in 2019). Individual sub-aspects such as taking a pain history (3.63 vs. 4.10) or drawing up an analgesia scheme (3.56 vs. 4.14) are now also subjectively better mastered.

CONCLUSION

Even though the results are encouraging, there is further potential for improvement in some sub-areas. For example, the students' rating regarding the question about their preparation for treating patients in pain is not yet satisfactory. Therefore, the curriculum should be developed further with a focus on competence orientation. Digital teaching formats can be integrated as well as interprofessional units and simulated patients. Additionally, the examination formats should be further developed towards standardized practical examinations.

Recall of Prior Knowledge in Medical Microbiology Among Medical Interns: A Multicenter Cross-Sectional Assessment in Saudi Arabia

BACKGROUND

Retention of basic biomedical sciences knowledge is of great importance in medical practice. This study aimed to provide some insights into medical interns' ability to recall theoretical knowledge of medical microbiology and to explore factors that affect its retention.

METHODS

In this cross-sectional study conducted between January and March 2019, an anonymized questionnaire with 10 validated multiple-choice questions about medical microbiology was distributed as hard copies to test the ability to recall knowledge of Saudi medical interns in three tertiary training hospitals in Riyadh, Saudi Arabia.

RESULTS

A total of 300 medical interns [164 females (54.7%) and 136 males (45.3%)], in three major tertiary medical care centers in Riyadh, Saudi Arabia, voluntarily participated in the study. Almost a third of participants, 107 (36.4%), graduated from medical schools adopting a traditional curriculum, whereas 184 (63.6%) graduated from medical schools adopting problem-based learning (PBL) instructional approach. The overall mean score out of 10 marks was 3.9±1.8 with almost 82% failures scoring less than six marks. Both total and pass/fail grades were significantly associated with interns who graduated from private colleges. Scores were not significantly associated with any of the investigated parameters except type of college (governmental vs private) with a p-value of 0.049.

CONCLUSION

The current study revealed an overall poor recall of knowledge in microbiology among interns. Our findings suggest a need for a careful revision of curriculum to correct deficiencies, particularly in teaching medical microbiology. Integration of basic sciences is required as well as aligning teaching of basic medical sciences with clinical skills.

The Science of Learning and Art of Education in Cardiology Fellowship

The science of learning, bolstered by the foundational principles of adult learning, has evolved to allow for a more sophisticated understanding of how humans acquire knowledge. To optimize learning outcomes, cardiology educators should be familiar with these concepts and apply them routinely when teaching trainees. This paper presents an overview of the neurobiology of learning and adult learning principles and offers examples of ways in which this science can be applied in cardiology fellowships. Both fellows and educators benefit from the science of learning and its artistic application to education.

Using Strategies from Physical Training of Athletes to Develop Self-Study Programs for Veterinary Medical Students

Veterinary medical students, similar to elite collegiate athletes, are developing strategies for learning new skills and for self-care to take their performance to the next level. As veterinary students learn to successfully navigate an information-dense, high-volume curriculum, many sacrifice wellness, leadership opportunities, extracurricular activities, and social interactions. Strategies from athletes' physical training were used to design a self-study program for first-year veterinary medical students. Major considerations in program design were the characteristics of the human being, learning goals, and contextual constraints. The study program included a warm-up, study sessions, and a cooldown. The program was offered to first-year veterinary medical students at Purdue University's College of Veterinary Medicine. Thirty-two students requested study programs and 21 completed surveys at the semester end. Results were analyzed quantitatively and by using an adapted conventional content analysis approach. Responses were organized into three main domains: reason for participation, program utility, and program satisfaction. Students shared that the most helpful aspects of the program were assisting with organization and time management, providing accountability, and reducing overwhelm by enhancing well-being and performance; they reported that these learned skills would support their well-being as future professionals. This article describes the experiences of one group of veterinary students at one college using these programs. The long-term goal is to develop a model program for all veterinary students to manage curricular demands while maintaining well-being.

"Involve Me and I Learn": Active Learning in a Hybrid Medical Biochemistry First Year Course on an American-Style MD Program in the UAE

Perceived as a subject with abstract jargon, requiring extensive memorization of complex metabolic pathways, chemical structures, and names, students lose sight of the significance of biochemistry on their MD journey (Afshar M, Han Z. Teaching and learning medical biochemistry: Perspectives from a student and an educator. Med Sci Educ. 2014;24:339-41.). A disconnect between what is taught in the classroom and its application to clinical settings arises through over emphasis on the need to pass board exams, documented to be a poor measure of core competencies. Employing active learning strategies with meaningful activities with clinical applications, centered around the curriculum, cognitively engages students and is a deviation from the didactic way in which biochemistry is traditionally taught.

The "Neurospeed" game: a fun tool to learn the neurological semiology

BACKGROUND

Neurological semiology is often considered by medical students as particularly difficult to learn. Finding alternative teaching methods may improve students' motivation and understanding of this field.

METHODS

We developed the "Neurospeed", a game to learn neurological syndromes. We assessed its efficiency on short-term learning of neurological syndromes in third-year medical students, through Multiple Choice Questions (MCQs) before and after the game session. Students' satisfaction was evaluated by a satisfaction survey.

RESULTS

Out of the 199 third-year medical students of the Faculty of Medicine Sorbonne Paris Nord, 180 attended the Neurospeed in December 2020, and 148 answered 20 Multiple Choice Questions before and after the game, with significant improvement of their score (p < 0.001). Most of the participants agreed that the game was playful, stimulating, and helpful to learn neurological semiology.

CONCLUSIONS

Overall, our results show that the Neurospeed game is an interesting tool as a complement to traditional lectures. Further studies are necessary to compare the efficacy of different types of serious games on short-term and long-term learning of neurological semiology.

The Importance of Professional Development in a Programmatic Assessment System: One Medical School’s Experience

The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (CCLCM) was created in 2004 as a 5-year undergraduate medical education program with a mission to produce future physician-investigators. CCLCM’s assessment system aligns with the principles of programmatic assessment. The curriculum is organized around nine competencies, where each competency has milestones that students use to self-assess their progress and performance. Throughout the program, students receive low-stakes feedback from a myriad of assessors across courses and contexts. With support of advisors, students construct portfolios to document their progress and performance. A separate promotion committee makes high-stakes promotion decisions after reviewing students’ portfolios. This case study describes a systematic approach to provide both student and faculty professional development essential for programmatic assessment. Facilitators, barriers, lessons learned, and future directions are discussed.

Sensing: The elephant in the room of management learning

This conceptual paper examines reasons why analytically educated learners may be reluctant to engage in sensory-based learning. Sensing is indispensable for constructing knowledge and should be employed on par with the intellect, particularly in today’s complex and uncertain context. Yet, we have observed learners’ reluctance to engage with sensing and attempted to understand the reasons for it. Our theoretical contribution illuminates the underlying causes of this phenomenon, thus furthering the study of sensing in the fields of individual learning and management learning. Our practical contribution prompts researchers, learners, educators, and managers to think more systematically about ways to overcome this reluctance and openly bring sensing into management learning practice on par with intellectual processing. With the help of phenomenal theorizing, the presented exploratory study identifies the following common barriers to sensory-based learning for analytically educated learners: corporate social norms against sensory-based evidence, discomfort of learning outside of one’s comfort zone, inadequate vocabulary for sensory experiences, lack of sensory awareness, preference for sequential reasoning, mistrust in sensory-based evidence, dismissive attitude, and denying (or not admitting to) the use of sensing.

Micro-habits for life-long learning

Radiology is a demanding career that requires a thorough understanding of evolving knowledge in both medical imaging and technology. Competing interests such as-familial obligations, clinical practice, committee meetings, and research projects-often leave little time for self-care and regular review of current medical literature. Healthy habits can be difficult to maintain, but micro-habits are more manageable and their benefits compound over time. Based on the book, Atomic Habits by James Clear, we discuss a micro-habit toolkit which includes: a two-minute rule, habit-stacking, environmental cues, task prioritization/automatization, habit tracking, and accountability. We offer practical suggestions for radiologists to incorporate this toolkit into their daily lives to become healthy life-long learners.

Obesity Hurts: The Why and How of Integrating Weight Reduction With Chronic Pain Management

Amongst adults with chronic pain, overweight and obesity are highly prevalent. The association between chronic pain and overweight is driven by several explanations, including increased biomechanical load, changes in the gut microbiome, and low-grade (neuro)inflammation. Moreover, the link between overweight, obesity and chronic pain can best be considered from a lifestyle perspective. Since conservative treatment for chronic pain is often limited to short-term and small effects, addressing important comorbidities within a lifestyle approach could be the next step towards precision medicine for these patients. Indeed, evidence shows that combining weight reduction with conservative pain management is more effective to reduce pain and disability, compared to either intervention alone. This perspective article aims to update the reader with the current understanding of the possible explanatory mechanisms behind the interaction between overweight/obesity and chronic pain in an adult population. Second, this paper applies this knowledge to clinical practice, including assessment and conservative treatment of overweight/obesity in adults with chronic pain. Henceforth, clinical recommendations and guidelines are provided based on available scientific evidence and the authors' clinical expertise.

IMPACT

This paper will guide clinicians in the implementation of weight reduction programs within pain management.

Using a digital whiteboard for student engagement in distance education

The COVID-19 pandemic transformed educational processes across different educational levels. As institutions and faculty members effort focused on guaranteeing academic continuity, the challenge was how to translate the learning methodologies applied in the classroom to virtual settings. A digital whiteboard was integrated to synchronous class sessions to complement the educational experience. During these sessions, students and teachers interacted to co-construct ideas and socialize learning. The objective of this study was to assess the impact of introducing a digital whiteboard in student engagement. The quantitative approach integrated student's perception through an online survey with 12 items. The results show that the students enjoyed the dynamic(4.56), students believe that the incorporation of digital whiteboard contributed to understanding abstract concepts(4.83), and perceived the resource contributed for class engagement(4.72). The design of educational projects that incorporate these resources translate to active learning dynamics which foster student engagement.

Trends and challenges of medical education

The aim of this article is to reflect on the contextual factors that influence medical education, in order to provide some recommendations about the challenges that physicians face. A literature review was conducted to write this reflection paper, and it was found that the education of health professionals has undergone significant changes that are based on the development of biomedical sciences, technology, and pedagogy, and are influenced by the needs of the general population, the requirements of the health systems of each country, and scientific progress. These changes have given rise to challenges inherent to the special characteristics of each country and related to the quantity, quality, and relevance of the training of physicians. In this regard, it has been suggested that, in the face of such changes, it is necessary to design curricula that integrate all aspects of health care, consider the supply and demand of medical services, emphasize professionalism, take into account the pedagogical training of health sciences teachers, comply with quality standards, assist students in selecting undergraduate programs adequately (in this case Medicine), and ensure relevant clinical practice scenarios. It should also be noted that medical education has not adapted adequately to the aforementioned changes in many countries and, therefore, the development of teaching and learning strategies has lagged behind and physicians in such countries do not have the capacity to provide the health care required by the general population in a proper manner.

Quantitative Assessment of Learning Behaviors for Oncology Providers

How health care providers select topics and activities for learning is key to meeting their needs. The goal of this study was to investigate how oncology providers identify knowledge gaps and choose learning activities. An online focus group within a larger longitudinal study was conducted between November 2015 and August 2016. Participants were chosen by convenience and stratified random sampling of diverse types of oncology providers. Providers were asked monthly to identify learning needs, explain how they identified those needs, and describe the learning activity they chose to meet those needs. Thirty-two oncology providers recorded 201 learning needs via online journal entries (mean 6 entries per person). Needs were associated with practice setting and professional role (p < .05). Colleague recommendation predicted learning needs for advanced practice providers (APPs) (p = .003). Patient cases drove > 50% of identified learning needs across groups. Learning activity preferences were associated with practice setting (p < .05). Choice of learning activity was associated with practice setting, professional role, and geographic location. Colleague recommendation was important for APPs (p = .025). Over 75% of learner responses identify convenience and content quality as important factors in choosing an activity. This study represents a quantitative assessment of learning behaviors for oncology providers and shows that identification of learning needs and activity selection differ by provider demographics. Limitations include small size and underrepresentation of some groups. Our findings should be confirmed with larger samples. Future research should focus on assessment of cohort versus individual needs and learning priorities.

Radiation oncology as part of medical education-current status and possible digital future prospects

Purpose

Education as part of medical education is currently changing rapidly. Not least because of the corona crisis, more and more digital teaching formats and innovative teaching concepts such as the flipped classroom model are finding their way into teaching. We analyzed the acceptance and effectiveness of traditional teaching methods as well as the interest in innovative e‑learning methods among medical students in the field of radiation oncology at the medical school of the Technical University of Munich.

Methods

We carried out an online-based survey as well as a knowledge test on all students from two terms who had completed the seminar series of radiation oncology. The survey comprised seven questions on the frequency of participation, acceptance, and judgment of the effectiveness in terms of learning and on a potential use of e‑learning methods using a six-point Likert scale. The test consisted of 10 multiple-choice questions.

Results

Traditional teaching methods are largely accepted by students and most students consider the current learning format to be effective in terms of the teaching effect in the field of radiation oncology. However, only about 50% of all knowledge questions were answered correctly. The possible use of e‑learning methods was judged critically or desired in roughly equal parts among the students.

Conclusion

Traditional seminars enjoy a high level of acceptance among students. Effectiveness with regard to the internalization of content taught, however, should be increased. After all, the future seems to lie in the integration of e‑learning in the form of educational videos and practical seminars.

Effective Way of Studying and Learning in Medical School

Medical knowledge is growing. We struggle a lot to retain most of the studied information, but we forget it. Most of us are unaware of how to study effectively and improve memory.Understanding the neurobiology of learning and knowing some of the productive study techniques backed up by the researches can help us to study as well as learn effectively. This article may help medical students to study productively and motivate them to search for effective ways of studying actively.

Focused Multisensory Anatomy Observation and Drawing for Enhancing Social Learning and Three-Dimensional Spatial Understanding

The concept that multisensory observation and drawing can be effective for enhancing anatomy learning is supported by pedagogic research and theory, and theories of drawing. A haptico-visual observation and drawing (HVOD) process has been previously introduced to support understanding of the three-dimensional (3D) spatial form of anatomical structures. The HVOD process involves exploration of 3D anatomy with the combined use of touch and sight, and the simultaneous act of making graphite marks on paper which correspond to the anatomy under observation. Findings from a previous study suggest that HVOD can increase perceptual understanding of anatomy through memorization and recall of the 3D form of observed structures. Here, additional pedagogic and cognitive underpinnings are presented to further demonstrate how and why HVOD can be effective for anatomy learning. Delivery of a HVOD workshop is described as a detailed guide for instructors, and themes arising from a phenomenological study of educator experiences of the HVOD process are presented. Findings indicate that HVOD can provide an engaging approach for the spatial exploration of anatomy within a supportive social learning environment, but also requires modification for effective curricular integration. Consequently, based on the most effective research-informed, theoretical, and logistical elements of art-based approaches in anatomy learning, including the framework provided by the observe-reflect-draw-edit-repeat (ORDER) method, an optimized "ORDER Touch" observation and drawing process has been developed. This is with the aim of providing a widely accessible resource for supporting social learning and 3D spatial understanding of anatomy, in addition to improving specific anatomical knowledge.

Unpacking Medical Students' Mixed Engagement in Health Systems Science Education

Phenomenon: Medical education is better aligning with the needs of health systems. Health systems science competencies, such as high-value care, population health, and systems thinking, are increasingly being integrated into curricula, but not without challenges. One challenge is mixed receptivity by students, the underlying reasons of which have not been extensively explored. In this qualitative study, we explored the research question: "How do students perceive health systems science curricula across all four years, and how do such perceptions inform the reasons for mixed quality ratings?" Approach: Following large-scale health systems science curricular changes in their medical school, we used students' open-ended comments obtained from course evaluations related to 1^st-, 2^nd-, and 4^th-year courses and performed a qualitative thematic analysis to explore students' perceptions. We identified themes, synthesized findings into a conceptual figure, and agreed upon results and quotations. Findings: Five themes were identified: (1) perceived importance and relevance of health systems science education, (2) tension between traditional and evolving health systems science-related professional identity, (3) dissatisfaction with redundancy of topics, (4) competition with basic and clinical science curricula, and, (5) preference for discrete, usable, testable facts over complexity and uncertainty. The relationship between themes is described along a continuum of competing agendas between students' traditional mindset (which focuses on basic/clinical science) and an emerging medical education approach (which focuses on basic, clinical, and health systems science). Insights: Health systems science education can be viewed by learners as peripheral to their future practice and not aligned with a professional identity that places emphasis on basic and clinical science topics. For some students, this traditional identity limits engagement in health systems science curricula. If health systems science is to achieve its full potential in medical education, further work is required to explore the adoption of new perspectives by students and create activities to accelerate the process.

Application of Frequent, Spaced Multiple-choice Questions as an Educational Tool in the Pediatric Emergency Department

OBJECTIVES

The objective was to assess the feasibility of using spaced multiple-choice questions (MCQs) to teach residents during their pediatric emergency department (PED) rotation and determine whether this teaching improves knowledge retention about pediatric rashes.

METHODS

Residents rotating in the PED from four sites were randomized to four groups: pretest and intervention, pretest and no intervention, no pretest and intervention, and no pretest and no intervention. Residents in intervention groups were automatically e-mailed quizlets with two MCQs every other day over 4 weeks (20 questions total) via an automated e-mail service with answers e-mailed 2 days later. Retention of knowledge was assessed 70 days after enrollment with a posttest of 20 unique, content-matched questions.

RESULTS

Between August 2015 and November 2016, a total 234 residents were enrolled. The completion rate of individual quizlets ranged from 93% on the first and 76% on the 10th quizlet. Sixty-six residents (55%) completed all 10 quizlets. One-hundred seventy-three residents (74%) completed the posttest. There was no difference in posttest scores between residents who received a pretest (61.0% ± 14.5%) and those who did not (64.6% ± 14.0%; mean difference = -3.7, 95% confidence interval [CI] = -8.0 to 0. 6) nor between residents who received the intervention (64.5% ± 13.3%) and those who did not receive the intervention (61.2% ± 15.2%; mean difference = 3.2, 95% CI = -1.1 to 7.5). For those who received a pretest, scores improved from the pretest to the posttest (46.4% vs. 60.1%, respectively; 95% CI = 9.7 to 19.5).

CONCLUSION

Providing spaced MCQs every other day to residents rotating through the PED is a feasible teaching tool with a high participation rate. There was no difference in posttest scores regardless of pretest or intervention. Repeated exposure to the same MCQs and an increase in the number of questions sent to residents may increase the impact of this educational strategy.

Conceptualising spaced learning in health professions education: A scoping review

OBJECTIVES

To investigate the definitions and applications of 'spaced learning' and to propose future directions for advancing its study and practice in health professions education.

METHOD

The authors searched five online databases for articles published on spaced learning in health professions education prior to February 2018. Two researchers independently screened articles for eligibility with set inclusion criteria. They extracted and analysed key data using both quantitative and qualitative methods.

RESULTS

Of the 2972 records retrieved, 120 articles were included in the review. More than 90% of these articles were published in the last 10 years. The definition of spaced learning varied widely and was often not theoretically grounded. Spaced learning was applied in distinct contexts, including online learning, simulation training and classroom settings. There was a large variety of spacing formats, ranging from dispersion of information or practice on a single day, to intervals lasting several months. Generally, spaced learning was implemented in practice or testing phases and rarely during teaching.

CONCLUSIONS

Spaced learning is infrequently and poorly defined in the health professions education literature. We propose a comprehensive definition of spaced learning and emphasise that detailed descriptions of spacing formats are needed in future research to facilitate the operationalisation of spaced learning research and practice in health professions education.

Applying Educational Theory and Best Practices to Solve Common Challenges of Simulation-based Procedural Training in Emergency Medicine

OBJECTIVES

Procedural competency is an essential prerequisite for the independent practice of emergency medicine. Multiple studies demonstrate that simulation-based procedural training (SBPT) is an effective method for acquiring and maintaining procedural competency and preferred over traditional paradigms ("see one, do one, teach one"). Although newer paradigms informing SBPT have emerged, educators often face circumstances that challenge and undermine their implementation. The goal of this paper is to identify and report on best practices and theory-supported solutions to some of these challenges as derived using a process of expert consensus building and reviews of the existing literature on SBPT.

METHODS

The Society for Academic Emergency Medicine (SAEM) Simulation Academy SBPT Workgroup convened approximately 8 months prior to the 2019 SAEM Annual Meeting to perform a review of the literature and participate in a consensus-building process to identify solutions (in the form of best practices and educational theory) to these challenges faced by educators engaging in SBPT.

RESULTS AND ANALYSIS

Thirteen distinct educational challenges to SBPT emerged from the expert group's primary literature reviews and consensus-building processes. Three domains emerged upon further analysis of the 13 challenges: learner, educator, and curriculum. Six challenges within the "learner" domain were selected for comprehensive discussion in this paper, as they were deemed representative of the most common and most significant threats to ideal SBPT. Each of the six challenges aligns with one of the following themes: 1) maximizing active learning, 2) maintaining learner engagement, 3) embracing learner diversity, 4) optimizing cognitive load, 5) promoting mindfulness and reflection, and 6) emphasizing deliberate practice for mastery learning. Over 20 "special treatments" for mitigating the impact of the 13 challenges were derived from the secondary literature search and consensus-building process prior to and during the preconference workshop; 11 of these that best address the six learner-centered challenges are explored, including implications for educators involved in SBPT.

CONCLUSIONS/IMPLICATIONS FOR EDUCATORS

We propose multiple consensus-generated solutions (in the form of best practices and applied educational theory) that we believe are suitable and well aligned to overcome commonly encountered learner-centered challenges and threats to optimal SBPT.

Twelve tips for incorporating gamification into medical education

This article was migrated. The article was marked as recommended. Gamification incorporates elements of gameplay into real-word activities and behaviours. These elements include progress mechanics, player development and narrative structure. Gamification is being increasingly used in an educational context as it has the ability to make learning fun, memorable and more effective. We recommend ways in which gamification can be effectively implemented in medical education, including common pitfalls and hurdles to avoid.

Training the next generation of Africa's doctors: why medical schools should embrace the team-based learning pedagogy

BACKGROUND

As far back as 1995, the Cape Town Declaration on training Africa's future doctor recognized the need for medical schools to adopt active-learning strategies in order to nurture holistic development of the doctor. However, medical education in Africa remains largely stuck with traditional pedagogies that emphasize the 'hard skills' such as knowledge and clinical acumen while doing little to develop 'soft skills' such as effective communication, teamwork, critical thinking or life-long learning skills. By reviewing literature on Africa's epidemiologic and demographic transitions, we establish the need for increasing the output of well-trained doctors in order to match the continent's complex current and future healthcare needs. Challenges that bedevil African medical education such as outdated curricula, limited educational infrastructure and chronic resource constraints are presented and discussed. Furthermore, increased student enrollments, a trend observed at many schools, coupled with chronic faculty shortages have inadvertently presented specific barriers against the success of small-group active-learning strategies such as Problem-Based and Case-Based Learning. We argue that Team-Based Learning (TBL) offers a robust alternative for delivering holistic medical education in the current setting. TBL is instructor-driven and embodies key attributes that foster development of both 'hard' and 'soft' skills. We elaborate on advantages that TBL is likely to bring to the African medical education landscape, including increased learner enthusiasm and creativity, accountability, peer mentorship, deep learning and better knowledge retention. As with all new pedagogical methods, challenges anticipated during initial implementation of TBL are discussed followed by the limited pilot experiences with TBL in Africa.

CONCLUSION

For its ability to enable a student-centered, active learning experience delivered at minimum cost, we encourage individual instructors and African medical schools at large, to adopt TBL as a complementary strategy towards realizing the goal of training Africa's fit-for-purpose doctor.

Learning and Teaching Together to Advance Evidence-Based Clinical Education: A Faculty Learning Community

Clinical teaching is a cornerstone of health sciences education; it is also the most challenging aspect. The University of Pittsburgh Schools of Dental Medicine, Nursing, and Pharmacy developed a new evidence-based interprofessional course framed as a faculty learning community (FLC) around the principles of learning in a clinical environment. The aim of this study was to assess the overall effectiveness of this two-semester FLC at four health professions schools in academic year 2014-15. The assessment included anonymous participant surveys in each session and an anonymous end-of-course survey. Thirty-five faculty members from dental, health and rehabilitation sciences, nursing, and pharmacy enrolled in the FLC, with six to 32 enrollees attending each session. All attendees at each session completed the session evaluation surveys, but the attendance rate at each session ranged from 17.1% to 91.4%. Sixteen participants (46%) completed the end-of-course survey. The results showed overall positive responses to the FLC and changes in the participants' self-reported knowledge. Session surveys showed that the participants found the FLC topics helpful and appreciated the opportunity to learn from each other and the interprofessional nature of the FLC. Responses to the end-of-course survey were in alignment with the individual session surveys and cited specific benefits as being the content, teaching materials, and structured discussions. In additional feedback, participants reported interest to continue as a cohort and to extend the peer-support system beyond the FLC. This outcomes assessment of the first round of the FLC confirmed that this cohort-based faculty development in an interprofessional setting was well received by its participants. Their feedback provided valuable insights for changes to future offerings.

Student experiences of two small group learning-teaching formats: Seminar and fishbowl

INTRODUCTION

As teaching strategies, the seminar and fishbowl approaches promote active learning and shift the focus from the teacher to the learner. The aim of this study was to compare the self-reported perceptions of each student-centred teaching technique amongst a group of dental students as well as resultant quiz scores after each teaching technique.

MATERIAL AND METHODS

During the first semester of 2017, all year-3 (N = 88) Semiology and year-5 (N = 71) Oral Surgery students participated in weekly seminars in which teams of students from both cohorts were given an actual clinical case to study; a diagnosis and treatment plan would be rendered, and an oral case presentation would be presented to the rest of the class. In the second semester, the same students tried to solve similar clinical cases using the fishbowl training format. A course coordinator provided final feedback, and the session culminated with a quiz. Students were invited to provide quantitative and qualitative perceptions whilst quiz scores obtained during seminar and fishbowl teaching formats were compared.

RESULTS AND DISCUSSION

A total of 97 (61%) seminar and 92 (58%) fishbowl students provided insights regarding these teaching techniques. Both cohorts believed the fishbowl format allowed them to be actively involved. However, only year-3 students gave the fishbowl format a significantly higher score than the seminar format, considering it an attractive format that allowed them to learn. In contrast, year-5 students believed the seminars met their expectations better than the fishbowl format. Interesting clinical cases as well as the final round of feedback were qualitative themes reported by both cohorts. The mean seminar and fishbowl quiz scores were statistically significant different for year-3 students (P < 0.0001), but not for year-5 students (P = 0.09).

CONCLUSIONS

These findings suggest that a more structured small-group learning-teaching format can be implemented for younger students whilst at the same time allowing more flexible organisation for senior students.

Designing and Evaluating a Virtual Patient Simulation—The Journey from Uniprofessional to Interprofessional Learning

“Ready to Practice?”(R2P) is a virtual patient simulation designed for undergraduate medical and pharmacy students. After initial prototyping, R2P developed into a screen-based virtual patient (VP) simulation with an intuitive interface using photorealistic images of people and places with speech bubbles and decision menus. We describe the design of the VP, findings from student experiences with the software, and the potential of VPs for interprofessional learning. We used a mixed methods study to assess students’ perceptions of the VP as a learning tool. Qualitative data were gathered using semi-structured interviews and observations, and quantitative data through the Readiness for Interprofessional Learning Scale (RIPLS) and an evaluation questionnaire. Overall, participants showed significantly improved RIPLS scores after participation in the simulation (78.78 to 82.25, p < 0.0001), including in the Positive Professional Identify domain (p < 0.001). Students also showed significant improvement in RIPLS scores in the Teamwork and Collaboration domain when pharmacy and medical students were working together in interprofessional pairs (40.75 to 43.00, p < 0.006) but not when working alone (n.s.). Five themes emerged from interviews where participants identified specific interprofessional insights into each other’s roles and skills. Students found the VP engaging and valuable for their learning and their understanding of teamwork.

Spaced radiology: encouraging durable memory using spaced testing in pediatric radiology

Applied memory research in the field of cognitive and educational psychology has generated a large body of data to support the use of spacing and testing to promote long-term or durable memory. Despite the consensus of this scientific community, most learners, including radiology residents, do not utilize these tools for learning new information. We present a discussion of these parallel and synergistic learning techniques and their incorporation into a software platform, called Spaced Radiology, which we created for teaching radiology residents. Specifically, this software uses these evidence-based strategies to teach pediatric radiology through a flashcard deck system.

Improving Handoffs: Implementing a Training Program for Incoming Internal Medicine Residents

BACKGROUND

The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program requires residents to receive training in handoffs, but there is limited information on best practices in implementing handoff training.

OBJECTIVE

We hypothesized that a bundled, standardized approach to handoffs during intern orientation would increase trainee comfort, confidence, and knowledge.

METHODS

All incoming internal medicine interns participated in a Care Transitions workshop during orientation that was divided into 3 sections: introduction and handoff videos using the I-PASS handoff tool, small group discussion of case scenarios, and a 1-on-1 handoff simulation with an evaluator. Participants completed pre- and postworkshop surveys. We reviewed handoff documents to assess whether residents continued to report illness severity-a key component of I-PASS-after the intervention.

RESULTS

Over 3 years, 225 of 229 (98%) interns completed the preworkshop survey, and 191 (83%) completed the postworkshop survey. Between 2014 and 2016, the number of incoming interns reporting prior training in handoffs during medical school increased from 45% to 63%. Interns' self-reported comfort with providing effective handoffs and self-reported confidence identifying factors essential to an effective verbal handoff (measured on a 5-point Likert scale) improved significantly after the intervention (P < .05 for all questions and years). During 1 year, written handoffs for 28 498 patients were analyzed, and I-PASS illness severity was documented 99.4% of the time.

CONCLUSIONS

The Care Transitions workshop consistently improved comfort, confidence, and knowledge of interns in performing handoffs and resulted in sustained change in handoff documentation.

Recall of physiology knowledge among medical interns: an exploratory study in Riyadh, Saudi Arabia

The aim of the study was to explore the factors associated with the recall of basic medical physiology knowledge among medical interns and to determine the level of retained basic science knowledge. Two hundred and four interns, 114 women and 90 men, working in two major tertiary medical care centers, King Fahad Medical City (KFMC; 29 students) and King Khalid University Hospital (KKUH; 117 students), in Riyadh city, participated in the study. An anonymous knowledge test with 10 validated multiple-choice questions was developed specifically for this purpose. One hundred and forty-six interns (117 working at KKUH and 29 at KFMC) had graduated from medical schools adopting a conventional instructional system, whereas 58 (3 from KKUH and 55 from KFMC had graduated from schools adopting an integrated system (hybrid problem-based learning). Fifty-two students (26%) gained a score ≥60%, whereas 152 students (74%) obtained <60% of the score. Higher scores were associated with younger age ( P < 0.01), traditional curriculum ( P < 0.001), interns from KKUH ( P < 0.001), and candidates for postgraduate studies ( P < 0.02). There was no significant association between recall of physiology knowledge and all other variables studied, including sex. Multivariate analyses show that age and traditional curriculum are the only significant predictors of knowledge retention. Almost three-fourths of the interns scored <60%, and higher scores were significantly associated with younger interns, traditional curriculum, working in KKUH, and interns preparing for graduate studies. However, the difference between the two curricula disappears when the influence of hospital training is considered.

Curricular Reform in Pharmacy Education Through the Lens of the Flexner Report of 1910

Abraham Flexner's 1910 report on medical education in the United States (US) and Canada propelled medical training forward into a contemporary renaissance. The report heralded many seismic changes that still resonate within medical and health professions education throughout the US. Today several factors are accelerating curricular reform within pharmacy education, including but not limited to accreditation standards, technologic advances, and student diversity. Despite the fact that Flexner's report is now over a century old, many of his observations and recommendations regarding education are as pertinent and timely today as they were in 1910. This commentary will discuss and reflect upon curricular reform in pharmacy education as it contrasts with some of the observations, findings, and recommendations of Flexner's 1910 report.

Improving diagnosis by improving education: a policy brief on education in healthcare professions

Diagnostic error is increasingly recognized as a major patient safety concern. Efforts to improve diagnosis have largely focused on safety and quality improvement initiatives that patients, providers, and health care organizations can take to improve the diagnostic process and its outcomes. This educational policy brief presents an alternative strategy for improving diagnosis, centered on future healthcare providers, to improve the education and training of clinicians in every health care profession. The hypothesis is that we can improve diagnosis by improving education. A literature search was first conducted to understand the relationship of education and training to diagnosis and diagnostic error in different health care professions. Based on the findings from this search we present the justification for focusing on education and training, recommendations for specific content that should be incorporated to improve diagnosis, and recommendations on educational approaches that should be used. Using an iterative, consensus-based process, we then developed a driver diagram that categorizes the key content into five areas. Learners should: 1) Acquire and effectively use a relevant knowledge base, 2) Optimize clinical reasoning to reduce cognitive error, 3) Understand system-related aspects of care, 4) Effectively engage patients and the diagnostic team, and 5) Acquire appropriate perspectives and attitudes about diagnosis. These domains echo recommendations in the National Academy of Medicine’s report Improving Diagnosis in Health Care. The National Academy report suggests that true interprofessional education and training, incorporating recent advances in understanding diagnostic error, and improving clinical reasoning and other aspects of education, can ultimately improve diagnosis by improving the knowledge, skills, and attitudes of all health care professionals.

Test-enhanced learning in health professions education: A systematic review: BEME Guide No. 48

BACKGROUND

Cognitive psychology studies demonstrate that subjects who attempt to recall information show better learning, retention, and transfer than subjects who spend the same time studying the same material (test-enhanced learning, TEL). We systematically reviewed TEL interventions in health professions education.

METHODS

We searched 13 databases, 14 medical education journals, and reference lists. Inclusion criteria included controlled studies of TEL that compared TEL to studying the same material or to a different TEL strategy. Two raters screened articles for inclusion, abstracted information, determined quality scores, and calculated the standardized mean difference (SMD) for the learning outcomes.

RESULTS

Inter-rater agreement was excellent for all comparisons. The 19 included studies reported 41 outcomes with data sufficient to determine a SMD. TEL interventions included short answer questions, multiple choice questions, simulation, and standardized patients. Five of six immediate learning outcomes (SMD 0.09-0.44), 21 of 23 retention outcomes (SMD 0.12-2.5), and all seven transfer outcomes (SMD 0.33-1.1) favored TEL over studying.

CONCLUSIONS

TEL demonstrates robust effects across health professions, learners, TEL formats, and learning outcomes. The effectiveness of TEL extends beyond knowledge assessed by examinations to clinical applications. Educators should include TEL in health professions curricula to enhance recall, retention, and transfer.

Technology-enhanced surgical education: attitudes and perceptions of the endoscopic surgery community in Turkey

The education programme of surgery has unique problems. In this study, first, a literature review is conducted to cover the studies found in the literature reporting on the problems of surgical education. Additionally, a survey study is conducted with 31 participants, who are either currently enrolled in endoscopic surgery education programmes in Turkey or are experts in the field. Supportively semistructured individual interviews are also conducted with five participants. These data are collected to better understand the instructional methods being used, their problems and the participants’ preferred methods to be used. Additionally, the participants’ attitudes are also investigated regarding the use of new technologies to enhance the current education programmes. The results indicate that, in Turkey, surgical education programmes are still mostly offered in traditional ways while other educational methods are used in an extremely limited manner. In general, the authors emphasise that more research needs to be conducted to better understand the characteristics of the medical students and develop standards for surgical education programmes, educational tools specific for related surgical domains and guidelines for the curriculum integration. The results of this study aimed to guide the instructional system designers for the endoscopic surgery education programmes.

A Reinforcement-Based Learning Paradigm Increases Anatomical Learning and Retention-A Neuroeducation Study

In anatomy education, a key hurdle to engaging in higher-level discussion in the classroom is recognizing and understanding the extensive terminology used to identify and describe anatomical structures. Given the time-limited classroom environment, seeking methods to impart this foundational knowledge to students in an efficient manner is essential. Just-in-Time Teaching (JiTT) methods incorporate pre-class exercises (typically online) meant to establish foundational knowledge in novice learners so subsequent instructor-led sessions can focus on deeper, more complex concepts. Determining how best do we design and assess pre-class exercises requires a detailed examination of learning and retention in an applied educational context. Here we used electroencephalography (EEG) as a quantitative dependent variable to track learning and examine the efficacy of JiTT activities to teach anatomy. Specifically, we examined changes in the amplitude of the N250 and reward positivity event-related brain potential (ERP) components alongside behavioral performance as novice students participated in a series of computerized reinforcement-based learning modules to teach neuroanatomical structures. We found that as students learned to identify anatomical structures, the amplitude of the N250 increased and reward positivity amplitude decreased in response to positive feedback. Both on a retention and transfer exercise when learners successfully remembered and translated their knowledge to novel images, the amplitude of the reward positivity remained decreased compared to early learning. Our findings suggest ERPs can be used as a tool to track learning, retention, and transfer of knowledge and that employing the reinforcement learning paradigm is an effective educational approach for developing anatomical expertise.

Responses to clinical uncertainty in Australian general practice trainees: a cross-sectional analysis

CONTEXT

Tolerance for ambiguity is essential for optimal learning and professional competence. General practice trainees must be, or must learn to be, adept at managing clinical uncertainty. However, few studies have examined associations of intolerance of uncertainty in this group.

OBJECTIVES

The aim of this study was to establish levels of tolerance of uncertainty in Australian general practice trainees and associations of uncertainty with demographic, educational and training practice factors.

METHODS

A cross-sectional analysis was performed on the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study. Scores on three of the four independent subscales of the Physicians' Reaction to Uncertainty (PRU) instrument were analysed as outcome variables in linear regression models with trainee and practice factors as independent variables.

RESULTS

A total of 594 trainees contributed data on a total of 1209 occasions. Trainees in earlier training terms had higher scores for 'Anxiety due to uncertainty', 'Concern about bad outcomes' and 'Reluctance to disclose diagnosis/treatment uncertainty to patients'. Beyond this, findings suggest two distinct sets of associations regarding reaction to uncertainty. Firstly, affective aspects of uncertainty (the 'Anxiety' and 'Concern' subscales) were associated with female gender, less experience in hospital prior to commencing general practice training, and graduation overseas. Secondly, a maladaptive response to uncertainty (the 'Reluctance to disclose' subscale) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio-economic status, and being Australian-trained.

CONCLUSIONS

This study has established levels of three measures of trainees' responses to uncertainty and associations with these responses. The current findings suggest differing 'phenotypes' of trainees with high 'affective' responses to uncertainty and those reluctant to disclose uncertainty to patients. More research is needed to examine the relationship between clinical uncertainty and clinical outcomes, temporal changes in tolerance for uncertainty, and strategies that might assist physicians in developing adaptive responses to clinical uncertainty.