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Abbasi M, Shirazi M, Torkmandi H, Homayoon S, Abdi M. Impact of teaching, learning, and assessment of medical law on cognitive, affective and psychomotor skills of medical students: a systematic review. BMC MEDICAL EDUCATION 2023; 23:703. [PMID: 37752500 PMCID: PMC10523676 DOI: 10.1186/s12909-023-04695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND It is necessary to improve medical students' legal cognitive, affective, and psychomotor skills to prevent further legal issues in the medical profession. Choosing the proper teaching and assessment methods is crucial in this matter. This study aimed to investigate the impact of teaching, learning, and assessment of medical law on the cognitive, affective, and psychomotor skills of medical students. METHODS A systematic review was conducted in PubMed, Embass, and Web of Science databases, and Google Scholar search engine using MECIR and PRISMA, AMEE Guide 94 for 1980 to 2022.12.30. Nineteen articles met the inclusion criteria. MERSQI checklist was used to assess the quality of the articles, and URSEC (theoretical underpinning of the development, resources required, setting, educational methods employed, and content) used to assess the risk of educational bias. RESULTS Internship courses called Medical Education Humanities and Society (MESH), clinical scenario design, seminars and small group discussions, web-based interactive training, legal training courses, PBL, and mind maps have been used to improve the medico-legal knowledge of medical students. MESH clerkship, simulation of a legal event, medico-legal advocacy program based on interdisciplinary education, group discussion, integration, and court-based learning used to improve student attitudes. Multidisciplinary training, small group discussions after the seminar, mock trial competition, and interdisciplinary education are used to teach psychomotor skills. All studies, except one on knowledge, reported positive effects of legal education on students' knowledge, attitudes, and legal performance. Written assessments were used for cognitive and affective domains, while performance was assessed by OSCE, simulated court, and evaluation of patient referrals. CONCLUSION There are few studies to examine the cognitive, affective, and legal psychomotor skills of medical students. The texts have not yet fully explored the high level of affective and psychomotor domains, which is evidence of a gap in this sector. Recognizing that medico-legal problems are prevented through proper education and assessment, it is recommended that this area be considered a research priority and that effective educational policies are adopted.
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Affiliation(s)
- Mahmoud Abbasi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mandana Shirazi
- Department of Medical Education, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hojjat Torkmandi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Nursing, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Mohammad Abdi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Medical Education, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Nursing, Zanjan University of Medical Sciences, Zanjan, Iran.
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Moreira BF, Santos CC, Duarte I. Consent for Teaching-The Experience of Pediatrics and Psychiatry. Healthcare (Basel) 2023; 11:healthcare11091270. [PMID: 37174813 PMCID: PMC10178240 DOI: 10.3390/healthcare11091270] [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: 03/02/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 05/15/2023] Open
Abstract
Informed consent protects patients' right of autonomy, as they may refuse to participate in clinical teaching. In Pediatrics, young people aged 16 or over, and with the necessary judgment, may consent; in Psychiatry, consent is also essential due to the personal nature of the subjects addressed. This study aimed mainly to assess the practical application of informed consent in medical education. An observational cross-sectional study was developed, and an interview-like questionnaire was applied to participants waiting for a scheduled consultation for themselves or the person they represented, in Pediatrics and Psychiatry. Only 54% of Pediatrics participants and 75% of Psychiatry participants stated that the physician asked them if they minded the students' presence and an even smaller percentage from both departments affirmed that students introduced themselves as medical students and requested their consent to examine them. Patients feel satisfied to contribute to the students' training, although a considerable percentage of them had experiences without being informed or asked for consent, which represents an evident disrespect for their autonomy. There is a need to intervene and provide an adequate education of ethical values in clinical practice to students.
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Affiliation(s)
- Bárbara Frade Moreira
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of General and Family Medicine, Family Health Unit (USF) Caminhos do Cértoma, Grouping of Health Centers (ACES) Baixo Mondego, Regional Health Administration (ARS) Centro, 3050-428 Mealhada, Portugal
| | - Cristina Costa Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS@REISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Ivone Duarte
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS@REISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Chen X, Gong MF, Wu S, He J. "LEARN", a novel teaching method for Chinese clinical clerkship: A cross-sectional study. Front Surg 2023; 10:1113267. [PMID: 36860941 PMCID: PMC9968847 DOI: 10.3389/fsurg.2023.1113267] [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] [Received: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Background Despite the clerkship being crucial in the training of a future doctor, no widely accepted education model has been proposed. This study devised a new model for clinical clerkship rotations, titled "LEARN" for Lecture, English-video, Advisor, Real-case and Notion, and evaluated whether the LEARN model is appropriate for medical education in China. Methods A cross-sectional study was performed among 101 fourth-year students from the Xiangya School of Medicine during an Orthopaedic Surgery clerkship rotation in the Third Xiangya Hospital. They were divided into seven groups and took clerkship based on the LEARN model. A questionnaire was collected at the conclusion to measure learning outcomes. Results The LEARN model was highly accepted with the acceptance of five sessions being 95.92% (94/98), 93.88% (92/98), 96.98% (97/98), 100% (98/98) and 96.94% (95/98). The outcomes of two genders were comparable, whereas a difference was observed in the test score among groups (group 3 scored 93.93 ± 5.20, higher than others). Quantitative analysis showed that positive correlations existed in participation in the Notion (Notion means students' case discussion) section with leadership (r = 0.84, 95% CI: 0.72-0.94, p < 0.001), participation in the Real-case section with leadership (r = 0.66, 95% CI: 0.50-0.80, p < 0.001), participation in the Real-case section with mastery of inquiring skills (r = 0.57, 95% CI: 0.40-0.71, p < 0.001) and participation in the Notion section with mastery of physical examination skills (r = 0.56, 95% CI: 0.40-0.69, p < 0.001). Further qualitative analysis demonstrated that high-level participation in the English-video section indicated better outcomes in mastery of inquiring (p < 0.01), physical examination (p < 0.001), film reading (p < 0.01) and clinical reasoning (p < 0.01) skills. Conclusion Our results support the LEARN model is a promising method for medical clerkship in China. Further research involving more participants and more meticulous design is planned to test its efficacy. For refinement, educators may try to promote students' participation in the English-video session.
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Affiliation(s)
- Xiangyu Chen
- Department of Orthopaedic Surgery, Central South University Third Xiangya Hospital, Changsha, China,Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Matthew F. Gong
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Song Wu
- Department of Orthopaedic Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Jinshen He
- Department of Orthopaedic Surgery, Central South University Third Xiangya Hospital, Changsha, China,Correspondence: Jinshen He
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Vandana K, Shruti G, Babu JN. Knowledge, attitudes, and perceptions toward informed consent and its implications among dental professionals in South India: A cross-sectional study. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2022. [DOI: 10.4103/jiaphd.jiaphd_10_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Trust, but Verify: Informed Consent, AI Technologies, and Public Health Emergencies. FUTURE INTERNET 2021. [DOI: 10.3390/fi13050132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To use technology or engage with research or medical treatment typically requires user consent: agreeing to terms of use with technology or services, or providing informed consent for research participation, for clinical trials and medical intervention, or as one legal basis for processing personal data. Introducing AI technologies, where explainability and trustworthiness are focus items for both government guidelines and responsible technologists, imposes additional challenges. Understanding enough of the technology to be able to make an informed decision, or consent, is essential but involves an acceptance of uncertain outcomes. Further, the contribution of AI-enabled technologies not least during the COVID-19 pandemic raises ethical concerns about the governance associated with their development and deployment. Using three typical scenarios—contact tracing, big data analytics and research during public emergencies—this paper explores a trust-based alternative to consent. Unlike existing consent-based mechanisms, this approach sees consent as a typical behavioural response to perceived contextual characteristics. Decisions to engage derive from the assumption that all relevant stakeholders including research participants will negotiate on an ongoing basis. Accepting dynamic negotiation between the main stakeholders as proposed here introduces a specifically socio–psychological perspective into the debate about human responses to artificial intelligence. This trust-based consent process leads to a set of recommendations for the ethical use of advanced technologies as well as for the ethical review of applied research projects.
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Diana E, Hamaoka D, Goldenberg M, Cozza KL. Psychotropic Medication Informed Consent: A Cross-Specialty Role-Playing Skill Builder. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11152. [PMID: 34013021 PMCID: PMC8096884 DOI: 10.15766/mep_2374-8265.11152] [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: 07/27/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Obtaining informed consent (IC) is an essential medical practice. Utilization of IC role-playing training with medication study cards and self-peer-supervisor review should improve student fund of knowledge and strengthen IC skills for clerkship-level medical students. METHODS Between 2017 and 2020, approximately 555 clerkship medical students used our formative role-playing exercise tools. Students independently prepared psychotropic medication study cards and role-played IC during group didactics. Peer and supervisor reviews were not recorded but were discussed as a group. Students completed routine anonymous postclerkship surveys regarding the IC exercise. An enhanced IC curriculum was deployed in 2020, adding a training video and peer/supervisor feedback form. Student feedback and specialty shelf exam scores were reviewed to assess the exercise's effectiveness. RESULTS Surveys indicated satisfaction with the exercise and increased confidence in obtaining IC. Interestingly, the student group that received enhanced IC training had fewer shelf exam failures than those without, perhaps indicating improved fund of psychotropic medication knowledge. DISCUSSION Peer role-playing IC training is well accepted by students, allows practice of essential elements of IC and shared decision-making, and provides an engaging way to improve medication fund of knowledge. Our clerkship has initiated development of an IC objective structured clinical examination station and is adapting the exercise across specialties for longitudinal learning in response to the positive feedback and ease of use. Structured review of psychotropics and peer IC role-playing can be tailored for other specialties, medications, and procedures and further developed for use in pre- and postclerkship education.
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Affiliation(s)
- Emily Diana
- Fourth-Year Medical Student, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
| | - Derrick Hamaoka
- Associate Professor, Department of Psychiatry, Uniformed Services University of the Health Sciences
| | | | - Kelly L. Cozza
- Professor, Department of Psychiatry, Uniformed Services University of the Health Sciences
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Nzaumvila D, Ntotolo P, Govender I, lukanu P, Niati JDL, Sanduku D, Bongongo T. Knowledge and practices of seeking informed consent for medical examinations and procedures by health workers in the Democratic Republic of Congo. Afr Health Sci 2021; 21:478-488. [PMID: 34394330 PMCID: PMC8356577 DOI: 10.4314/ahs.v21i1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Informed consent (IC) is linked to the ethical principle of respecting patient autonomy, respect for human rights and ethical practice, while in many countries it is a standard procedure. Anecdotally, it should be noted that in the Democratic Republic of Congo (DRC) in many instances ICs are not obtained systematically. To date, no research appears to have been conducted on this matter. This study aimed to assess the knowledge and practice of obtaining IC from patients among health care providers (HCP) in the DRC. METHODS This was a cross-sectional study, with a convenient sampling of 422 participants. Data from the questions were collected on an imported Microsoft Excel spreadsheet for review at INSTAT.TM The authors set IC's accurate knowledge and practice at 80% or higher. The Fisher Exact test was used to compare categorical association results, and a p-value < 0.05 was considered statistically significant. RESULTS Results showed that giving information in detail to patients on their medical condition was associated with formal training on medical ethics and IC (p: 0.0028; OR: 1.894; CI: 1.246 to 2.881), which was also associated with answering the patient's questions in detail (p: 0.0035; OR: 1.852; CI: 1.236 to 2.774). About 127(30.09 %) of participants scored 80% or higher. Extracurricular training was associated with withholding information from patients, up to 27 times more than other factors (p< 0.0001; OR: 27.042; CI: 13.628 to 53.657). when it comes to get IC, HCP with many years of practice scored better than others, in one of the question the odd ratio was closer to 7 (p< 0.0001; OR: 6.713; CI: 4.352 to 10.356). Only 47(11.14%) of the participants scored 80% or more of the questions about practice of IC. CONCLUSION For a variety of reasons, knowledge and practice of IC among HCPs was very low. A common programme for the country as part of formal training might lead to an improvement. In addition, patients' education on IC should be displayed in waiting areas at all medical centres.
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AlMahmoud T, Hashim MJ, Naeem N, Almahmoud R, Branicki F, Elzubeir M. Relationships and boundaries: Learning needs and preferences in clerkship medical environments. PLoS One 2020; 15:e0236145. [PMID: 32687536 PMCID: PMC7371200 DOI: 10.1371/journal.pone.0236145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Relationship boundaries recognition is an essential element of medical practice. The aim of the study was to assess final year medical students' perceived need for education regarding professional boundaries. MATERIALS AND METHODS This was a cross-sectional study. An anonymous paper questionnaire was distributed to 128 final year medical students. Standard descriptive statistics, unpaired t-test to evaluate differences between male and female groups and Pearson correlation to determine relationships between variables were used. RESULTS The survey was completed by 84.4% of students who identified the need for more emphasis in the curriculum for all of topics during training and practice pertaining to boundaries and relationships (mean 6.61±1.32 on a scale of 0 to 9; and 6.66±1.27 respectively). Topics with a high interest ranking requiring additional attention were mistreatment of medical students (mean 7.22±1.96), coping with mistakes in clinical care (mean 7.25±1.63), reporting of medical mistakes (mean 7.58±1.36), and gender bias in clinical care (mean 7.10±1.82). Women perceived a greater need for attention to all topics in the curriculum. Significant differences between the perceptions of female and male students were observed regarding topics such as responding to an impaired colleague (p<0.001), and a physician's social responsibilities (p = 0.001). CONCLUSION Medical students recognized the need for more education and training in the undergraduate medical ethics curriculum regarding patient-physician relationship boundaries.
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Affiliation(s)
- Tahra AlMahmoud
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
- * E-mail:
| | - M. Jawad Hashim
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Naghma Naeem
- Department of Medical Education, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Rabah Almahmoud
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Frank Branicki
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Margaret Elzubeir
- Department of Medical Education, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
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