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1.
Background
Despite concussion now being recognized as a public health priority in Canada, recent studies—including our 2012 survey of Canadian medical schools—have revealed major gaps in concussion education at the undergraduate medical school level.Methods
We re-surveyed all 17 Canadian medical schools using a questionnaire divided in two categories: (1) concussion-specific education (2) head injury education incorporating a concussion component to determine whether there have been any improvements in concussion education at the medical school level during the last five years. For each year of medical school, respondents were asked to provide the estimated number of hours and teaching format for each category.Results
We received replies from 13 of the 17 medical schools (76%). 11 of the 13 (85%) medical schools now reported providing concussion-specific education compared to 29% in our 2012 survey. The mean number of hours dedicated to category 1 learning in 2017 was 2.65?h compared to 0.57 in 2012, and the mean number of hours of category 2 increased to 7.5 from 1.54.Conclusion
Our follow-up study reveals increased exposure to concussion-related teaching in Canadian medical schools during the last five years. Persistent deficiencies in a minority of schools are highlighted. These should be addressed by reiterating the importance of concussion education for undergraduate medical students and by developing clear concussion-specific objectives at the national licensure level.2.
Background
With the adoption of the English language in medical education, a gap in clinical communication may develop in countries where the native language is different from the language of medical education. This study investigates the association between medical education in a foreign language and students’ confidence in their history-taking skills in their native language.Methods
This cross-sectional study consisted of a 17-question survey among medical students in clinical clerkships of Lebanese medical schools. The relationship between the language of medical education and confidence in conducting a medical history in Arabic (the native language) was evaluated (n?=?457).Results
The majority (88.5%) of students whose native language was Arabic were confident they could conduct a medical history in Arabic. Among participants enrolled in the first clinical year, high confidence in Arabic history-taking was independently associated with Arabic being the native language and with conducting medical history in Arabic either in the pre-clinical years or during extracurricular activities. Among students in their second clinical year, however, these factors were not associated with confidence levels.Conclusions
Despite having their medical education in a foreign language, the majority of students in Lebanese medical schools are confident in conducting a medical history in their native language.3.
Background
A number of obesity studies have been focused on identifying the relationships between socioeconomic status and physical activity involvement. In behavioral medicine, the limited data are available on obese people’s physical activity and its related psychological predictors based on psychological theories.Purpose
To identify the differences in physical activity and its related motivational attributes among normal weight, overweight, and obese adolescents and to find the effect of body mass index (BMI) and the Self-Determination Theory (SDT) constructs in predicting physical activity.Method
One thousand seventy-one students ranging from seventh to ninth grades were randomly selected from three junior high schools in Seoul (359 normal weight students, 468 overweight students, and 244 obese students). A Korean version of Behavioral Regulation in Exercise Questionnaire-2 and Leisure Time Exercise Questionnaire were applied to measure the participants’ motivational attributes and physical activity.Results
Overweight and obese adolescents showed higher scores on amotivation and externally motivated regulations for physical activity than their normal weight counterparts. Internal regulation was more significant for physical activity in normal weight adolescent. However, there was no difference in physical activity among the three groups. Additionally, the findings identified that BMI and the SDT constructs were significant to explain physical activity.Conclusion
This study offers fundamental knowledge in gaining a clearer understanding of the types of motivation most likely to contribute to the initiation and promotion of physical activity in overweight and obese adolescents.4.
Background
Incivility in nursing education can adversely affect the academic environment, the learning outcomes, and safety. Nursing faculty (NF) and nursing students (NS) contribute to the academic incivility. Little is known about the extent of NF academic incivility in the Middle East region. This study aimed at exploring the perceptions and extent of NF academic incivility in an undergraduate nursing program of a public university in Oman.Methods
A cross sectional survey was used to collect data from 155 undergraduate NS and 40 NF about faculty academic incivility. Data was collected using the Incivility in Nursing Education Survey.Results
The majority of NS and NF had similar perceptions about disruptive faculty behaviors. The incidence of faculty incivility was low (Mean?=?1.5). The disruptive behaviors with the highest incidence were arriving late for scheduled activities, leaving schedule activities early, cancelling scheduled activities without warning, ineffective teaching styles and methods, and subjective grading. The most common uncivil faculty behaviors reported by participants were general taunts or disrespect to other NF, challenges to other faculty knowledge or credibility, and general taunts or disrespect to NS.Conclusion
The relatively low level of NF academic incivility could still affect the performance of some students, faculty, and program outcomes. Academic institutions need to ensure a policy of zero tolerance to all academic incivility, and regular monitoring and evaluation as part of the prevention strategies.5.
Background
Within the field of renal transplantation there is a lack of qualified and trainee surgeons and a shortage of donated organs. Any steps to tackle these issues should, in part, be aimed at future doctors.Methods
A questionnaire was distributed to final year students at a single medical school in the UK to assess their exposure to and knowledge of renal transplantation.Results
Although 46% of responding students had examined a transplant recipient, only 14% had ever witnessed the surgery. Worryingly, 9% of students believed that xenotransplantation commonly occurs in the UK and 35% were unable to name a single drug that a recipient may need to take.Conclusions
This survey demonstrates a lack of exposure to, and knowledge of, the field of renal transplantation. Recommendations to address the problems with the recruitment of surgeons and donation of organs, by targeting medical students are made.6.
Markus A. Fischer Kieran M. Kennedy Steven Durning Marlies P. Schijven Jean Ker Paul O’Connor Eva Doherty Thomas J. B. Kropmans 《BMC medical education》2017,17(1):262
Background
Medical students may not be able to identify the essential elements of situational awareness (SA) necessary for clinical reasoning. Recent studies suggest that students have little insight into cognitive processing and SA in clinical scenarios. Objective Structured Clinical Examinations (OSCEs) could be used to assess certain elements of situational awareness. The purpose of this paper is to review the literature with a view to identifying whether levels of SA based on Endsley’s model can be assessed utilising OSCEs during undergraduate medical training.Methods
A systematic search was performed pertaining to SA and OSCEs, to identify studies published between January 1975 (first paper describing an OSCE) and February 2017, in peer reviewed international journals published in English. PUBMED, EMBASE, PsycINFO Ovid and SCOPUS were searched for papers that described the assessment of SA using OSCEs among undergraduate medical students. Key search terms included “objective structured clinical examination”, “objective structured clinical assessment” or “OSCE” and “non-technical skills”, “sense-making”, “clinical reasoning”, “perception”, “comprehension”, “projection”, “situation awareness”, “situational awareness” and “situation assessment”. Boolean operators (AND, OR) were used as conjunctions to narrow the search strategy, resulting in the limitation of papers relevant to the research interest. Areas of interest were elements of SA that can be assessed by these examinations.Results
The initial search of the literature retrieved 1127 publications. Upon removal of duplicates and papers relating to nursing, paramedical disciplines, pharmacy and veterinary education by title, abstract or full text, 11 articles were eligible for inclusion as related to the assessment of elements of SA in undergraduate medical students.Discussion
Review of the literature suggests that whole-task OSCEs enable the evaluation of SA associated with clinical reasoning skills. If they address the levels of SA, these OSCEs can provide supportive feedback and strengthen educational measures associated with higher diagnostic accuracy and reasoning abilities.Conclusion
Based on the findings, the early exposure of medical students to SA is recommended, utilising OSCEs to evaluate and facilitate SA in dynamic environments.7.
Background
Medical students are exposed to high amounts of stress. Stress and poor academic performance can become part of a vicious circle. In order to counteract this circularity, it seems important to better understand the relationship between stress and performance during medical education. The most widespread stress questionnaire designed for use in Medical School is the “Perceived Medical School Stress Instrument” (PMSS). It addresses a wide range of stressors, including workload, competition, social isolation and financial worries. Our aim was to examine the relation between the perceived Medical School stress of undergraduate medical students and academic performance.Methods
We measured Medical School stress using the PMSS at two different time points (at the end of freshman year and at the end of sophomore year) and matched stress scores together with age and gender to the first medical examination (M1) grade of the students (n?=?456).Results
PMSS scores from 2 and 14 months before M1 proved to be significant predictors for medical students’ M1 grade. Age and gender also predict academic performance, making older female students with high stress scores a potential risk group for entering the vicious circle of stress and poor academic performance.Conclusions
PMSS sum scores 2 and 14 months before the M1 exam seem to have an independent predictive validity for medical students’ M1 grade. More research is needed to identify potential confounders.8.
Jean H. D. Fasel Diego Aguiar Daniel Kiss-Bodolay Xavier Montet Afksendiyos Kalangos Bojan V. Stimec Osman Ratib 《Surgical and radiologic anatomy : SRA》2016,38(3):361-367
Purpose
Many regions worldwide report difficulties in recruiting applicants to surgery. One strategy proposed to reverse this trend consists of early exposure of medical students to the field. Against this backdrop, the present study presents an innovative approach for anatomy teaching, integrating a surgically relevant trend: 3D printing.Methods
Whole-body computed tomography (CT) was made of two cadavers. Twelve students performed measurements and 3D reconstructions of selected anatomical structures (Osirix, Mimics). 3D printed (3DP) models were obtained (ZPrinter 310 Plus), and the students completed the analogous measurements on these replicas. Finally, classical anatomical dissection was performed and the same parameters were measured. The differences between the values obtained by the three modalities were submitted to standard statistical analysis (Wilcoxon two-tail paired test).Results
Qualitative comparison of the digital 3D reconstructions based on the students’ manual CT segmentation and the anatomical reality showed excellent correlation. Quantitatively, the values measured on the CT images and the physical models created by 3D printing differed from those measured on the cadavers by less than 2 mm. Students were highly appreciative of the approach (CT, 3DP, cadaver). Their average satisfaction score was 5.8 on a 1–6 scale.Conclusions
This study shows that the approach proposed can be achieved. The results obtained also show that CT-based 3D printed models are close to the authentic anatomic reality. The program allows early and interactive exposure of medical students to a surgically relevant trend—in this case 3D printing.9.
Background
This study aims to determine the correlation between medical education systems, medical college (MC) and medical school (MS), and empathy by investigating the changes in empathy among students with each additional year of medical education.Methods
The subjects were MC and MS students who had participated in the same study the previous year. All participants completed the same self-report instruments: a questionnaire on sociodemographic characteristics, and the Korean edition of the Student Version of the Jefferson Scale of Empathy (JSE-S-K), Among 334 students, the final analysis was conducted on the data provided by 113 MC and 120 MS students, excluding 101 with incomplete data.Results
The age and sex did not affect the changes in empathy. Though the JSE-S-K score of MS was significantly higher than that of MC in initial investigation, this study found no difference of empathy between MC and MS.Conclusion
Empathy increased significantly after one year of medical education. The difference between two education systems, MC and MS, did not affect the changes in empathy.10.
Background
A Family Day program was implemented at Indiana University School of Medicine to educate the families and friends of in-coming medical students about the rigors of medical school and the factors that contribute to stress.Methods
Surveys that assessed knowledge, beliefs, and attitudes about medical school were administered to participants before and after the program.Results
After the program, participants showed a significant improvement in their understanding of medical school culture and the importance of support systems for medical students. Post-test scores improved by an average of 29% (P < 0.001) in each of the two years this program was administered.Conclusions
The inclusion of family members and other loved ones in pre-matriculation educational programs may serve to mitigate the stress associated with medical school by enhancing the students' social support systems.11.
Background
An increasing part of medical students’ learning takes place in primary healthcare (PHC) but little is known about how the students perceive PHC as a clinical learning environment. This study aimed to explore medical students’ perceptions of the clinical learning environment in PHC and how these vary with stage of education.Methods
Free-text course evaluation comments from students in nine different semesters during spring 2014 were analysed using qualitative content analysis. The students had placements in PHC from the first semester, progressing through the whole 5.5 year medical programme, and this was their main clinical training environment during the final 11th semester.Results
In total, 800 students (56%) agreed to participate in the study and 437 of these (54%) provided comments. Two overall themes were identified: the supervisor was the central factor that determined the meaningfulness of the placement at all stages of the education, and basic prerequisites for perceived clinical learning were to have an active role in an authentic clinical context and to be trusted to work independently with patients.The three main categories found under these themes were: i) the perceived relationship with the supervisor; ii) the perceived journey to become a doctor; and iii) the perceived structure and culture.Conclusion
The supervisor’s role was perceived as central at all stages of the education but the focus changed for other aspects, related to the students’ professional development. The need for trust and independence in patient work increased towards the end of the education.12.
Andrew W. Manigault Alex Woody Peggy M. Zoccola Sally S. Dickerson 《International journal of behavioral medicine》2018,25(5):532-539
Purpose
Researchers benefit from controlling for individual differences that systematically account for variance in acute cortisol responses (e.g., sex). Similarly, some suggest that education could be used as a cortisol covariate because prior work found a negative relationship between education and the magnitude of acute cortisol responses in middle-aged adults. Nevertheless, education is seldom controlled for in tests of cortisol responses to acute stress, in part because the effect of education on acute cortisol responses has yet to be tested in a college sample. The present study therefore tested the relationship between education and cortisol responses to acute stress in college students.Method
Participants (124 healthy undergraduate students) self-reported education level and were subjected to a stressful speech task. Salivary cortisol was collected 0, +?15, +?25, +?40, and +?55 min post-stressor onset. Participant also completed a battery of questionnaires assessing individual differences, day-to-day demands, and stress-related appraisals.Results
Students in their fourth year of college education or above had significantly less curvilinear responses to the stress task relative to first-, second-, and third-year students.Conclusion
The effect of education on cortisol responses previously found in middle-aged adults was replicated in college students. Future research may therefore benefit from controlling for education when analyzing acute cortisol responses in college samples.13.
Amelia?ZE?Chua Daryl?YK?Lo Wilbert?HH?Ho Yun Qing?Koh Daniel?SY?Lim John?KC?Tam Sok Ying?Liaw Gerald?CH?Koh
Background
In recent years, increasing emphasis has been placed on the importance of collaboration within multi-disciplinary healthcare teams, so as to facilitate holistic patient care and thus allow improved treatment outcomes. There is hence an urgent need to educate healthcare undergraduates early in their professional careers on the importance of and complexities involved in cooperating with counterparts from other allied healthcare professions. In conjunction with this, a milestone student-led conference for undergraduate students, the 9th Student Medical-Nursing Education Conference (SMEC), was organised in 2013 to provide a unique opportunity for shared learning among the entire cohort of undergraduate medical and nursing students in Singapore matriculating in that year.Methods
This study evaluated the effectiveness of the 9th SMEC 2013 as a shared conference experience in improving the attitudes of undergraduate medical and nursing students in Singapore towards inter-professional education (IPE). A 19-point Readiness for Inter-Professional Learning Scale (RIPLS) questionnaire comprising three subscales was administered to participants both before and after the conference. 352 responses were collected, giving a response rate of 75.1 %. Results were analysed using paired-samples t-tests with statistical significance set at p?=?0.05.Results
Improvements in overall scores for both medical and nursing students were reported for all three RIPLS subscales. Examining the RIPLS items individually, significant improvement in scores for both medical and nursing students was obtained in all 19 items. Prior exposure to IPE activities was not a predictor of improvement in IPE attitudes.Conclusion
The authors propose that student-led jointly-organised conference experiences are effective in improving healthcare students’ attitudes towards IPE. This study provides valuable insights to facilitate the development of further IPE programs to allow for the rapid and effective promotion of cooperation and collaboration between students across various healthcare disciplines.14.
Background
Residents face demanding situations on the job and have been found to perceive high levels of strain. Medical students also reported a high degree of strain and even depressive tendencies when entering their clinical rotations. The aim of this study was to explore the perceived strain of medical students from different undergraduate curricula and at different stages of academic advancement during different phases of an assessment simulating a resident’s first day in hospital.Methods
Sixty-seven undergraduate medical students participated in the following three phases of the assessment in the role of a resident: a consultation hour with five simulated patients, a management phase with interprofessional contact, and a patient handover with a colleague. They completed the Strain Perception Questionnaire (STRAIPER) after each phase. Students from different undergraduate curricula (VI: vertically integrated, n =?35 versus non-VI: not vertically integrated, n =?26) and different academic advancement (semester 10, n =?26 versus final year, n =?41) were compared.Results
All students showed the highest strain level after the management phase compared to the consultation hour and the handover. Medical students from a non-VI curriculum felt significantly more strain in the dimension of agitation (p <?.05) after the consultation hour compared to students from a VI curriculum and compared to the management phase and the handover. No significant difference in perceived strain was found between students from semester 10 compared to final year students.Conclusions
During the consultation hour and the handover with a colleague medical students faced tasks which are familiar to them from undergraduate education. Their higher strain levels during the management phase might occur because they are confronted with unfamiliar tasks and decisions. Feeling responsible for the right actions in this phase of multitasking and professional interaction might have added to the strain students perceived during this phase. Patient management should be emphasized more in any type of undergraduate medical curriculum.15.
Nicolas Degand Justine Dautremer Benoît Pilmis Agnès Ferroni Fanny Lanternier Julie Bruneau Olivier Hermine Stéphane Blanche Xavier Nassif Olivier Lortholary Marc Lecuit 《Journal of clinical immunology》2017,37(7):727-731
?
Helicobacter bilis is a commensal bacterium causing chronic hepatitis and colitis in mice. In humans, enterohepatic Helicobacter spp. are associated with chronic hepatobiliary diseases.Purpose
We aimed at understanding the microbial etiology in a patient with X-linked agammaglobulinemia presenting with suppurative cholangitis.Methods
16S rDNA PCR directly performed on a liver biopsy retrieved DNA of H. bilis.Results
Clinical outcome resulted in the normalization of clinical and biological parameters under antibiotic treatment by a combination of ceftriaxone, metronidazole, and doxycyclin followed by a 2-week treatment with moxifloxacin and a 2-month treatment with azithromycin.Conclusion
In conclusion, these data suggest a specific clinical and microbiological approach in patients with humoral deficiency in order to detect H. bilis hepatobiliary diseases.16.
Background
Binge eating (BE) has long been identified as a correlate of overweight and obesity. However, less empirical attention has been given to overeating with and without loss of control (LOC) in nonclinical samples.Purpose
The goal of the present study was to examine the association of (1) established correlates of BE, namely, weight and shape concerns, dietary restraint, and negative affect, and (2) three additional correlates, disinhibition, hunger, and interoceptive awareness (IA), to overeating in a nonclinical sample of college women.Method
Female students (n?=?1,447) aged 18 to 21 years recruited from colleges in three Canadian metropolitan areas completed self-report questionnaires in class to assess sociodemographic and anthropomorphic characteristics, overeating, LOC, dietary restraint, negative affect, weight and shape concerns, IA, disinhibition, and hunger.Results
The established correlates of BE were significant correlates of all types of overeating and explained 33 % of the variance. Disinhibition was the most strongly associated correlate of overeating.Conclusions
Findings suggest that established correlates of BE are associated with other types of overeating such as objective overeating (OOE), as are disinhibition and hunger.17.
Background
Most medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning between school years among medical students and residents.Methods
Questionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan.Results
PIT results showed an increase in moral sensitivity in 4th and 5th year students followed by a decrease in 6th year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires.Conclusion
This study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan.18.
Background
Turkey, with a Muslim population of officially over 99 %, is one of the few secular states in the Muslim world. Although state institutions are not based on Islamic juridical and ethical norms, the latter play a significant role in defining people’s attitudes towards controversial issues in the modern world, especially when backed by opinions of Muslim scholars living in Turkey. Accordingly, opinions of Muslim scholars undoubtedly have an important effect on bioethical decisions made by institutions and individuals.Objective(s)
To explore the ethical positions of Muslim scholars living in Turkey and their arguments used in the ethical assessment of embryonic stem cell research; to discuss the biological-moral tensions arising in medical research on human embryos.Design
Qualitative study.Setting
Muslim scholars located in different parts of Turkey.Methods
Qualitative method, involving the collection of opinions of various scholars, by means of 15 individual semi-structured interviews, evaluated using thematic qualitative analysis.Results
Positions regarding embryonic stem cell research differ among Muslim scholars in Turkey. On the other hand, even where positions are similar, they are often supported by different arguments.Conclusion
Despite the heterogeneity of the arguments presented, the dominant position considers embryonic stem cell research as morally acceptable.19.
Kneginja Richter Lukas Peter Stefanie Kellner Thomas Hillemacher 《Somnologie - Schlafforschung und Schlafmedizin》2018,22(3):194-198
Background
Millions of people share a bed with their partner. Sleep und relationship could possibly influence each other.Objectives
To identify and discuss connections between relationship and sleep quality.Methods
Review of the literature in electronic databases.Results
Conflict and violence in relationships lead to decreases in both partners’ sleep quality. Constructive approaches to resolving conflicts is necessary for good sleep, and vice versa. Women prefer partners with sleep-wake rhythms matching their own and report higher relationship satisfactions when the couple’s chronotypes are compatible.Conclusions
Sleep and circadian rhythms play important roles in relationships. When treating insomnia, the relationship and the partner’s sleep should be taken into account.20.