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Comrie CE, Coe TM, Moses J, Dageforde LA. Evaluating Medical Students' Perceptions of Patient-Led Transplant Surgery Education 1-2 Years Later. J Surg Res 2024; 296:149-154. [PMID: 38277951 PMCID: PMC11401503 DOI: 10.1016/j.jss.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/16/2023] [Accepted: 12/28/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Medical students value the opportunity to learn from patients as a supplement to traditional faculty-led education; however, long-term follow-up to understand the educational impact of these experiences is lacking. We surveyed medical students who conducted non-medical virtual encounters with transplant recipients or living donors to understand the impact on students' patient care approach after 1-2 y. METHODS Students who completed their surgery clerkship from July 2020 to September 2021 were surveyed about this nonmedical patient encounter in January 2023. Quantitative and qualitative survey data were analyzed using descriptive statistics and inductive thematic analysis, respectively. RESULTS Of the 27 respondents (46% response rate), 44.4% completed the experience 1 y ago and 55.6% completed the experience 2 y ago. Nearly all respondents (96.3%) agreed that this experience was an effective way to learn about organ donation and transplantation and that learning from patients was beneficial to their development as a doctor. Over 50% felt this experience changed how they provide care to patients. Qualitatively, students reported that this activity cultivated their empathy for patients, provided unique insight into patients' illness experiences, and enhanced their understanding of the longitudinal patient-surgeon relationship. CONCLUSIONS Utilizing patients as teachers in transplant surgery not only taught medical students more about organ donation and transplantation but also built empathy and highlighted unique, non-clinical aspects of the patient experience that persisted over time. This is one of the first studies to evaluate patient-led teaching of this type over a year later and assess its unique influence on medical student development.
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Affiliation(s)
| | - Taylor M Coe
- Harvard Medical School, Boston, Massachusetts; Surgery Department, Massachusetts General Hospital, Boston, Massachusetts
| | - Joy Moses
- Surgery Department, Massachusetts General Hospital, Boston, Massachusetts
| | - Leigh Anne Dageforde
- Harvard Medical School, Boston, Massachusetts; Surgery Department, Massachusetts General Hospital, Boston, Massachusetts.
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Harkins P, Burke E, Conway R. Musculoskeletal education in undergraduate medical curricula-A systematic review. Int J Rheum Dis 2023; 26:210-224. [PMID: 36502533 PMCID: PMC10107471 DOI: 10.1111/1756-185x.14508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/04/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
Rheumatic and musculoskeletal diseases encompass a vast spectrum of up to 200 conditions that are increasingly prevalent, with significant associated disability and socioeconomic burden. Their impact is pervasive, with musculoskeletal conditions being the second leading cause of years lived with disability worldwide, in addition to the 9th most common cause of disability-adjusted life years. It is therefore imperative that all graduating medical physicians are competent in their management, and that the quality of undergraduate musculoskeletal education is commensurate with patient and societal needs. A systematic literature review was conducted between April 1, 2021 and June 1, 2021 assessing the quality of undergraduate musculoskeletal education in medical schools. Educational interventions in musculoskeletal medicine were also included. Quality assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. One thousand and thirty-three titles were screened, and 44 studies were included in the final analysis. Our analysis of these studies showed that the quality of undergraduate musculoskeletal education, as determined by the cognitive mastery and clinical confidence of undergraduate medical students remains inadequate. Multiple educational interventions were assessed with mixed results. Despite the prevalence, and burden associated with rheumatic and musculoskeletal diseases, the musculoskeletal education of undergraduate medical students remains inadequate. Urgent international collaboration is required to devise teaching strategies and curriculum initiatives that are globally and reproducibly applicable and effective. Further research into educational interventions and teaching strategies is also required.
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Affiliation(s)
- Patricia Harkins
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Eoghan Burke
- Royal College of Surgeons, Dublin, Ireland, Dublin, Ireland
| | - Richard Conway
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Alomar AZ. A structured multimodal teaching approach enhancing musculoskeletal physical examination skills among undergraduate medical students. MEDICAL EDUCATION ONLINE 2022; 27:2114134. [PMID: 35993497 PMCID: PMC9466621 DOI: 10.1080/10872981.2022.2114134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Current evidence indicates that undergraduate medical students display deficits in musculoskeletal physical examination skills (MPES). While various instructional methods are recommended for teaching clinical skills, effective methods for teaching MPES have not been established. This study compared the effectiveness of a multimodal teaching approach incorporating video-based learning, interactive small-group teaching, hands-on practicing, peer-assisted learning, formative assessment, and constructive feedback with traditional bedside teaching in developing undergraduate orthopedic MPES. Participants were 151 fifth-year medical students divided into two groups. One group received multimodal teaching, and the other received traditional bedside teaching. In both groups, the participants learned how to physically examine the knee and shoulder. The primary outcome was objective structured clinical examination (OSCE) scores, while the secondary outcomes included teaching sessions' total durations, facilitator's demonstration time, participants' practice time, and proportion of students with passing checklist scores and global ratings-based assessments for the two teaching approaches. The multimodal teaching group had significantly higher OSCE scores (checklist scores, global ratings, and passing rates; p = 0.02, 0.02, 0.01, respectively) than the comparison group. Individual OSCE component assessments showed significant improvements in the special musculoskeletal physical examination test. The overall duration and amount of participants' hands-on time were significantly longer for the multimodal than for the traditional bedside teaching group (p = 0.01 and 0.01, respectively), and the facilitator's demonstration time was significantly shorter (p = 0.01). The multimodal learner-centered teaching approach evaluated in this study was effective for teaching MPES. It appeared to maximize learner engagement through enhancing interactions and providing increased time to engage in hands-on practice. This teaching approach improved MPES levels, maximized teaching efficiency for scenarios with limited instruction time and resources, and enhanced competency of undergraduate medical students in performing special musculoskeletal physical examinations compared to traditional bedside teaching.
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Affiliation(s)
- Abdulaziz Z. Alomar
- Division of Arthroscopy & Sports Medicine, Department of Orthopaedic Surgery, King Saud University, Riyadh, Saudi Arabia
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Yamauchi K, Hagiwara Y, Iwakura N, Kubo S, Sato A, Ohtsuru T, Okazaki K, Okubo Y. Using peer role-playing to improve students' clinical skills for musculoskeletal physical examinations. BMC MEDICAL EDUCATION 2021; 21:322. [PMID: 34090441 PMCID: PMC8179699 DOI: 10.1186/s12909-021-02742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 05/18/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX). METHODS Participants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants' performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis. RESULTS The mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p < .05, physical examination: p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters. CONCLUSIONS Through a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.
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Affiliation(s)
- Kazuyo Yamauchi
- Department of Medical Education, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoko Hagiwara
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Nahoko Iwakura
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Saori Kubo
- Department of Medical Education, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Azusa Sato
- Department of Chemistry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tadahiko Ohtsuru
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yumiko Okubo
- Department of Medical Education, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
- Centre for Medical Education, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
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Dean R, Morrow D, Connelly S. A Multifaceted Resident-Led Physical Exam Course. MEDEDPUBLISH 2021; 10:109. [PMID: 38486536 PMCID: PMC10939526 DOI: 10.15694/mep.2021.000109.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. BACKGROUND Physicians frequently report poor confidence applying the physical exam for medical decision making. We developed a novel, multifaceted, resident-led curriculum to teach medical students the physical exam for clinical practice. METHODS We created a two-week elective comprised of didactics, journal discussions, bedside ultrasound, and physical exam rounds for fourth year medical students at the University of South Carolina School of Medicine - Greenville. JAMA: The Rational Clinical Exam and Evidence-Based Physical Diagnoses, by Steven McGee, MD, were used to develop content. The curriculum focused on cardiac, pulmonary, abdominal, endocrine, and neurologic exams. Faculty and residents facilitated all portions of the course. Chi-squared testing was used to calculate confidence intervals on pre- and post-course assessments. RESULTS Twenty-two fourth year medical students enrolled in the elective over the course of three years. Seventeen faculty, three chief residents, and 13 residents provided instruction. Residents provided roughly half of the total instruction hours. Students demonstrated statistically significant improvement on multiple choice pre-course and post-course assessments (56.8% vs 77.1%, p < 0.001). 95.5% of students reported feeling "confident" in their physical exam skills after the course. CONCLUSION After participating in the course, students demonstrated improved skill and comfort using the physical exam for clinical decision making.
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Miniato M, Schaefer P, Weldy D. Impact of a Hands-on Knee Exam Workshop on Medical Student Clinical Examination Scores. PRIMER (LEAWOOD, KAN.) 2019; 3:24. [PMID: 32537595 PMCID: PMC7205136 DOI: 10.22454/primer.2019.185529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The goal of this research project was to retrospectively evaluate the effect of a voluntary hands-on musculoskeletal knee exam workshop, presented to medical students in the family medicine rotation at the University of Toledo, on the outcomes of a required objective structured clinical examination (OSCE). METHODS We analyzed student OSCE scores for both knee and back exams before (July 2011 to June 2012) and after (August 2013 to June 2015) the workshop was offered. The analysis was based on those who attended the voluntary knee exam workshop and those who did not. We compared scores between the two groups of students using two-tailed t testing and χ 2 testing, and assessed the correlation of attending the workshop to passing the knee OSCE. RESULTS One hundred eighty-seven students attended the workshop and 279 did not. During the period when the workshop was offered, the overall mean score on the knee OSCE was 59.5% for the 187 who attended the workshop and 35.9% for the 116 who did not, which was significantly different (P<.001). A χ2 test with α=0.05 showed that attending the workshop correlated with completing at least 70% of maneuvers acceptably during the knee OSCE (P<.001). CONCLUSIONS Our study yielded positive outcomes on OSCE scores, comparable to other studies that investigated the effect of similar teaching techniques. Comparison of the scores of those who attended the knee workshop on the simpler back exam OSCE, in which no workshop was offered, demonstrated the efficacy of the workshop.
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Affiliation(s)
- Mohammed Miniato
- The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Paul Schaefer
- College of Medicine and Life Sciences, and Department of Family Medicine, University of Toledo Toledo, OH
| | - David Weldy
- College of Medicine and Life Sciences, and Department of Family Medicine, University of Toledo, Toledo, OH
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Zabel J, Sterz J, Hoefer SH, Stefanescu MC, Lehmann M, Sakmen DK, Marzi I, Ruesseler M. The Use of Teaching Associates for Knee and Shoulder Examination: A Comparative Effectiveness Analysis. JOURNAL OF SURGICAL EDUCATION 2019; 76:1440-1449. [PMID: 30956084 DOI: 10.1016/j.jsurg.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 11/08/2018] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Musculoskeletal diseases and injuries are the most common cause of long-term pain and physical disability. Thus, every medical graduate should be able to perform a structured examination of the musculoskeletal system. Besides the see-one-do-one principle, other teaching methods have been proposed to be effective. The use of teaching associates offers an established, proven pathway for teaching examination skills in urology and gynecology. During the patient experience method, students are examined first, thus giving them an opportunity to feel the examination before performing it themselves. The objective of this study was to compare the efficiency of 3 distinct teaching methods for both knee and shoulder examination. DESIGN The study took place during obligatory knee and shoulder examination training. Participants received basic training, including a demonstration of the structured examination by a specialist in trauma surgery. Afterward, group 1 examined each other under professional supervision; group 2 students examined the teaching associates, followed by mutual examinations; and group 3 students were each examined by the instructor, followed by mutual examinations. The acquired competence was assessed in 5-minute practical assessments directly after training and again 5 weeks later. SETTING The study was conducted at the medical faculty of Goethe University, Frankfurt, Germany. PARTICIPANTS Study participants were third-year undergraduate medical students completing their obligatory 3-week surgical training. RESULTS One hundred and forty-four students [group 1 (N = 53), group 2 (N = 46), and group 3 (N = 45)] participated in the first measurement, 92 students in the second measurement of the study. Directly after the training, group 2 and group 3 performed significantly better than group 1 regarding overall score (p < 0.001) and all 4 checklist parts (p < 0.001). At the second measurement, group 2 performed significantly better than group 1 regarding shoulder examination (p = 0.003) and significantly better than group 3 (p = 0.025) regarding knee examination. CONCLUSIONS The use of a teaching associate and the patient perspective can increase students' performance in knee and shoulder examinations.
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Affiliation(s)
- Julian Zabel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Jasmina Sterz
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Sebastian H Hoefer
- Centre of Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | | | - Marieke Lehmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Dennis K Sakmen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Miriam Ruesseler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
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A global perspective on the challenges and opportunities in learning about rheumatic and musculoskeletal diseases in undergraduate medical education. Clin Rheumatol 2019; 39:627-642. [DOI: 10.1007/s10067-019-04544-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
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Fong S, Tan A, Czupryn J, Oswald A. Patient-centred education: How do learners' perceptions change as they experience clinical training? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:15-32. [PMID: 30051154 DOI: 10.1007/s10459-018-9845-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
The use of patient educators is one of many teaching strategies meant to foster principles of patient-centred care. We previously found that early patient educator exposure helped to shape the understanding of patient-centredness in pre-clerkship learners. We now expand on this work to evaluate whether there is persistence of initial perceptions and to explore general reflections on longer-term impacts of early patient educator exposures once learners are immersed in the clinical phase of their training. In this follow-up study, we conducted group interviews with a sample of learners who wrote reflections as part of their pre-clerkship patient educator experience. We explored how perspectives on patient educators changed over time, and determined which themes identified during pre-clerkship remained relevant to clinical trainees. Audio recordings were transcribed and analyzed thematically using a hybrid inductive and deductive analysis to construct a thematic framework derived through a method of constant comparison. We identified three new themes: "value of early clinical experience", "change in learners' perspectives", and "valuing and applying CanMEDS roles other than Medical Expert". Themes from pre-clerkship that remained relevant included: "patients' perspective humanizes disease", "patients' experiences with navigating the healthcare system", "learners' perceptions of the learning strategy", and "inaccuracies and inconsistencies in the learning experience." Many themes identified in pre-clerkship learners remain relevant in early clinical trainees. Further, insights from pre-clerkship experiences with patient educators evolve as learners experience clerkship with definite shifts in emphasis and new perspectives. This work illuminates the utility of patient educators for those considering this strategy for supporting the development of patient-centredness in undergraduate medical education.
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Affiliation(s)
| | - Amy Tan
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | - Joanna Czupryn
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Anna Oswald
- Department of Medicine, University of Alberta, Edmonton, Canada
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Menon A, Menon R, Mourougavelou V. Clinical examinations: a medical student's perspective. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 9:1-4. [PMID: 29319056 PMCID: PMC5743193 DOI: 10.2147/amep.s157205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Arjun Menon
- Faculty of Medicine, Imperial College London, London, UK
| | - Rahul Menon
- Faculty of Medicine, Imperial College London, London, UK
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