Undergraduate medical students’ perceptions of their learning experience in pediatric rotation at King Abdulaziz University Medical College in Jeddah,Saudi Arabia

Abstract

Aim: This study aimed to evaluate fifth-year medical students' perception of their learning experience during pediatric rotation at the medical college of King Abdulaziz University (KAU), Jeddah, Saudi Arabia.

Method: This cross-sectional study was conducted by distributing a questionnaire to fifth-year students who attended the pediatric rotation at KAU, during 2013–2014.

Results: Three hundred fifty-six out of 360 students agreed to participate, representing a response rate of 99%. More than 90% were satisfied with the module, and 80% reported the usefulness of the orientation session. The mean scores for the usefulness of morning experience and afternoon activities were 7.20?±?2.40 and 6.40?±?2.70, respectively. A significant difference in the mean scores for supervision was observed between the clerkship sites (p?=?.0001), with the highest score for consultants’ supervision (7.01?±?2.90) and lowest for interns’ supervision (4.81?±?3.30).

Conclusions: Overall, although the program was satisfactory to the majority of participants, areas of concern were identified. Students reported more effective learning and development of clinical skills , during the morning rounds, when supervised by consultants and senior specialists, and in activities that involved examining patients, presenting cases, and participating in discussions.     

Awareness and usage of evidence-based learning strategies among health professions students and faculty

Abstract

Introduction: Learning is essential and life-long for faculty and students. Often students and teachers use ineffective learning strategies and are not aware of evidence-based strategies.

Methods: A multicenter, international, cross-sectional, online survey-based assessment of awareness of evidence-based learning strategies among health professions students (n?=?679) and faculty (n?=?205).

Results: Students endorsed many study habits which violate evidence-based principles, including studying whatever is due soonest (389/679, 57%), failing to return to course material once a course has ended (465/679, 68%), and re-reading underlined or highlighted notes (298.679, 44%). While the majority of faculty surveyed (125/157, 80%) reported recommending effective study strategies for their students, most students (558/679, 82%) said they did not study the way they do because of instruction from faculty. The majority of faculty (142/156, 91%) and students (347/661, 53%) believe students have different learning styles.

Discussion: The results of this study demonstrate health professions students continue to use many ineffective study strategies, and both students and faculty hold misconceptions about evidence-based learning. While planning a curriculum, medical educators should focus on teaching students how to learn and use higher order thinking procedures in addition to teaching content.     

Uncover it,students would learn leadership from Team-Based Learning (TBL): The effect of guided reflection and feedback

Context: Little is known about best practices for teaching and learning leadership through Team-Based learning? (TBL?) with medical students. We hypothesized that guided reflection and feedback would improve shared leadership and shared leadership capacity, and enhance team decision quality in TBL teams. We used the Kolb experiential learning theory as the theoretical framework.

Method: The study was conducted at Tehran University of Medical Sciences. Three TBL sessions with 206 students (39 teams) participated in the study. Using a quasi-experimental design, one batch received guided reflection and feedback on their team leadership processes (n?=?20 teams) and the other received only TBL (n?=?19 teams). Observers measured shared leadership using a checklist. Shared leadership capacity was measured using a questionnaire. Scores on a team application exercise were used to assess quality of team decisions.

Results: Evidence did not support our first hypothesis that reflection and feedback enhance shared leadership in TBL teams. Percentages of teams displaying shared leadership did not differ between intervention and control groups in sessions 1 (p?=?0.6), 2 (p?=?1) or 3 (p?=?1). The results did not support the second hypothesis. We found no difference in quality of decision making between the intervention and control groups for sessions 1 (p?=?0.77), 2 (p?=?0.23), or 3 (p?=?0.07). The third hypothesis that the reflection and feedback would have an effect on shared leadership capacity was supported (T?=??8.55, p?>?0.001 adjusted on baseline; T?=??8.55, p?>?0.001 adjusted on gender).

Discussion and conclusion: We found that reflection and feedback improved shared leadership capacity but not shared leadership behaviors or team decision quality. We propose medical educators who apply TBL, should provide guided exercise in reflection and feedback so that students may better understand the benefits of working in teams as preparation for their future roles as leaders and members of health care teams.     

An e-Delphi study generates expert consensus on the trends in future continuing medical education engagement by resident,practicing, and expert surgeons

Abstract

Background: The Delphi method is a demonstrated way to gather structured expert opinions to forecast, plan, and prioritize around a given topic. It builds consensus through iterative rounds.

Aims: The goal of this study was to build consensus-based predictions for the year 2022 about: future trends in surgeon continuing medical education (CME); the role of technology in learning for surgeons of different experience levels (trainee/resident, practicing, expert); and CME funding models.

Methods: A three round e-Delphi method was employed for this study. Panelist identities were anonymized, and controlled feedback and consensus rules were employed. Fifteen international expert panelists’ input was collected via electronically distributed, open-ended questionnaire (Round 1) and 5-point Likert scale ranking surveys (Rounds 2 and 3), in a series of nine questions (Round 1) and 26 and 25 summary statements (Rounds 2 and 3, respectively). Summary statements were collated via key words and ideas collected from panelist’s input. Mean, median, standard deviation, and 95% confidence intervals were calculated.

Results: Response rate was 100% for each round. Consensus in Round 2 was 61% and 88% in Round 3. Seven key finding statements with supporting background information was the result.

Discussion: Reliable, affordable internet access was identified as a likely barrier to education for certain regions, even in 5 years’ time. The use of similar educational resources were identified for all levels of surgeon, what varied was the reliance on a particular resource by each level of surgeon.

Conclusion: Institutes of employment were predicted to have ended CME funding for expert surgeons by 2022. Industry sponsored CME was predicted to have a continued role for trainee/residents and practicing surgeons.     

How do formative objective structured clinical examinations drive learning? Analysis of residents’ perceptions

Introduction: Although several studies have explored the relationship between learning and written tests, little is understood about how performance-based examinations influence learning. The purpose of this study was to explore how a formative objective structured clinical examination (OSCE) drives learning.

Methods: We administered surveys to residents (n?=?35) at three time points to determine if and how an OSCE influenced their learning: before and immediately following the OSCE, and after the distribution of their results. Differences in quantitative responses between high- and low-performing residents and across time were compared using repeated-measures ANOVA. Thematic analysis was used to analyze narrative comments.

Results: Participants’ goals for the OSCE related to performance, mastery and feedback. Almost all participants reported that they had learned something from the OSCE (94%) and most participants generated learning goals after the OSCE (71%). High performers appeared to recognize the importance of content-related knowledge for scoring well before and after the OSCE, whereas low performers may have under-estimated its importance until after the examination.

Discussion: Participants viewed a formative OSCE as both a hurdle to overcome (assessment of learning) and an opportunity to learn (assessment for learning). Understanding how OSCEs influence study behavior can help guide the development of assessments that promote learning.     

Speed and quality goals in procedural skills learning: A randomized experiment

Abstract

Purpose: Compare time (speed) and product quality goals in a surgical procedural task.

Methods: Secondary school students participating in a medical simulation-based training activity participated in a randomized experiment. Each participant completed eight repetitions of a blood vessel ligation. Once, between repetitions four and five, each participant received a randomly-assigned speed goal or quality goal. Outcomes included time and leak-free ligatures.

Results: 80 students participated. The speed-goal group performed 18% faster on the final repetition than the quality-goal group, with adjusted fold change (FC) 0.82 (95% confidence interval [CI], 0.71, 0.94; p?=?0.01). Conversely, the speed-goal group had fewer high-quality (leak-free) ligatures (odds ratio [OR] 0.36 [95% CI, 0.22, 0.58; p?<?0.001]). For the quality-goal group, leaky ligatures took longer post-intervention than leak-free ligatures (FC 1.09 [95% CI, 1.02, 1.17; p?=?0.01]), whereas average times for leaky and leak-free ligatures were similar for the speed-goal group (FC 0.97 [95% CI, 0.91, 1.04; p?=?0.38]). For a given performance time, the speed-goal group had more leaks post-intervention than the quality-goal group (OR 3.35 [95% CI, 1.58, 7.10; p?=?0.002]).

Conclusions: Speed and quality goals promote different learning processes and outcomes among novices. Use of both speed and quality goals may facilitate more effective and efficient learning.     

Shedding light into the black box: A prospective longitudinal study identifying the CanMEDS roles of final year medical students’ on-ward activities

Introduction: To our best knowledge, a rigorous prospective analysis of final year medical students’ (FY medical students) activity profiles during workplace learning is lacking. The present study investigated the CanMEDS characteristics of all on-ward activities performed by internal medicine FY medical students. We tested the hypotheses that during FY medical student workplace training (I) routine activities are predominantly performed, while supervised, more complex activities are underrepresented with (II) FY medical students performing an insufficient number of autonomous activities and that (III) the CanMEDS roles of the Communicator and the Professional prevail.

Methods: During the second and the sixth week of their final year trimester at the University of Heidelberg Medical Hospital, N?=?34 FY medical students (73% female; mean age 26.4?±?2.4) were asked to keep a detailed record of all their on-ward activities and to document the duration, mode of action (active versus passive; independent versus supervised), estimated relevance for later practice, and difficulty-level in specially designed activity logbooks. CanMEDS roles were assigned to the documented activities via post-hoc expert consensus.

Results: About 4308 activities lasting a total of 2211.4?h were documented. Drawing blood (20.8%) was the most frequently documented medical activity followed by full admission procedures (9.6%). About 14.9% of the time was spent with non-medical activities. About 82.1% of all medical activities performed went unsupervised. The Communicator (42%), the Professional (38%), and the Collaborator (7%) were assigned as the top three CanMEDS roles.

Conclusions: The results call for increased efforts in creating more authentic learning experiences for FY medical students shifting towards more complex, supervised tasks, and improved team integration.     

Undergraduate medical students’ perspectives of skills,uses and preferences of information technology in medical education: A cross-sectional study in a Saudi Medical College

Abstract

Background: Information technology (IT) is widely used in medical education. However, there are not enough studies about IT uses and preferences among traditional and problem-based learning (PBL) medical students.

Aim: To compare IT skills, uses and preferences for education between traditional and PBL medical students’.

Method: A cross-sectional study; a modified Educause Center for Analysis and Research online survey was sent to traditional curriculum 5th and PBL 4th year medical students of King Saud University.

Results: Most of the responding 176 students prefer mobile devices and moderate amount of IT in education. Fourth and fifth year students perceived high academic value of Google (94.2 vs. 86.7%, p?=?0.34), YouTube (90.7 vs. 92.2%, p?=?0.83) and PubMed (83.7 vs. 86.7%, p?=?0.06). More 4th year than 5th year students rated themselves as skilled in learning management system (54.7 vs. 21.1%, p?=?0.0001) and Smartboard use (40.7 vs. 23.3%, p?=?0.04). Most students rated faculty IT skills as effective. Students agreed that technology helps working faster (95.5%) and make learning creative (85.9%).

Conclusions: More integration of information literacy and IT training in medical curricula is needed to enhance better utilization of full features of IT resources available for learning and problem solving. National multi-institutional studies are recommended.     

Long-term benefits by a mind–body medicine skills course on perceived stress and empathy among medical and nursing students

Background: A significant number of medical students suffer from burnout symptoms and reduced empathy. This controlled, quasi-experimental study aimed to investigate whether a mind–body medicine (MBM) skills course could reduce perceived stress and increase empathy and self-reflection in medical and nursing students.

Methods: The MBM course (consisting of experiential sessions of mind–body techniques and group reflections) was piloted among Dutch medical students and Swedish nursing students. Main outcome variables were perceived stress (PSS), empathy (IRI subscales perspective taking, fantasy, empathic concern, and personal distress), and self-reflection (GRAS). Participating and control students completed questionnaires at baseline, post-intervention, at 6 and 12 months follow-up.

Results: Seventy-four medical and 47 nursing students participated in the course. Participating medical students showed significantly increased empathic concern [1.42 (95% CI 0.05, 2.78), p?=?0.042], increased fantasy [3.24 (95% CI 1.58, 4.90), p?p?=?0.010] compared to controls until 12 months follow-up. Participating nursing students showed significantly decreased levels of perceived stress [?5.09 (95% CI ?8.37, ?1.82), p?=?0.002] and decreased personal distress [?5.01 (95% CI ?6.97, ?3.06), p?Conclusions: This study demonstrated long-term beneficial effects of the MBM course on perceived stress and empathy in medical and nursing students.     

Clinical prioritisation questions: A novel assessment tool to encourage tolerance of uncertainty?

Abstract

Uncertainty is a common and increasingly acknowledged problem in clinical practice. Current single best answer (SBA) style assessments test areas where there is one correct answer, and as the approach to assessment impacts on the approach to learning, these exams may poorly prepare our future doctors to handle uncertainty. We therefore, need to modify our approach to assessment to emphasize reasoning and introduce the possibility of more than one ‘correct’ answer. We have developed clinical prioritization questions (CPQs), a novel formative assessment tool in which students prioritize possible responses in order of likelihood. This assessment format was piloted with a group of medical students and evaluated in comparison with the more traditional SBA question format in a team-based learning setting. Students reported that they felt ongoing use would help improve their tolerance of uncertainty (p?<?0.01). Furthermore, over 80% of students felt that CPQs were more reflective of real-life clinical practice. Group based discussions were significantly longer when answering CPQs (p?<?0.01), suggesting they may promote richer discourse. CPQs may have a role in formative assessment to help equip students with the skills to cope with ambiguity and strengthen clinical reasoning and decision-making. Institutions may find them more practical to implement compared with other clinical reasoning assessment tools.     

Associations between teaching effectiveness and participant self-reflection in continuing medical education

Effective medical educators can engage learners through self-reflection. However, little is known about the relationships between teaching effectiveness and self-reflection in continuing medical education (CME). We aimed to determine associations between presenter teaching effectiveness and participant self-reflection in conference-based CME. This cross-sectional study evaluated presenters and participants at a national CME course. Participants provided CME teaching effectiveness (CMETE) ratings and self-reflection scores for each presentation. Overall CMETE and CME self-reflection scores (five-point Likert scale with one as strongly disagree and five as strongly agree) were averaged for each presentation. Correlations were measured among self-reflection, CMETE, and presentation characteristics. In total, 624 participants returned 430 evaluations (response, 68.9%) for the 38 presentations. Correlation between CMETE and self-reflection was medium (Pearson correlation, 0.3–0.5) or large (0.5–1.0) for most presentations (n?=?33, 86.9%). Higher mean (SD) CME reflection scores were associated with clinical cases (3.66 [0.12] vs. 3.48 [0.14]; p?=?0.003) and audience response (3.66 [0.12] vs. 3.51 [0.14]; p?=?0.005). To our knowledge, this is the first study to show a relationship between teaching effectiveness and participant self-reflection in conference-based CME. Presenters should consider using clinical cases and audience response systems to increase teaching effectiveness and promote self-reflection among CME learners.     

Bolstering diagnostic reasoning skills with adaptive learning

Abstract

Purpose: Adaptive learning emerges when precise assessment informs delivery of educational materials. This study will demonstrate how data from Human Dx, a case-based e-learning platform, can characterize an individual’s diagnostic reasoning skills, and deliver tailored content to improve accuracy.

Methods: Pearson Chi-square analysis was used to assess variability in accuracy across three groups of participants (attendings, residents, and medical students) and three categories of cases (core medical, surgical, and other). Logistic regression analyses were conducted to explore the relationship between solve duration and accuracy. Mean accuracy and duration were calculated for 370 individuals. Repeated measures analysis of variance (ANOVA) were used to assess variability for an individual solver across the three categories.

Results: There were significant differences in accuracy across the three groups and the three categories (p?<?0.001). Individual solvers have significant variance in accuracy across the three categories. Shorter solve duration predicted higher accuracy. Patterns of performance were identified; four profiles are highlighted to demonstrate potential adaptive learning interventions.

Conclusions: Human Dx can assess diagnostic reasoning skills. When weaknesses are identified, adaptive learning strategies can push content to promote skill development. This has implications for customizing curricular elements to improve the diagnostic skills of healthcare professionals.     

Mixed reality as a time-efficient alternative to cadaveric dissection

Abstract

Objectives: The extent of medical knowledge increases yearly, but the time available for students to learn is limited, leading to administrative pressures to revise and reconfigure medical school curricula. The goal of the present study is to determine whether the mixed reality platform HoloAnatomy represents an effective and time-efficient modality to learn anatomy when compared to traditional cadaveric dissection.

Methods: This was a prospective, longitudinal study of medical students completing a musculoskeletal anatomy course at Case Western Reserve University School of Medicine. Participants were divided into two groups based on learning platform (HoloAnatomy versus traditional cadaveric dissection) and content area (upper limb versus lower limb anatomy). Time spent in lab and end of course practical exam scores were compared between groups.

Results: The average study time of 48 medical students who completed study requirements was 4.564?h using HoloAnatomy and 7.318?h in the cadaver lab (p?=?0.001). No significant difference was found between exam scores for HoloAnatomy and cadaver learners (p?=?0.185).

Conclusions: Our results indicate that HoloAnatomy may decrease the time necessary for anatomy didactics without sacrificing student understanding of the material.     

The pattern of social media use and its association with academic performance among medical students

Abstract

Background: There are concerns that the use of social media (SM) among medical students could affect academic performance. The objectives of the study were to investigate the pattern and reasons for SM use and their association with academic performance.

Methods: A stratified random sample, frequency distribution and comparison of categorical variables with Chi-square and Fisher exact tests were used.

Results: Of the 97% who responded, 98% used SM. The most popular were Whatsapp (87.8%), You tube (60.8%) and Twitter (51.8%) for general use; while You tube (83.5%), Whatsapp (35.5%) and Twitter (35.3%) for learning. For general use, there was a significant higher number of visits to You tube and Facebook among male students, while the reverse was true for Instagram and Path. Around 71% visited SM?>4 times/day and 55% spent 1–4?hours/day. The main reasons for SM use were entertainment (95.8%), staying up-to-date with news (88.3%), and socializing (85.5%); for academic studies (40%). There was no significant association between Grade Point Average and the frequency of daily SM use or use during lectures.

Conclusions: While almost all the students used SM, only a minority used them for academic purposes. SM use was not associated with academic performance.     

A unique flipped classroom approach shows promising results in physician assistant education

Abstract

Aims: The flipped classroom (FC) model utilizes pre-class foundational learning with in-class higher-order application exercises. FC approaches have reported positive perceptions and mixed academic performance outcomes in medical education; however, little evidence exists on their impact in the 56-week didactic curriculum of Physician Assistant (PA) education.

Methods: A 4-week FC curriculum was piloted in a PA behavioral medicine course (n?=?34). Before class, students completed online video modules. During class, students completed a pre-class quiz and answered clinical case-based questions in a think-pair-share format.

Results: Students rated in-class time higher than a lecture-based segment of the same course (p?=?0.028). Assessment of achievement emotions demonstrated increased enjoyment (p?=?0.028) and decreased boredom (p?<?0.001) in the FC curriculum with no difference in anxiety. The FC curriculum produced a 57.2?min increase in pre-class preparation time with no change in post-class studying time. Compared to historical lecture-based controls (n?=?35), students in the FC curriculum scored significantly higher on clinical vignette questions (p?=?0.019) with equivalent performance on other question formats.

Conclusions: This study offers the first positive outcomes of an FC approach in PA education and provides a framework for improving academic performance while scaling back in-class time.     

The simulated clinical environment: Cognitive and emotional impact among undergraduates

Context: Simulated clinical immersion (SCI) is used in undergraduate healthcare programs to expose the learner to real-life situations in authentic simulated clinical environments. For novices, the environment in which the simulation occurs can be distracting and stressful, hence potentially compromising learning.

Objectives: This study aims to determine whether SCI (with environment) imposes greater extraneous cognitive load and stress on undergraduate pharmacy students than simulated patients (SP) (without environment). It also aims to explore how features of the simulated environment influence students’ perception of learning.

Methods: In this mixed-methods study, 143 undergraduate pharmacy students experienced both SCI and SP in a crossover design. After the simulations, participants rated their cognitive load and emotions. Thirty-five students met in focus groups to explore their perception of learning in simulation.

Results: Intrinsic and extraneous cognitive load and stress scores in SCI were significantly but modestly higher compared to SP. Qualitative findings reveal that the physical environment in SCI generated more stress and affected students? focus. In SP, students concentrated on clinical reasoning. SCI stimulated a focus on data collection but impeded in-depth problem solving processes.

Conclusion: The physical environment in simulation influences what and how students learn. SCI was reported as more cognitively demanding than SP. Our findings emphasize the need for the development of adapted instructional design guidelines in simulation for novices.     

Interprofessional learning experiences: Exploring the perception and attitudes of Saudi Arabian medical and dental students

Abstract

Objective: The objective of this study is to evaluate the awareness and attitudes of medical and dental students regarding interprofessional learning (IPL).

Methods: A cross-sectional study was conducted with 278 female undergraduate Medical and Dental students from Princess Nourah bint Abdulrahman University, Riyadh. These students undertook IPL in the Foundation block, in basic science teaching, clinical skills’ laboratories and in professionalism and learning skills’ modules. A modified, validated RIPLS questionnaire with four subscales and 29 items was used to collect data regarding their perception and attitudes towards shared learning. A five-point Likert scale was used with a value ranging from 1 (strongly disagree) to 5 (strongly agree) for each item. Factor analysis was done using Varimox rotation. Student’s t test was applied to detect difference between mean scores of medical and dental student’s responses

Results: The mean age of respondents was 19.8?±?1.7?years with the majority in the second year of each program. There was no difference in mean responses of the medical and dental students. The respondents favored shared learning in the areas of professional skills and patient care. They agreed that IPL helps to develop respect, trust and appreciation for other professions; however, both groups preferred to learn uni-professionally with regard to developing discrete professional identities and roles.

Conclusions: There is an overall positive response towards IPL and the value of team work; however, more attention needs to be paid to enabling students to learn about the specific roles of each profession in the healthcare team.     

The impact of simulated patient death on medical students’ stress response and learning of ACLS

Introduction: There is considerable controversy as to whether the simulator should die during high-fidelity simulation (HFS). We sought to describe the physiologic and biochemical stress response induced by simulated patient death as well as the impact on long-term retention of Advanced Cardiovascular Life Support (ACLS) knowledge and skills.

Methods: Twenty-six subjects received an American Heart Association (AHA) ACLS provider course. Following the course, subjects participated in HFS and were randomized to simulated death or survival. Heart rate and salivary cortisol (SC) and dihydroepiandrosterone (DHEA) were collected at this time. Subjects returned six months later for a follow-up simulation in which ACLS knowledge and skills were tested.

Results: For all participants, there was an increase in heart rate during simulation compared with baseline heart rate (+ 32 beats/minute), p < 0.0001. Similarly, SC and DHEA were higher compared with baseline levels (+ 0.115?μg/dL, p <0.01 and + 97?pg/mL, p < 0.001, respectively). However, the only statistically significant difference between groups was an increase in heart rate response at the end of the simulation compared with baseline in the death group (+ 29.2 beats/minute versus + 18.5 beats/minute), p < 0.05. There was no difference on long-term knowledge or skills.

Conclusions: Learners experience stress during high-fidelity simulation; however, there does not appear to be a readily detectable difference or negative response to a simulated patient death compared with simulated survival.