Proximie in the operating theatre: evaluation of a virtual operating platform for medical student education

INTRODUCTION

Medical students often hesitate to enter the operating theatre because of poor visibility of the surgical field and anxiety about the theatre environment. In addition, ear, nose and throat (ENT) surgery is underrepresented in many medical curricula. Virtual systems like Proximie offer flexible viewing of surgeries with surgeon commentary, potentially addressing these issues.

METHODS

This descriptive survey study aimed to evaluate the use of Proximie as a surgical education tool for delivering ENT teaching to medical students. Live ENT procedures were recorded at the ENT Department of the John Radcliffe Hospital and shared with interested clinical medical students through Proximie accounts. Students were added to a private group chat to ask questions and provided feedback through structured forms, assessing procedural effectiveness and the platform's technology. Live-streaming and recording of procedures were facilitated by ENT surgeons providing commentary.

RESULTS

Conducted over four virtual theatre days, the study gathered 52 responses: 96% of students rated Proximie's educational value as 4 of 5 or higher; 57% preferred the virtual experience over physical attendance because of its convenience and the improved view of the surgical field. Students valued the live commentary and showed interest in using Proximie for a broader range of surgeries. Suggested improvements included fixing technical issues, better communication of theatre lists, and expanding surgical specialty coverage.

CONCLUSIONS

Proximie has been highly rated by medical students for its effective and engaging approach in the instruction of surgical skills, underscoring its value as an educational tool. Future research is needed to formally assess knowledge acquisition and retention across multiple surgical subspecialties. This work is the first step towards evaluating the utility of virtual operating theatre platforms for medical student education.

How well do UK assistantships equip medical students for graduate practice? Think EPAs

The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness. It is important to know whether meaningful EPAs occur in assistantships, and with what impact. Final year students at one UK medical school kept learning logs and audio-diaries for six one-week periods during a year-long assistantship. Further data were also obtained through interviewing participants when students and after three months as junior doctors. This was combined with data from new doctors from 17 other UK schools. Realist methods explored what worked for whom and why. 32 medical students and 70 junior doctors participated. All assistantship students reported engaging with EPAs but gaps in the types of EPAs undertaken exist, with level of entrustment and frequency of access depending on the context. Engagement is enhanced by integration into the team and shared understanding of what constitutes legitimate activities. Improving the shared understanding between student and supervisor of what constitutes important assistantship activity may result in an increase in the amount and/or quality of EPAs achieved.

Perception of health sciences and feminist medical students about obstetric violence

OBJECTIVE

To measure the perception of obstetric violence among health sciences students.

METHOD

Cross-sectional design in which the validated questionnaire PercOV-S (Perception of Student Obstetric Violence) was used. The questionnaire was offered to the students who participated in the I Congress of Feminist Medicine of the CEEM (State Councils of Medical Students) held on March 12, 2021. This questionnaire was sent online through Google Forms.

RESULTS

The mean score obtained on the total scale was 3.83 scores (SD=0.61). For the dimension of protocolized-visible obstetric violence, the mean score is 2.79 points (SD=0.84) and for the dimension of non-protocolized-invisible obstetric violence, a mean of 4.16 points is obtained (SD=0.61). The global score of the displayed question differs statistically significantly with the variable scope (p=0.019), course (p=0.008), treatment according to ethnicity (p=0.008), treatment according to socioeconomic level, immigrant status (p<0.001), and prior knowledge about the concept of obstetric violence (p<0.001).

CONCLUSIONS

The data show a marked generalised sensitivity of the sample to the issue of obstetric violence, especially with regard to the ethnic characteristics of the women. Likewise, the need to generate ethical-attitudinal training in the response to obstetric violence is observed.

HPV Knowledge Retention and Concurrent Increase in Vaccination Rates 1.5 Years After a Novel HPV Workshop in Medical School

Comprehensive education regarding human papillomavirus (HPV) pathogenesis, vaccination, and patient counseling are not routinely included in the medical school curriculum; consequently, student and provider knowledge, especially concerning head and neck pathology, remains low. The objective of this study was to demonstrate long-term retention of HPV knowledge and positive attitudes towards HPV vaccination after attending our novel HPV workshop, with a focus on knowledge of oropharyngeal cancer. A follow-up survey was administered to medical students 1.5 years after the initial completion of the workshop. HPV vaccination records from the student-led clinic were collected from the immunization information system. Awareness that HPV causes oropharyngeal cancer was present in 33% of medical students pre-curriculum; immediate and long-term post-curricular awareness of this association remained at 90% or higher (p < 0.0001). Comfort with HPV counseling, having enough information to recommend the vaccine, and knowledge of HPV malignancies, symptoms, transmission, and vaccination schedule remained persistently elevated over pre-curriculum scores (p < 0.05). Long-term knowledge scores were also higher than a control group of medical students at the same stage of training who had never participated in the workshop (p < 0.05). HPV vaccination rates at the medical school's student-run clinic also increased after the curriculum, from an average of 1.89 HPV vaccines given per clinic to 3.55 (p = 0.001). This study demonstrates that knowledge and positive attitudes were maintained 1.5 years after participating in this HPV curriculum during students' preclinical years of medical school. Additionally, an increase in HPV vaccination rates occurred at a student-led clinic, indicating a positive clinical impact on the curriculum.

Evaluation of interprofessional student teams in the emergency department: opportunities and challenges

BACKGROUND

Interprofessional education opportunities are commonly university-based and require further development during clinical practice. Many clinical contexts offer the potential for meaningful learning of both collaborative and discipline-specific practice. The emergency department (ED) demands efficient teamwork, so presents a logical location for interprofessional learning.

METHODS

An interprofessional clinical placement program was implemented with the aim to enhance students' capacity and self-efficacy for collaborative practice. Fifty-five medical and nursing students participated as interdisciplinary pairs in a two-week clinical placement in the ED. Students' perceptions of the learning environment were measured pre- and post-placement with the Self-efficacy for Interprofessional Experiential Learning Scale and the Interprofessional Clinical Placement Learning Inventory was completed post-placement. Non-parametric tests were used to establish change differences.

RESULTS

The Placement Learning Inventory revealed positive outcomes; the majority (16/19) agreed/agreed strongly that the placement provided sufficient learning opportunities, was interesting, and made them feel as if they belonged and most (14/19) reported they achieved the discipline specific learning objectives set by the university. Self-efficacy improved significantly (p = 0.017), showing promise for future use of the placement model Challenges were identified in the organisation and supervision of students. In the absence of additional dedicated student supervision, this model of interprofessional student pairs in the ED was challenging.

CONCLUSIONS

Interprofessional clinical placements in ED are an effective clinical learning approach for final year undergraduate medicine and nursing students. Recommendations for improvements for students' clinical supervision are proposed for the placement model.

Vitamin D Deficiency and Depression in Thai Medical Students During COVID-19 Pandemic: a Cross-Sectional Study

INTRODUCTION

Vitamin D deficiency is associated with osteoporosis, cancer, and autoimmune disease; evidence on its association with depression remains controversial. During the COVID-19 pandemic, preventive measures lead to reduced outdoor time and sunlight exposure, which is the major source of vitamin D. This study aims to assess the prevalence of vitamin D deficiency in Thai medical students during the pandemic and to determine its association with depression.

METHODS

Medical students of year 4 and year 5 rotating in the Srinakharinwirot University Hospital who had no diseases associated with vitamin D deficiency and had not taken vitamin D supplement in the past year were invited to participate. Their total serum 25-hydroxyvitamin D levels were assessed with ELISA. Their demographic data were recorded, including age, sex, family income, class year, grade point average, current and history of psychiatrist-diagnosed psychiatric illnesses, other underlying diseases, and perceived difficulties in academic, relationship, substance use, and social supports. Students' depressive symptoms were assessed using the Thai version of Patient Health Questionnaire-adolescent (PHQ-A).

RESULTS

A total of 63 female and 36 male medical students participated. 47.5% were year 4 and 52.5% were year 5. The mean vitamin D level was 21.7 ng/mL. The prevalence of vitamin D deficiency/insufficiency during the COVID-19 pandemic was 52.6% (using the cut-off of <20 ng/mL) or 69.5% (using the cut-off of <30 ng/mL). The mean vitamin D level in year 4 students was significantly lower than that in year 5 students (12.2 vs 30.2 ng/mL, t = -10.00, p < 0.01). Vitamin D level was associated with age (r = 0.38, p < 0.01) and sex (marginally) [t = -1.80, p = 0.07]. In linear regression analysis, vitamin D level remained associated with the year of class after adjusting for age and sex (B = 18.67, p < 0.01). The mean PHQ-A score was 5.8. 16 participants were identified to have depression. Vitamin D level was not correlated with PHQ-A score (r = 0.03, p = 0.80). In stepwise regression analysis, only total perceived difficulties score remained a predictor for PHQ-A score. In linear regression analysis, vitamin D level was not associated with PHQ-A score after adjusting for total perceived difficulties score (B = -0.02, p = 0.46).

CONCLUSION

The prevalence of vitamin D deficiency/insufficiency in Thai medical students during the COVID-19 pandemic was high (52.6% or 69.5%), probably owing to a lack of sunlight exposure. Nonetheless, vitamin D level was not associated with depressive symptoms, probably owing to the small sample size or delayed onset of depressive symptoms.

Experiences of French medical students during their clerkship in adolescent psychiatry: a qualitative study

The epidemiology of adolescent psychiatric disorders and the relational complexity of their management make exposure to adolescent psychiatry essential during medical school. However, some clinical particularities can complicate the students' learning experiences. Our work aimed to explore the experience of being a medical student during clerkships in adolescent psychiatry. Following the Interpretative Phenomenological Analysis qualitative approach, 20 semi-structured face-to-face interviews were conducted with medical students at the end of their clerkship in adolescent psychiatry. Three super-ordered themes emerged to describe their experience: in-depth self-exploration calling on emotions, thoughts and experiences; changes in the view of adolescent mental health; better understanding of the role and meaning of adolescent psychiatric care and how to approach it. Identification between students and patients could result from time-related factors (the end of adolescent brain remodeling, long, demanding studies, and financial and material dependence). In addition, the predominant use of non-analytical clinical reasoning processes-less valued in the rest of the graduate curriculum-poses a challenge for students. Indeed, for a student to find his or her place in adolescent psychiatry requires the student to reinvent him or herself, because the codes are different (no gown, less well-defined tasks, etc.). Finally, the excess prevalence of mental disorders among medical students requires increased vigilance on the part of tutors. For all these reasons, close, attentive tutoring seems essential to support students, while these clerkships afford a real opportunity for students to broaden their interpersonal skills.

Physical Medicine and Rehabilitation Residency Applicants: A Decade of Change

Physical medicine and rehabilitation (PM&R) has been an expanding specialty in medicine since its induction into the American Medical Association in 1947. This article quantifies the growth of PM&R by analyzing the number of residency positions and applicants as well as the characteristics of the applicants. Review of the United States (US) National Residency Matching Program (NRMP) data from 2010-2020 shows that the number of PM&R residency positions has grown by 26%, while the number of applicants has grown by 37% with a decreasing ratio of allopathic to osteopathic matched applicants. Matched applicants have had increasing Step 1 and 2 scores, abstracts, presentations, publications, and volunteer experiences. In the last decade there has been a growing interest in PM&R that outpaces residency positions and with increasingly qualified applicants. This analysis can guide residency administration and future applicants on the trends in the PM&R residency selection process.

Balint groups and narrative medicine compared to a control condition in promoting students' empathy

BACKGROUND

The perceived importance of clinical empathy may decline among students during medical training. Several interventions have been shown to be effective in promoting or preserving medical students' empathic abilities, such as empathy skills training or Balint groups. Although narrative medicine training shares some features with these interventions, no randomized study to date examined the efficacy of narrative medicine training. This study aimed to assess the effects of Balint groups and narrative medicine training on clinical empathy measured by the self-rated Jefferson's School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students.

METHODS

Students who gave their consent to participate were randomly allocated in equal proportion to Balint groups, narrative medicine training or to the control group. Participants in the intervention groups received either seven sessions of 1.5-h Balint groups or a 2-h lecture and five sessions of 1.5-h narrative medicine training from October 2015 to December 2015. The main outcome was the change in JSPE-MS© score from baseline to one week after the last session.

RESULTS

Data from 362 out of 392 participants were analyzed: 117 in the control group, 125 in the Balint group and 120 in the narrative medicine group. The change in JSPE-MS© score from baseline to follow-up was significantly higher in the Balint group than in the control group [mean (SD): 0.27 (8.00) vs. -2,36 (11.41), t = 2.086, P = 0.038]. The change in JSPE-MS© score in the narrative medicine group [mean (SD): - 0.57 (8.76)] did not significantly differ from the changes in the control group (t = 1.355, P = 0.18) or the Balint group (t = 0.784, P = 0.43). Adjusting for participants' characteristics at baseline, Balint groups remained associated with better outcomes compared to the control group (β = 2.673, P = 0.030).

CONCLUSIONS

Balint groups may promote clinical empathy to some extent among medical students, at least in the short run.

Peer-teaching at the University of Rwanda - a qualitative study based on self-determination theory

BACKGROUND

Peer-teaching is an educational format in which one student teaches one, or more, fellow students. Self-determination theory suggests that intrinsic motivation increases with the enhancement of autonomy, competence and relatedness.

AIMS

This qualitative study sought to explore and better understand the lived experiences, attitudes and perceptions of medical students as peer-teachers at the University of Rwanda when participating in a peer-learning intervention in the pediatric department.

METHODS

Students participated in a 3-h peer-taught symposium, supervised by a pediatric specialist or resident. Students worked in small groups to deliver a short didactic presentation related to acute illness in children. The symposium prepared the students for simulation-based teaching activities. In-depth, semi-structured, interviews were then employed to explore the students' experiences of the peer-teaching symposium. We specifically aimed to scaffold the analysis of these experiences on the themes of autonomy, competence and relatedness.

RESULTS

Saturation was achieved after interviews with ten students. Students described developing their own autonomous learning strategies, but despite developing this autonomy had a desire for support in the delivery of the sessions. Competence was developed through enhanced learning of the material, developing teaching skills and confidence in public speaking. Students valued the different aspects of relatedness that developed through preparing and delivering the peer-teaching. Several other themes were identified during the interviews, which are not described here, namely; i. Satisfaction with peer-teaching; ii. Peer-teaching as a concept; iii. Practical issues related to the peer-teaching session, and iv. Teaching style from faculty.

CONCLUSIONS

This is the first study to assess peer-learning activities in Rwanda. It has used qualitative methods to deeply explore the lived experiences, attitudes and perceptions of medical students. The peer-teaching strategy used here demonstrates the potential to enhance intrinsic motivation while increasing knowledge acquisition and teaching skills. We postulate that students in resource-limited settings, similar to Rwanda, would benefit from peer-teaching activities, and in doing so could enhance their intrinsic motivation.

[Mediation of data literacy in curricular education in otorhinolaryngology: watch and wait or anticipatory obedience?]

A comprehensive societal change is currently taking place, which also includes the medical field. The often heard "digital transformation" is also fundamentally transforming the health care system familiar to us, including the medical schools. While the Masterplan 2020 includes changes in the medical school structure and in the curricular content, it unfortunately focuses on special competencies, e.g., communication or scientific work, but not on digitization. However, precisely these skills are becoming increasingly indispensable in daily routine work. The seminar "Digitization in otorhinolaryngology (ORL)" was incorporated as a pilot project in the students' curriculum of the Department of ORL, at the University of Freiburg/Germany: the 141 medical students completed and evaluated this seminar as part of their 2 week rotation in otorhinolaryngology during the fall semester 2017/2018. The content of the seminar mediated digital competencies on the basis of practical examples. The evaluation showed high interest of the students in the topic in general, but also in more detailed subitems of the digitization topic. The students were generally open-minded concerning digitization but also critical of the topic. The acceptance of this newly implemented seminar was clearly positive. Another positive side effect is that this teaching concept can be transferred to other disciplines. Hence, we suggest to consider the training of digital competencies when implementing the Masterplan 2020.

[Use and acceptance of the ORL logbook for final year students in German university and academic teaching hospitals]

BACKGROUND

The current German medical licensing system from 2013 dictates the mandatory keeping of logbooks for final year students. A field-specific logbook for the practical year was created by the national otorhinolaryngology (ORL) society in 2012, which has been in use since then in all academic teaching and university hospitals nationwide.

OBJECTIVE

After this time interval it seemed appropriate to evaluate this logbook for its usefulness by associate lecturers and students. The objectives were whether the actual learning targets could be considered relevant, suitable and feasible concerning department location, practical and clinical education for medical students.

MATERIAL AND METHODS

A total of 165 associate lecturers of all registered national ORL departments were asked to participate using a 2-step evaluation. The logbook was evaluated by 77 lecturers in general and 17 lecturers also evaluated each of the 78 learning targets. Out of the 24 final year students from the Universities of Freiburg and Dresden who were contacted, 16 evaluated the logbook.

RESULTS

Analysis demonstrated that the ORL logbook was used in 55% without alterations to the content and in 36% a medical faculty-specific logbook was used. The lecturers' judgement revealed no significant differences between the two logbooks. They approved the 78 learning targets with a majority vote of between 60-100%. Only 3 learning targets (otoacoustic emission, rhinomanometry and sonography) showed approval of less than 60%, associated with a request for modifications. Students evaluated the ORL logbook as being significantly better than the faculty's version concerning practical education.

CONCLUSION

The results demonstrated the nationwide acceptance of the ORL logbook by lecturers and students. The amount of critical learning targets which will have to be changed is moderate. This evaluation confirmed the relevance and balance of the ORL logbook content in the practical year training and the possibility of use independent of the location of ORL departments.

Awareness of fertility preservation among Chinese medical students

INTRODUCTION

The fertility preservation (FP) services offered in Hong Kong are underutilised. There have been no previous studies on Chinese medical students to investigate the underlying reasons for this underutilisation in terms of awareness, knowledge, and attitudes towards FP and age-related fertility.

METHODS

This was a cross-sectional survey among Chinese medical students in Hong Kong.

RESULTS

The majority of participants (77.8%) were not familiar with any clinics or specialists who provide FP services. The vast majority (88.1%) underestimated female infertility at age 45 years, and 89.8% overestimated the age of male fertility decline. The students' FP knowledge was mainly acquired from electronic media (58.4%) and medical school (57.6%). Medical students showed overwhelming support towards FP for medical reasons (97.9%) but had mixed responses about FP for elective reasons related to career development in women (58.8%). Of the participants, 80.2% agreed that the government should subsidise FP services for patients with medical reasons.

CONCLUSION

This study highlights the limited awareness and knowledge of FP among Chinese medical students. There is a strong worldwide need to increase education about and exposure to FP in the medical curriculum and improve medical students' knowledge.

A Near-Peer Teaching Module to Supplement Current Undergraduate Teaching in ENT Surgery

BACKGROUND

Near-peer teaching (NPT) has been successfully used in other medical specialties but not in ear, nose and throat surgery (ENT). Historically, undergraduates receive limited ENT exposure and subsequently report low confidence in ENT competencies. This has been a posited cause of high referral rates to the specialty. This study aimed to see if NPT could be implemented as an adjunct to traditional ENT teaching.

ACTIVITY

Learners received a short NPT module that was focused on clinical ENT. Pre- and post-module questionnaires collected data on students' confidence and knowledge.

RESULTS AND DISCUSSION

One hundred twenty-five undergraduate learners received the intervention. There was a significant percentage increase in both confidence (24.2%, p = < 0.001) and knowledge (35.9%, p = < 0.001) of learners. In a supervised setting, NPT could be a valuable adjunct to traditional undergraduate ENT education.

Assessing the effects of an empathy education program using psychometric instruments and brain fMRI

This study aimed to (1) evaluate the effects of an empathy education program, and (2) explore functional magnetic resonance imaging (fMRI) as a potential empathy assessment tool. An empathy enhancement program for premedical students was developed. The Korean version of the Jefferson Scale of Empathy-Student version (JSE-S) and Interpersonal Reactivity Index (K-IRI) were used to measure self-assessed changes in empathy. Clinical vignettes demonstrating empathy tasks were presented to participants undergoing fMRI, to assess regional changes in the brain. Self-reported empathy scores and brain activity signals using fMRI from before and after the program were compared. The JSE-S total and perspective taking scores significantly increased after the program. Data from the fMRI revealed noticeable differences in cognitive regions associated with empathy, namely the right superior medial frontal gyrus and left precentral gyrus. This study results support the prior evidence of positive impact of empathy education. In addition, the authors suggest that brain fMRI might be used in measuring the effectiveness of empathy education.

Prevalence and Correlates of Depressive Symptoms among Medical Students: a Cross-sectional Single-centre Study

BACKGROUND

Depressive symptoms are common among medical students. The aim of the present study was to determine the prevalence and risk factors of depressive symptoms among medical students in Sultan Qaboos University in Oman.

METHOD

A cross-sectional study was conducted among a random sample selected from 1041 medical students at Sultan Qaboos University, Oman. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to determine risk factors for depressive symptoms.

RESULTS

Of 197 medical students selected, 189 (61 men and 128 women) responded. The PHQ-9 results showed that the prevalence of depressive symptoms was 41.3%. In multivariate analysis, female students were more likely than male students to develop depression (adjusted odds ratio = 2.866, p = 0.004). Medical students with a family history of depression were more likely to develop depression than those without a family history of depression (adjusted odds ratio = 4.150, p = 0.014).

CONCLUSIONS

Depressive symptoms are common among medical students in Sultan Qaboos University. Risk factors for depressive symptoms are female sex and family history of depression.

The Effect of Gender on Team-Based Learning Peer Assessment in a Psychiatry Clerkship

In team-based learning (TBL), peer evaluation is important, but also open to bias. We examined the relation between gender and summative peer feedback over 3 years in all 90 teams created in our psychiatry clerkship. Gender-equivalent (92.7 vs 88.1, p < 0.05) and majority-women (93.6 vs 88.1, p < 0.05) teams scored higher than majority-men in the first 2 years, as did women-majority teams in the third (98.3 vs 94.8, p < 0.05). Mean scores were little-affected by team size. These findings suggest TBL team gender balance can adversely affect peer evaluations. Instructors should consider team gender composition and the weight given to feedback scores.

[Apps in General Medicine : A topic for medical education?​]

BACKGROUND

Health-related apps can provide helpful resources for both doctors and patients. The selection of potentially useful apps and the appraisal of their quality are particularly important in the context of medicine as false or confusing app content may put patients at risk.

AIM

In this article a brief overview of the topic is provided and the results of a pilot study, in which medical students tested and evaluated the quality of 143 health-related apps on the topics of cardiology and pulmonology are presented.

MATERIAL AND METHODS

Using the semiautomated retrospective app store analysis (SARASA) method, a group of apps concerned with cardiology and pulmonology were identified from a pool of over 2,000,000 apps available in the Apple Store. As part of a practical exercise, 138 4th year medical students tested a total of 143 of these apps, subsequently evaluating them using a specially devised questionnaire.

RESULTS

The most frequent target population among the tested apps was identified as patients and their carers and the primary purpose in the majority of cases was the provision of information. Despite this, at least one quarter of all apps tested required users to enter sensitive health-related information. The evaluations by the students portrayed a large range in terms of the quality of the apps tested.

DISCUSSION

Health-related apps play a growing role in the management of illnesses in the field of internal medicine. Doctors must be aware of the benefits and limitations of using such apps and should be prepared during their medical studies for the challenge of advising patients on this topic.

Perception, knowledge, and interest of urologic surgery: a medical student survey

BACKGROUND

Although only a limited number of medical schools require a formal educational rotation in urologic surgery, urology as a medical specialty continues to attract a large number of students into the match each year. The purpose of this study was to describe medical student awareness, perception, and knowledge of urology, to determine factors influencing students' consideration of urology as a career, and to determine if prior urology clerkship experience is associated with differences in these variables.

METHODS

In this cross-sectional study, medical students were electronically surveyed in 07/2016. Self-reported and question-based knowledge of urology were determined. A total of 25 factors were assessed with a five-point Likert scale to determine their influence on students' consideration of urology as a career. Data analysis was performed using R.

RESULTS

The survey was completed by 114 students (13.5% of all medical students). A total of 11(9.65%)students had previously participated in a urology clerkship. All students reported awareness of urology; however, only 74 students (64.9%) correctly identified the training pathway and job duties of urologists. Self-perceived knowledge of urology was poor but improved with increased medical school training. Question-based assessment also demonstrated increased knowledge with advanced medical school training (27% per year; p < 0.01). Prior urology clerkship experience appeared to be associated with increased urologic knowledge; however, this was confounded by year in medical school training. When assessing factors impacting students' consideration of a career in urology, 'combination of medicine and surgery' was the most positively influential and 'competitiveness of the specialty' was the most negatively influential.

CONCLUSIONS

Although medical students are aware of urology as a specialty, they perceive their knowledge of urology as poor. However, knowledge of urology increases throughout medical school training. Multiple factors influence students' consideration of urology as a career choice. Additional studies are needed to further explore how participation in a formal urology experience alters students' perceptions and influences their consideration of urology as a career choice.

TRIAL REGISTRATION

Retrospectively registered.

Intraoperative Disruptive Behavior: The Medical Student's Perspective

OBJECTIVE

Intraoperative disruptive behavior can reduce psychological safety and hinder teamwork and communication. Medical students may provide unique insights into how to prevent these adverse impacts. We sought to characterize medical student perspectives on the causes and consequences of intraoperative disruptive behavior and ideal intraoperative working environments.

DESIGN

In this retrospective qualitative analysis, authors coded de-identified field notes from residency interviews to identify themes and key insights and to explore gender differences in perspectives.

SETTING

A tertiary academic medical training center in the Midwestern United States.

PARTICIPANTS

Forty-two medical students applying for urology residency placement.

RESULTS

Students were 57% male with an average age of 26 years (range 23-34). Most students witnessed intraoperative disruptive behavior (usually by surgeons) such as yelling, throwing instruments, or blaming others. Students described frustration with missing instruments and incompetent assistants as the most common instigators of disruptive behavior. They noted undesirable effects of disruptive behavior, including decreased communication/teamwork, lack of learning, increased technical mistakes, and recalled feeling afraid and stressed by these situations. They described ideal intraoperative working environments as calm, efficient and collaborative environments where questioning and learning is encouraged.

CONCLUSIONS

Students provide a valuable perspective on the causes and consequences of disruptive behavior during surgery and point to potential pathways to improvement. Their experiences suggest prevention or reduction of surgeon frustration might be a fruitful target for intervention efforts to prevent intraoperative disruption.

Study-related behavior patterns of medical students compared to students of science, technology, engineering and mathematics (STEM): a three-year longitudinal study

BACKGROUND

Medical education is perceived as demanding and stressful. Whether this is particularly pronounced in this course of study remains under debate.

METHODS

We used the questionnaire "Work-Related Behavior and Experience Patterns (Arbeitsbezogene Verhaltens- und Erlebensmuster (AVEM))" to assess the development of study-related behavior and experience patterns in medical (n = 584) and STEM students (n = 757) at one German university, with a special emphasis on gender differences, over 3 years of study. Students were surveyed at the beginning of their studies (t0) and again in each consecutive summer semester (t1-t3). Both cross-sectional and longitudinal data were generated and analyzed. Results in the abstract are from the cross-sectional analysis.

RESULTS

Freshman medical students presented with a larger proportion of students with a healthy pattern (58.1%) than STEM students (42.5%). In both groups this proportion decreased to 33.8%/25.1% at t2, with only a minor improvement at t3 (38.1/27.0%). Correspondingly, the proportion of students with a burnout-related risk pattern increased from 8.0% (Med)/13.7% (STEM) to a maximum of 16.9% at t2 in medical students and 27.0% at t3 in STEM students. In both groups female students showed a more unfavorable distribution of patterns and a higher vulnerability, especially in the area of resistance toward stress.

CONCLUSIONS

The unfavorable development of behavior and experience patterns in both student groups demonstrates increasing study related stress and emphasizes the need for prevention and health promotion on an individual and a contextual level.

PERCEPTION OF FIRST-YEAR VERSUS SIXTH-YEAR MEDICAL STUDENTS IN SERBIA ON STUDYING MEDICINE AND POSTGRADUATE CAREER

Self-perceived stress during undergraduate medical training could influence forthcoming career choices. The aim of this study was to explore the attitudes and potential differences between 1^st and 6^th year students regarding aspects of medical training and career plans. As many as 570 students in 1^st and 400 in 6^th year of studies at the Faculty of Medicine, University of Belgrade, were recruited on December 2-9, 2013. Data were acquired through a self-administered questionnaire. Students in both years rated “Helping other people” as the most important reason to study medicine. Freshmen rated statistically significantly higher ‘good incomes’ and ‘social status’ as reasons to study medicine (p=0.003 and p=0.037, respectively). The most desirable fields of specialization were surgery and internal medicine (36.4% and 18.7% for 1^st year, and 26.3% and 36.6% for 6^th year, respectively). Significantly more freshmen would prefer working abroad (χ²=3.891, p=0.029). In terms of careers abroad, students in both years expressed the highest interest in working in western and northern Europe. Desires for specialty training among medical students follow the pattern of the most frequent disciplines in the Serbian physician population, with gender differences comparable to other populations. A certain percentage of students would likely emigrate.

Translation, transcultural adaptation, and validation of the role-modeling cost-conscious behaviors scale

BACKGROUND

Training in the use of cost-conscious strategies for medical students may prepare new physicians to deliver health care in a more sustainable way. Recently, a role-modeling cost-conscious behaviors scale (RMCCBS) was developed for assessing students' perceptions of their teachers' attitudes to cost consciousness. We aimed to translate the RMCCBS into Brazilian Portuguese, adapt the scale, transculturally, and validate it.

METHODS

We adopted rigorous methodological approaches for translating, transculturally adapting and validating the original scale English version into Brazilian Portuguese. We invited all 400 undergraduate medical students enrolled in the 5th and 6th years of a medical course in Northeast Brazil between January and March 2017 to participate. Of the 400 students, 281 accepted to take part in the study. We analyzed the collected data using the SPSS software version 21 and structural equation modeling (SEM) was performed using AMOS SPSS version 18. We conducted exploratory factor analysis (EFA), varimax rotation, with Kaiser Normalization and Principal Axis Factoring extraction method. We conducted confirmatory factor analysis (CFA), using the SEM. We used the following indexes of adherence of the model: Comparative fit index (CFI), Goodness-of-fit index (GFI) and Tucker-Lewis Index (TLI). We considered the Bayesian Information Criterion (BIC) for Sample-size adjusted. The root mean square error of approximation was calculated. Values below 0.08 were considered acceptable. Composite reliability analyzes were performed to evaluate the accuracy of the instrument. Values above 0.70 were considered satisfactory.

RESULTS

Of the 281 undergraduate medical students, 195 (69.3%) were female. Mean age of participants was 25.0 ± 2.6 years. In the EFA, the KMO was 0.720 and the Bartlett sphericity test was significant (p < 0.001). We conducted the EFA into two factors: role-modeling cost-conscious behaviors in health (seven items) and health waste behaviors (six items). The 13 item-scale was submitted to composite reliability analyzes, obtaining values of 0.813 and 0.761 for the role-modeling cost-conscious behaviors and the health waste behaviors factors, respectively.

CONCLUSIONS

We concluded that the cost-conscious behaviors scale has good psychometric properties and is a valid and reliable instrument for evaluating medical students' perception of their teachers' cost-conscious behaviors.

What keeps medical students healthy and well? A systematic review of observational studies on protective factors for health and well-being during medical education

BACKGROUND

Despite the growing evidence of a negative impact of medical school on students' health and well-being, little is known about protective factors for staying healthy and well during medical education. Therefore, a systematic review of peer-reviewed studies aiming to identify such predictors was conducted.

METHODS

Medline, Embase, and PsychInfo were systematically searched by using preselected MeSH terms to identify English- and German-language peer-reviewed articles (observational studies) examining predictors for medical students' health and well-being, published between January 2001 and April 2018. Two authors independently selected abstracts reporting predictors for medical students' health and well-being. Further, two authors extracted information from the identified studies, needed for methodological quality assessment of the studies, as well as for comprehensive description of identified predictors.

RESULTS

From 5013 hits in the database search, six observational studies met the inclusion criteria and were included in the final analysis. These studies were of heterogeneous design and quality. They featured a wide variety of health and well-being related outcomes and of its predictors. Lower levels of perceived stress, as well as lower levels of neuroticism were found to predict better health-related outcomes.

CONCLUSIONS

Further research, by using harmonized tools for the assessment of outcomes, as well as predictors, is needed to determine what keeps students healthy and well during medical education. Identifying protective factors is an essential prerequisite for the design of evidence-based health-promoting interventions.

Attitude of Medical Students in Paraguay Towards Homosexuality

INTRODUCTION

The attitude of medical students towards homosexuality may affect the quality of care for homosexual patients. This study aimed to describe the attitude of medical students at the National University of Asuncion, Paraguay towards homosexuality.

METHODS

This observational, cross-sectional study was conducted in June 2016 in consecutive medical students from the National University of Asunción (Santa Rosa del Aguaray branch), Paraguay. The 10-item attitude towards homosexuality scale (EAH-10) was used to assess participants' acceptance/ rejection of homosexuals as individuals, homosexuality as a sexual orientation, and public manifestations of homosexuality.

RESULTS

A total of 48 female and 29 male participants (mean age, 21 ± 2 years) were included. Most were Catholic (71.4%), followed by non-Catholic Christian (10.4%), agnostic (9.1%), atheist (2.6%), and other (6.5%). 71.4% reported having at least one homosexual friend. The mean EAH-10 score was 27.23 ± 9.379. 42.9% of participants were indifferent or undecided in their attitude towards homosexuality and 28.6% were discriminatory. Having homosexual friends was associated with a lower EAH-10 score (t = -3.447 [75], p = 0.001).

CONCLUSION

Education about health issues of homosexuals is needed for medical students in Paraguay.

Attitude of Indian Medical Students Towards Homosexuality

INTRODUCTION

It is important to understand the attitude of medical students towards homosexuality, as this may affect patient care.

METHODS

Year 2 and 3 students at Calcutta National Medical College, Kolkata, India were asked to selfadminister an 18-item questionnaire anonymously. Internal consistency of the questionnaire statements was high (Cronbach's alpha of 0.91). There were five responses for each statement: strongly agree, generally agree, unsure, generally disagree, and strongly disagree.

RESULTS

Of 290 students, 270 (93.1%) [148 males and 122 females] completed the questionnaire and were included in the analysis. Overall, 55.6% strongly disagreed that homosexuality was an illness; 70.8% agreed that homosexuals were capable of forming stable relationships. Only 31.1% believed that homosexual doctors would better understand homosexual patients. About 71.8% reported that talking about homosexuality did not embarrass them, and 81.8% believed that problems associated with homosexuality could be reduced if society was more liberal. Nonetheless, negative attitudes were reflected in the stereotypical image of homosexuality. About 15.9% of respondents believed that homosexuality was an illness; 24.8% considered homosexuals neurotic, 28.1% considered homosexuals promiscuous; and 8.2% thought that they posed a danger to children.

CONCLUSION

Although the overall attitude of Indian medical students towards homosexuality is positive, the percentage of students with negative attitudes remains quite high. Further work on the medical curriculum is needed to change these negative attitudes so that patients receive appropriate care.

Differences in Health-Promoting Lifestyle Profile Among Croatian Medical Students According to Gender and Year of Study

Increasing awareness of healthy lifestyle is important during the period of adolescence because habits are difficult to modify in adulthood. The aim of the study was to examine gender differences in health-promoting lifestyle among medical students and to analyze changes between the first and second year of the study. This cross sectional study was conducted on a sample of 1186 students (36% male). Data were collected by self-administered anonymous questionnaire, the Health- Promoting Lifestyle Profile [HPLP II] (Adult Version), and analyzed by descriptive statistics and nonparametric tests. The 941 HPLP II questionnaires were collected and analyzed (79% response rate). Both genders showed a medium level HPLP II total score (male M=2.68; IQR=2.42-2.92 vs. female M=2.65; IQR=2.46-2.90), without significant gender difference. A significantly higher score was observed in the subscales on health responsibility (p=0.027) and interpersonal relations (p<0.001) among female compared to male students, and a significantly higher score in the subscales on physical activity (p<0.001) and stress management (p=0.025) among male compared to female students. Considering differences in the health-promoting lifestyle between study years, a significantly higher score was recorded among second-year students in the HPLP II total score (p=0.004) and the subscales on physical activity (p=0.007), stress management (p=0.006) and spiritual growth (p=0.029). In conclusion, study results implied the need of organized health care and physical activity programs for university students based on specific requirements and needs.

Insights into an Award-Winning Summer Internship Program: The First Six Years

Since its inception in 2008, the American Center for Reproductive Medicine's summer internship program in reproductive research and writing has trained 114 students from 23 states within the United States and 10 countries worldwide. Its fundamental goal is to inspire pre-medical and medical students to embrace a career as a physician-scientist. During this intensive course, established scientists and clinicians train interns in the essential principles and fundamental concepts of bench research and scientific writing. Over the first six years (2008~2013), interns have collectively published 98 research articles and performed 12 bench research projects on current and emerging topics in reproductive medicine. Interns have also developed and honed valuable soft skills including time management, communication and presentation skills, as well as life values, which all enhance personal and professional satisfaction. Program graduates are able to recognize the value of medical research and its potential to impact patient care and gain insight into their own career pathway. Between 2011 and 2014, the internship program was thrice awarded a Scholarship in Teaching Award by Case Western Reserve School of Medicine for its innovative teaching approach and positive impact on medical education and student careers. This report highlights the demographics, logistics, implementation, feedback, and results of the first six years of the American Center for Reproductive Medicine's summer internship program at Cleveland Clinic (Cleveland, OH, USA). This may be helpful to other research and academic institutions considering implementing a similar program. In addition, it creates awareness among potential physician-scientists of what the world of research has to offer in both scientific writing and bench research. Finally, it may stimulate further discussion regarding narrowing the gap between physicians and scientists and refinement of the current program.

Factors influencing the career interest of medical graduates in obstetrics and gynaecology in Hong Kong: a cross-sectional questionnaire survey

INTRODUCTION

The trend of declining interest of medical graduates in pursuing obstetrics and gynaecology as a career has been observed in many overseas studies. This study aimed to evaluate the career interest of the most recent medical graduates in Hong Kong, especially their level of interest in obstetrics and gynaecology, and to identify key influential factors for career choice and career interest in obstetrics and gynaecology.

METHODS

All medical graduates from the Chinese University of Hong Kong and the University of Hong Kong who attended the pre-internship lectures in June 2015 were invited to participate in this cross-sectional questionnaire survey. The main outcome measures were the level of career interest in obstetrics and gynaecology, the first three choices of specialty as a career, key influential factors for career choice, and key influential factors for career interest in obstetrics and gynaecology.

RESULTS

Overall, 73.7% of 323 new medical graduates participated in the study and 233 questionnaires were analysed. The median score (out of 10) for the level of career interest in obstetrics and gynaecology was 3. There were 37 (16.2%) participants in whom obstetrics and gynaecology was among their first three choices, of whom 29 (78.4%) were female. Obstetrics and gynaecology ranked as the eighth most popular career choice. By factor analysis, the strongest key influential factor for career interest in obstetrics and gynaecology was clerkship experience (variance explained 28.9%) and the strongest key influential factor for career choice was working style (variance explained 26.4%).

CONCLUSIONS

The study confirmed a low level of career interest in obstetrics and gynaecology among medical graduates and a decreasing popularity of the specialty as a career choice. The three key influential factors for career interest in obstetrics and gynaecology and career choice were working style, clerkship experience, and career prospects.

Teaching and addressing health disparities through the family medicine social and community context of care project

By training future physicians to care for patients with backgrounds different from their own, medical schools can help reduce health disparities. To address the need for education in this area, the leaders of the Family Medicine Clerkship at the Warren Alpert Medical School of Brown University developed the Social and Community Context of Care project, required of all medical students rotating through this clerkship. Students develop a hypothetical intervention addressing a health issue seen at their preceptor site, and are assessed on their grasp of the social and contextual issues affecting that health issue in their particular community. Some interventions are actualized in later clerkships or independent study projects; one example, a health class for pregnant and parenting teens at Central Falls High School, is described here. If made a routine part of medical education, projects such as these may help medical students address the health disparities they will encounter in future practice.

Health disparity curriculum at the Warren Alpert Medical School of Brown University

There is increasing recognition that, in addition to acquiring knowledge of basic sciences and clinical skills, medical students must also gain an understanding of health disparities, and develop a defined skill set to address these inequalities. There are few descriptions in the literature of a systematic, longitudinal curriculum in health disparities. Using Kern's six-step approach to curriculum development along with principles of experiential and active learning, student champions and the Office of Medical Education developed a multimodal health disparities curriculum. This curriculum includes required experiences for medical students in the 1st, 2nd and 3rd year, along with elective experiences throughout medical school. Students are examined on their knowledge, skills and attitudes towards health disparities prior to graduation. It is our hope this curriculum empowers students with the knowledge, skills and attitudes to care for patients while helping patients navigate the socioeconomic and cultural issues that may affect their health.

Building a workforce of physicians to care for underserved patients

There is a shortage of physicians to care for underserved populations. Medical educators at The Warren Alpert Medical School of Brown University have used five years of Health Resources and Services Administration funding to train medical students to provide outstanding primary care for underserved populations. The grant has two major goals: 1) to increase the number of graduating medical students who practice primary care in underserved communities ("Professional Development"); and 2) to prepare all medical school graduates to care for underserved patients, regardless of specialty choice ("Curriculum Development"). Professional Development, including a new scholarly concentration and an eight-year primary care pipeline, has been achieved in partnership with the Program in Liberal Medical Education, the medical school's Admissions Committee, and an Area Health Education Center. Curriculum Development has involved systematic recruitment of clinical training sites and disease-specific curricula including tools for providing care to vulnerable populations. A comprehensive, longitudinal evaluation is ongoing.

Future health disparity initiatives at the Warren Alpert Medical School of Brown University

As the United States embarks on health care reform through the Affordable Care Act (ACA), the knowledge, skills and attitudes necessary to practice medicine will change. Education centered on health disparities and social determinants of health will become increasingly more important as 32 million Americans receive coverage through the ACA. In this paper, we describe future initiatives at the Warren Alpert Medical School of Brown University in training medical students on health disparities and social determinants of health through mechanisms such as the Primary Care-Population Medicine Program, the Rhode Island Area Health Education Center, the Scholarly Concentration program and other mechanisms.

Interprofessional Education (IPE) Activity amongst Health Sciences Students at Sultan Qaboos University: The time is now!

Historically, health professionals have been educated in profession-specific institutions which provide limited opportunities for learning interprofessional (IP) skills. Many qualified practitioners are therefore poorly prepared for the challenges of IP practice (IPP). Patients today have complex needs and typically require more than one professional to address their medical issues and effective IP care relies upon health care professionals' abilities to communicate with one another. Competent communication improves the quality of care, thus enhancing patient outcomes. The objective of IP education (IPE) is to prepare students to deliver IP care in the future. Sultan Qaboos University's medical and nursing colleges train the future health workforce for Oman. However, students have no opportunities for collaborative learning. It is imperative that opportunities be created where students learn with, about, and from each other with the aim of improving the quality of care they are likely to deliver in the future.

Student feedback about The Skeptic Doctor, a module on pharmaceutical promotion

Pharmaceutical promotion is an integral part of modern medical practice. Surveys show that medical students have a positive attitude towards promotion. Pharmaceutical promotion is not adequately taught in medical schools. A module based on the manual produced by Health Action International was conducted for second year medical students at KIST Medical College, Lalitpur, Nepal. Student feedback on various aspects of the module was obtained using a semi-structured questionnaire. Eighty-six of the 100 students (86%) provided feedback about the module. Forty-five (52.3%) were female and 39 (45.3%) were male. Participant feedback about the module was positive. Small group work and role plays were appreciated, and the ratings of the module and the manual were satisfactory. Respondents felt pharmaceutical promotion will play an important role in their future practice and that the module prepared them to respond appropriately to promotion and select and use medicines properly. The module further developed on issues covered during pharmacology practical and majority felt the module was of relevance to Nepal. Students appreciated the module though there were suggestions for improvement. The module should be considered during the years of clinical training (third and fourth years) and internship and in other medical schools.