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Kearney M, Downing M, Gignac EA. Research integrity and academic medicine: the pressure to publish and research misconduct. J Osteopath Med 2024; 124:187-194. [PMID: 38407191 DOI: 10.1515/jom-2023-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 02/27/2024]
Abstract
CONTEXT This narrative review article explores research integrity and the implications of scholarly work in medical education. The paper describes how the current landscape of medical education emphasizes research and scholarly activity for medical students, resident physicians, and faculty physician educators. There is a gap in the existing literature that fully explores research integrity, the challenges surrounding the significant pressure to perform scholarly activity, and the potential for ethical lapses by those involved in medical education. OBJECTIVES The objectives of this review article are to provide a background on authorship and publication safeguards, outline common types of research misconduct, describe the implications of publication in medical education, discuss the consequences of ethical breaches, and outline possible solutions to promote research integrity in academic medicine. METHODS To complete this narrative review, the authors explored the current literature utilizing multiple databases beginning in June of 2021, and they completed the literature review in January of 2023. To capture the wide scope of the review, numerous searches were performed. A number of Medical Subject Headings (MeSH) terms were utilized to identify relevant articles. The MeSH terms included "scientific misconduct," "research misconduct," "authorship," "plagiarism," "biomedical research/ethics," "faculty, medical," "fellowships and scholarships," and "internship and residency." Additional references were accessed to include medical school and residency accreditation standards, residency match statistics, regulatory guidelines, and standard definitions. RESULTS Within the realm of academic medicine, research misconduct and misrepresentation continue to occur without clear solutions. There is a wide range of severity in breaches of research integrity, ranging from minor infractions to fraud. Throughout the medical education system in the United States, there is pressure to publish research and scholarly work. Higher rates of publications are associated with a successful residency match for students and academic promotion for faculty physicians. For those who participate in research misconduct, there is a multitude of potential adverse consequences. Potential solutions to ensure research integrity exist but are not without barriers to implementation. CONCLUSIONS Pressure in the world of academic medicine to publish contributes to the potential for research misconduct and authorship misrepresentation. Lapses in research integrity can result in a wide range of potentially adverse consequences for the offender, their institution, the scientific community, and the public. If adopted, universal research integrity policies and procedures could make major strides in eliminating research misconduct in the realm of academic medicine.
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Affiliation(s)
- Molly Kearney
- 364432 Campbell University School of Osteopathic Medicine , Lillington, NC, USA
| | - Maren Downing
- 364432 Campbell University School of Osteopathic Medicine , Lillington, NC, USA
| | - Elizabeth A Gignac
- Chair of Simulation and Clinical Education and Chair of Emergency Medicine, Leon Levine Hall of Medical Science, 364432 Campbell University School of Osteopathic Medicine , Lillington, NC, USA
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Bockrath R, Osman C, Trainor J, Wang HC, Phatak UP, Richards DG, Keeley M, Chung EK. Education Scholarship Assessment Reconsidered: Expansion of Glassick's Criteria to Incorporate Health Equity. Acad Med 2024; 99:487-492. [PMID: 38306582 DOI: 10.1097/acm.0000000000005654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
ABSTRACT Recent events have ignited widespread attention to structural racism and implicit bias throughout the U.S. health care system and medical institutions, resulting in a call for antiracism approaches to advance health equity. Medical education leaders are well positioned to advance health equity, not only through their training of fellows, residents, and medical students, but also in their approach to scholarship. Education scholarship drives innovation and critical evaluation of current practices; it impacts and intersects with multiple factors that have the potential to reduce health inequities. Thus, it is critical to prioritize the assessment of education scholarship through a health equity lens. Medical education scholarly dissemination has markedly expanded over the past 2 to 3 decades, yet medical educators have continued to embrace Boyer's and Glassick and colleagues' definitions of scholarship. The authors propose an approach to medical education scholarship assessment that expands each of Glassick's 6 existing criteria to address health inequities and adds health equity as a seventh criterion. With this, medical educators, researchers, reviewers, and others can consider how education scholarship affects diverse populations and settings, direct educational products and scholarship to address health inequities, and raise the importance of advancing health equity in medical education scholarship. By expanding and standardizing the assessment of scholarship to incorporate health equity, the medical education community can foster a cultural shift that brings health equity to the forefront of education scholarship.
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Adler AV, Nadone HR, Dafinone ME, Facemyer KC. Social justice in medical education: a student-led approach to addressing COVID-19 vaccine equity in the Hispanic/Latinx community. Med Educ Online 2023; 28:2241169. [PMID: 37499134 PMCID: PMC10375929 DOI: 10.1080/10872981.2023.2241169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/28/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023]
Abstract
The current healthcare system disproportionately affects vulnerable populations, leading to disparities in health outcomes. As a result, medical schools need to equip future physicians with the tools to identify and address healthcare disparities. The University of Nevada, Reno School of Medicine implemented a Scholarly Concentration in Medical Social Justice (SCiMSJ) program to address this issue. Three medical students joined the program and pioneered a project to address the equitable vaccine distribution within the local Hispanic/Latinx community. After identifying the disparity in vaccine uptake and high levels of vaccine hesitancy, they collaborated with local organizations to address vaccine misinformation and accessibility. They organized outreach events, provided vaccine education, and hosted a vaccine clinic at a Catholic church with a high Hispanic/Latinx congregation. Through their efforts, they administered 1,456 vaccines. The estimated economic and societal impacts of their work was 879 COVID-19 cases avoided, 5 deaths avoided, 45 life years saved, and $29,286 in economic value. The project's success highlights the effectiveness of a student-led approach to promote skill development in social justice training. Leadership skills and coalition building were crucial in overcoming resource limitations and connecting organizations with the necessary volunteer force. Building trust with the Hispanic/Latinx community through outreach efforts and addressing vaccine hesitancy contributed to the well-attended vaccine clinic. The project's framework and approach can be adopted by other medical students and organizations to address health disparities and improve health outcomes in their communities.
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Affiliation(s)
- Audrey V. Adler
- University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Haley R. Nadone
- University of Nevada, Reno School of Medicine, Reno, Nevada, USA
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Hussain T, Namvar S, Jones M. Authentic Pathology Specimen Reception: A Valuable Resource for Developing Biomedical Science Student Competencies and Employability. Br J Biomed Sci 2023; 80:11731. [PMID: 37818106 PMCID: PMC10561093 DOI: 10.3389/bjbs.2023.11731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/15/2023] [Indexed: 10/12/2023]
Abstract
Background/Introduction: The pathology specimen reception is fundamental to the services provided by Biomedical Science laboratories worldwide. To ensure patient safety and that samples are of adequate quality to send for analysis, prospective Biomedical Scientists should have a robust knowledge of the processes involved and the acceptance criteria of the pathology specimen reception. This knowledge has been highlighted by employers as a current gap in Biomedical Science graduates and therefore needs to be addressed within higher education settings. To do this, this study aimed to 1) design a practical session to simulate the key processes of the pathology specimen reception and 2) to understand Biomedical Science students' opinions on these activities and the development of transferable skills required for post-graduate employment. Methods: The practical session was designed based on industrial requirements and academic knowledge of student skill sets to ensure suitability. Qualitative information regarding participant demographics and career interests was acquired through open-answer or multiple-choice questions. Quantitative student feedback was acquired via questionnaires utilising a 5-point Likert scale (n = 77). Results: The scenario-based practical session provided students with a positive learning experience with 98.7% of participants enjoying the session, with 87.0% stating they learned a lot by completing the session. It was also identified that participants preferred this style of learning to that of conventional higher education teaching modalities with 97.4% stating they would prefer simulated employment focussed scenarios embedded into the curriculum more often. The majority of participants also thought this session was helpful for the development of their key transferrable skills including teamworking, communication, and confidence. When stratified based on demographic data, there was minimal difference between cohorts and in the majority of cases, those participants from non-traditional university entry backgrounds had a more positive experience and better transferable skill development following the completion of this style of learning experience. Conclusion: This study highlights simulation-based learning as a tool to develop core Biomedical Science knowledge, build student graduate capital, and ensure the preparedness of students for post-graduation employment.
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Affiliation(s)
- T. Hussain
- School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
| | - S. Namvar
- School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
- Biomedical Research Centre, School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
- Faculty of Biology Medicine and Health, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - M. Jones
- School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
- Biomedical Research Centre, School of Science, Engineering and Environment, University of Salford, Manchester, United Kingdom
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Tavakol M, O'Brien D, Stewart C. Determining intra-standard-setter inconsistency in the Angoff method using the three-parameter item response theory. Int J Med Educ 2023; 14:123-130. [PMID: 37678838 PMCID: PMC10693949 DOI: 10.5116/ijme.64ed.e296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
Objectives To measure intra-standard-setter variability and assess the variations between the pass marks obtained from Angoff ratings, guided by the latent trait theory as the theoretical model. Methods A non-experimental cross-sectional study was conducted to achieve the purpose of the study. Two knowledge-based tests were administered to 358 final-year medical students (223 females and 135 males) as part of their normal summative programme of assessments. The results of judgmental standard-setting using the Angoff method, which is widely used in medical schools, were used to determine intra-standard-setter inconsistency using the three-parameter item response theory (IRT). Permission for this study was granted by the local Research Ethics Committee of the University of Nottingham. To ensure anonymity and confidentiality, all identifiers at the student level were removed before the data were analysed. Results The results of this study confirm that the three-parameter IRT can be used to analyse the results of individual judgmental standard setters. Overall, standard-setters behaved fairly consistently in both tests. The mean Angoff ratings and conditional probability were strongly positively correlated, which is a matter of inter-standard-setter validity. Conclusions We recommend that assessment providers adopt the methodology used in this study to help determine inter and intra-judgmental inconsistencies across standard setters to minimise the number of false positive and false negative decisions.
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Affiliation(s)
- Mohsen Tavakol
- Medical Education Centre, School of Medicine, The University of Nottingham, UK
| | - David O'Brien
- Medical Education Centre, School of Medicine, The University of Nottingham, UK
| | - Claire Stewart
- Medical Education Centre, School of Medicine, The University of Nottingham, UK
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Abstract
This Viewpoint discusses how states’ restrictions on abortion will affect medical students’ training in providing reproductive health care and also create moral distress by being forced to provide care that may harm patients.
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Affiliation(s)
- Biftu Mengesha
- Innovating Education in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Nikki Zite
- Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville
| | - Jody Steinauer
- Kenneth J. Ryan Residency Training Program in Abortion and Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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Training in Sociology and Public Health an Essential in Medical Education. JAMA 2022; 328:401. [PMID: 35881134 DOI: 10.1001/jama.2021.17065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ali HJR, Little SH, Faza NN. The Pandemic and Beyond: Innovation in Cardiovascular Training to Improve Quality of Education and Trainees’ Well-being. Methodist Debakey Cardiovasc J 2022; 18:78-86. [PMID: 35734158 PMCID: PMC9165684 DOI: 10.14797/mdcvj.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/26/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hyeon-Ju R Ali
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas, US
| | - Stephen H Little
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas, US
| | - Nadeen N Faza
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas, US
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Affiliation(s)
- Raja-Elie E Abdulnour
- From the University of Virginia School of Medicine and UVAHealth, Charlottesville (A.S.P.); and Boston Medical Center and Boston University School of Medicine, Boston (J.R.)
| | - Andrew S Parsons
- From the University of Virginia School of Medicine and UVAHealth, Charlottesville (A.S.P.); and Boston Medical Center and Boston University School of Medicine, Boston (J.R.)
| | - Daniel Muller
- From the University of Virginia School of Medicine and UVAHealth, Charlottesville (A.S.P.); and Boston Medical Center and Boston University School of Medicine, Boston (J.R.)
| | - Jeffrey Drazen
- From the University of Virginia School of Medicine and UVAHealth, Charlottesville (A.S.P.); and Boston Medical Center and Boston University School of Medicine, Boston (J.R.)
| | - Eric J Rubin
- From the University of Virginia School of Medicine and UVAHealth, Charlottesville (A.S.P.); and Boston Medical Center and Boston University School of Medicine, Boston (J.R.)
| | - Joseph Rencic
- From the University of Virginia School of Medicine and UVAHealth, Charlottesville (A.S.P.); and Boston Medical Center and Boston University School of Medicine, Boston (J.R.)
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Affiliation(s)
- Peter Davey
- University of Dundee Medical School, Dundee, UK
| | | | - Vicki Tully
- University of Dundee Medical School, Dundee, UK
- Patient Safety Team, NHS Tayside
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Brünahl CA, Hinding B, Eilers L, Höck J, Hollinderbäumer A, Buggenhagen H, Reschke K, Schultz JH, Jünger J. Implementing and optimizing a communication curriculum in medical teaching: Stakeholders’ perspectives. PLoS One 2022; 17:e0263380. [PMID: 35130309 PMCID: PMC8820607 DOI: 10.1371/journal.pone.0263380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The relevance of communication in medical education is continuously increasing. At the Medical Faculty of Hamburg, the communication curriculum was further developed and optimized during this project. This article aims to describe the stakeholders’ perceived challenges and supporting factors in the implementation and optimization processes. Methods The initial communication curriculum and its development after a one-year optimization process were assessed with a curricular mapping. A SWOT analysis and group discussions were carried out to provide information on the need for optimization and on challenges the different stakeholders faced. Results The curricular mapping showed that the communication curriculum is comprehensive, coherent, integrated and longitudinal. In both the implementation and the project-related optimization processes, support from the dean, cooperation among all stakeholders and structural prerequisites were deemed the most critical factors for successfully integrating communication content into the curriculum. Conclusion The initiative and support of all stakeholders, including the dean, teachers and students, were crucial for the project’s success. Practice implications Although the implementation of a communication curriculum is recommended for all medical faculties, their actual implementation processes may differ. In a “top-down” and “bottom-up” approach, all stakeholders should be continuously involved in the process to ensure successful integration.
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Affiliation(s)
- Christian Andreas Brünahl
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP), Mainz, Germany
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail: ,
| | - Barbara Hinding
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP), Mainz, Germany
| | - Leonie Eilers
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP), Mainz, Germany
| | - Jennifer Höck
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Hollinderbäumer
- Rudolf Frey Lernklinik, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Holger Buggenhagen
- Rudolf Frey Lernklinik, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Kirsten Reschke
- University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital Magdeburg, Magdeburg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jana Jünger
- The German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP), Mainz, Germany
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Affi Koprowski M, Dickinson KJ, Johnson-Mann CN, Godfrey M, Diego EJ, Crandall M, Pei KY. Cross-mentorship: A Unique Lens Into the Realities and Challenges of Diversity in Surgery. Ann Surg 2022; 275:e6-e7. [PMID: 34520426 DOI: 10.1097/sla.0000000000005213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Karen J Dickinson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Crystal N Johnson-Mann
- Division of Gastrointestinal Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Martha Godfrey
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Emilia J Diego
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Marie Crandall
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Kevin Y Pei
- Department of Surgery, Parkview Health Graduate Medical Education, Fort Wayne, IN
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Doyle JM, Baiocchi MT, Kiernan M. Downstream funding success of early career researchers for resubmitted versus new applications: A matched cohort. PLoS One 2021; 16:e0257559. [PMID: 34793439 PMCID: PMC8601543 DOI: 10.1371/journal.pone.0257559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Early career researchers face a hypercompetitive funding environment. To help identify effective intervention strategies for early career researchers, we examined whether first-time NIH R01 applicants who resubmitted their original, unfunded R01 application were more successful at obtaining any R01 funding within 3 and 5 years than original, unfunded applicants who submitted new NIH applications, and we examined whether underrepresented minority (URM) applicants differentially benefited from resubmission. Our observational study is consistent with an NIH working group’s recommendations to develop interventions to encourage resubmission. Methods and findings First-time applicants with US medical school academic faculty appointments who submitted an unfunded R01 application between 2000–2014 yielded 4,789 discussed and 7,019 not discussed applications. We then created comparable groups of first-time R01 applicants (resubmitted original R01 application or submitted new NIH applications) using optimal full matching that included applicant and application characteristics. Primary and subgroup analyses used generalized mixed models with obtaining any NIH R01 funding within 3 and 5 years as the two outcomes. A gamma sensitivity analysis was performed. URM applicants represented 11% and 12% of discussed and not discussed applications, respectively. First-time R01 applicants resubmitting their original, unfunded R01 application were more successful obtaining R01 funding within 3 and 5 years than applicants submitting new applications—for both discussed and not discussed applications: discussed within 3 years (OR 4.17 [95 CI 3.53, 4.93]) and 5 years (3.33 [2.82–3.92]); and not discussed within 3 years (2.81 [2.52, 3.13]) and 5 years (2.47 [2.22–2.74]). URM applicants additionally benefited within 5 years for not discussed applications. Conclusions Encouraging early career researchers applying as faculty at a school of medicine to resubmit R01 applications is a promising potential modifiable factor and intervention strategy. First-time R01 applicants who resubmitted their original, unfunded R01 application had log-odds of obtaining downstream R01 funding within 3 and 5 years 2–4 times higher than applicants who did not resubmit their original application and submitted new NIH applications instead. Findings held for both discussed and not discussed applications.
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Affiliation(s)
- Jamie Mihoko Doyle
- Division of Clinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, United States of America
- * E-mail:
| | - Michael T. Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Michaela Kiernan
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States of America
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White RM. Reaching for Harrison's and the Tuskegee Study of Untreated Syphilis. South Med J 2021; 114:723-725. [PMID: 34729619 DOI: 10.14423/smj.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cojab J. When We Needed His Wisdom More Than Ever. Acad Med 2021; 96:1579. [PMID: 34380929 DOI: 10.1097/acm.0000000000004355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Jimmy Cojab
- J. Cojab is an internist and clinical nutritionist, Hospital Angeles Lomas, Mexico City, Mexico;
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Helming AG, Adler DS, Keltner C, Igelman AD, Woodworth GE. The Content Quality of YouTube Videos for Professional Medical Education: A Systematic Review. Acad Med 2021; 96:1484-1493. [PMID: 33856363 DOI: 10.1097/acm.0000000000004121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To evaluate the content quality of YouTube videos intended for professional medical education based on quality rating tool (QRT) scores and determine if video characteristics, engagement metrics, or author type are associated with quality. METHOD The authors searched 7 databases for English-language studies about the quality of YouTube videos intended for professional medical education from each database's inception through April 2019. To be included, studies had to be published in 2005 (when YouTube was created) or later. Studies were classified according to the type of QRT used: externally validated, internally validated, or limited global. Study information and video characteristics and engagement metrics were extracted. Videos were classified by video author type. RESULTS Thirty-one studies were included in this review. Three studies used externally validated QRTs, 20 used internally validated QRTs, and 13 used limited global QRTs. Studies using externally validated QRTs had average scores/total possible scores of 1.3/4, 26/80, and 1.7/5. Among the 18 studies using internally validated QRTs, from which an average percentage of total possible QRT score could be computed or extracted, the average score was 44% (range: 9%-71%). Videos with academic-physician authors had higher internally validated QRT mean scores (46%) than those with nonacademic-physician or other authors (26%; P < .05). CONCLUSIONS The authors found a wide variation in QRT scores of videos, with many low QRT scores. While videos authored by academic-physicians were of higher quality on average, their quality still varied significantly. Video characteristics and engagement metrics were found to be unreliable surrogate measures of video quality. A lack of unifying grading criteria for video content quality, poor search algorithm optimization, and insufficient peer review or controls on submitted videos likely contributed to the overall poor quality of YouTube videos that could be used for professional medical education.
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Affiliation(s)
- Andrew G Helming
- A.G. Helming is currently incoming resident physician, Department of Diagnostic Radiology, Oregon Health and Sciences University School of Medicine, Portland, Oregon. At the time of writing, he was a fourth-year medical student, Oregon Health and Sciences University School of Medicine, Portland, Oregon
| | - David S Adler
- D.S. Adler is currently incoming resident physician, Department of Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois. At the time of writing, he was a fourth-year medical student, Oregon Health and Sciences University School of Medicine, Portland, Oregon
| | - Case Keltner
- C. Keltner is currently incoming resident physician, Department of Preventative Medicine and Public Health, Madigan Army Medical Center, Tacoma, Washington. At the time of writing, he was a fourth-year medical student, Oregon Health and Sciences University School of Medicine, Portland, Oregon
| | - Austin D Igelman
- A.D. Igelman is a fourth-year medical student, Oregon Health and Sciences University School of Medicine, Portland, Oregon
| | - Glenn E Woodworth
- G.E. Woodworth is professor of anesthesiology and perioperative medicine, Oregon Health and Sciences University School of Medicine, Portland, Oregon; ORCID: http://orcid.org/0000-0002-1924-801X
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Kogan JR, Hauer KE, Holmboe ES. The Dissolution of the Step 2 Clinical Skills Examination and the Duty of Medical Educators to Step Up the Effectiveness of Clinical Skills Assessment. Acad Med 2021; 96:1242-1246. [PMID: 34166235 DOI: 10.1097/acm.0000000000004216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this Invited Commentary, the authors explore the implications of the dissolution of the Step 2 Clinical Skills Examination (Step 2 CS) for medical student clinical skills assessment. The authors describe the need for medical educators (at both the undergraduate and graduate levels) to work collaboratively to improve medical student clinical skills assessment to assure the public that medical school graduates have the requisite skills to begin residency training. The authors outline 6 specific recommendations for how to capitalize on the discontinuation of Step 2 CS to improve clinical skills assessment: (1) defining national, end-of-clerkship, and transition-to-residency standards for required clinical skills and for levels of competence; (2) creating a national resource for standardized patient, augmented reality, and virtual reality assessments; (3) improving workplace-based assessment through local collaborations and national resources; (4) improving learner engagement in and coproduction of assessments; (5) requiring, as a new standard for accreditation, medical schools to establish and maintain competency committees; and (6) establishing a national registry of assessment data for research and evaluation. Together, these actions will help the medical education community earn the public's trust by enhancing the rigor of assessment to ensure the mastery of skills that are essential to providing safe, high-quality care for patients.
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Affiliation(s)
- Jennifer R Kogan
- J.R. Kogan is associate dean, Student Success and Professional Development, and professor of medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-8426-9506
| | - Karen E Hauer
- K.E. Hauer is associate dean, Competency Assessment and Professional Standards, and professor of medicine, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045
| | - Eric S Holmboe
- E.S. Holmboe is chief, Research, Milestones Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0108-6021
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Abstract
The term "health systems science" (HSS) has recently emerged as a unifying label for competencies in health care delivery and in population and community health. Despite strong evidence that HSS competencies are needed in the current and future health care workforce, heretofore the integration of HSS into medical education has been slow or fragmented-due, in part, to a lack of evidence that these curricula improve education or population outcomes. The recent COVID-19 pandemic and the national reckoning with racial inequities in the United States further highlight the time-sensitive imperative to integrate HSS content across the medical education continuum. While acknowledging challenges, the authors highlight the unique opportunities inherent in an HSS curriculum and present an elaborated curricular framework for incorporating health care delivery and population health into undergraduate medical education. This framework includes competencies previously left out of medical education, increases the scope of faculty development, and allows for evidence of effectiveness beyond traditional learner-centric metrics. The authors apply a widely adopted 6-step approach to curriculum development to address the unique challenges of incorporating HSS. Two examples-of a module on quality improvement (health care delivery) and of an introductory course on health equity (population and community health)-illustrate how the 6-step approach can be used to build HSS curricula. The Supplemental Digital Appendix (at http://links.lww.com/ACADMED/B106) outlines this approach and provides specific examples and resources. Adapting these resources within local environments to build HSS curricula will allow medical educators to ensure future graduates have the expertise and commitment necessary to effect health systems change and to advocate for their communities, while also building the much-needed evidence for such curricula.
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Affiliation(s)
- Mamta K Singh
- M.K. Singh is professor of medicine, Jerome Kowal, MD Designated Professor for Geriatric Health Education, Veterans Affairs Northeast Ohio Healthcare System, and former assistant dean, Health Systems Science, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0001-8235-4272
| | - Heidi L Gullett
- H.L. Gullett is associate professor and Charles Kent Smith, MD and Patricia Hughes Moore, MD Professor in Medical Student Education in Family Medicine, Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-3984-517X
| | - Patricia A Thomas
- P.A. Thomas was, when this was written, professor of medicine, Amasa B. Ford Professor of Geriatrics, and vice dean, Medical Education, Case Western Reserve University School of Medicine, Cleveland, Ohio; she is currently professor of medicine emerita, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-4528-9891
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Abstract
The unexpected discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills (CS) exam in January 2021 carries both risks and opportunities for medical education in the United States. Step 2 CS had far-reaching effects on medical school curricula and school-based clinical skills assessments. Absent the need to prepare students for this high-stakes exam, will the rigor of foundational clinical skills instruction and assessment remain a priority at medical schools? In this article, the authors consider the potential losses and gains from the elimination of Step 2 CS and explore opportunities to expand local summative assessments beyond the narrow bounds of Step 2 CS. The responsibility for implementing a rigorous and credible summative assessment of clinical skills that are critical for patient safety as medical students transition to residency now lies squarely with medical schools. Robust human simulation (standardized patient) programs, including regional and virtual simulation consortia, can provide infrastructure and expertise for innovative and creative local assessments to meet this need. Novel applications of human simulation and traditional formative assessment methods, such as workplace-based assessments and virtual patients, can contribute to defensible summative decisions about medical students' clinical skills. The need to establish validity evidence for decisions based on these novel assessment methods comprises a timely and relevant focus for medical education research.
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Affiliation(s)
- Rachel Yudkowsky
- R. Yudkowsky is professor and director of graduate studies, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-2145-7582
| | - Karen Szauter
- K. Szauter is assistant dean of educational affairs, University of Texas Medical Branch, Galveston, Texas; ORCID: https://orcid.org/0000-0002-2064-3535
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Abstract
The United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) was discontinued in January 2021, marking a significant milestone in assessment of clinical skills. In this commentary, the authors trace the history of the Step 2 CS exam-beginning with its early roots in the 1960s up to its discontinuation in 2021. In this new era, the medical education community is replete with opportunities for advancing methodology and content associated with clinical skills assessment. The authors propose 3 main lessons gleaned from this rich history and modern evolution, which are aimed at defining a future that includes creative collaboration toward development of comprehensive, equitable, student-focused, and patient-centered clinical performance assessment. First, as it has done throughout history, the medical education community should continue to innovate, collaborate, and improve upon methods of clinical skills assessment. Second, medical educators should continue to shift to more complex and student-driven approaches of assessment, that is, assessments that provide an unstructured environment, are realistic with respect to the natural conditions, and do not limit students to lists of options or force them to take a certain path of reasoning. Third, medical educators should continue to rethink the role of assessment and ensure that all assessments, regardless of stakes or type, provide sufficient feedback for the student to identify areas of strength and weakness.
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Affiliation(s)
- Lisa D Howley
- L.D. Howley is senior director of strategic initiatives and partnership, Association of American Medical Colleges, Washington, DC, and adjunct associate professor, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Deborah L Engle
- D.L. Engle is assistant dean of assessment and evaluation and associate professor, Duke University School of Medicine, Durham, North Carolina
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Bobos P, Pouliopoulou DV, Harriss A, Sadi J, Rushton A, MacDermid JC. A systematic review and meta-analysis of measurement properties of objective structured clinical examinations used in physical therapy licensure and a structured review of licensure practices in countries with well-developed regulation systems. PLoS One 2021; 16:e0255696. [PMID: 34343213 PMCID: PMC8330929 DOI: 10.1371/journal.pone.0255696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Objective Structured Clinical Examination (OSCE) is a commonly used tool internationally to assess clinical competency. Physical therapy (PT) licensure processes vary internationally. The OSCE is the tool used in Canada to assess clinical competency for PT graduates seeking licensure. Previous studies that examined the measurement properties of OSCEs present contradictory results. OBJECTIVES The first objective was to investigate the reliability and validity of OSCEs when administered to PTs during their education or as part of a licensure process. The second objective was to conduct a structured review to report PT educational and licensing components and policies in 17 countries with well-developed PT regulation systems. METHODS An electronic search was performed in four databases from inception to 31st March 2021 to identify relevant articles. Two reviewers performed the critical appraisal of the included studies using a validated quality assessment tool. We deployed a random effects meta-analysis on reliability and validity estimates of OSCEs and examined sources of heterogeneity with univariate meta-regressions. We searched websites of professional regulatory bodies and associations for data on educational and licencing components and policies. Educational and licensing components across countries were synthesized descriptively. RESULTS A pooled estimate of Cronbach's alpha of 0.55, (95% CI: 0.41, 0.67) was determined for OSCEs. The pooled estimate of Intraclass Correlation Coefficient (ICC) between assessors was 0.77 (95% CI: 0.70, 0.83). The pooled estimate of Pearson Correlation between multiple OSCE stations' scores was 0.27 (95% CI: 0.15, 0.39); and between each station score and the total score was 0.71 (95% CI: 0.61, 0.79). The pooled estimates for kappa Coefficients were 0.75 (95% CI: 0.58, 0.86) and 0.84, (95% CI: 0.72, 0.91) for intra-rater and inter-rater reliability of the standardised patient respectively. From the 17 included countries, Canada (excluding Quebec) was the only country that required both a clinical and written competency exam following graduation from an accredited PT program. Two countries (USA, UAE) required a written competency exam. The remaining 14 countries did not require an additional competency examination after completion of degree requirements from an accredited program. CONCLUSIONS We found weak evidence that OSCE examinations items are internally consistent when used to assess PTs. Canada (excluding Quebec) is the only country out of 17 implementing a national clinical competency examination for their PT graduates to achieve licensure after completing professional degree requirements.
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Affiliation(s)
- Pavlos Bobos
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
- Department of Clinical Epidemiology and Health Care Research, Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Dimitra V. Pouliopoulou
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Harriss
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
| | - Jackie Sadi
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
| | - Joy C. MacDermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Lanier C, Muller-Juge V, Dominicé Dao M, Gaspoz JM, Junod Perron N, Audétat MC. Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary! PLoS One 2021; 16:e0254336. [PMID: 34283854 PMCID: PMC8291751 DOI: 10.1371/journal.pone.0254336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS OF THE STUDY Residents in difficulty are a major cause for concern in medical education, with a prevalence of 7-15%. They are often detected late in their training and cannot make use of remediation plans. Nowadays, most training hospitals in Switzerland do not have a specific program to identify and manage residents in difficulty. The aim of the study was to explore the challenges perceived by physicians regarding the process of identifying, diagnosing, and supporting residents in difficulty in a structured and programmatic way. We explored perceptions of physicians at different hierarchical levels (residents (R), Chief residents (CR), attending physicians (A), Chief Physician (CP)) in order to better understand these challenges. METHODS We conducted an exploratory qualitative study between December 2015 and July 2016. We asked volunteers from the Primary Care Division of the Geneva University Hospitals to partake to three focus groups (with CR, A, R) and one interview with the division's CP. We transcribed, coded, and qualitatively analyzed the three focus groups and the interview, using a content thematic approach and Fishbein's conceptual framework. RESULTS We identified similarities and differences in the challenges of the management of residents in difficulty on a programmatic way amongst physicians of different hierarchical levels. Our main findings: Supervisors (CR, A, CP) have good identification skills of residents in difficulty, but they did not put in place systematic remediation strategies.Supervisors (CR, A) were concerned about managing residents in difficulty. They were aware of the possible adverse effects on patient care, but "feared to harm" resident's career by documenting a poor institutional assessment.Residents "feared to share" their own difficulties with their supervisors. They thought that it would impact their career negatively.The four physician's hierarchical level reported environmental constraints (lack of funding, time constraint, lack of time and resources…). CONCLUSION Our results add two perspectives to specialized recommendations regarding the implementation of remediation programs for residents in difficulty. The first revolves around the need to identify and fully understand not only the beliefs but also the implicit norms and the feeling of self-efficacy that are shared by teachers and that are likely to motivate them to engage in the management of residents in difficulty. The second emphasizes the importance of analyzing these elements that constitute the context for a change and of identifying, in close contact with the heads of the institutions, which factors may favor or hinder it. This research action process has fostered awareness and discussions at different levels. Since then, various actions and processes have been put in place at the Faculty of Medicine in Geneva.
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Affiliation(s)
- Cédric Lanier
- Family Medicine Unit (UIGP), University of Geneva, Geneva, Switzerland
- * E-mail:
| | | | - Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Noëlle Junod Perron
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Marie-Claude Audétat
- Family Medicine Unit (UIGP), University of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
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27
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Affiliation(s)
| | - Sam Everington
- North East London Clinical Commissioning Group, London, UK
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28
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Gao J, Yang L, Zou J, Fan X. Comparison of the influence of massive open online courses and traditional teaching methods in medical education in China: A meta-analysis. Biochem Mol Biol Educ 2021; 49:639-651. [PMID: 33894023 DOI: 10.1002/bmb.21523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/17/2021] [Accepted: 04/19/2021] [Indexed: 05/11/2023]
Abstract
In the past 5 years, the MOOC-based teaching method has been extensively applied as an experimental educational method in medical education in China. However, the effects of this teaching method on medical education are still controversial and ambiguous. To assess the effectiveness of the MOOC-based teaching method in medical education in China, we conducted the meta-analysis. Literature search was performed through the PubMed, Embase, Web of Knowledge and CNKI databases through March 3, 2020. Studies evaluating the effectiveness of the MOOC-based teaching method in medical education in China were included in our meta-analysis. All data were pooled using a fixed- or random-effect model based on a heterogeneity test. Hedges' g was calculated to evaluate the effectiveness of the MOOC-based teaching method on the final exam knowledge scores of participants. Subgroup analyses were also carried out. There were 27 studies (25 records) identified in our meta-analysis. The final exam knowledge scores of participants were statistically higher in the MOOC group compared with the controls in medical courses in China (Hedges' g = 1.080, 95%CI 0.592-1.567, p < 0.001). Obvious heterogeneity across studies was found in the study. Further analysis demonstrated that a significant difference in favor of the MOOC-based teaching method compared with the traditional teaching method in medical students and doctors. The MOOC-based teaching method may be applicable to medical education in China, strengthening the roles of MOOCs in medical education.
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Affiliation(s)
- Junwei Gao
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ling Yang
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jiao Zou
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaotang Fan
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
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Abstract
BACKGROUND Medical education affects learner well-being. We explored the breadth and depth of interventions to improve the well-being of medical learners in Canada. METHODS We searched MEDLINE, EMBASE, CINAHL and PsycINFO from inception to July 11, 2020, using the Arksey-O'Malley, 5-stage, scoping review method. We included interventions to improve well-being across 5 wellness domains (i.e., social, mental, physical, intellectual, occupational) for medical learners in Canada, grouped as undergraduate or graduate nonmedical (i.e., health sciences) students, undergraduate medical students or postgraduate medical students (i.e., residents). We categorized interventions as targeting the individual (learner), program (i.e., in which learners are enrolled) or system (i.e., higher education or health care) levels. RESULTS Of 1753 studies identified, we included 65 interventions that aimed to improve well-being in 10 202 medical learners, published from 1972 through 2020; 52 (80%) were uncontrolled trials. The median year for intervention implementation was 2010 (range 1971-2018) and the median length was 3 months (range 1 h-48 mo). Most (n = 34, 52%) interventions were implemented with undergraduate medical students. Two interventions included only undergraduate, nonmedical students; none included graduate nonmedical students. Most studies (n = 51, 78%) targeted intellectual well-being, followed by occupational (n = 32, 49%) and social (n = 17, 26%) well-being. Among 19 interventions implemented for individuals, 14 (74%) were for medical students; of the 27 program-level interventions, 17 (63%) were for resident physicians. Most (n = 58, 89%) interventions reported positive well-being outcomes. INTERPRETATION Many Canadian medical schools address intellectual, occupational and social well-being by targeting interventions at medical learners. Important emphasis on the mental and physical well-being of medical learners in Canada warrants further exploration.
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Affiliation(s)
- Stephana J Moss
- Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta.
| | - Krista Wollny
- Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta
| | - Mungunzul Amarbayan
- Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta
| | - Diane L Lorenzetti
- Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta
| | - Aliya Kassam
- Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta
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Kaul V, Gallo de Moraes A, Khateeb D, Greenstein Y, Winter G, Chae J, Stewart NH, Qadir N, Dangayach NS. Medical Education During the COVID-19 Pandemic. Chest 2021; 159:1949-1960. [PMID: 33385380 PMCID: PMC7772576 DOI: 10.1016/j.chest.2020.12.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022] Open
Abstract
All aspects of medical education were affected by the COVID-19 pandemic. Several challenges were experienced by trainees and programs alike, including economic repercussions of the pandemic; social distancing affecting the delivery of medical education, testing, and interviewing; the surge of patients affecting redeployment of personnel and potential compromises in core training; and the overall impact on the wellness and mental health of trainees and educators. The ability of medical teams and researchers to peer review, conduct clinical research, and keep up with literature was similarly challenged by the rapid growth in peer-reviewed and preprint literature. This article reviews these challenges and shares strategies that institutions, educators, and learners adopted, adapted, and developed to provide quality education during these unprecedented times.
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Affiliation(s)
- Viren Kaul
- Crouse Health/Upstate Medical University.
| | | | | | | | | | - JuneMee Chae
- Mayo Clinic Health System-Franciscan Healthcare at La Crosse
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Ramotshwana B, Gupta A, Seth S, Shah H. New Physicians, New Challenges: The Impact of Accelerated Graduation and Deployment Due to COVID-19. Acad Med 2021; 96:e15. [PMID: 33570852 DOI: 10.1097/acm.0000000000003996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Boitumelo Ramotshwana
- Third-year medical student, Aston University, Birmingham, United Kingdom; ; ORCID: https://orcid.org/0000-0001-9727-7396
| | - Arnick Gupta
- Third-year medical student, Aston University, Birmingham, United Kingdom; ORCID: https://orcid.org/0000-0002-9195-8948
| | - Sahil Seth
- Third-year medical student, University of Birmingham, Birmingham, United Kingdom; ORCID: https://orcid.org/0000-0003-3126-3826
| | - Haroon Shah
- Final-year medical student, University of Birmingham, Birmingham, United Kingdom; ORCID: https://orcid.org/0000-0001-8904-2300
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Sharma A, Sharma A. Discussion of DNACPR processes in medical education would improve practice. BMJ 2021; 373:n1045. [PMID: 33883122 DOI: 10.1136/bmj.n1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lottspeich C, Braun LT, Fischer MR, Schmidmaier R. Simulated ward round training in the medical curriculum Munich. GMS J Med Educ 2021; 38:Doc75. [PMID: 34056064 PMCID: PMC8136345 DOI: 10.3205/zma001471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/17/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Conducting a ward round in a structured and goal-oriented manner is one of the central competencies of a physician's work. Despite its relevance, ward round competence was only addressed in an unstructured way in the Medical Curriculum Munich (MeCuM) prior to 2011. Therefore, the project's aim was to implement an evidence-based course on medical ward round competence. This project report provides a guideline for developing such a training course. Project planning and development was guided by the steps of the "Kern cycle", beginning with needs assessment, learning objectives definition, and selection of appropriate teaching methods, and ending with implementation and evaluation.
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Affiliation(s)
- Christian Lottspeich
- Ludwig-Maximilians-Universität München, LMU Klinikum, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Leah T. Braun
- Ludwig-Maximilians-Universität München, LMU Klinikum, Medizinische Klinik und Poliklinik IV, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Klinikum, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
| | - Martin R. Fischer
- Ludwig-Maximilians-Universität München, LMU Klinikum, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
| | - Ralf Schmidmaier
- Ludwig-Maximilians-Universität München, LMU Klinikum, Medizinische Klinik und Poliklinik IV, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Klinikum, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
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Guinez-Molinos S, Gomar-Sancho C. Collaborative clinical simulation in cardiologic emergency scenarios for medical students. An exploratory study on model applicability and assessment instruments. GMS J Med Educ 2021; 38:Doc76. [PMID: 34056065 PMCID: PMC8136348 DOI: 10.3205/zma001472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/01/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Aims: This paper evaluates the feasibility of piloting the collaborative clinical simulation (CCS) model and its assessment instruments applicability for measuring interpersonal, collaborative, and clinical competencies in cardiologic emergency scenarios for medical students. The CCS model is a structured learning model for the acquisition and assessment of clinical competencies through small groups working collaboratively to design and perform in simulated environments supported by technology. Methods: Fifty-five students were allocated in five sessions (one weekly session) conducted with the CCS model within the course Cardiovascular Diseases. The applied practice aimed at the diagnosis and treatment of tachyarrhythmias in a simulated emergency department. In addition to the theoretical classes four weeks before the simulation sessions, students were sent a study guide that summarized the Guide to the European Society of Cardiology. For each simulation session, one clinical simulation instructor, one cardiologist teacher, and the principal investigator participated. Students were divided into three groups (3-5 students) for each-session. They designed, performed, role-played, and debriefed three different diagnoses. Three instruments to assess each group's performance were applied: peer assessment used by groups, performance assessment, created and applied by the cardiologist teacher, and individual satisfaction questionnaire for students. Results: The applicability of the CCS model was satisfactory for both students and teachers. The assessment instruments' internal reliability was good, as was internal consistency with a Cronbach Alpha of 0.7, 0.4, and 0.8 for each section (Interpersonal, Clinical, and Collaborative competencies, respectively). The performance group's evaluation was 0.8 for the two competencies assessed (Tachyarrhythmia and Electrical Cardioversion) and 0.8 for the satisfaction questionnaire's reliability. Conclusions: The CCS model for teaching emergency tachyarrhythmias to medical students was applicable and well accepted. The internal reliability of the assessment instruments was considered satisfactory by measuring satisfaction and performance in the exploratory study.
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Affiliation(s)
- Sergio Guinez-Molinos
- Universidad de Talca, School of Medicine, Center of Clinical Simulation, Talca; Región del Maule, Chile
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Nakae S, Porfeli EJ, Davis D, Grabowski CJ, Harrison LE, Amiri L, Ross W. Enrollment Management in Undergraduate Medical School Admissions: A Complementary Framework to Holistic Review for Increasing Diversity in Medicine. Acad Med 2021; 96:501-506. [PMID: 33298697 DOI: 10.1097/acm.0000000000003866] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Medical schools implemented holistic review more than a decade ago, which led to more deliberate consideration and inclusion of applicants historically underrepresented in medicine. This article presents a theory of holistic enrollment management that unites holistic review with enrollment management principles. This theory contextualizes medical school admissions as a complex marketplace with multifaceted, competing forces. Applying an enrollment management framework of mission, market, means, and metrics can improve the capacity of a medical school to efficiently advance its mission over time. Medical schools employing a clear, compelling, and focused mission to direct all aspects of the medical education enterprise can more effectively attract applicants who are better prepared to enact that mission throughout their careers. Medical schools share a marketplace and collectively compete to identify, attract, admit, and matriculate the most mission-aligned student body within the pool of applicants they share. Institutions that deliberately mobilize resources within this dynamic marketplace will engage, admit, and matriculate the most suiting applicants and attract even more mission-aligned matriculants over time. Widespread adoption of this holistic framework of enrollment management may enhance the capacity of the medical education system to better capitalize on the existing diversity in the national pool of applicants, encourage more underrepresented applicants to apply in the future, admit and matriculate a more diverse national student body, and ultimately better prepare new physicians to meet the increasingly diverse health care needs of the nation.
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Affiliation(s)
- Sunny Nakae
- S. Nakae is senior associate dean for equity, inclusion, diversity and partnership, and associate professor of medical education, California University of Science and Medicine, Colton, California
| | - Erik J Porfeli
- E.J. Porfeli is professor and chair, Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Dwight Davis
- D. Davis is professor of medicine and senior associate dean for admissions and student affairs, Penn State College of Medicine, Hershey, Pennsylvania
| | - Christina J Grabowski
- C.J. Grabowski is associate dean for admissions and enrollment management, and assistant professor of medical education, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Leila E Harrison
- L.E. Harrison is senior associate dean for admissions, and student affairs and clinical assistant professor, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington
| | - Leila Amiri
- L. Amiri is assistant dean for admissions and recruitment, Office of the Dean, University of Illinois College of Medicine, Chicago, Illinois
| | - Will Ross
- W. Ross is associate dean for diversity, principal officer for community partnerships, and alumni endowed professor of medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri
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Zimmermann A, Baerwald C, Fuchs M, Girbardt C, Götze H, Hempel G, von Klitzing K, Rotzoll D. The Longitudinal Communication Curriculum at Leipzig University, Medical Faculty - implementation and first experiences. GMS J Med Educ 2021; 38:Doc58. [PMID: 33824894 PMCID: PMC7994878 DOI: 10.3205/zma001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/20/2020] [Accepted: 09/21/2020] [Indexed: 06/12/2023]
Abstract
Purpose: Communication skills are an essential instrument for building a sustainable patient-doctor-relationship for future doctors. They are learnable and teachable. The learning should be facilitated with the help of a longitudinal curriculum, which is planned at Leipzig University. Project: At the Medical Faculty of Leipzig University, the Longitudinal Communication Curriculum is established since 2016/17. Up to now, the curriculum consists of four parts in which students repeatedly practise their communication skills in curricular and extracurricular courses. Several formats help to teach an integrated learning of communication and physical examination skills. Assessment of communication skills is also performed. Curricular implementation is accompanied by concomitant evaluation. Results: Three parts of the curriculum already have taken place. Students report an increase in communication skills. Students rate the units as instructive and helpful. The assessment of communication skills occurs in two clinical practical examinations (OSCEs). Together with summative assessment a formative feedback was implemented. Students judge this practice as highly positive. Discussion: The curriculum is part of undergraduate medical education in Leipzig. It would be beneficial to add another simulated patient encounter, as well as interprofessional units. Student questionnaires will be evaluated and results will help to develop the curriculum. Conclusion: Consolidation of the curriculum accompanied by evaluation and adaption of content can help to assure the quality of the curriculum. Additional professions and study units shall be integrated in the Longitudinal Communication Curriculum in the future.
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Affiliation(s)
- Anja Zimmermann
- University of Leipzig, Medical Faculty, LernKlinik Leipzig, Skills and Simulation Centre, Leipzig, Germany
- University of Leipzig, Medical Faculty, Centre for Didactics in Medicine, Leipzig, Germany
| | - Christoph Baerwald
- University of Leipzig Medical Centre, Medical Department III – Endocrinology, Nephrology, Rheumatology, Leipzig, Germany
| | - Michael Fuchs
- University of Leipzig Medical Centre, Department of Otorhinolaryngology, Head and Neck Surgery – Division of Phoniatrics and Audiology, Leipzig, Germany
| | - Christian Girbardt
- University of Leipzig Medical Centre, Department of Ophthalmology, Leipzig, Germany
| | - Heide Götze
- University of Leipzig, Medical Faculty, Division of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Gunther Hempel
- University of Leipzig Medical Centre, Department of Anaesthesiology and Intensive Care, Leipzig, Germany
| | - Kai von Klitzing
- University of Leipzig Medical Centre, Department of Paediatric Psychiatry, Psychotherapy and Psychosomatics, Leipzig, Germany
| | - Daisy Rotzoll
- University of Leipzig, Medical Faculty, LernKlinik Leipzig, Skills and Simulation Centre, Leipzig, Germany
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Snekalatha S, Marzuk SM, Meshram SA, Maheswari KU, Sugapriya G, Sivasharan K. Medical students' perception of the reliability, usefulness and feasibility of unproctored online formative assessment tests. Adv Physiol Educ 2021; 45:84-88. [PMID: 33529145 DOI: 10.1152/advan.00178.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/27/2020] [Accepted: 11/11/2020] [Indexed: 05/24/2023]
Abstract
Medical education has gone online because of the COVID-19 pandemic. Formative assessment is essential to facilitate the learning process in medical education. However, various challenges arise during online assessment, which include reliability, when done without monitoring and practical concerns like Internet connectivity issues. This study was done to assess the medical students' perceptions of the reliability, usefulness, and practical challenges of online tests. One hundred first-year undergraduate medical students taking up online classes and tests in the subject of physiology were enrolled in this study. A questionnaire with items regarding practical challenges, reliability, and usefulness of the online tests, in general, and about different types of online assessment methods, in particular, were sent to the students online. Each item was rated on a five-point Likert scale, and the responses were analyzed anonymously. A large percentage of students used mobile phones (81.4%) to undertake online tests. Although most students (73.2%; P < 0.001) felt that online tests helped them substantially in learning the subject, network connectivity issues were considered to be a matter of serious concern (85.5%, P < 0.001). Among the assessment methods used, viva voce by video conferencing was thought to be most reliable (83%, P < 0.001). Multiple-choice question-based assessment when done online was felt to be more practically feasible with faster feedback than classroom assessment. The results of the study suggest that medical students find online formative assessments helpful for their learning, despite their concerns about reliability and practical challenges.
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Affiliation(s)
- S Snekalatha
- Department of Physiology, ESIC Medical College and Post Graduate Institute of Medical Science and Research, Chennai, India
| | - S Mohamed Marzuk
- Department of Physiology, ESIC Medical College and Post Graduate Institute of Medical Science and Research, Chennai, India
| | - Swapnatai A Meshram
- Department of Physiology, ESIC Medical College and Post Graduate Institute of Medical Science and Research, Chennai, India
| | - K Uma Maheswari
- Department of Physiology, ESIC Medical College and Post Graduate Institute of Medical Science and Research, Chennai, India
| | - G Sugapriya
- Department of Physiology, ESIC Medical College and Post Graduate Institute of Medical Science and Research, Chennai, India
| | - K Sivasharan
- Department of Physiology, ESIC Medical College and Post Graduate Institute of Medical Science and Research, Chennai, India
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Lim GHT, Sibanda Z, Erhabor J, Bandyopadhyay S. Students' perceptions on race in medical education and healthcare. Perspect Med Educ 2021; 10:130-134. [PMID: 33415681 PMCID: PMC7790028 DOI: 10.1007/s40037-020-00645-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 05/23/2023]
Abstract
Major racial disparities continue to exist in our healthcare education, from the underrepresentation of ethnic minorities when teaching about clinical signs to health management in primary and secondary care. A multi-centre group of students discuss what needs to change in medical education to cultivate physicians who are better prepared to care for patients of all backgrounds. We argue that the accurate portrayal of race in medical education is a vital step towards educating medical students to consider alternative explanations to biology when considering health inequities.
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Affiliation(s)
- Guan Hui Tricia Lim
- University College London Medical School, University College London, London, UK
| | | | | | - Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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40
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Kim YC. Korean Institute of Medical Education and Evaluation Presidential Address: the role of KIMEE as a medical education accreditation agency during the coronavirus disease 2019 pandemic. J Educ Eval Health Prof 2021; 18:2. [PMID: 33621459 PMCID: PMC7985295 DOI: 10.3352/jeehp.2021.18.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/15/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Young Chang Kim
- President, Korean Institute of Medical Education and Evaluation, Seoul, Korea
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Denizon Arranz S, Blanco Canseco JM, Pouplana Malagarriga MM, Holgado Catalán MS, Gámez Cabero MI, Ruiz Sánchez A, Monge Martín D, Ruiz Moral R, Álvarez Montero S. Multi-source evaluation of an educational program aimed at medical students for interviewing/taking the clinical history using standardized patients. GMS J Med Educ 2021; 38:Doc40. [PMID: 33763525 PMCID: PMC7958917 DOI: 10.3205/zma001436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 09/03/2020] [Accepted: 10/19/2020] [Indexed: 06/12/2023]
Abstract
Introduction: Simulations with standardized patients (SP) have long been used for teaching/assessing communication skills. The present study describes and evaluates an experiential training methodology aimed at medical students and based on interviews with standardized simulated patients. The training was focused on developing basic communication skills and taking medical histories. Methods: Longitudinal observational study of a cohort of third-year medical students. Three interviews with SP were carried out and videotaped. These interviews were assessed by the students, the SPs and the professors of the relevant subject areas. Results: 83 students conducted the interviews. The self-evaluations performed by the students showed an improvement between the first and third interviews, as demonstrated by the increase of 6.7% (CI 95%=3.6-10.0%) (p<0.001) in the percentage of detected items. The SPs stated an improvement of 8.5% (CI 95%=2.9-14.1) (p=0.003) from the first to the third interview regarding the percentage of students that showed a level of interest in, and ease with, the patients' concerns. Finally, the teachers found a mean percentage of items identified in the third written clinical history of 61.4% (CI 95%=59.1-63.7) of the total available. Conclusions: This educational program, carried out with standardized simulated patients, showed positive signs of improvement from the first to the third interview, in both the student self-evaluations and the level of interest and ease perceived by the SPs. Additionally, the mean level of information recorded in the written medical histories was considered to be acceptable.
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Affiliation(s)
- Sophia Denizon Arranz
- Francisco de Vitoria University, Faculty of Health Sciences, School of Medicine, Madrid, Spain
| | | | | | | | | | - Antonio Ruiz Sánchez
- Francisco de Vitoria University, Faculty of Health Sciences, School of Medicine, Madrid, Spain
| | - Diana Monge Martín
- Francisco de Vitoria University, Faculty of Health Sciences, School of Medicine, Madrid, Spain
| | - Roger Ruiz Moral
- Francisco de Vitoria University, Faculty of Health Sciences, School of Medicine, Madrid, Spain
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Ziegler S, Wahedi K, Stiller M, Jahn R, Straßner C, Schwill S, Bozorgmehr K. Health and medical care for refugees: design and evaluation of a multidisciplinary clinical elective for medical students. GMS J Med Educ 2021; 38:Doc39. [PMID: 33763524 PMCID: PMC7958918 DOI: 10.3205/zma001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 09/30/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
Objective: Caring for refugee patients places special demands on health professionals. To date, medical students in Germany have rarely been systematically prepared for these challenges. This article reports on the development, conceptualisation, implementation, evaluation, and relevance of a multidisciplinary elective for medical students in the clinical study phase. Methodology: The course content was developed based on a needs-assessment among medical students and in cooperation with medical colleagues working in the field of refugee care. The course consisted of a seminar with medical, legal, administrative and socio-cultural learning content as well as a field placement in the medical outpatient clinic of the local reception centre for asylum seekers, which was accompanied by a systematic reflection process. The evaluation concept contained qualitative and quantitative elements. Results: 123 students completed the elective over six semesters (summer 2016 through to winter 2018). It was continuously evaluated and further developed. The students reported learning progress mainly in the following areas: Legal foundations of the asylum procedure and health care entitlements for asylum seekers; multi-perspectivity through multidisciplinarity as well as professional, ethical, interpersonal, and political insights gained through the practical experience. Summary: To prepare students for the complex challenges to be faced in medical care for refugees, a structured, multidisciplinary teaching programme, which combines theory, practice and reflection helps to foster insights into the many facets of this field of activity. The questions students brought to the seminar, the course contents and evaluation results are intended to inspire the design and implementation of similar courses at other universities.
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Affiliation(s)
- Sandra Ziegler
- Heidelberg University Hospital, Section Health Equity Studies & Migration, Department of General Medicine and Health Services Research, Heidelberg, Germany
| | - Katharina Wahedi
- Heidelberg University Hospital, Section Health Equity Studies & Migration, Department of General Medicine and Health Services Research, Heidelberg, Germany
| | - Mariella Stiller
- Heidelberg University Hospital, Section Health Equity Studies & Migration, Department of General Medicine and Health Services Research, Heidelberg, Germany
| | - Rosa Jahn
- Heidelberg University Hospital, Section Health Equity Studies & Migration, Department of General Medicine and Health Services Research, Heidelberg, Germany
| | - Cornelia Straßner
- Heidelberg University Hospital, Section Health Equity Studies & Migration, Department of General Medicine and Health Services Research, Heidelberg, Germany
| | - Simon Schwill
- Heidelberg University Hospital, Section Health Equity Studies & Migration, Department of General Medicine and Health Services Research, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Heidelberg University Hospital, Section Health Equity Studies & Migration, Department of General Medicine and Health Services Research, Heidelberg, Germany
- Bielefeld University, School of Public Health, Department of Population Medicine and Health Services Research, Bielefeld, Germany
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Ten Cate O, Carraccio C, Damodaran A, Gofton W, Hamstra SJ, Hart DE, Richardson D, Ross S, Schultz K, Warm EJ, Whelan AJ, Schumacher DJ. Entrustment Decision Making: Extending Miller's Pyramid. Acad Med 2021; 96:199-204. [PMID: 33060399 DOI: 10.1097/acm.0000000000003800] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The iconic Miller's pyramid, proposed in 1989, characterizes 4 levels of assessment in medical education ("knows," "knows how," "shows how," "does"). The frame work has created a worldwide awareness of the need to have different assessment approaches for different expected outcomes of education and training. At the time, Miller stressed the innovative use of simulation techniques, geared at the third level ("shows how"); however, the "does" level, assessment in the workplace, remained a largely uncharted area. In the 30 years since Miller's conference address and seminal paper, much attention has been devoted to procedures and instrument development for workplace-based assessment. With the rise of competency-based medical education (CBME), the need for approaches to determine the competence of learners in the clinical workplace has intensified. The proposal to use entrustable professional activities as a framework of assessment and the related entrustment decision making for clinical responsibilities at designated levels of supervision of learners (e.g., direct, indirect, and no supervision) has become a recent critical innovation of CBME at the "does" level. Analysis of the entrustment concept reveals that trust in a learner to work without assistance or supervision encompasses more than the observation of "doing" in practice (the "does" level). It implies the readiness of educators to accept the inherent risks involved in health care tasks and the judgment that the learner has enough experience to act appropriately when facing unexpected challenges. Earning this qualification requires qualities beyond observed proficiency, which led the authors to propose adding the level "trusted" to the apex of Miller's pyramid.
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Affiliation(s)
- Olle Ten Cate
- O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780
| | - Carol Carraccio
- C. Carraccio was vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina, at the time of writing; ORCID: https://orcid.org/0000-0001-5473-8914
| | - Arvin Damodaran
- A. Damodaran is rheumatologist and director of medical education, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-5067-9483
| | - Wade Gofton
- W. Gofton is professor of surgery, University of Ottawa, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0438-1659
| | - Stanley J Hamstra
- S.J. Hamstra is research consultant, milestone research and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada, and adjunct professor, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-0680-366X
| | - Danielle E Hart
- D.E. Hart is program director, Emergency Medicine, and director of simulation, Interdisciplinary Simulation and Education Center, Hennepin Healthcare, Minneapolis, Minnesota
| | - Denyse Richardson
- D. Richardson is associate professor, Department of Medicine, Division of Physiatry, and a faculty member, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-6113-158X
| | - Shelley Ross
- S. Ross is associate professor, Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada; ORCID: https://orcid.org/0000-0001-9581-3191
| | - Karen Schultz
- K. Schultz is professor and assessment director, Department of Family Medicine, Queens University, Kingston, Ontario, Canada, and chair, Certification Process and Assessment Committee, College of Family Physicians of Canada, Mississauga, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7041-1700
| | - Eric J Warm
- E.J. Warm is Richard W. Vilter Professor of Medicine, director, Internal Medicine Residency Program, and medical director, Resident Ambulatory Practice, University of Cincinnati, College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434
| | - Alison J Whelan
- A.J. Whelan is chief medical education officer, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0001-7661-148X
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-3747-2410
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McDonald JA, Lai CJ, Lin MYC, O'Sullivan PS, Hauer KE. "There Is a Lot of Change Afoot": A Qualitative Study of Faculty Adaptation to Elimination of Tiered Grades With Increased Emphasis on Feedback in Core Clerkships. Acad Med 2021; 96:263-270. [PMID: 32909998 DOI: 10.1097/acm.0000000000003730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Medical schools responding to challenges with fairness, equity, learning environments, and student wellness have reconsidered clerkship grades. This study used the Concerns-Based Adoption Model (CBAM) to explore how faculty responded to a change in the approach to assessment from focus on grades toward focus on feedback. METHOD This qualitative study used an inductive approach to analyze data from semistructured interviews with teaching faculty and education leaders at University of California, San Francisco, School of Medicine 6 months following the elimination of traditional tiered clerkship grades. Participants were recruited in 2019 using purposive sampling. Interview questions addressed participants' perceptions of the new approach to assessment and grading that emphasizes assessment for learning, including advantages and concerns. The authors analyzed data using thematic analysis informed by sensitizing concepts from CBAM. RESULTS Nineteen faculty participated (11 medicine, 8 surgery). Faculty expressed optimism about the impact of the change on their clinical educator roles and sought faculty development to enhance feedback and assessment skills. Perceived benefits to students addressed learning and wellness, with concern for students' motivation and professional development. Faculty shared uncertainty about their roles and larger systemic consequences involving the residency match and institutional reputation. Participants acknowledged that traditional grading is imperfect, yet felt a departure from this system represented significant culture change. CONCLUSIONS Faculty perceptions of the assessment and grade change in 2 large departments demonstrated tensions around grading. Their descriptions of change as an ongoing process aligned with CBAM and required them to consider new approaches and perspectives. While discourse about assessment and grading frequently focuses on learners, these findings support institutional consideration of the impact of changes in assessment on teaching faculty.
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MESH Headings
- Clinical Clerkship/standards
- Clinical Clerkship/statistics & numerical data
- Clinical Competence/statistics & numerical data
- Education, Medical/standards
- Education, Medical/statistics & numerical data
- Education, Medical, Undergraduate/standards
- Education, Medical, Undergraduate/statistics & numerical data
- Educational Measurement/methods
- Faculty, Medical/statistics & numerical data
- Faculty, Medical/trends
- Feedback
- Female
- Humans
- Leadership
- Learning/physiology
- Male
- Perception
- Qualitative Research
- San Francisco/epidemiology
- Schools, Medical/organization & administration
- Students, Medical/psychology
- Surveys and Questionnaires
- Thematic Apperception Test/statistics & numerical data
- Universities/organization & administration
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Affiliation(s)
- Jordan A McDonald
- J.A. McDonald is a third-year medical student, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Cindy J Lai
- C.J. Lai is director of internal medicine clerkships and professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Matthew Y C Lin
- M.Y.C. Lin is director of surgery clerkships and associate professor, Department of Surgery, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Patricia S O'Sullivan
- P.S. O'Sullivan is director of research and development in medical education and professor, Department of Medicine and Department of Surgery, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
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Abstract
Conditions caused by the COVID-19 pandemic have disrupted clinical practice and all aspects of medical education. Yet the need to continue to train physicians to care for patients and communities is greater than ever. Medical educators are responding by adapting curricula in response to requirements for social distancing, changing availability of clinical learning opportunities, and limitations on testing center availability for examinations. These disruptions require a systems approach to ensure that learners achieve competence in preparation for advancement in training toward unsupervised practice. In this article, the authors assert that medical educators, obligated by current conditions to adapt educational experiences, should seize the opportunity presented by the pandemic to make needed changes in 3 areas aligned with competency-based medical education: focusing on outcomes, broadening the assessment toolbox, and improving the undergraduate medical education-to-graduate medical education (UME-to-GME) transition. Defined outcomes, as exemplified by entrustable professional activities, will enable curricular designers to shorten and adapt learning experiences by focusing on students' achievement of prespecified learning outcomes. Broadening the assessment toolbox entails capturing more and different assessment information about learners to provide a well-rounded view of their strengths and areas for growth in both traditional and novel settings, such as telehealth. Limitations on available data, such as licensing examination scores and clerkship grades, heighten the urgency to revise the system for the UME-to-GME transition by enhancing the quality and usability of information available to residency program directors. Educators should capitalize on the opportunity presented by altered conditions due to the COVID-19 pandemic to make these needed changes to the educational system, to prepare physicians to provide health care and lead the health care system into the future.
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Affiliation(s)
- Karen E. Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards, and professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045
| | - Tai M. Lockspeiser
- T.M. Lockspeiser is assistant dean of medical education–assessment, evaluation, and outcomes, and associate professor, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - H. Carrie Chen
- H.C. Chen is associate dean of assessment and educational scholarship, and professor, Department of Pediatrics, Georgetown University School of Medicine, Washington, DC; ORCID: https://orcid.org/0000-0003-1663-1598
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46
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Michl S, Katsarov J, Krug H, Rogge A, Eichinger T. Ethics in times of physical distancing: virtual training of ethical competences. GMS J Med Educ 2021; 38:Doc28. [PMID: 33659633 PMCID: PMC7899095 DOI: 10.3205/zma001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/20/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
Ethics teaching in medicine, nursing and other health care professions does not only consist of knowledge transfer that can be easily implemented digitally. Rather, it focuses on specific ethical competences (such as arguing and articulating one's own moral position) and attitudes (such as empathic patient orientation, critical self-reflection, and ambiguity tolerance), for whose development interactive formats are superior. Competence-oriented ethical learning goals are important for the development of professionalism, but require time, space and personal exchange. Due to contact restrictions and the widespread cancellation of (face-to-face) courses in the wake of the corona pandemic, ethics teaching was forced to keep its distance in many places, which posed great challenges. This article is based on an exchange of experiences from members of the working group ethik learning of the Academy for Ethics in Medicine about ethics teaching in times of physical distancing. Recommendations will be given on how ethical competence can be successfully taught in the context of exclusively digital teaching. Starting with the question what is at risk of being lost in digital teaching, the potentials of digital formats are explored and illustrated with concrete practical examples. Beyond ethics teaching, the article also aims to provide ideas and suggestions for other specialist and cross-sectional areas where interactive formats are central.
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Affiliation(s)
- Susanne Michl
- Charité – Universitätsmedizin Berlin, Institut für Geschichte der Medizin und Ethik in der Medizin, Berlin, Germany
| | | | - Henriette Krug
- Medical School Hamburg, Fakultät für Gesundheitswissenschaften, Hamburg, Germany
| | - Annette Rogge
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Medizinethik, Institut für Experimentelle Medizin, Kiel, Germany
| | - Tobias Eichinger
- Universität Zürich, Institut für Biomedizinische Ethik und Medizingeschichte, Zurich, Switzerland
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47
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Dohle NJ, Machner M, Buchmann M. Peer teaching under pandemic conditions - options and challenges of online tutorials on practical skills. GMS J Med Educ 2021; 38:Doc7. [PMID: 33659612 PMCID: PMC7899113 DOI: 10.3205/zma001403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/18/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
Background: Within days, the corona crisis has forced the "Lernzentrum", as well as all other places of training and further education, to discontinue classroom teaching at German universities and vocational schools. In order to start teaching online, tutors had to face the challenge to develop new digital learning formats (virtual classrooms) for the peer teaching of practical skills within a short time. This paper aims at outlining the project of developing e-tutorials with regard to the teaching of practical skills. Methodology: After analyzing the classroom lessons (n=30), some of the tutorials were transformed into digital formats. These so-called "e-tutorials" were held via a digital platform. They have been evaluated continuously with a standardized online questionnaire. The results of this evaluation have been analyzed descriptively. Results: From 27/04/2020 to 17/07/2020 eleven different e-tutorial formats were offered on 246 dates. The evaluation revealed a high degree of acceptance with these course offers as well as with the implementation by the tutors. Interpretation: During the pandemic crisis the substitution of peer teaching into forms of e-tutorials was considered valuable; however, these learning formats present challenges, especially with regard to the interaction between teachers and students. They cannot therefore fully replace the peer teaching of practical skills.
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Affiliation(s)
- Niklas Julian Dohle
- Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Lernzentrum, Campus Charité Mitte, Berlin, Germany
| | - Mareen Machner
- Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Lernzentrum, Campus Charité Mitte, Berlin, Germany
- Berliner Bildungscampus für Gesundheitsberufe, Bereich Weiterbildung, Berlin, Germany
| | - Maike Buchmann
- Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Lernzentrum, Campus Charité Mitte, Berlin, Germany
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Extermann M, Brain E, Canin B, Cherian MN, Cheung KL, de Glas N, Devi B, Hamaker M, Kanesvaran R, Karnakis T, Kenis C, Musolino N, O'Donovan A, Soto-Perez-de-Celis E, Steer C, Wildiers H. Priorities for the global advancement of care for older adults with cancer: an update of the International Society of Geriatric Oncology Priorities Initiative. Lancet Oncol 2021; 22:e29-e36. [PMID: 33387502 DOI: 10.1016/s1470-2045(20)30473-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/23/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022]
Abstract
In 2011, the International Society of Geriatric Oncology (SIOG) published the SIOG 10 Priorities Initiative, which defined top priorities for the improvement of the care of older adults with cancer worldwide.1 Substantial scientific, clinical, and educational progress has been made in line with these priorities and international health policy developments have occurred, such as the shift of emphasis by WHO from communicable to non-communicable diseases and the adoption by the UN of its Sustainable Development Goals 2030. Therefore, SIOG has updated its priority list. The present document addresses four priority domains: education, clinical practice, research, and strengthening collaborations and partnerships. In this Policy Review, we reflect on how these priorities would apply in different economic settings, namely in high-income countries versus low-income and middle-income countries. SIOG hopes that it will offer guidance for international and national endeavours to provide adequate universal health coverage for older adults with cancer, who represent a major and rapidly growing group in global epidemiology.
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Affiliation(s)
| | - Etienne Brain
- Institut Curie-Hôpital René Huguenin, Saint-Cloud, France
| | - Beverly Canin
- Patient Representative from the Cancer and Aging Research Group, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | | | - Nienke de Glas
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Beena Devi
- Normah Medical Specialist Centre, Kuching, Sarawak, Malaysia
| | | | | | - Theodora Karnakis
- Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Cindy Kenis
- Department of Medical Oncology University Hospitals Leuven, Leuven, Belgium
| | - Najia Musolino
- International Society of Geriatric Oncology, Geneva, Switzerland
| | - Anita O'Donovan
- Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin, Ireland
| | | | - Christopher Steer
- Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia; Rural Clinical School, University of New South Wales, Albury, NSW, Australia
| | - Hans Wildiers
- Department of Medical Oncology University Hospitals Leuven, Leuven, Belgium
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Reid MD, Sam AH. Reflections on assessment in the wake of change from the COVID-19 pandemic. Med Educ 2021; 55:128-130. [PMID: 32893894 DOI: 10.1111/medu.14368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Michael D Reid
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Amir H Sam
- Imperial College School of Medicine, Imperial College London, London, UK
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50
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Sonne C, Persch H, Rosner S, Ott I, Nagy E, Nikendei C. Significant differences in written assessments as a result of a blended learning approach used in a clinical examination course in internal medicine: a randomized controlled pilot study. GMS J Med Educ 2021; 38:Doc42. [PMID: 33763527 PMCID: PMC7958916 DOI: 10.3205/zma001438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/14/2020] [Accepted: 09/30/2020] [Indexed: 05/21/2023]
Abstract
Background: Taking a medical history and performing a physical examination represent basic medical skills. However, numerous national and international studies show that medical students and physicians-to-be demonstrate substantial deficiencies in the proper examination of individual organ systems. Aim: The objective of this study was to conduct a randomized controlled pilot study to see if, in the context of a bedside clinical examination course in internal medicine, an additional app-based blended-learning strategy resulted in (a) higher satisfaction, better self-assessments by students when rating their history-taking skills (b1) and their ability to perform physical examinations (b2), as well as (c) higher multiple-choice test scores at the end of the course, when compared to a traditional teaching strategy. Methods: Within the scope of a bedside course teaching the techniques of clinical examination, 26 students out of a total of 335 students enrolled in the 2012 summer semester and 2012/2013 winter semester were randomly assigned to two groups of the same size. Thirteen students were in an intervention group (IG) with pre- and post-material for studying via an app-based blended-learning tool, and another 13 students were in a control group (CG) with the usual pre- and post-material (handouts). The IG was given an app specifically created for the history-taking and physical exam course, an application program for smartphones enabling them to view course material directly on the smartphone. The CG received the same information in the form of paper-based notes. Prior to course begin, all of the students filled out a questionnaire on sociodemographic data and took a multiple-choice pretest with questions on anamnesis and physical examination. After completing the course, the students again took a multiple-choice test with questions on anamnesis and physical examination. Results: When compared to the CG, the IG showed significantly more improvement on the multiple-choice tests after taking the clinical examination course (p=0.022). This improvement on the MC tests in the IG significantly correlated with the amount of time spent using the app (Spearman's rho=0.741, p=0.004). Conclusion: When compared to conventional teaching, an app-based blended-learning approach leads to improvement in test scores, possibly as a result of more intensive preparation for and review of the clinical examination course material.
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Affiliation(s)
- Carolin Sonne
- Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany
- *To whom correspondence should be addressed: Carolin Sonne, Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany, Phone: +49 (0)178/6139340, E-mail:
| | - Hasema Persch
- Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany
- Universitätsklinikum Ulm, Innere Medizin II, Sektion Sport- und Rehabilitationsmedizin, Ulm, Germany
| | - Stefanie Rosner
- Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany
| | - Ilka Ott
- Technische Universität München, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen des Erwachsenen, Munich, Germany
| | - Ede Nagy
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik, Heidelberg, Germany
| | - Christoph Nikendei
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik, Heidelberg, Germany
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