Perceptions on the importance of gerontological education by teachers and students of undergraduate health sciences

Mental health status and substance abuse among medical students in Karaikal, Puducherry, India

Mental health disorders and substance abuse are prevalent issues that significantly impact individuals and societies. Medical students are particularly vulnerable due to the intense pressures and challenges inherent in medical education. This current investigation aims to explore the mental health status and patterns of substance abuse among medical students, identifying associated factors and potential interventions. A cross-sectional study was executed with 421 undergraduate and post graduate medical students from a tertiary care centre. Multivariate logistic regression was used to determine the factors associated with psychological distress and substance abuse. Substance abuse was reported by 21.4% of participants, while 20.7% experienced psychological distress. There was a statistically significant association between substance abuse and psychological distress (p=0.005). Factors associated with psychological distress included sleep deprivation (Adjusted OR: 24.8, p=0.001), whereas factors associated with substance abuse included male gender (Adjusted OR: 2.3, p=0.001), older age, staying with friends (Adjusted OR: 1.8, p=0.04) and sleep deprivation abuse (OR: 2.0, p=0.01). This study highlights a significant occurrence of psychological distress and substance abuse among medical students. Interventions to improve mental health and reduce substance abuse among medical students should consider these associated factors, emphasizing the importance of sleep hygiene, stress management and supportive environments.

Australian dental school academics' perceptions of gerodontology education in the undergraduate curriculum

INTRODUCTION

Australia's rapidly growing population of dentate, frail, care-dependent older people require graduates skilled in managing the health needs of this patient group. The perceptions of academics teaching gerodontology may inform future dental curricula recommendations. This study explored the perceptions of gerodontology education amongst Australian dental school academics.

MATERIALS AND METHODS

All nine Australian dental schools providing entry-to-practice dentistry programs were invited to participate in semi-structured interviews. Academics from six dentistry programs took part, and the data were analysed using a thematic approach.

RESULTS

The three main themes identified from interviews included 'clinical exposure', 'organisational levers', and 'sociological barriers'. The attitudes of students, as well as society and health professionals, were seen as strongly influential in preparing the workforce for managing the oral health of older people. The themes inter-linked with a knock-on effect where societal attitudes and organisational levers impact on the ability to successfully support students' preparation for gerodontology practice. Limited resources were barriers to achieving ideal learning and teaching and continued upon graduation as oral health care for older people was perceived as undervalued and under-resourced.

CONCLUSION

There has been a continued cycle of failure in healthcare schemes and advocacy for the improvement of oral health for older people which has contributed to the inadequate preparation of dental graduates for managing frail and care-dependent older people. Organisational, societal, and political change is needed to support the education of dental students in this area to ensure graduate dentists are competent to manage the oral care needs of this growing population.

A Novel Framework for the Generation of Multiple Choice Question Stems Using Semantic and Machine-Learning Techniques

Multiple Choice Questions (MCQs) are a popular assessment method because they enable automated evaluation, flexible administration and use with huge groups. Despite these benefits, the manual construction of MCQs is challenging, time-consuming and error-prone. This is because each MCQ is comprised of a question called the "stem", a correct option called the "key" along with alternative options called "distractors" whose construction demands expertise from the MCQ developers. In addition, there are different kinds of MCQs such as Wh-type, Fill-in-the-blank, Odd one out, and many more needed to assess understanding at different cognitive levels. Automatic Question Generation (AQG) for developing heterogeneous MCQ stems has generally followed two approaches: semantics-based and machine-learning-based. Questions generated via AQG techniques can be utilized only if they are grammatically correct. Semantics-based techniques have been able to generate a range of different types of grammatically correct MCQs but require the semantics to be specified. In contrast, most machine-learning approaches have been primarily able to generate only grammatically correct Fill-in-the-blank/Cloze by reusing the original text. This paper describes a technique for combining semantic-based and machine-learning-based techniques to generate grammatically correct MCQ stems of various types for a technical domain. Expert evaluation of the resultant MCQ stems demonstrated that they were promising in terms of their usefulness and grammatical correctness.

Teaching about chronicity in medical schools - A review of the current situation

In recent decades, progressive population aging in developed countries has led to a significant increase in the number of people with at least one chronic medical condition. As a result, acquiring knowledge about chronicity in medical school is key for physicians to be able to provide proper management for these patients. However, the presence of chronicity in educational curricula is scarce and highly variable. On the one hand, this work consisted of a review of the educational programs of the main medical schools on each continent with the aim of identifying whether they included chronicity and, on the other, a literature review focused on identifying educational projects in the field of chronicity. The presence of chronicity in most medical schools' curricula is marginal and only a few universities include specific skills or competences linked to chronicity. In most cases, this topic appears as a global, cross-curricular competence that students are supposed to acquire over the course of their entire education. The literature review retrieved 21 articles on innovative teaching projects on chronicity. Direct contact with chronic patients, most times as "health mentors," the role of the student as a teacher, and continuous evaluation and feedback from all participants are the main characteristics of the projects analyzed. Some previously published experiences support the usefulness of innovative methodologies for better approaching this capital field in current medical practice. Despite the current situation in which chronic patients consume most healthcare resources, the presence of chronicity in medical schools is marginal. However, a literature review did identify some useful experiences for improving education on chronicity in medical schools. Medical schools should change their academic curricula and redirect them towards providing students all the necessary tools for improving their knowledge on chronicity.

How to design and deliver a successful paediatric placement for medical students

Paediatric placement is an invaluable opportunity for medical students to gain experience in the specialty. It is often their first tangible experience observing how children are looked after. An ideal placement would offer diverse and immersive clinical experiences while providing insight into a career in paediatrics. This article provides a template for a paediatric placement appealing to current medical students and future generations constructed on the strong foundations of evidence-based practices in medical education.

Teaching Medical Professionalism with a Scenario-based Approach Using Role-Playing and Reflection: A Step towards Promoting Integration of Theory and Practice

INTRODUCTION

Professionalism, as one of the core competencies of physicians, is essential for providing the patients with higher quality care. It is an abstract concept and its education and assessment need objective and operational methods. The present study aimed at teaching the concepts of professionalism based on a scenario-based approach using role-playing and reflection.

METHODS

This is a pre-experimental study (one-group pretest-posttest design) with a mixed method approach. The study was conducted on 18 medical students (by voluntary sampling method) who had enrolled in the Medical Ethics Course at Kashan University of Medical Sciences in 2020. Twelve scenarios were designed about the most prevalent issues of medical professionalism. In each session, one group of students played out their scenarios and then, the participants and instructors discussed their role-playing. Participants' knowledge about professionalism was assessed at the beginning and end of each session, and they completed a satisfaction questionnaire and a reflection form. T-tests (one-sample and paired T-test) were applied for statistical analysis. Quantitative and qualitative data were analyzed using SPSS software (version 26), and P<0.05 was considered statistically significant. Conventional content analysis was used to analyze the qualitative data.

RESULTS

The mean scores of the participants' knowledge in post-test were significantly higher than those in the pre-test (P=0.042, t=-2.074). The mean scores of the participants' role-playing quality (p<0.001) and satisfaction (p=0.001) were significantly higher than their corresponding test values. Qualitative analysis of the participants' reflections revealed their satisfaction with the study intervention.

CONCLUSION

The scenarios, role-playing, and reflection could provide an opportunity for operationalizing the concepts of professionalism and deep learning of students. Medical instructors need to improve their knowledge and skills of using active methods in teaching professionalism to medical students.

Learning innovation in community medicine teaching: A-Z of job responsibilities of anganwadi worker, accredited social health activist, and auxiliary nurse midwife

The interaction between medical students and frontline healthcare workers is one of the crucial components of community medicine. The interaction of medical students with frontline healthcare workers provides multiple opportunities. Medical students like to understand their job responsibilities and their involvement in implementing the various national health programs at the community level. Innovation is required to train our medical students better and enhance their learning. A learning and teaching innovation was developed by us to provide insight into the various roles and involvement of frontline healthcare workers in the community. One innovation is the A-Z activity calendar of frontline healthcare workers in teaching and learning in medical education.

Global perspectives on trends in health higher education

Today, changes in political and economic conditions, epidemiological and sociological developments, and the advancement of science and technology have necessitated the health and medical education systems to change. Therefore, we conducted a study entitled "Global perspectives on trends in higher education in healthcare," to improve the quality of healthcare so that it can be used as a model for predicting future events related to medical education. This futures study applied the social, technological, economical, ecological, political, values (STEEPV) model to identify and analyze the trends that affect medical education at different levels. To collect and analyze the data, a scoping review of the articles published from the year 2000 was conducted on the World Health Organization (WHO), Web of Science, Scopus, PubMed/MEDLINE, EMBASE, Science Direct, Google Scholar, EBSCO, and Cochrane databases. The review process was performed in five stages: 1- Determining the research question, 2- Identifying relevant studies, 3- Selecting the studies, 4- Charting the data, and 5- Analyzing data. The preferred reporting item for systematic review and meta-analysis (PRISMA) statement was used in the selection and screening of articles. A total of 213 articles were included in the study for qualitative synthesis. A total of 154 trends were identified using the STEEPV model at seven levels of health behaviors and patients, diseases and health problems, healthcare system, medical education system, medical education institutions, medical curricula, and teaching and learning. Considering the results of this study, it is possible to formulate proper and efficient future scenarios for the higher health education system. Also, it will be helpful for medical education policymaking.

Perception of undergraduate medical students toward stressors and de-stressors during COVID-19 pandemic: Online cross-sectional survey from a medical institute in Eastern India

INTRODUCTION

COVID-19 has affected the quality of life of all age groups. Medical education during the pandemic shifted to online mode due to lockdown restrictions. The stress felt by medical students during the pandemic has been studied less. The current study aimed to assessed the stressors and de-stressors for undergraduate medical students during the COVID-19 pandemic.

MATERIALS AND METHODS

A cross-sectional online survey was conducted for the undergraduate medical students of a tertiary care institute of eastern India. A total of 307 medical students were included in the study by convenient and snowball sampling. A self-designed semi-structural questionnaire was created as a Google form and circulated among the students between September and October 2020. A combination of purposive and snowball sampling was adopted. Responses regarding stressors and de-stressors were recorded on a Likert scale. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 22. Categorical variables were presented as percentages and descriptive statistics were performed.

RESULTS

A total of 307 students responded and 64.5% of them were men and 35.5% were women. 47.6% of the students experienced stress due to changes brought about by COVID-19. Risk of parents getting infection (63.2%), fear of not easily returning home (53.1%), lack of clinical exposure (52.7%), and financial impact (47.9%) were the major stressors perceived by the students. Connecting with family and friends through social media (47.5%), gaming (45.0%), online streaming platform (51.2%), spending time with family members (54.4%) were the coping strategies adopted by these students.

CONCLUSION

Higher level of psychological stress perceived by the undergraduate students needs psychological intervention. Academic revamp and adaptation of coping strategies are required for the medical under-graduates.

Burnout and dropout intention in medical students: the protective role of academic engagement

INTRODUCTION

The influence of burnout, academic engagement, and their interaction in dropout intention among medical students should be further studied. Current research shows its consequences are relevant, however, there is little understanding on burnout and academic engagement moderation in dropout intention. The current study tested a model that relates the effects of coping strategies, social support satisfaction, general distress on academic engagement, burnout, and dropout intention, on medical students.

METHODS

Through an online survey a non-probabilistic sample of one Medical Faculty's 1st- and 2nd-year students was recruited. Cross-sectional data were collected using psychometric instruments (Maslach Burnout Inventory - Student Survey, Social Support Satisfaction Scale for College Students, Brief COPE Scale for College Students, University Student Engagement Inventory, and Depression, Anxiety and Stress Scale), sociodemographic and academic variables, and analyzed using structural equation modeling.

RESULTS

532 students (76% response rate) enrolled in the study. Latent variables structural model presented a satisfactory fit to the data and confirmed the expected negative path between burnout and dropout intention (β_DI<-SB=0.430; p<.001) and the latent moderation burnout x engagement (β_DI<-SB*SE=-0.218; p<.001).

CONCLUSION

Academic engagement attenuates the impact of burnout on dropout intention, working as a protective factor. Social support satisfaction and adaptive coping are associated with increased levels of academic engagement, and general distress and maladaptive coping are associated with burnout. Medical Schools should develop interventions to prevent dropout intention, tackle students' stress and academic challenges, and develop their academic engagement levels.

Specialty preferences and factors affecting the choices of postgraduate specialty among undergraduate medical students

Objectives

To study specialties preference of the students at the College of Medicine, Majmaah University, Saudi Arabia; and to determine the factors that affect the choice of their postgraduate specialty.

Methods

A cross-sectional study was conducted among 138 undergraduate medical students at the College of Medicine, Majmaah University, Saudi Arabia for the current academic year 2021-2022. Data were collected using a questionnaire. Data were analyzed using SPSS version 24, and a Chi-square test was utilized to compare qualitative data.

Results

Internal medicine is the first choice for 16 (19.8%) students. General surgery and family medicine were selected by 15 (18.5%) and 12 (14.8%) students, respectively. Sixty-seven (82.7%) students relied on their selection of a good future guaranteed by specialty, and 48 (49.3%) selected challenging specialty; 64 (79.0%) were motivated by a practicing doctor for their future specialty selection and 54 (66.7%) by their families.

Conclusions

Most preferred specialty for medical students is internal medicine followed by general surgery. Both genders preferred internal medicine as their future specialty. Some important specialties such as public health and basic medical sciences were not selected as a future specialty by any student. The most stated reason behind specialty selection is the provision for a good future. Most students are motivated by a practicing doctor to select a postgraduate specialty.

Comparing the effect of traditional and role-play training methods on nursing students' performance and satisfaction in the principles of patient education course

BACKGROUND

Education is considered as one of the most important well-known roles of nurses, which is based on the patients' needs and awareness level. Thus, training the skill to nursing students is highly prioritized. The present study aimed to compare traditional and role-play training methods on nursing students' performance and satisfaction in the principles of patient education course.

MATERIALS AND METHODS

The present quasi-empirical study was conducted in 2019 among 36 fourth-semester nursing students at the School of Nursing in Borujen branch. In this regard, the students were randomly divided into experimental (n = 18) and control (n = 18) groups and trained through role-play and traditional methods, respectively. The data were collected using demographic questionnaire, training method satisfaction form, and student performance evaluation checklist (30 items), among which the two last ones were researcher made. Then, data were analyzed by SPSS software version 19 and using descriptive and analytical statistical tests such as Chi-square and Mann-Whitney.

RESULTS

The results demonstrated a statistically significant difference (P < 0.05) between the mean score of students' satisfaction with teaching method in the control (17.15 ± 0.89) and experimental groups (19.03 ± 1.49), as well as between that of their performance in the control and experimental groups (115.31 ± 2.07 and 118.28 ± 3.59, respectively).

CONCLUSION

Based on the results, role-play training method affected nursing students' performance in the principles of patient education course higher. Thus, using the method in training students and in-service training for nursing personnel is recommended to education planners and nursing education authorities for improving the skill.

Improving the communicational skills in medicine using role play: a study about 28 students in the second cycle of medical studies

BACKGROUND

Medical teaching is usually centred on an objective-based approach and influenced by a flexnerian approach inducing an emphasis on abilities and skills more than the know-how. The know-how is usually under taught and assessed.

AIM

To assess the competencies in announcing bad news of students in medicine in addition to their satisfaction about the methods used which were serious games.

METHODS

Students in the third-pregraduate year of medicine who performed their externship in a Department of Pathology of a university Hopsital were included during the year 2018-2019. Seven groups including 4 externs performing a 3-week-period were included. The training started with a pre-test, which consisted in an Objective-Structured-Clinical situation with a simulated patient and a evaluator with a checklist. The students were asked to perform a serious game, then they assisted to a lecture-based learning about the rules of announce of bad news. The serious game was screened then watched by all the students. After a debriefing session, the students were asked to fulfill a post test and a questionnaire-test.

RESULTS

Twenty-eight students were included. The mean score accounted for 6,76 +/- 2,78 over 20 for the pre-test and 13,17 +/- 1,99 over 20 for the post-test. A significant difference was observed between the pre and post test (p<0.0001). All the students expressed their satisfaction. 27 students wished to repeat the experience. All the students put emphasis on the importance of the peer and auto-evaluation phase using videos. 14 students suggested to integrate this teaching method to the curriculum of the Faculty before their internship.

CONCLUSION

Inspite of some limits, this study highlighted the improvement of the students' relational competences in addition to their satisfaction related to the use of role play in the acquisition of relational competences related to particular situation such as the announce of bad news.

Visual arts in the clinical clerkship: a pilot cluster-randomized, controlled trial

BACKGROUND

Arts exposure is associated with positive psychological constructs. To date, no randomized, controlled studies have integrated art into clinical medical education or measured its effects on positive psychological constructs or educational outcomes. In this study, we assessed the possibility and potential benefits of integrating visual arts education into a required internal medicine (IM) clinical clerkship.

METHODS

We conducted a controlled trial in an academic healthcare system with an affiliated art museum. IM students were assigned to one of three interventions: museum-based arts (n = 11), hospital-based arts (n = 10), or hospital-based conventional education (n = 13). Arts groups explored empathy, resilience, and compassion in works of art during facilitator-guided discussions. We assessed pre- and post-intervention measures of empathy, mindfulness, tolerance of ambiguity, and grit and tracked National Board of Medical Examiners IM shelf exam performance to capture changes in educational outcomes. Focus group discussions with participants in the arts-based interventions were performed at the study's conclusion.

RESULTS

Arts education was successfully integrated into a busy clinical clerkship in both hospital and art museum settings. Focus group participants reported increased implicit bias cognizance and time for reflection, but no significant differences in psychometric or educational outcomes were identified. While most students felt positively toward the experience; some experienced distress from missed clinical time.

CONCLUSIONS

This pilot study demonstrates the feasibility of integrating visual arts education into the clerkship. Although observable quantitative differences in measures of positive psychological constructs and educational outcomes were not found, qualitative assessment suggested benefits as well as the feasibility of bringing fine arts instruction into the clinical space. A larger, multi-center study is warranted.

Evaluation of the effect of items' format and type on psychometric properties of sixth year pharmacy students clinical clerkship assessment items

BACKGROUND

Examinations are the traditional assessment tools. In addition to measurement of learning, exams are used to guide the improvement of academic programs. The current study attempted to evaluate the quality of assessment items of sixth year clinical clerkships examinations as a function of assessment items format and type/structure and to assess the effect of the number of response choices on the characteristics of MCQs as assessment items.

METHODS

A total of 173 assessment items used in the examinations of sixth year clinical clerkships of a PharmD program were included. Items were classified as case based or noncase based and as MCQs or open-ended. The psychometric characteristics of the items were studied as a function of the Bloom's levels addressed, item format, and number of choices in MCQs.

RESULTS

Items addressing analysis skills were more difficult. No differences were found between case based and noncase based items in terms of their difficulty, with a slightly better discrimination in the latter. Open-ended items were easier, yet more discriminative. MCQs with higher number of options were easier. Open-ended questions were significantly more discriminative in comparison to MCQs as case based items while they were more discriminative as noncase based items.

CONCLUSION

Item formats, structure, and number of options in MCQs significantly affected the psychometric properties of the studied items. Noncase based items and open-ended items were easier and more discriminative than case based items and MCQs, respectively. Examination items should be prepared considering the above characteristics to improve their psychometric properties and maximize their usefulness.

DOES EXPERIENCE MATTER? A mixed methods study of medical student experiences of near-peer and senior clinician-led tutorials

This article was migrated. The article was marked as recommended. Objectives:The primary aim of the study was to determine whether classroom-based acute care teaching delivered by junior doctors is comparable to that by senior doctors or faculty. This study reviews student opinions of near-peer and faculty led teaching on acute medicine to explore the differences and student preferences. Methods:This study aimed to evaluate the role of trainees as near-peer tutors in the acute medicine tutorial based setting by randomly allocating the sessions to a junior or senior doctor. Student opinions were then invited through questionnaires and focus groups. Results:There was no statistical difference in students' perception of the level, pace and usefulness of the sessions. All teachers were approachable and enthusiastic. Students felt that senior doctors were more knowledgeable and better able to explain concepts. Students felt that all sessions were useful to their learning. Conclusion:Students enjoyed and derived educational benefit from both types of teaching session. Students found that senior doctor-led tutorials were more beneficial to their technical medical knowledge but felt that they gained more practical advice from junior doctor-led teaching. Trainees could provide reassurance, advice and mentorship regarding their careers and role of a doctor. Students recognised the value of tutorials by junior and senior doctors and requested the inclusion of both in their undergraduate curriculum.

Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals: identifying avenues for further development through a scoping review

BACKGROUND

This paper responds to previously published debate in this journal around the use of sociolinguistic methods in communication skills training (CST), which has raised the significant question of how far consultations with simulated patients reflect real clinical encounters. This debate concluded with a suggestion that sociolinguistic methods offer an alternative analytic lens for evaluating CST. We demonstrate here that the utility of sociolinguistic methods in CST is not limited to critique, but also presents an important tool for development and delivery.

METHODS

Following a scoping review of the use of role play and simulated interaction in CST for healthcare professionals, we consider the use of the specific sociolinguistic approach of conversation analysis (CA), which has been applied to the study of health communication in a wide range of settings, as well as to the development of training.

DISCUSSION

Role play and simulated interaction have been criticised by both clinicians and sociolinguists for a lack of authenticity as compared to real life interactions. However they contain a number of aspects which healthcare professionals report finding particularly useful: the need to think on one's feet in real time, as in actual interaction with patients; the ability to receive feedback on the simulation; and the ability to watch and reflect on how others approach the same simulation task in real time. Since sociolinguistic approaches can help to identify inauthenticity in role play and simulation, they can also be used to improve authenticity. Analysis of real-life interactions using sociolinguistic methods, and CA in particular, can identify actual interactional practices that are used by particular patient groups. These practices can then be used to inform the training of actors simulating patients. In addition, the emphasis of CA on talk as joint activity means that proper account can be taken of the way in which simulated interaction is co-constructed between simulator and trainee. We suggest that as well as identifying potential weaknesses in current role play and simulation practice, conversation analysis offers the potential to enhance and develop the authenticity of these training methods.

The use of quality assurance instruments and methods to integrate diversity aspects into health professions study programmes

This article was migrated. The article was marked as recommended. Background With the increasing diversity in our population, future medical doctors need to have adequate diversity and gender competencies in order to provide adequate and good quality of medical care. Diversity, especially sex and gender aspects, were therefore systematically integrated into the new modular medical curriculum at Charité - Universitätsmedizin Berlin. The aim was to integrate diversity aspects into further study programmes of the Charité Berlin by assessing the current degree of integration and the relevance for the professional work of students and graduates and identifying suitable and effective quality assurance instruments. Methods After the curriculum development of the new modular medical curriculum was completed, the gender and diversity change agent was transferred from the curriculum development team to the quality assurance section of the Office of the Dean of Student Affairs. The change agent identified in cooperation with the quality assurance team the accreditation process, student evaluations and graduate surveys as suitable methods for the integration. Furthermore, the change agent provided support to the programme directors and coordinators with the integration. The impact of the measures and instruments used for the integration are measured within the reaccredition process of the programmes. Results Diversity aspects could be integrated into the accreditation standards admission, curricular structure, didactics, assessment and student counselling. In the student evaluations and graduate surveys gender and diversity items like migration background, number of children, caring responsibilities, disabilities and economic status could be integrated. Furthermore, students and graduates were asked to evaluate the relevance of gender and diversity competencies for their professional work and the degree of the curricular integration. Discussion and Conclusion The impact of the integrated diversity aspects can only be evaluated within the accreditation process. In order to increase and improve the awareness of students and faculty members of diversity aspects and issues the support by a gender and diversity change agent with the integration and by lecturing on this subject is important. A gender and diversity sensitive accreditation process contributes to the reflexivity and awareness of the faculty members involved.

Editorial: Diversity in Medical Education

This article was migrated. The article was marked as recommended. While medical schools need to address the health care needs of diverse populations and to accommodate to the diverse needs of their students and staff, addressing and studying diversity in medical education remains challenging. In teaching cultural competence, several approaches are identified, including a cultural expertise approach, a cultural sensibility approach and a cross-cultural approach with the more recently emerging call for reflexivity. We propose the analysis of diversity related issues at three distinct levels: fixing the numbers, fixing the institutions and fixing the knowledge.

Psychometric properties of the communication skills attitude scale (CSAS) measure in a sample of Iranian medical students

INTRODUCTION

Communication skill (CS) has been regarded as one of the fundamental competencies for medical and other health care professionals. Student's attitude toward learning CS is a key factor in designing educational interventions. The original CSAS, as positive and negative subscales, was developed in the UK; however, there is no scale to measure these attitudes in Iran. The aim of this study was to assess the psychometric characteristic of the Communication Skills Attitude Scale (CSAS), in an Iranian context and to understand if it is a valid tool to assess attitude toward learning communication skills among health care professionals.

METHODS

Psychometric characteristics of the CSAS were assessed by using a cross-sectional design. In the current study, 410 medical students were selected using stratified sampling framework. The face validity of the scale was estimated through students and experts' opinion. Content validity of CSAS was assessed qualitatively and quantitatively. Reliability was examined through two methods including Chronbach's alpha coefficient and Intraclass Correlation of Coefficient (ICC). Construct validity of CSAS was assessed using confirmatory factor analysis (CFA) and explanatory factor analysis (PCA) followed by varimax rotation. Convergent and discriminant validity of the scale was measured through Spearman correlation. Statistical analysis was performed using SPSS 19 and EQS, 6.1.

RESULTS

The internal consistency and reproducibility of the total CSAS score were 0.84 (Cronbach's alpha) and 0.81, which demonstrates an acceptable reliability of the questionnaire. The item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI/Ave) demonstrated appropriate results: 0.97 and 0.94, respectively. An exploratory factor analysis (EFA) on the 25 items of the CSAS revealed 4-factor structure that all together explained %55 of the variance. Results of the confirmatory factor analysis indicated an acceptable goodness-of-fit between the model and the observed data. [χ2/df = 2.36, Comparative Fit Index (CFI) = 0.95, the GFI=0.96, Root Mean Square Error of Approximation (RMSEA) = 0.05].

CONCLUSION

The Persian version of CSAS is a multidimensional, valid and reliable tool for assessing attitudes towards communication skill among medical students.

The impact of item-writing flaws and item complexity on examination item difficulty and discrimination value

BACKGROUND

Failure to adhere to standard item-writing guidelines may render examination questions easier or more difficult than intended. Item complexity describes the cognitive skill level required to obtain a correct answer. Higher cognitive examination items promote critical thinking and are recommended to prepare students for clinical training. This study evaluated faculty-authored examinations to determine the impact of item-writing flaws and item complexity on the difficulty and discrimination value of examination items used to assess third year veterinary students.

METHODS

The impact of item-writing flaws and item complexity (cognitive level I-V) on examination item difficulty and discrimination value was evaluated on 1925 examination items prepared by clinical faculty for third year veterinary students.

RESULTS

The mean (± SE) percent correct (83.3 % ± 17.5) was consistent with target values in professional education, and the mean discrimination index (0.18 ± 0.17) was slightly lower than recommended (0.20). More than one item-writing flaw was identified in 37.3 % of questions. The most common item-writing flaws were awkward stem structure, implausible distractors, longest response is correct, and responses are series of true-false statements. Higher cognitive skills (complexity level III-IV) were required to correctly answer 38.4 % of examination items. As item complexity increased, item difficulty and discrimination values increased. The probability of writing discriminating, difficult examination items decreased when implausible distractors and all of the above were used, and increased if the distractors were comprised of a series of true/false statements. Items with four distractors were not more difficult or discriminating than items with three distractors.

CONCLUSION

Preparation of examination questions targeting higher cognitive levels will increase the likelihood of constructing discriminating items. Use of implausible distractors to complete a five-option multiple choice question does not strengthen the discrimination value.

Design of formative assessment model for professional behavior using stages of change theory

Background: Professionalism is a core competency of physicians. This study was conducted to design a model for formative assessment of professional commitment in medical students according to stages of change theory. Methods: In this qualitative study, data were collected through literature review & focus group interviews in the Tehran University of Medical Sciences in 2013 and analyzed using content analysis approach. Results: Review of the literature and results of focus group interviews led to design a formative assessment model of professional commitment in three phases, including pre-contemplation, contemplation, and readiness for behavior change that each one has interventional and assessment components. In the second phase of the study, experts' opinion collected in two main categories: the educational environment (factors related to students, students' assessment and educational program); and administrative problems (factors related to subcultures, policymakers or managers and budget). Moreover, there was a section of recommendations for each category related to curriculum, professors, students, assessments, making culture, the staff and reinforcing administrative factors. Conclusion: This type of framework analysis made it possible to develop a conceptual model that could be effective on forming the professional commitment and behavioral change in medical students.

Use of PowerPoint presentation as a teaching tool for undergraduate students in the subject of gerodontology

AIM

Though different teaching learning media have been employed in the instruction of geriatric dentistry, their efficacy has not been adequately evaluated. This study was conducted with the aim to determine the efficacy of a PowerPoint presentation in teaching gerodontology.

MATERIALS AND METHODS

This is a prospective follow-up study using a pre- and post-intervention assessment. A pilot study was conducted on the final year students to check the feasibility of the study. A convenience sampling procedure was used. All interns (n = 80) of the Modern Dental College and Research Centre, Indore, India were invited to participate. Interns completed a 24-item questionnaire documenting their current knowledge on gerodontology. One week after a 30 min PowerPoint presentation on gerodontology, the same interns completed the same questionnaire again, providing an indication of the efficacy of the learning tool. Paired t-test and McNemar test were employed for statistical analysis.

RESULTS

A statistically significant difference was observed in pre- and post-intervention scores (P < 0.05).

CONCLUSION

The results of this study indicated that PowerPoint presentation can be used as an effective tool for improving the knowledge regarding gerodontology.

A trial model for medical subspecialty training in South Africa

This article outlines the trial model in reproductive medicine that was created as a first step in the development of a business model for medical subspecialty training to complement the current academic subspecialty training in South Africa. A two-tiered training model was developed over time. The hurdles that had to be overcome were the development of a curriculum and academic capacity, acquisition of appropriate funding, acceptance and accreditation of the decentralised training facility, and lastly, registration of the fellowship with the Health Professions Council of South Africa. The end result of the trial programme was a two-year full-time training with supportive funding, or a four-year programme, where the subspecialists would spend three weeks of the month in their home practice environment, attached to an accredited unit, and the last week in an academic institution. Due to the trial program's success for the South African context and the potential of such model for the developing world, it was evident that the trial programme had to be tested to determine whether and how it can be implemented on a wider basis.

Assessment of educational criteria in academic promotion: Perspectives of faculty members of medical sciences universities in Iran

INTRODUCTION

One of the important criteria in the promotion of faculty members is in the scope of their educational roles and duties. The purpose of this study was the assessment of reasonability and attainability of educational criteria for scientific rank promotion from the perspective of the faculty members of Medical Sciences Universities in Iran.

MATERIALS AND METHODS

This descriptive study was conducted in 2011 in 13 Universities of Medical Sciences in Iran. Through stratified sampling method, 350 faculty members were recruited. A questionnaire developed by the researchers was used to investigate the reasonability and attainability of educational criteria with scores from 1 to 5. The self-administered questionnaire was distributed and collected at each university. The mean and standard deviation of reasonability and attainability scores were calculated and reported by using the SPSS software version 16.

RESULTS

Faculty members considered many criteria of educational activities reasonable and available (with a mean score of more than 3). The highest reasonability and attainability have been obtained by the quantity and quality of teaching with the mean scores (3.93 ± 1.15 and 3.82 ± 1.17) and (3.9 ± 1.22 and 4.13 ± 1.06) out of five, respectively. The mean and standard deviation of total scores of reasonability of educational activities were 50.91 ± 14.22 and its attainability was 60.3 ± 13.72 from the total score of 90.

DISCUSSION AND CONCLUSION

The faculty members of the Universities of Medical Sciences in Iran considered the educational criteria of promotion moderately reasonable and achievable. It is recommended to revise these criteria and adapt them according to the mission and special conditions of medical universities. Furthermore, providing feedback of evaluations, running educational researches, and implementing faculty development programs are suggested.

Preferred question types for computer-based assessment of clinical reasoning: a literature study

Clinical reasoning is a core competence of doctors. Therefore, the assessment of clinical reasoning of undergraduate students is an important part of medical education. Three medical universities in the Netherlands wish to develop a shared question database in order to assess clinical reasoning of undergraduate students in Computer-Based Assessments (CBA). To determine suitable question types for this purpose a literature study was carried out. Search of ERIC and PubMed and subsequent cross referencing yielded 30 articles which met the inclusion criteria of a focus on question types suitable to assess clinical reasoning of medical students and providing recommendations for their use. Script Concordance Tests, Extended Matching Questions, Comprehensive Integrative Puzzles, Modified Essay Questions/Short Answer Questions, Long Menu Questions, Multiple Choice Questions, Multiple True/False Questions and Virtual Patients meet the above-mentioned criteria, but for different reasons not all types can be used easily in CBA. A combination of Comprehensive Integrative Puzzles and Extended Matching Questions seems to assess most aspects of clinical reasoning and these question types can be adapted for use in CBA. Regardless of the question type chosen, patient vignettes should be used as a standard stimulus format to assess clinical reasoning. Further research is necessary to ensure that the combination of these question types produces valid assessments and reliable test results.

Evaluation of medical consultation letters at King Fahd Hospital, Al Hufuf, Saudi Arabia

BACKGROUND

In surgical wards, it is of paramount importance to communicate with other health care providers, mostly physicians, referring patients to them for their consultation on any health conditions that affect pre-operative, operative and post-operative patient care. The purposes of this investigation were to assess the appropriateness of physician responses in medical consultation reports and compare physician responses when using these reports from different levels of health care providers.

METHODS

This study was conducted in Al-Hufuf, Saudi Arabia. The researchers evaluated all the surgical consultation letters in the files during the period between March 2010 and March 2011. From the explored 234 files, only 200 consultation letters were chosen as there was a referral data plus consultation data in the same file. We evaluated the quality of consultation report included the ethical concerns towards colleagues and patient, consideration of patient safety in all opinions, comprehensive pertinent scientific information, addressing the patient's medical condition with putting possible differential diagnosis, conclusion and precise management plans suggested.

RESULTS

The results showed that the specialists' consultation letters had the highest percentage of fulfillment of all the six items in the consultation report. There is no uniform existing consultation report form.

CONCLUSION

Specialist form showed the highest number of mentioning the diagnosis. Consultant form showed the highest number of mentioning the concise aim of referral. The highest percentage of all categories mentioned all items in consultation report with a good level were the specialists.

Assessing the perceptions of a biostatistics and epidemiology module: views of Year 2 medical students from a Malaysian university. A cross-sectional survey

BACKGROUND

In the era of evidence based medicine, biostatistics and epidemiology are considered as the main elements aiding the health professional to design a research study, understand the literature, and make decisions about patient care. The aim of the study is to explore students' perception about this subject because it plays an important role in determining educational outcome.

METHODS

Data were collected from a self-administered questionnaire distributed among 164 Year 2 medical students. The 5-point Likert scale anchored by Strongly disagree = 1 and Strongly agree = 5 included 36 questions in four domains designed to assess the perception of a biostatistics and epidemiology module amongst students.

RESULTS

138 students with ages ranging from 20 to 24 years (Mean = 20.7; SD = 0.62) returned their responses to the questionnaire. This was a response rate of 84.14%. Of the 138 students, 80.7% realized the relevance of the subject to real health issues at the end of the module, while 89.8% believed the module focused on interpretation more than calculation.More than three quarters (78.1%) agreed that lack of practicing exercises was the cause for declining interest in the subject, while only 26.1% believed that lectures were not interesting. Another three quarters (75.4%) believed that there were too many lectures for one day of teaching activities, while 84.6% recommended practical sessions for designing research and data collection.

CONCLUSIONS

This study found that students perceived the relevance of biostatistics and epidemiology to real health issues. The major cause of poor interest in the subject was attributed to the short duration of the course, lack of practicing exercises, and the need for practical data collection sessions. Emphasis should be given to early introduction of projects for data collection and analysis.