Self-Regulated Learning Practice of Undergraduate Students in Health Professions Programs

BACKGROUND

University students are expected to take charge of their learning without being dependent on teachers. Self-regulated learning (SRL) is the process by which students direct their learning to achieve their set targets and goals in a timely and controlled manner. This study was undertaken to explore the practice of SRL by undergraduate students from different programs in a health science focused university during COVID-19 pandemic.

METHOD

Thirty-three undergraduate students of five health professions education programs were recruited to take part in focus group discussions to explore their SRL practice with online learning. Their responses were subjected to thematic analysis.

RESULT

Our students appeared to practice SRL, going through the phases of forethought and goal setting, performance and self-reflection. They set goals for academic as well as personal development in the university. Academic goals like achieving target GPA or marks were achieved by following different study techniques, personal management including time management, and by creating a conducive learning environment. Personal development such as interpersonal skills, social networking was achieved through socializing and participating in extracurricular activities. The students also engaged in self-reflection and analysis of their own performance followed by designing strategies to manage the challenges they faced.

CONCLUSION

Undergraduates of health professions programs appear to show evidence of practicing SRL. Although impacted by COVID-19 induced lockdown and online learning, they seem to have strategized and achieved their goals through individualized SRL processes. Promoting and fostering an atmosphere of SRL in universities to cater to the needs of the students would help them be more successful in their careers.

Medical Students' and Trainees' Country-By-Gender Profiles: Hofstede's Cultural Dimensions Across Sixteen Diverse Countries

Purpose

The global mobility of medical student and trainee populations has drawn researchers' attention to consider internationalization in medical education. Recently, researchers have focused on cultural diversity, predominately drawing on Hofstede's cross-cultural analysis of cultural dimensions from general population data to explain their findings. However, to date no research has been specifically undertaken to examine cultural dimensions within a medical student or trainee population. This is problematic as within-country differences between gender and professional groups have been identified within these dimensions. We address this gap by drawing on the theoretical concept of national context effects: specifically Hofstede's six-dimensional perspective. In doing so we examine medical students' and trainees' country profiles across dimensions, country-by-gender clustering, and differences between our data and Hofstede's general population data.

Methods

We undertook a cross-cultural online questionnaire study (eight languages) containing Hofstede's 2013 Values Survey. Our questionnaire was live between 1st March to 19th Aug 2018, and December 2018 to mitigate country holiday periods. We recruited undergraduate medical students and trainees with at least 6-months' clinical training using school-specific methods including emails, announcements, and snowballing.

Results

We received 2,529 responses. Sixteen countries were retained for analyses (n = 2,307, 91%): Australia, Chile, China, Hong Kong, India, Indonesia, Ireland, Israel, Japan, Malaysia, New Zealand, Pakistan, South Africa, South Korea, Sri-Lanka, Taiwan. Power distance and masculinity are homogenous across countries. Uncertainty avoidance shows the greatest diversity. We identified four country clusters. Masculinity and uncertainty are uncorrelated with Hofstede's general population data.

Conclusions

Our medical student and trainee data provides medical education researchers with more appropriate cultural dimension profiles than those from general population data. Country cluster profiles stimulate useful hypotheses for further research, especially as patterning between clusters cuts across traditional Eastern-Western divides with national culture being stronger than gendered influences. The Uncertainty dimension with its complex pattern across clusters is a particularly fruitful avenue for further investigation.

A scoping review of clinical reasoning research with Asian healthcare professionals

Clinical reasoning is the thought process that guides practice. Although a plethora of clinical reasoning studies in healthcare professionals exists, the majority appear to originate from Western cultures. A scoping review was undertaken to examine clinical reasoning related research across Asian cultures. PubMed, SciVerse Scopus, Web of Science and Airiti Library databases were searched. Inclusion criteria included full-text articles published in Asian countries (2007 to 2019). Search terms included clinical reasoning, thinking process, differential diagnosis, decision making, problem-based learning, critical thinking, healthcare profession, institution, medical students and nursing students. After applying exclusion criteria, n = 240 were included in the review. The number of publications increased in 2012 (from 5%, n = 13 in 2011 to 9%, n = 22) with a steady increase onwards to 12% (n = 29) in 2016. South Korea published the most articles (19%, n = 46) followed by Iran (17%, n = 41). Nurse Education Today published 11% of the articles (n = 26), followed by BMC Medical Education (5%, n = 13). Nursing and Medical students account for the largest population groups studied. Analysis of the articles resulted in seven themes: Evaluation of existing courses (30%, n = 73) being the most frequently identified theme. Only seven comparative articles showed cultural implications, but none provided direct evidence of the impact of culture on clinical reasoning. We illuminate the potential necessity of further research in clinical reasoning, specifically with a focus on how clinical reasoning is affected by national culture. A better understanding of current clinical reasoning research in Asian cultures may assist curricula developers in establishing a culturally appropriate learning environment.

IMoCC - Measure of cultural competence among medical students in the Malaysian context

Cultural beliefs and practices impact heavily on health outcomes of patients. Doctors' ability to deal with such issues in clinical practice, i.e. cultural competence, is widely studied in the west. It has yet to be given due importance in non-western contexts. This study aimed to develop a valid and reliable measure of cultural competence in the Malaysian cultural context and to assess cultural competence among Malaysian medical students. Thirty-five cultural issues faced by Malaysian doctors were identified with a series of interviews to develop a preliminary tool. The responses of students to these cultural issues were evaluated against the extent of inquiry and advocacy based on a theoretical framework of cultural competence. The responses were subjected to statistical analysis to determine the internal structure of the tool and to reduce the number of items in the tool. The final tool (IMU Measure of Cultural Competence - IMoCC) comprised of 22 issues, which deemed to be reliable in the second round of testing. In both tools, student cohorts demonstrated an acceptable level of cultural competence with room for improvement. However, they appeared to learn how to deal with cultural issues primarily through informal means and not in the formal curriculum.

Female victims and female perpetrators: medical students' narratives of gender dynamics and professionalism dilemmas

Medicine is a gendered discipline, in which women, both as patients and practitioners, have often held subordinate positions. The reproduction of dominant gender biases in the medical setting can negatively impact the professional development of medical students and the wellbeing of patients. In this analysis of medical students' narratives of professionalism dilemmas, we explore students' experiences of gender bias in hospital settings. Seventy-one students participated in 12 group interviews, where they discussed witnessing or participating in various activities that they thought were professionalism lapses. Within the dataset, 21 narratives had a distinctly gendered component broadly pertaining to patient dignity and safety dilemmas, informed consent issues, and female student abuse. Interestingly, perpetrators of such acts were commonly female healthcare professionals and educators. Although students recognized such acts as professionalism lapses and often expressed concern for patient wellbeing, students did not intervene or report such acts due to hierarchical cultural contexts, and at times even reproduced the discriminatory behavior they were criticizing. This raises concerns about medical students' professionalism development and the extent to which gender bias is ingrained within particular medical systems. The normalization of disrespectful and abusive treatment of female patients poses immediate and future consequences to the wellbeing and safety of women. Furthermore, the same socio-cultural values that sustain these acts may account for perpetrators often being women themselves as they strive to overcome their subordinate position within medicine.

What information and the extent of information research participants need in informed consent forms: a multi-country survey

Background

The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research.

Methods

This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important).

Results

Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making (mean score, ranging from 3.58 to 4.47). Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF (mean score = 4.47, 4.47, and 4.45, respectively).

Conclusions

Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF.

Electronic supplementary material

The online version of this article (10.1186/s12910-018-0318-x) contains supplementary material, which is available to authorized users.

Use of portfolios for assessment of global health residents: qualitative evaluation of design and implementation

BACKGROUND

When the Global Health training program was created at the University of Calgary, residents were encouraged to seek learning experiences that met their career goals and individualized objectives. An assessment tool was sought that could be reliable, valid, yet flexible. A portfolio process was chosen, but research was necessary to determine whether it was robust.

METHODS

A qualitative study was conducted with academic experts in Canadian residency training, as well as directors and residents involved in Global Health study in order to assess the validity and benefit of such a tool. Through an online survey, interviews, and focus groups, views on the portfolio and intended content were collected and coded thematically.

RESULTS

Multiple themes emerged from the content analysis. Overall, all stakeholders (residents and faculty) were supportive of the use of portfolios for summative assessment, mentioning authentic and varying assessments, reflective and narrative components, and mentor interaction as positive attributes, but they did have many recommendations.

CONCLUSION

This qualitative evaluation validated the use of portfolios for this cohort of students while yielding comments and suggestions that will further enhance the interactive and flexible nature of this seldom used assessment tool. These findings contribute to the understanding of how Global Health assessment can remain individualized yet rigorous.

Taiwanese and Sri Lankan students' dimensions and discourses of professionalism

CONTEXT

The definition of medical professionalism poses a challenge to global medical educators. This is especially pronounced in settings where professionalism frameworks developed in the west are transferred into different cultures. Building upon our previous study across Western contexts, we examine Taiwanese and Sri Lankan medical students' conceptualisations of professionalism in terms of what professionalism comprises (i.e. dimensions) and how it is linguistically framed (i.e. discourses).

METHODS

A qualitative group interview study was undertaken comprising 26 group interviews with 135 participants from one Taiwanese (n = 64; Years 4-7) and one Sri Lankan medical school (n = 71; Years 2-5). Through thematic framework analysis we examined the data for explicit dimensions of professionalism. Through discourse analysis we identified how participants constructed professionalism linguistically (discourses).

RESULTS

Thirteen common dimensions across Taiwanese and Sri Lankan talk were identified, with the dimensions (contextual, integration and internalised self) being identified only in Sri Lankan data. Professionalism as knowledge and patient-centredness were dominant dimensions in Taiwan; in Sri Lanka, attributes of the individual and rules were dominant dimensions. Participants in both countries used four types of discourses previously identified in the literature. Individual and interpersonal discourses were dominant in Taiwanese talk; the collective discourse was dominant in Sri Lankan talk. Findings were compared with our previous data collected in Western contexts.

CONCLUSIONS

Despite some overlap in the dimensions and discourses identified across both this and Western studies, Taiwanese and Sri Lankan students' dominant dimensions and discourses were distinct. We therefore encourage global medical educators to look beyond a one-size-fits-all approach to professionalism, and to recognise the significance of context and culture in conceptualisations of professionalism.

Palliative care education for medical students: Differences in course evolution, organisation, evaluation and funding: A survey of all UK medical schools

BACKGROUND

A proportion of newly qualified doctors report feeling unprepared to manage patients with palliative care and end-of-life needs. This may be related to barriers within their institution during undergraduate training. Information is limited regarding the current organisation of palliative care teaching across UK medical schools.

AIMS

To investigate the evolution and structure of palliative care teaching at UK medical schools.

DESIGN

Anonymised, web-based questionnaire. Settings/participants: Results were obtained from palliative care course organisers at all 30 UK medical schools.

RESULTS

The palliative care course was established through active planning (13/30, 43%), ad hoc development (10, 33%) or combination of approaches (7, 23%). The place of palliative care teaching within the curriculum varied. A student-selected palliative care component was offered by 29/30 (97%). All medical schools sought student feedback. The course was reviewed in 26/30 (87%) but not in 4. Similarly, a course organiser was responsible for the palliative care programme in 26/30 but not in 4. A total of 22 respondents spent a mean of 3.9 h (median 2.5)/week in supporting/delivering palliative care education (<1-16 h). In all, 17/29 (59%) had attended a teaching course or shared duties with a colleague who had done so. Course organisers received titular recognition in 18/27 (67%; no title 9 (33%); unknown 3 (11%)). An academic department of Palliative Medicine existed in 12/30 (40%) medical schools. Funding was not universally transparent. Palliative care teaching was associated with some form of funding in 20/30 (66%).

CONCLUSION

Development, organisation, course evaluation and funding for palliative care teaching at UK medical schools are variable. This may have implications for delivery of effective palliative care education for medical students.

Taiwanese medical students' narratives of intercultural professionalism dilemmas: exploring tensions between Western medicine and Taiwanese culture

In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas. Noting the prominence of culture in students' narratives, we explored this theme further using secondary analysis, identifying tensions between Western medicine and Taiwanese culture and categorizing students' intercultural professionalism dilemmas according to Friedman and Berthoin Antal's 'intercultural competence' framework: involving combinations of advocacy (i.e., championing one's own culture) and inquiry (i.e., exploring one's own and others' cultures). One or more intercultural dilemmas were identified in nearly half of students' professionalism dilemma narratives. Qualitative themes included: family relations, local policy, end-of-life care, traditional medicine, gender relations and Taiwanese language. Of the 62 narratives with sufficient detail for further analysis, the majority demonstrated the 'suboptimal' low advocacy/low inquiry approach (i.e., withdrawal or inaction), while very few demonstrated the 'ideal' high advocacy/high inquiry approach (i.e., generating mutual understanding, so 'intercultural competence'). Though nearly half of students' professionalism narratives concerned intercultural dilemmas, most narratives represented disengagement from intercultural dilemmas, highlighting a possible need for more attention on intercultural competence training in Taiwan. The advocacy/inquiry framework may help educators to address similar disconnects between Western medicine and non-Western cultures in other contexts.

Preparing future doctors for palliative care: views of course organisers

BACKGROUND

Effective training at medical school is essential to prepare new doctors to safely manage patients with palliative care (PC) and end of life care (EOLC) needs. The contribution of undergraduate PC course organisers is central but their collective views regarding role are unknown.

OBJECTIVE

To survey attitudes of PC course organisers regarding their course, organisation, the adequacy of training provided and level of personal satisfaction.

METHODS

An anonymised, multifactorial, web-based questionnaire was devised, tested, modified and then sent to lead PC course organisers at all UK medical schools.

RESULTS

Data were obtained from all 30 UK medical schools. Organisers agreed/strongly agreed (=agreed) that their PC course was highly rated by students (26, 87%). 25 (83%) agreed their course 'enabled misconceptions and fears about PC, death, dying and bereavement to be addressed', 'delivered quality PC training' (23, 77%), 'fulfilled General Medical Council requirements' (19, 63%), 'prepared students well to care for patients with PC/EOLC needs' (18, 60%) and 'enabled students to visit a hospice and see the role of doctors in caring for the dying' (17, 57%). Concerns were limited capacity to accommodate students (agreed 20, 66%) and variability in teaching according to location (15, 50%). Most agreed their institution recognised PC training as important (22, 73%), they felt supported by colleagues (21, 70%) and experienced cooperation between stakeholders (20, 67%). All agreed that PC training was essential for undergraduates, while 29 (97%) supported inclusion of a hospice visit in the curriculum. 27 agreed that their role was satisfying (90%), 3 disagreed (10%).

CONCLUSIONS

Approximately two-thirds of organisers were generally positive about their PC course, institution and role. A minority expressed concerns; these may reflect suboptimal PC training at their medical school and poor preparation of new doctors.

Progress and divergence in palliative care education for medical students: A comparative survey of UK course structure, content, delivery, contact with patients and assessment of learning

BACKGROUND

Effective undergraduate education is required to enable newly qualified doctors to safely care for patients with palliative care and end-of-life needs. The status of palliative care teaching for UK medical students is unknown.

AIM

To investigate palliative care training at UK medical schools and compare with data collected in 2000.

DESIGN

An anonymised, web-based multifactorial questionnaire.

SETTINGS/PARTICIPANTS

Results were obtained from palliative care course organisers at all 30 medical schools in 2013 and compared with 23 medical schools (24 programmes) in 2000.

RESULTS

All continue to deliver mandatory teaching on 'last days of life, death and bereavement'. Time devoted to palliative care teaching time varied (2000: 6-100 h, mean 20 h; 2013: 7-98 h, mean 36 h, median 25 h). Current palliative care teaching is more integrated. There was little change in core topics and teaching methods. New features include 'involvement in clinical areas', participation of patient and carers and attendance at multidisciplinary team meetings. Hospice visits are offered (22/24 (92%) vs 27/30 (90%)) although they do not always involve patient contact. There has been an increase in students' assessments (2000: 6/24, 25% vs 2013: 25/30, 83%) using a mixture of formative and summative methods. Some course organisers lack an overview of what is delivered locally.

CONCLUSION

Undergraduate palliative care training continues to evolve with greater integration, increased teaching, new delivery methods and wider assessment. There is a trend towards increased patient contact and clinical involvement. A minority of medical schools offer limited teaching and patient contact which could impact on the delivery of safe palliative care by newly qualified doctors.

Egyptian medical students' recommended responses to the Dundee Polyprofessionalism Inventory I: Academic Integrity

The Dundee Polyprofessionalism Inventory I: Academic Integrity was administered to 219 medical students from three Egyptian medical schools. The results indicate a high level of congruence between the genders in Recommended Sanctions on a scale of 1-10 ranging from Ignore through Reprimand to Expulsion/Report to Regulatory Body. Some variations in Recommended Sanctions occurred among the age groups 17-19 years; 20-24 years, and 25 years and older. The Egyptian responses were more lenient than a Scottish medical school cohort on four lapses of professionalism and stricter on 5. The Dundee Polyprofessionalism Inventory I: Academic Integrity can be used as a 'diagnostic tool' to profile a cohort's recommended responses to 30 lapses of professionalism at undergraduate level in health professions education. That profile can be compared with another cohort to indicate parallels and differences in the importance with which different respondents (perhaps in different countries and cultures) place on generic elements of academic professionalism. This information in turn can be used to target further education in expected standards of professionalism. The process can be used as an e-learning programme as well as for needs analysis, including that for International Medical Graduates moving from one culture to work in another.

Recommended sanctions for lapses in professionalism by student and faculty respondents to Dundee Polyprofessionalism inventory I: academic integrity in one medical school in Saudi Arabia

BACKGROUND

At a time when the Committee of Deans of the Medical Schools in the Kingdom of Saudi Arabia is entering the second phase of developing Learning Outcomes for Bachelor Degree Programs in Medicine, we investigated the current level of understanding of the importance of academic probity in one Saudi medical school.

METHODS

We administered the Dundee Polyprofessionalism Inventory I: Academic Integrity to students and faculty at one Saudi medical school.

RESULTS

While there was considerable concordance between the 103 Saudi students and 64 Saudi faculty, there were also some aspects of lapses in professionalism relating to academic integrity where enhanced teaching is indicated to help the students prepare for their responsibilities as doctors.

CONCLUSION

These data may begin to help focus teaching about professionalism in the Saudi medical school and inform the refinement of Learning Outcomes for Bachelor Degree Programs in Medicine in the Kingdom of Saudi Arabia. The generalizability of the findings needs to be further tested to see if mapping of Professionalism learning in relatively homogenous populations such as a medical school can be robustly conducted with well-constructed stratified, representative reference groups.

Low fidelity, high quality: a model for e-learning

BACKGROUND

E-learning continues to proliferate as a method to deliver continuing medical education. The effectiveness of e-learning has been widely studied, showing that it is as effective as traditional forms of education. However, most reports focus on whether the e-learning is effective, rather than discussing innovations to allow clinical educators to ask 'how' and 'why' it is effective, and to facilitate local reproduction.

CONTEXT

Previous work has set out a number of barriers to the introduction of e-learning interventions. Cost, the time to produce interventions, and the training requirements for educators and trainees have all been identified as barriers. We set out to design an e-learning intervention on paediatric prescribing that could address these issues using a low-fidelity approach, and report our methods so as to allow interested readers to use a similar approach.

INNOVATION

Using low-cost, readily accessible tools and applying appropriate educational theory, the intervention was produced in a short period of time. As part of a randomised controlled trial, long-term retention of prescribing skills was demonstrated, with significantly higher prescribing skill scores in the e-learning group at 4 and 12 weeks (p < 0.0001). Feedback was universally positive, with Likert responses suggesting that it was useful, convenient and easy to use.

IMPLICATIONS

A low-fidelity approach to designing can successfully overcome many of the barriers to the introduction of e-learning. The design model described is simple and can be used by clinical teachers to support local development. Further research could investigate the experiences of these clinicians using this method of instructional design.

An evaluation of operative self-assessment by UK postgraduate trainees

BACKGROUND

Surgeons in training undertake procedure-based assessment (PBA) with their trainers. Time pressures limit when this occurs. Self-assessment would provide additional opportunities but requires evaluation of your own skills and knowledge.

AIM

To investigate the validity of a self-assessment PBA in the operating theatre and evaluate learning needs and change in practice identified.

METHODS

In a prospective study, postgraduate UK trainees performed a self-assessment PBA after formally reflecting on appendicectomy surgery. Later, they performed their usual external assessment PBA on the same case and outcomes were compared. Learning outcomes were analysed independently by two trainers.

RESULTS

There were 25 trainees (14 males), of age 29 years (25-33). They had performed a median of five previous appendicectomies (2-21) after a median three years of speciality training (range 1-4). There were no significant differences in global summary scores, trainee satisfaction or learning outcomes between external and self-assessment PBAs. Construct validity of the self-assessment PBA was demonstrated. The self-assessment PBA was more likely to identify non-technical skills.

CONCLUSION

Our results suggest self-assessment PBA is valid for formative assessment. It identified a wide range of learning outcomes. Self-assessment PBA would help trainees maximise every learning opportunity and practice self-assessment skills.

Validation and piloting of direct observation of practical skills tool to assess intubation in the Chilean context

BACKGROUND

The use of Workplace-Based Assessment (WBA) has increased in recent years.

AIMS

To create a modified version of Direct Observation of Procedural Skills (DOPS) adapted to the Chilean context and establish its psychometric properties.

METHODS

The content validity of DOPS was established through interviews and consensus survey. To be included in the new version, the respective domain should have been considered by over 80% of interviewers and it should have a Content Validity Index (CVI and kappa statistic over 0.78 and 0.6, respectively. For four months, the new DOPS was used to assess the intubation skills of the anesthesia trainees. Generalizability theory was used to establish reliability and internal consistency.

RESULTS

The interview suggested a DOPS with twelve domains. All were included in the final version as the CVI and kappa values were above 0.9 and 0.8, respectively. 585 procedures were assessed. The G coefficient was 0.90. The intubation needs to be assessed with DOPS at least six times to obtain a G coefficient of 0.80.

CONCLUSIONS

The modified DOPS was a valid, reliable and practical tool for assessing the intubation procedure. Effort needs to be made to improve the staff's feedback skills.

Medical professionalism: development and validation of the Arabian LAMPS

AIM

The attributes of the professional physicians varies among cultures. This study aims to develop and validate a questionnaire that measures attitudes of medical students on professionalism in the Arabian context.

METHOD

Thirty-two experts contributed to item generation in particular domains. The instrument was administered to Arabian medical students and interns and responses were collected using five-point Likert scales. Data were analyzed to estimate the reliability of the instrument. The inventory in its final version was labeled as the Learners' Attitude of Medical Professionalism Scale (LAMPS).

RESULTS

A total of 413 medical students and interns responded from two universities in Egypt and Saudi Arabia. Means of item response ranged from 2.38 to 4.72. The highest mainly deals with "Respect to others," while the lowest belong to "Honor/Integrity." The final version of the LAMPS has 28 items in five domains, with a reliability of 0.79.

DISCUSSION

The LAMPS has salient features compared to other similar instrument. It was designed based on a reliable framework in explicit behavioral items, not abstract attributes of professionalism. The LAMPS can help teachers to identify learning gaps regarding professionalism amongst their students and track attitude changes over time or as the result of interventions.

CONCLUSION

To the best of our knowledge, the LAMPS is the first context-specific inventory on medical professionalism attitudes in the Arabian context.

Is there a chilly climate? An educational environmental mixed method study in a chiropractic training institution

OBJECTIVE

The attitude towards gender in an educational environment has a significant impact on a student's behavior, sense of well-being, and academic performance. Our study aimed to explore the presence and extent of gender-related issues in a chiropractic undergraduate learning environment, which has been a scarcely researched topic in the literature.

METHODS

The Perceived Chilly Climate Scale (PCCS) was used as the initial tool for screening the gender issues among undergraduates. The issues identified were explored further with a series of focus group interviews.

RESULTS

The PCCS had an 83% response rate. The PCCS score (105/196) indicated the nonexistence of alarming gender-related issues. However, the PCCS score was significantly higher among female than male subjects, immigrants than nonimmigrants, and minorities than majority ethnic groups. Despite high ratings on the questionnaire quantitative findings, the focus groups indicated a good sense of equality, oppression-free environment, and no obvious signs of discrimination.

CONCLUSION

The educational environment of the institution concerned was conducive to equality. However, subtle but important gender-, ethnic-, and minority-related issues could be addressed to provide an enhanced educational environment to learners.

The weak relationship between anatomy competence and clinical skills in junior medical students

In modern curricula, the early integration of anatomy and clinical skills education at undergraduate level is seen as important. However, the direct relationship between medical students' competence in anatomy, and their clinical proficiency during early undergraduate years, has scarcely been studied. In this study, the marks for anatomy and clinical skills of three consecutive cohorts of medical students (n = 538 in total) during their first two years were correlated. The anatomy competence was measured using a new marker, the Anatomy Competence Score (ACS) which was calculated with equal contributions from theory knowledge and its practical and clinical application. Proficiency in clinical skills was determined by OSCE performance marks for stations which examined physical examination and practical procedural skills. The possible compounding effect of students' general academic ability was investigated by using the overall performance mark for each student based on their performance in all subjects over the first two years of the medical curriculum. We found that the correlation between anatomy and clinical skills marks was weak to moderate. However, this correlation was virtually nullified once the effect of academic ability was accounted for. Although these findings suggest that anatomy education does not compliment early clinical education, the lack of complexity of clinical problems used in clinical skills assessments (OSCEs) during the early stages may well be the primary contributing factor to this finding.

Medical student rankings of proposed sanction for unprofessional behaviours relating to academic integrity: results from a Scottish medical school

The General Medical Council emphasizes the cultivation of professional behaviours among medical students from early undergraduate years. Learning professional behaviours, however, is a progression and is constituted of several developmental stages. Behaving with academic integrity may be the first stage. In an educational setting, academic integrity is represented by a collection of diverse behaviours. Although there is consensus within the medical community that the absence of (or lapses in) academic integrity is unacceptable, the level of sanctions recommended for medical students is controversial. In the main, these punitive decisions over students are taken by teachers and clinicians. What sanctions would students suggest for a colleague who is academically unprofessional? This study reports the sanctions recommended by 375/700 (54%) of the students of one Scottish medical school in relation to lapses in academic integrity.

Preparing medical students for clinical decision making: a pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention

BACKGROUND

Junior doctors are frequently faced with making difficult clinical decisions and previous studies have shown that they are unprepared for some aspects of clinical decision making.

AIM

To explore medical students' feelings and strategies when responsible for making clinical decisions and to obtain students' views of the effectiveness of a clinical decision making teaching intervention.

METHODS

A teaching intervention was developed, consisting of a clinical decision making tool, a tutorial and scenarios within a simulated ward environment. A total of 23 volunteer students participated in individual interviews immediately after their simulator sessions. The qualitative data from the interviews were analysed to identify emerging themes.

RESULTS

Despite extended shadowing programmes, students feel unprepared for clinical decision making as FY1s, and lack effective decision making strategies. Experiencing complex decision making scenarios through individually orientated simulation results in students being subjectively more prepared for work as FY1s.

CONCLUSION

Students continue to feel unprepared for the responsibility of clinical decision making. A teaching intervention, including simulated individual clinical scenarios, later in undergraduate training, appeared to be useful in improving medical students' decision making, specifically in relation to making a diagnosis, prioritising, asking for help and multi-tasking, but further work is required.

Cultural similarities and differences in medical professionalism: a multi-region study

CONTEXT

Over the last two decades, many medical educators have sought to define professionalism. Initial attempts to do so were focused on defining professionalism in a manner that allowed for universal agreement. This quest was later transformed into an effort to 'understand professionalism' as many researchers realised that professionalism is a social construct and is culture-sensitive. The determination of cultural differences in the understanding of professionalism, however, has been subject to very little research, possibly because of the practical difficulties of doing so. In this multi-region study, we illustrate the universal and culture-specific aspects of medical professionalism as it is perceived by medical practitioners.

METHODS

Forty-six professional attributes were identified by reviewing the literature. A total of 584 medical practitioners, representing the UK, Europe, North America and Asia, participated in a survey in which they indicated the importance of each of these attributes. We determined the 'essentialness' of each attribute in different geographic regions using the content validity index, supplemented with kappa statistics.

RESULTS

With acceptable levels of consensus, all regional groups identified 29 attributes as 'essential', thereby indicating the universality of these professional attributes, and six attributes as non-essential. The essentialness of the rest varied by regional group.

CONCLUSIONS

This study has helped to identify regional similarities and dissimilarities in understandings of professionalism, most of which can be explained by cultural differences in line with the theories of cultural dimensions and cultural value. However, certain dissonances among regions may well be attributable to socio-economic factors. Some of the responses appear to be counter-cultural and demonstrate practitioners' keenness to overcome cultural barriers in order to provide better patient care.

How medical professionalism is conceptualised in Arabian context: a validation study

Professionalism has been increasingly recognised as an explicit component of medical education, especially in the western world. Professionalism is culture-sensitive. Few efforts have been made to conceptualise professionalism in relation to the Arabian context. The aim of this study is to validate the components of professionalism framework of the American Board of Internal Medicine (ABIM) to the Arabian context. The authors invited a heterogeneous group of native Arab health professionals and academics to contribute to a reference panel. They represented a variety of disciplines, and seniority levels, and from different healthcare institutions and medical schools in Egypt, Saudi Arabia and United Arab Emirates. They were queried about their perception of the importance of each domain of professionalism as proposed by the ABIM, and were encouraged to suggest new domains if they thought it necessary. Thirty two out of the 45 invited health professionals and educators (71%) contributed to the reference panel. The panel confirmed the appropriateness of the six ABIM domains to the Arabian context, and further proposed the Autonomy of professionals as an additional domain. The modified framework, based on ABIM domains, demonstrated the Arabian conceptualisation of professionalism.

The anatomy competence score: a new marker for anatomical ability

The assessment of students' ability in gross anatomy is a complex process as it involves the measurement of multiple facets. In this work, the authors developed and introduced the Anatomy Competence Score (ACS), which incorporates the three domains of anatomy teaching and assessment namely: theoretical knowledge, practical 3D application of the knowledge, and clinical or bedside application of knowledge on patients. Equal contributions from these tripartite domains were used to synthesize the ACS. The theory knowledge was assessed using MCQs and short answer questions while the knowledge of practical 3D application was assessed using an Objective Structured Practical Examination (OSPE). The clinical or bedside application of anatomy knowledge was assessed by an Objective Structured Clinical Examination (OSCE). In this correlation study, the authors examined the interdomain correlations of the summative marks for the three contributing domains of the ACS, in order to examine the rationality of this new marker. Three cohorts of medical students (n = 538) at St. George's, University of London (SGUL) Medical School in the United Kingdom were included and analyzed. The results demonstrated that the correlations between the three domains were significantly low or moderate. The three domains probably represent unique knowledge and abilities. Therefore, it would appear that the average of the domains scores (the ACS) provide a comprehensive picture of a student's ability in anatomy.

Improved junior paediatric prescribing skills after a short e-learning intervention: a randomised controlled trial

OBJECTIVE

Medication errors are common, with junior doctors accounting for the majority in acute healthcare. Paediatrics is uniquely challenging, but the evidence base to guide prescribing education is limited. The authors set out to develop a short, educationally sound, low cost e-learning resource for paediatric prescribing to improve junior doctors' prescribing skills and to evaluate its effectiveness.

DESIGN

A non-blinded randomised controlled trial.

SETTING

North Western Deanery Foundation School, UK.

PARTICIPANTS

162 volunteer foundation (junior) doctors randomised into control (86) and intervention (76) groups.

INTERVENTIONS

On study entry, participants were assessed on prescribing skill, prescribing habits and confidence. The intervention group completed the e-learning course designed for the study, which took 1-2 h. At 1 and 3 months after the intervention, both groups were assessed on similar prescribing assessments, habits and confidence.

MAIN OUTCOME MEASURES

Total score (expressed as a percentage) on prescribing assessments, confidence and satisfaction scores.

RESULTS

There were no preintervention differences in prescribing assessments (67% vs 67%, p=0.56). Postintervention, the e-learning group scored significantly higher than the control group (63% vs 79%, p<0.0001). At 3 months, the e-learning group still scored significantly higher (69% vs 79%, p<0.0001), with improved confidence scores (p<0.0001).

CONCLUSIONS

This short e-learning resource significantly improved the paediatric prescribing skills of junior doctors. Outcomes were maintained at 3 months, suggesting the utility of low cost, low fidelity, educationally sound e-learning interventions. However, the direct impact on patient outcomes following this intervention has yet to be determined.

Assessment of medical knowledge: the pros and cons of using true/false multiple choice questions

True/false multiple choice items, commonly referred to as true/ false multiple choice questions (MCQs), were previously a widely used selected response examination format. They can be written relatively easily and cover a wide range of content. Educational researchers have however highlighted several adverse features of this format that make it inappropriate for many assessment settings. These include: (i) there is a high chance of guessing the correct answer; (ii) some marks are not awarded for knowing the correct answer, but for knowing that an answer is incorrect; (iii) they are weak in discriminating between high and low performers; (iv) identifying items which are absolutely true or false may lead to assessment of trivial knowledge; (v) there are difficulties with constructing flawless items; (vi) they may not encourage learning around the items; and (vii) they may not assess what they purport to assess. Many assessment agencies abandoned the use of this format decades ago due to these shortcomings. The use of single best answer (SBA) and extended matching item (EMI) formats helps overcome or minimize the above weaknesses. Assessors who plan to change to SBA or EMI formats from true/false MCQs may, however, need to increase the number of questions to include a representative sample of the curriculum (lengthening the question paper). However, they may not need to increase the examination time, as in general students can answer more SBAs or EMIs than true/false MCQs per unit time. It is time that we reflect upon the disadvantages of true/false MCQs and review their place in our assessment toolkit, as their use in summative examinations may not be fair to students, especially 'good' students.

Preliminary benchmarking of appropriate sanctions for lapses in undergraduate professionalism in the health professions

OBJECTIVE

To investigate the extent of consensus between faculty and students in order to benchmark appropriate sanctions for first-time offences with no mitigating factors in the area of Academic Probity by quota sampling in one cohort of medical, nursing and dental students in a Scottish university.

METHODS

This study reports administration of a web-based preliminary inventory derived from the international research literature to a target population of health professions staff and students. This study was conducted at Scottish University College of Medicine, Dentistry, Nursing and Midwifery.

SUBJECTS

57 faculty and 689 students in the College in first quarter of 2009 participated in this study.

RESULTS

50% of medical students, 26% of dental students, 22% of nursing students and 27% of midwifery students responded; 22% of faculty responded. Administration of a preliminary 41-item inventory to 57 faculty and 689 students from a Scottish College of Medicine, Dentistry, Nursing and Midwifery has allowed us to preliminarily rank the sanctions that are broadly agreed between the two cohorts as well as to identify a small cluster of behaviours which are viewed less severely by students than by faculty.

CONCLUSIONS

These data will give guidance to undergraduate Fitness to Practice committees but also guidance to curriculum planners about the areas in which students may need more teaching. The results informed the reduction of the inventory and its refinement in to a 30-item e-learning tool that is being field tested for generalisability within and beyond the UK. The researchers have also been invited to adapt the proposed teaching and learning tools beyond the health professions.

Perception of educational environment among undergraduate students in a chiropractic training institution

PURPOSE

The impact of the educational environment in student learning is well documented. However, there is a scarcity in the literature exploring the educational environment in chiropractic training institutions. This study aimed to identify the perceived educational environment in a chiropractic training institution and the possible perceptual differences among different demographic groups.

METHODS

The perceived educational environment was surveyed using Dundee Ready Education Environment (DREEM), which is a validated, self-administered, and Likert-type inventory. DREEM items focus on subdomains related to learning, teachers, self-confidence, academic atmosphere, and social environment. The results were analyzed and interpreted in relation to standard norms of DREEM and demographic variables.

RESULTS

The survey was completed by 124 chiropractic undergraduate students (response rate 83%). Statistically, the inventory items showed high correlation and the subdomains showed a close relationship. Overall the DREEM score was very high: 156.1/200 (78%). The subdomain scores were also at very high levels. However, the scoring of four items by students was consistently poor: lack of a support system for stressed students, 1.8 (SD 1.1); authoritarian teachers, 1.8 (SD 1.2); inadequate school time-tabling, 2.0 (SD 1.1); and overemphasis on factual learning, 2.0 (SD 1.0). There were no statistically significant differences in DREEM scores between gender, age, minority, and ethnicity groups.

CONCLUSIONS

In general, students perceived that a sound educational environment is fostered by the institution and its educational program for all students despite their demographic variations. However, certain specific elements of the educational process may need to be addressed to improve the educational experience.

Perception of educational environment among undergraduate students in a chiropractic training institution

PURPOSE

The impact of the educational environment in student learning is well documented. However, there is a scarcity in the literature exploring the educational environment in chiropractic training institutions. This study aimed to identify the perceived educational environment in a chiropractic training institution and the possible perceptual differences among different demographic groups.

METHODS

The perceived educational environment was surveyed using Dundee Ready Education Environment (DREEM), which is a validated, self-administered, and Likert-type inventory. DREEM items focus on subdomains related to learning, teachers, self-confidence, academic atmosphere, and social environment. The results were analyzed and interpreted in relation to standard norms of DREEM and demographic variables.

RESULTS

The survey was completed by 124 chiropractic undergraduate students (response rate 83%). Statistically, the inventory items showed high correlation and the subdomains showed a close relationship. Overall the DREEM score was very high: 156.1/200 (78%). The subdomain scores were also at very high levels. However, the scoring of four items by students was consistently poor: lack of a support system for stressed students, 1.8 (SD 1.1); authoritarian teachers, 1.8 (SD 1.2); inadequate school time-tabling, 2.0 (SD 1.1); and overemphasis on factual learning, 2.0 (SD 1.0). There were no statistically significant differences in DREEM scores between gender, age, minority, and ethnicity groups.

CONCLUSIONS

In general, students perceived that a sound educational environment is fostered by the institution and its educational program for all students despite their demographic variations. However, certain specific elements of the educational process may need to be addressed to improve the educational experience.

Medical professionalism: what does the public think?

In the context of professionalism being viewed increasingly as a social contract, a survey was conducted to investigate the importance placed by the general public on doctors' professional attributes. A quota sample of 953 responded to a 55-item online inventory of professional attributes. The quotas closely represented the national census. The majority of the highly important attributes focused on the relationship with patients. Statistically, the responses emerged as a three-facet model (clinicianship, workmanship and citizenship) of medical professionalism. The general public did not equate professionalism with social standing, wealth production, physique or appearance. They recognised doctors as professionals by their good behaviour, high values and positive attitudes as clinicians, workmen and citizens. Although, their preference of professional attributes varied with the setting, eg patient consultation, working with others and behaving in society, they expected doctors to be confident, reliable, dependable, composed, accountable and dedicated across all settings.