Predicting students' academic progress and related attributes in first-year medical students: an analysis with artificial neural networks and Naïve Bayes

BACKGROUND

Dropout and poor academic performance are persistent problems in medical schools in emerging economies. Identifying at-risk students early and knowing the factors that contribute to their success would be useful for designing educational interventions. Educational Data Mining (EDM) methods can identify students at risk of poor academic progress and dropping out. The main goal of this study was to use machine learning models, Artificial Neural Networks (ANN) and Naïve Bayes (NB), to identify first year medical students that succeed academically, using sociodemographic data and academic history.

METHODS

Data from seven cohorts (2011 to 2017) of admitted medical students to the National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City were analysed. Data from 7,976 students (2011 to 2017 cohorts) of the program were included. Information from admission diagnostic exam results, academic history, sociodemographic characteristics and family environment was used. The main dataset included 48 variables. The study followed the general knowledge discovery process: pre-processing, data analysis, and validation. Artificial Neural Networks (ANN) and Naïve Bayes (NB) models were used for data mining analysis.

RESULTS

ANNs models had slightly better performance in accuracy, sensitivity, and specificity. Both models had better sensitivity when classifying regular students and better specificity when classifying irregular students. Of the 25 variables with highest predictive value in the Naïve Bayes model, percentage of correct answers in the diagnostic exam was the best variable.

CONCLUSIONS

Both ANN and Naïve Bayes methods can be useful for predicting medical students' academic achievement in an undergraduate program, based on information of their prior knowledge and socio-demographic factors. Although ANN offered slightly superior results, Naïve Bayes made it possible to obtain an in-depth analysis of how the different variables influenced the model. The use of educational data mining techniques and machine learning classification techniques have potential in medical education.

Bridging Validity Frameworks in Assessment: Beyond Traditional Approaches in Health Professions Education

Construct: High-stakes assessments measure several constructs, such as knowledge, competencies, and skills. In this case, validity evidence for test scores' uses and interpretations is of utmost importance, because of the consequences for everyone involved in their development and implementation. Background: Educational assessment requires an appropriate understanding and use of validity frameworks; however, health professions educators still struggle with the conceptual challenges of validity, and frequently validity analyses have a narrow focus. Important obstacles are the plurality of validity frameworks and the difficulty of grounding these abstract concepts in practice. Approach: We reviewed the validity frameworks literature to identify the main elements of frequently used models (Messick and Kane's) and proposed linking frameworks including Russell's recent overarching proposal. Examples are provided with commonly used assessment instruments in health professions education. Findings: Several elements in these frameworks can be integrated into a common approach, matching and aligning Messick's sources of validity with Kane's four inference types. Conclusions: This proposal to contribute evidence for assessment inferences may provide guidance to understanding the use of validity evidence in applied settings. The evolving field of validity research provides opportunities for its integration and practical use in health professions education.

Health sciences undergraduate students academic track records

BACKGROUND

Academic track record analysis is essential for evaluating the training of students and the structure of higher education study programs, which allows diagnosing and preventing educational lag and school dropout.

OBJECTIVE

To analyze the differences in academic track records of UNAM health sciences undergraduate students from generations 2001 to 2016.

MATERIAL AND METHODS

Study of real cohorts; graduation and lag rates were calculated. ANOVA was used to contrast the graduation rates between campuses by undergraduate program and time. To identify critical periods, survival functions were used with Kaplan-Meier's method.

RESULTS

The lowest percentages of lag were observed in nursing and medicine students; nursing students had the highest graduation rates, especially at Zaragoza campus; dentistry students had the lowest graduation rates and the highest dropout and lag rates. Women showed higher graduation rates and lower risk of dropout and lag.

CONCLUSIONS

Nursing, medicine and psychology undergraduate students at Zaragoza and Iztacala campuses, with modular programs, achieved the highest graduation percentages and the lowest dropout and lag rates.

Medicine and the metaverse: current applications and future

Innovative technologies such as the metaverse and chat GPT-4 (based on artificial intelligence) are present in the daily discourse of society; recently, they have been introduced into medical practice and are bringing about important changes. In the case of the metaverse ("beyond the universe"), various medical schools and departments around the world are beginning to use it as an innovative strategy for teaching subjects such as anatomy, histology, ophthalmology, and simulation in parallel (virtual) worlds for learning and supervision of surgeries, as well as for other applications in medical education and in the doctor-patient relationship. Although it should be regarded as an area of opportunity for the transformation of medicine, it is important to consider the various limitations and risks of the metaverse in medical practice, student training, and physicians' relationship with the health problems they have to deal with in their practice.

ChatGPT: opportunities and risks in the fields of medical care, teaching, and research

ChatGPT is a virtual assistant with artificial intelligence (AI) that uses natural language to communicate, i.e., it holds conversations as those that would take place with another human being. It can be applied at all educational levels, including medical education, where it can impact medical training, research, the writing of scientific articles, clinical care, and personalized medicine. It can modify interactions between physicians and patients and thus improve the standards of healthcare quality and safety, for example, by suggesting preventive measures in a patient that sometimes are not considered by the physician for multiple reasons. ChatGPT potential uses in medical education, as a tool to support the writing of scientific articles, as a medical care assistant for patients and doctors for a more personalized medical approach, are some of the applications discussed in this article. Ethical aspects, originality, inappropriate or incorrect content, incorrect citations, cybersecurity, hallucinations, and plagiarism are some examples of situations to be considered when using AI-based tools in medicine.

Antibiotic prescription errors: the relationship with clinical competence in junior medical residents

BACKGROUND

A large portion of prescribing errors can be attributed to deficiencies in medication knowledge. These errors are preventable and most often occur at the time of prescription. Antimicrobials are the drug class most common incorrectly prescribed.

OBJECTIVE

To characterize the relationship between clinical competence and antibiotic prescription errors. We also investigated the frequency and severity of antibiotic prescription errors to identify items and attributes of clinical competence which are correlated with the antibiotic prescription error ratio.

METHOD

A cross-sectional study was applied to assess clinical competence of junior medical residents in two reference academic hospitals and a regional hospital in Mexico City. It was conducted during February 2019. We used an infectious disease Objective Structured Clinical Examination (OSCE) to assess clinical competence and a measure of frequency, and severity of antibiotic prescription errors.

RESULTS

The number of eligible participants was ~ 255 (hospital meeting attendance), and the number of residents in this study were 51 (~ 20%), 31 were female (60.8%). The mean OSCE score was 0.692 ± 0.073. The inter-item (Cronbach's alpha = 0.927) and inter-station internal consistency was adequate (Cronbach's alpha = 0.774). The G coefficient in generalizability theory analysis was 0.84. The antibiotic prescription error ratio was 45.1% ± 7%. The most frequent category of severity of antibiotic prescription errors was category E (errors that may contribute to or result in temporary harm to the patient and require intervention), 235 (65.2%). We observed a negative and significant correlation between clinical competence and antibiotic prescription errors (r = -0.33, p < 0.05, CI95% -0.57 to -0.07), which remained significant after controlling for the effect of gender and time since graduation from medical school (r = -0.39, p < 0.01, CI95% -0.625 to -0.118). Using exploratory factor analysis we identified two factors, which explained 69% of the variance in clinical competence, factor 1 evaluated socio-clinical skills and factor 2 evaluated diagnostic-therapeutic skills. Factor 2 was correlated with antibiotic prescription error ratio (r = -0.536, p < 0.001).

CONCLUSIONS

We observed a negative correlation between clinical competence and antibiotic prescription error ratio in graduated physicians who have been accepted in a medical specialty. The therapeutic plan, which is a component of the clinical competence score, and the prescription skills had a negative correlation with antibiotic prescription errors. The most frequent errors in antibiotic prescriptions would require a second intervention.

Analysis of physical learning spaces in a university hospital: A case study

BACKGROUND

Attributes of physical learning spaces can facilitate or hinder learning. There are few studies about this topic in hospitals. The objective of this study was to explore the characteristics of physical learning spaces in a university hospital.

METHODS

The setting was a large research-oriented public university hospital in Mexico City, affiliated with the National Autonomous University of Mexico. An intrinsic case study design was conducted with two instruments: a questionnaire to identify physical learning spaces and their attributes; the Learning Space Rating System (LSRS), an instrument used to evaluate spaces' characteristics that promote effective learning.

RESULTS

49 medical students and 60 internal medicine residents responded to the questionnaire. The attributes with the highest importance for students were: instructor physical availability, silence, comfort of the seating furniture, and Internet access. The study authors directly performed an evaluation of the learning spaces using the LSRS tool, the sections' scores were: clinical ward discussion room (74%), external consultation unit (71%), auditorium (70%), classroom (68%), library (66%), and the hospitalization room (61%).

CONCLUSIONS

Physical learning spaces in medical training can be formally assessed to identify the attributes that students consider relevant for learning and provide needed information for redesign and reuse of spaces. Medical education scholars and trainees should be involved in the design and evaluation of university and hospital buildings.

Dissolving the Dichotomies Between Online and Campus-Based Teaching: a Collective Response to The Manifesto for Teaching Online (Bayne et al. 2020)

This article is a collective response to the 2020 iteration of The Manifesto for Teaching Online. Originally published in 2011 as 20 simple but provocative statements, the aim was, and continues to be, to critically challenge the normalization of education as techno-corporate enterprise and the failure to properly account for digital methods in teaching in Higher Education. The 2020 Manifesto continues in the same critically provocative fashion, and, as the response collected here demonstrates, its publication could not be timelier. Though the Manifesto was written before the Covid-19 pandemic, many of the responses gathered here inevitably reflect on the experiences of moving to digital, distant, online teaching under unprecedented conditions. As these contributions reveal, the challenges were many and varied, ranging from the positive, breakthrough opportunities that digital learning offered to many students, including the disabled, to the problematic, such as poor digital networks and access, and simple digital poverty. Regardless of the nature of each response, taken together, what they show is that The Manifesto for Teaching Online offers welcome insights into and practical advice on how to teach online, and creatively confront the supremacy of face-to-face teaching.

Pros and cons of innovations in medical education

Medical education has implemented various innovative strategies with the purpose to attain better learning achievements. An evaluation is made of the experiences in the competencies approach, new learning technologies, curricular alternatives, professional evaluation and distance education technologies in order to locate them in the areas they belong.

MOOC Learning Assessment in Clinical Settings: Analysis from Quality Dimensions

Online learning is becoming a fundamental modality of learning in medical education, and can be of great help during global crisis like the current COVID-19 pandemic. The MOOC (massive open online course) mode of e-learning is increasing its penetration worldwide, as a valid teaching approach to reach large populations. A major challenge in clinical education is the assessment of medical students and residents in clinical settings, and there is substantial evidence that the current situation requires improvement. The goal of this study was to evaluate the quality dimensions of a MOOC titled "Learning assessment in clinical settings," developed by three Mexican universities in the Coursera platform. A mixed-method study design was used to assess the quality dimensions of the MOOC in two phases: pilot and implementation. The best-rated aspects were learning resources and pedagogical perspective, and those with opportunity for improvement were collaboration and time management. Assessment might be learned through a MOOC format, especially for participants willing to engage with educational technology and self-direction.

Specialty choice determinants among Mexican medical students: a cross-sectional study

BACKGROUND

The choice of medical specialty is related to multiple factors, students' values, and specialty perceptions. Research in this area is needed in low- and middle-income countries, where the alignment of specialty training with national healthcare needs has a complex local interdependency. The study aimed to identify factors that influence specialty choice among medical students.

METHODS

Senior students at the National Autonomous University of Mexico (UNAM) Faculty of Medicine answered a questionnaire covering demographics, personal experiences, vocational features, and other factors related to specialty choice. Chi-square tests and factor analyses were performed.

RESULTS

The questionnaire was applied to 714 fifth-year students, and 697 provided complete responses (response rate 81%). The instrument Cronbach's alpha was 0.8. The mean age was 24 ± 1 years; 65% were women. Eighty percent of the students wanted to specialize, and 60% had participated in congresses related to the specialty of interest. Only 5% wanted to remain as general practitioners. The majority (80%) wanted to enter a core specialty: internal medicine (29%), general surgery (24%), pediatrics (11%), gynecology and obstetrics (11%) and family medicine (4%). The relevant variables for specialty choice were grouped in three dimensions: personal values that develop and change during undergraduate training, career needs to be satisfied, and perception of specialty characteristics.

CONCLUSIONS

Specialty choice of medical students in a middle-income country public university is influenced by the undergraduate experience, the desire to study a subspecialty and other factors (including having skills related to the specialty and type of patients).

[La analítica del aprendizaje en educación médica: ¿punto de inflexión?]

La analítica del aprendizaje es una disciplina novedosa que tiene un enorme potencial para mejorar la calidad de la educación médica y la evaluación del aprendizaje. Se define como: "la medición, recopilación, análisis y reporte de datos sobre los alumnos y sus contextos, con el propósito de entender y optimizar el aprendizaje y los entornos en que ocurre". En las últimas décadas, la aparición de grandes volúmenes de datos (big data), acompañada de una rápida evolución en la minería de datos educativos, la aparición de tecnologías sofisticadas para analizar y visualizar datos de cualquier tipo, así como la disponibilidad de dispositivos móviles con conectividad permanente, mayor velocidad de procesamiento y capacidad de recuperación de información, han generado un contexto que favorece el uso de la analítica del aprendizaje en la medicina clínica y la educación médica. En este artículo se describe la historia reciente del concepto de analítica del aprendizaje, sus ventajas y desventajas en educación superior, así como sus aplicaciones en la enseñanza de las ciencias de la salud y la evaluación educativa. Es necesario que la comunidad de educadores médicos conozca la analítica del aprendizaje, para ser capaces de integrarla en su contexto eficaz y oportunamente.

Educational experiences in a master of health professions education program at the National Autonomous University of Mexico: A qualitative study

BACKGROUND

Medical schools and healthcare institutions need leaders with formal training in education, in order to provide quality medical teaching. An answer to this need lies in the graduate programs of health professions education. Many programs exist, but there is a dearth of publications about their educational processes and experiences. The purpose of this study was to explore the teaching and learning experiences of students, teachers, and graduates of the Master in Health Professions Education (MHPE) program at the National Autonomous University of Mexico (UNAM).

METHODS

A qualitative approach was used with focus group discussions with students, graduates, and teachers, to explore their opinions, feelings, and experiences about the program. Purposeful sampling of participants was done. Focus group guides were developed for the different study groups; testimonies were codified and categorized with axial coding and a constant comparison method.

RESULTS

Testimonies from 19 participants in three focus groups were obtained (five graduates, seven current students, and seven teachers). The data were grouped in seven thematic categories: expectations, feedback of research projects, the tutorial process, teaching strategies, usefulness of what was learned, professional development, and assessment. Positive elements of the program were identified as well as areas in need of improvement.

DISCUSSION

The MHPE program at UNAM has been a positive experience for students and mostly fulfilled their expectations, they learned the basic theories and practical aspects of teaching, learning, and assessment in the health professions. Some areas need improvement, such as tutor performance and timely feedback to the students. Graduates think the competencies acquired in the program are useful for their professional practice. This information will be used to improve the program. There is a need to meet international standards in MHPE programs.

Collaborating internationally on physician leadership development: why now?

Purpose This paper aims to highlight the importance of leadership development for all physicians within a competency-based medical education (CBME) framework. It describes the importance of timely international collaboration as a key strategy in promoting physician leadership development. Design/methodology/approach The paper explores published and Grey literature around physician leadership development and proposes that international collaboration will meet the expanding call for development of leadership competencies in postgraduate medical learners. Two grounding frameworks were used: complexity science supports adding physician leadership training to the current momentum of CBME adoption, and relational cultural theory supports the engagement of diverse stakeholders in multiple jurisdictions around the world to ensure inclusivity in leadership education development. Findings An international collaborative identified key insights regarding the need to frame physician leadership education within a competency-based model. Practical implications International collaboration can be a vehicle for developing a globally relevant, generalizable physician leadership curriculum. This model can be expanded to encourage innovation, scholarship and program evaluation. Originality/value A competency-based leadership development curriculum is being designed by an international collaborative. The curriculum is based on established leadership and education frameworks. The international collaboration model provides opportunities for ongoing sharing, networking and diversification.

Factores relacionados con la elección de una especialidad en médicos residentes mexicanos

Objective

This study explored choice factors in four specialties in Mexico.

Method

Mixed methods design. Qualitative phase: four focus groups with first-year residents, to obtain information of how specialty choice was done. With this information a web-based cross-sectional questionnaire was applied to residents registered in the 1st year of Postgraduate Studies Division, UNAM.

Results

32 residents participated in qualitative phase and for the quantitative phase, the survey was answered by 35 surgical, 28 gynecology, 61 internal medicine and 62 pediatric residents. The specialty choice decision was done during the last years of the medical career. The majority of the resident choice was a subspecialty after the general residency. The type of patient was more crucial to choose pediatrics while a good academic program was for internal medicine. Negative models and bullying were decisive to rule out surgery as well as a not well-known hospital was to rule out pediatrics.

Conclusion

The specialty choice is done during undergraduate training, with the intention of doing a subspecialty. Demographic and personality traits were identified.

[Level of teaching competence at the Undergraduate Medical Internship of UNAM's Faculty of Medicine]

BACKGROUND

There is no systematic evaluation of teaching performance in the clinical area at UNAM Faculty of Medicine. The study purpose is to assess the teaching competence level in the Undergraduate Medical Internship (UMI).

METHODS

The paper describes the process of psychometric validity for the instrument designed to evaluate teaching competence in the UMI. This instrument was constructed from two previously developed instruments. The final version with 54 items in a Likert scale was studied with exploratory factorial analysis. Four dimensions were obtained: Solution of clinical problems, Psychopedagogy, Mentoring, and Evaluation. The instrument had a reliability of 0.994, with an explained variance of 77.75%.

RESULTS

To evaluate the teaching competence level, we administered 844 questionnaires to a sample of students with a response rate of 89%. We obtained an overall global score of 89.4 ± 9.6 (mean ± SD). The dimension Solution of clinical problems was the one with a greater value, in contrast with the dimension of Evaluation, which had a lower score.

CONCLUSION

The teachers of the UMI are considered educators with high level of teaching competence, according to the perceptions of the undergraduate internal doctors. The evaluation of teaching competence level is very important for institutions that look for the continuous professional development of its faculty.

[Diagnostic and formative assessment of competencies at the beginning of undergraduate medical internship]

INTRODUCTION

Research on diagnostic and formative assessment competencies during undergraduate medical training is scarce in Latin America.

OBJECTIVE

To assess the level of clinical competence of students at the beginning of their medical internship in a new curriculum.

METHODS

This was an observational cross-sectional study in UNAM Faculty of Medicine students in Mexico City: a formative assessment of the second class of Curriculum 2010 students as part of the integral evaluation of the program. The assessment had two components: theoretical and practical.

RESULTS

We assessed 577 students (65.5%) of the 880 total population that finished the 9th semester of Curriculum 2010. The written exam consisted of 232 items, with a mean of 61.0 ± 19.6, a difficulty index of 0.61, and Cronbach's alpha of 0.89. The mean of the objective structured clinical examination (OSCE) was 62.2 ± 16.8, with a mean Cronbach's alpha of 0.51. Results were analyzed by knowledge area and exam stations.

CONCLUSIONS

The overall results provide evidence that students achieve sufficiently the competencies established in the curriculum at the beginning of the internship, that they have the necessary foundation for learning new and more complex information, and integrate it with existing knowledge to achieve significant learning and continue their training.

[Level of clinical competence in seven cohorts of medical students at the end of the internship]

INTRODUCTION

Objective structured clinical examination is the instrument with more validated evidence to assess the degree of clinical competence of medical students.

OBJECTIVES

To assess the degree of clinical competence of medical students at the end of their internship; to assess the reliability of the instruments with G theory.

METHODS

This was an observational, longitudinal, and comparative study. The target population was composed of 5,399 interns of seven generations that finished their internship at the Faculty of Medicine of UNAM, between 2009 and 2015. The instrument used was 18 OSCE stations, three in each subject of the internship.

RESULTS

The undergraduate medical interns show a sufficient degree of clinical competence to be general practitioners. The laboratory interpretation and physical examination had the highest scores. The interpretation of imaging studies was the component with the lowest score. The Family Medicine disciplinal area had the highest average score in the OSCE; in contrast, Pediatrics obtained the lowest score on average. The reliability was measured with Generalizability Theory and ranged between 0.81 and 0.93.

CONCLUSIONS

The clinical competence of undergraduate medical interns is considered sufficient. The results also show the subjects that require educational interventions to improve clinical competence of students.

[Teacher's perfomance assessment in Family Medicine specialization]

BACKGROUND

In Mexico there is no systematic evaluation of teachers in medical specialties. It is difficult to identify appropriate teaching practices. The lack of evaluation has limited the recognition and improvement of teaching. The objective of this study was to analyze feedback from students about teaching activities of teachers-tutors responsible for the specialization course in family medicine, and evaluate the evidence of reliability and validity of the instrument applied online.

METHODS

It was an observational and cross-sectional study. Seventy eight teachers of Family Medicine of medical residency were evaluated by 734 resident´s opinion. The anonymous questionnaire to assess teaching performance by resident's opinion and it is composed of 5 dimensions using a Likert scale. Descriptive and inferential statistics (t test, one-way ANOVA and factor analysis) were used.

RESULTS

Residents stated that teaching performance is acceptable, with an average of 4.25 ± 0.93. The best valued dimension was "Methodology" with an average of 4.34 ± .92 in contrast to the "assessment" dimension with 4.16 ± 1.04.

CONCLUSION

Teachers of specialization in family medicine have acceptable performance by resident's opinion. The online assessment tool meets the criteria of validity and reliability.

Reliability analysis of the objective structured clinical examination using generalizability theory

BACKGROUND

The objective structured clinical examination (OSCE) is a widely used method for assessing clinical competence in health sciences education. Studies using this method have shown evidence of validity and reliability. There are no published studies of OSCE reliability measurement with generalizability theory (G-theory) in Latin America. The aims of this study were to assess the reliability of an OSCE in medical students using G-theory and explore its usefulness for quality improvement.

METHODS

An observational cross-sectional study was conducted at National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City. A total of 278 fifth-year medical students were assessed with an 18-station OSCE in a summative end-of-career final examination. There were four exam versions. G-theory with a crossover random effects design was used to identify the main sources of variance. Examiners, standardized patients, and cases were considered as a single facet of analysis.

RESULTS

The exam was applied to 278 medical students. The OSCE had a generalizability coefficient of 0.93. The major components of variance were stations, students, and residual error. The sites and the versions of the tests had minimum variance.

CONCLUSIONS

Our study achieved a G coefficient similar to that found in other reports, which is acceptable for summative tests. G-theory allows the estimation of the magnitude of multiple sources of error and helps decision makers to determine the number of stations, test versions, and examiners needed to obtain reliable measurements.

Collaborating internationally on physician leadership education: first steps

Purpose

Physicians are often ill-equipped for the leadership activities their work demands. In part, this is due to a gap in traditional medical education. An emergent international network is developing a globally relevant leadership curriculum for postgraduate medical education. The purpose of this article is to share key learnings from this process to date.

Design/methodology/approach

The Toronto International Summit on Leadership Education for Physicians (TISLEP) was hosted by the Royal College of Physicians and Surgeons of Canada, and the University of Toronto’s Faculty of Medicine and Institute of Health Policy, Management and Evaluation. Of 64 attendees from eight countries, 34 joined working groups to develop leadership competencies. The CanMEDS Competency Framework, stage of learner development and venue of learning formed the scaffold for the work. Emotional intelligence was selected as the topic to test the feasibility of fruitful international collaboration; results were presented at TISLEP 2015.

Findings

Dedicated international stakeholders engaged actively and constructively through defined working groups to develop a globally relevant, competency-based curriculum for physician leadership education. Eleven principles are recommended for consideration in physician leadership curriculum development. Defining common language and taxonomy is essential for a harmonized product. The importance of establishing an international network to support implementation, evaluation, sustainability and dissemination of the work was underscored.

Originality/value

International stakeholders are collaborating successfully on a graduated, competency-based leadership curriculum for postgraduate medical learners. The final product will be available for adaptation to local needs. An international physician leadership education network is being developed to support and expand the work underway.

Eight years' experience with a Medical Education Journal Club in Mexico: a quasi-experimental one-group study

BACKGROUND

A time-honored strategy for keeping up to date in medicine and improving critical appraisal skills is the Journal Club (JC). There are several reports of its use in medicine and allied health sciences but almost no reports of JC focused on medical education. The purpose of the study is to describe and evaluate an eight years' experience with a medical education Journal Club (MEJC).

METHODS

We started a monthly medical education JC in 2006 at UNAM Faculty of Medicine in Mexico City. Its goal is to provide faculty with continuing professional development in medical education. A discussion guide and a published paper were sent 2 weeks before sessions. We reviewed the themes and publication types of the papers used in the sessions, and in June-July 2014 administered a retrospective post-then-pre evaluation questionnaire to current participants that had been regular attendees to the JC for more than 2 years. The retrospective post-then-pre comparisons were analyzed with Wilcoxon signed-rank test. Effect sizes were calculated for the pre-post comparisons with Cohen's r.

RESULTS

There have been 94 MEJC sessions until July 2014. Average attendance is 20 persons, a mix of clinicians, educators, psychologists and a sociologist. The articles were published in 32 different journals, and covered several medical education themes (curriculum, faculty development, educational research methodology, learning methods, assessment, residency education). 22 Attendees answered the evaluation instrument. The MEJC had a positive evaluation from good to excellent, and there was an improvement in self-reported competencies in medical education literature critical appraisal and behaviors related to the use of evidence in educational practice, with a median effect size higher than 0.5. The evaluation instrument had a Cronbach's alpha of 0.96.

CONCLUSIONS

A periodic Medical Education Journal Club can improve critical appraisal of the literature, and be maintained long-term using evidence-based strategies. This activity is a useful adjunct to the scholarship of teaching.

A typology of uncertainty derived from an analysis of critical incidents in medical residents: A mixed methods study

BACKGROUND

Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied.

METHODS

We carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies.

RESULTS

From the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician's personal level.

CONCLUSIONS

This study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents. These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.

Evaluation of a Biomedical Informatics course for medical students: a pre-posttest study at UNAM Faculty of Medicine in Mexico

BACKGROUND

Biomedical Informatics (BMI) education in medical schools is developing a sound curricular base, but there are few published reports of their educational usefulness. The goal of this paper is to assess knowledge change and satisfaction in medical students after a BMI curriculum.

METHODS

The National Autonomous University of México Faculty of Medicine (UNAM) recently implemented a curricular reform that includes two BMI sequential courses (BMI-1 and BMI-2). The research design was one-group pretest-posttest. An objective test with evidence of validity was used for knowledge measurement. A satisfaction questionnaire was applied at the end of the courses. Two-tailed paired Student's t-tests were applied, comparing knowledge scores in the pre and post-test for each course.

RESULTS

The study included student cohorts during two consecutive academic years. The 2013 BMI-1 course (n = 986 students) knowledge pretest score was 43.0 ± 8.6 (mean percent correct ± SD), and the post-test score was 57.7 ± 10.3 (p < 0.001); the 2014 BMI-1 (n = 907) pretest score was 43.7 ± 8.5, and the post-test was 58.1 ± 10.5 (p < 0.001). The 2012 BMI-2 course (n = 683) pretest score was 26.3 ± 7.9, the post-test score was 44.3 ± 13.3 (p < 0.001); the 2013 BMI-2 (n = 926) pretest score was 27.5 ± 7.5, and the post-test was 42.0 ± 11.0 (p < 0.001). The overall opinion of the students regarding the course was from good to excellent, with a response rate higher than 90%. The satisfaction questionnaires had high reliability (Cronbach's alpha of 0.93).

CONCLUSIONS

The study shows a significant increase in BMI knowledge after an educational intervention in four medical student cohorts, and an overall positive evaluation by the students. Long-term follow-up is needed, as well as controlled studies of BMI educational interventions using performance endpoints.

Development and implementation of a biomedical informatics course for medical students: challenges of a large-scale blended-learning program

Biomedical informatics (BMI) competencies are recognized as core requirements for the healthcare professional, but the amount of BMI educational interventions in the curricula of medical schools is limited. UNAM Faculty of Medicine in Mexico is a large public medical school, with more than 7000 undergraduate students. The undergraduate program recently underwent a major curricular revision, which includes BMI education. Two one-semester BMI courses (BMI-1 and BMI-2) were designed, with a blended-learning educational model. A department of BMI was created, with budget, offices and personnel. The first class of 1199 students started the course in 2010, with 32 groups of 40 students each. BMI-1 includes core conceptual notions of informatics applied to medicine (medical databases, electronic health record, telemedicine, among other topics), and BMI-2 embodies medical decision making and clinical reasoning. The program had a positive evaluation by students and teachers. BMI can be successfully incorporated in a large-scale medical school program in a developing country, using a blended-learning model and organizational change strategies.

Teaching of evidence-based medicine to medical students in Mexico: a randomized controlled trial

BACKGROUND

Evidence-Based Medicine (EBM) is an important competency for the healthcare professional. Experimental evidence of EBM educational interventions from rigorous research studies is limited. The main objective of this study was to assess EBM learning (knowledge, attitudes and self-reported skills) in undergraduate medical students with a randomized controlled trial.

METHODS

The educational intervention was a one-semester EBM course in the 5th year of a public medical school in Mexico. The study design was an experimental parallel group randomized controlled trial for the main outcome measures in the 5th year class (M5 EBM vs. M5 non-EBM groups), and quasi-experimental with static-groups comparisons for the 4th year (M4, not yet exposed) and 6th year (M6, exposed 6 months to a year earlier) groups. EBM attitudes, knowledge and self-reported skills were measured using Taylor's questionnaire and a summative exam which comprised of a 100-item multiple-choice question (MCQ) test.

RESULTS

289 Medical students were assessed: M5 EBM=48, M5 non-EBM=47, M4=87, and M6=107. There was a higher reported use of the Cochrane Library and secondary journals in the intervention group (M5 vs. M5 non-EBM). Critical appraisal skills and attitude scores were higher in the intervention group (M5) and in the group of students exposed to EBM instruction during the previous year (M6). The knowledge level was higher after the intervention in the M5 EBM group compared to the M5 non-EBM group (p<0.001, Cohen's d=0.88 with Taylor's instrument and 3.54 with the 100-item MCQ test). M6 Students that received the intervention in the previous year had a knowledge score higher than the M4 and M5 non-EBM groups, but lower than the M5 EBM group.

CONCLUSIONS

Formal medical student training in EBM produced higher scores in attitudes, knowledge and self-reported critical appraisal skills compared with a randomized control group. Data from the concurrent groups add validity evidence to the study, but rigorous follow-up needs to be done to document retention of EBM abilities.

[The 2010 curriculum of the faculty of medicine at the National University of Mexico]

The 2010 undergraduate medical degree curriculum at the faculty of medicine of the Universidad Nacional Autonoma de Mexico (UNAM) constitutes an important curricular reform of medical education in our country. It is the result of an institutional reflective process and academic dialog, which culminated in its approval by UNAM’s Academic Council for the Biology, Chemistry, and Health Sciences areas on February 2nd, 2010. Some distinguishing characteristics of the new academic curriculum are: organization by courses with a focus on outcome competencies; three curricular axes that link three knowledge areas; four educational phases with achievement profiles; new courses (biomedical informatics, basic-clinical and clinical-basic integration, among others); and core curriculum. The aforementioned curriculum was decided within a framework of effective teaching strategies, competency oriented learning assessment methods, restructuring of the training of teaching staff, and establishment of a curriculum committee follow-up and evaluation of the program. Curricular change in medical education is a complex process through which the institution can achieve its mission and vision. This change process faces challenges and opportunities, and requires strategic planning with long-term foresight to guarantee a successful dynamic transition for students, teachers, and for the institution itself.

The resident-as-teacher educational challenge: a needs assessment survey at the National Autonomous University of Mexico Faculty of Medicine

BACKGROUND

The role of residents as educators is increasingly recognized, since it impacts residents, interns, medical students and other healthcare professionals. A widespread implementation of resident-as-teacher courses in developed countries' medical schools has occurred, with variable results. There is a dearth of information about this theme in developing countries. The National Autonomous University of Mexico (UNAM) Faculty of Medicine has more than 50% of the residency programs' physician population in Mexico. This report describes a needs assessment survey for a resident as teacher program at our institution.

METHODS

A cross-sectional descriptive survey was developed based on a review of the available literature and discussion by an expert multidisciplinary committee. The goal was to identify the residents' attitudes, academic needs and preferred educational strategies regarding resident-as-teacher activities throughout the residency. The survey was piloted and modified accordingly. The paper anonymous survey was sent to 7,685 residents, the total population of medical residents in UNAM programs in the country.

RESULTS

There was a 65.7% return rate (5,186 questionnaires), a broad and representative sample of the student population. The residents felt they had knowledge and were competent in medical education, but the majority felt a need to improve their knowledge and skills in this discipline. Most residents (92.5%) felt that their role as educators of medical students, interns and other residents was important/very important. They estimated that 45.5% of their learning came from other residents. Ninety percent stated that it was necessary to be trained in teaching skills. The themes identified to include in the educational intervention were mostly clinically oriented. The educational strategies in order of preference were interactive lectures with a professor, small groups with a moderator, material available in a website for self-learning, printed material for self-study and homework, and small group web-based learning.

CONCLUSIONS

There is a large unmet need to implement educational interventions to improve residents' educational skills in postgraduate educational programs in developing countries. Most perceived needs of residents are practical and clinically oriented, and they prefer traditional educational strategies. Resident as teachers educational interventions need to be designed taking into account local needs and resources.

[Treatment of hyaline membrane disease in the preterm newborn with exogenous lung surfactant: a controlled study]

BACKGROUND

Hyaline membrane disease (HMD) due to lung surfactant deficiency in the preterm newborn is an important cause of neonatal morbidity and mortality. Exogenous lung surfactant has transformed HMD therapy in developed countries, but an equivalent benefit has not been accomplished in developing countries due to a variety of factors. Porcine surfactant developed in Cuba is an inexpensive alternative to other surfactants, and its use has not been studied in our settings.

METHODS

A randomized, open, prospective and controlled trial was undertaken in 44 preterm newborns with HMD diagnosis. One group received bovine surfactant (BS) (Survanta) and the other Cuban porcine surfactant (PS) (Surfacen). The following clinical response variables were evaluated: oxygenation and ventilation indexes, days with supplementary oxygen, days with mechanical ventilation, incidence of complications, time of hospitalization, and mortality.

RESULTS

23 Patients received bovine surfactant and 21 the porcine type. The two groups were clinically similar, with patterns of oxygenation and ventilation response that were the same between groups, with a tendency to higher initial oxygenation increase in the PS group. The incidence of complications was similar between groups. 10 Patients (47.6%) died in the PS group, versus 12 (52.2%) in the BS group (p > 0.05).

CONCLUSIONS

Porcine surfactant had similar clinical effects than bovine surfactant in the oxygenation and ventilation variables, with no significant differences in complications ormortality. Porcine surfactant is an effective and lower cost altenative to bovine surfactant in the treatment of HMD.

Evidence-based medicine teaching in the Mexican Army Medical School

Training of medical students must include the skills necessary to use advances in scientific research. Evidence-based medicine (EBM) has been incorporated in undergraduate programs in several countries, a process that has not been well studied in developing countries' medical schools. An EBM course was incorporated into the curriculum of the Mexican Army Medical School. In the first year of its implementation it was given to half the fifth- and sixth-year groups. At the end of the semester, a previously validated questionnaire designed to evaluate the effectiveness of EBM teaching was administered. In total, 67 students took the course and 64 did not. A significant increase in the self-assessment of critical appraisal skills and the self-reported use of the Cochrane Library were found. There was a significant increase in the attitudes score, 22.9 +/- 5.9 (mean +/- SD) in the non-EBM group vs. 28.8 +/- 3.2 in the EBM group (p < 0.001), and a trend towards higher scores in the knowledge domain, 1.89 +/- 3.3 in the non-EBM group vs. 2.56 +/- 3.6 in the EBM group (p > 0.05). EBM concepts can be taught in a developing country medical school, with a short-term gain in attitude and probably in knowledge.

[Agenesis of the trachea. Presentation of a case and review of the literature]

Tracheal agenesis is one of the rarest and most refractory causes of neonatal respiratory distress; only 35 cases have been reported. We describe another example of this rare condition and review the literature.