Evaluation of the Opinions and Knowledge of Medical School Students on Organ Donation and Transplantation

Background: Insufficient organ donation is one of the most significant current problems in medical care. The students of the faculty of medicine could be the strongest supporters of organ donation and transplantation, and may play an important role in increasing organ donation. This study aimed to determine the relevant educational needs of the medical students by evaluating their knowledge and opinions about organ donation and transplantation, according to their grade levels.Methods: A cross-sectional study was conducted among 395 (83.6%) students in the first, third, and sixth grades of the faculty of medicine. A questionnaire consisting of 42 questions was used to measure their opinions and knowledge about organ transplantation.Results: Among the students who responded, 6.8% (n = 27) had donated their organs and 81.4% of the donors had donation cards, while 73.4% (n = 290) were considering organ donation. The percentages of women and students at the grade six level considering organ donation were significantly higher (P < .05). The study revealed that 38.7% of the students did not have enough knowledge about organ donation, 47.8% stated that they had some knowledge and 61.8% of the students did not know the principles of brain death. The students of all grades reported that most of the information about organ donation and transplantation was obtained from their family and friends.Conclusion: As medical students progress through the grade levels, their perceptions and knowledge of organ donation and transplantation also increase positively. Courses on organ donation and transplantation can be added to the curriculum from the very first year of medical education.     

Recognizing the Importance of Aging Skills and Knowledge in Generalist Social Work Practice: Effective Strategies for MSW Students

This article examines the impact of a curricular infusion strategy aimed at integrating gerontological practice issues into social work education. Findings (N = 83) illustrate that student interest, knowledge, and skills in aging practice increased immediately following implementation of a three-tiered infusion approach; however, ongoing exposure to gerontology in and out of the classroom appears necessary to sustain students' interest in working with older adults over time. Although the majority of students endorsed aging issues as important to social work in general, many did not understand its relevance to their own careers. Next steps are outlined to enable students to make this important connection.     

Medical student reflections on geriatrics: Moral distress,empathy, ethics and end of life

ABSTRACT

Medical students’ early clinical encounters may influence their perceptions of geriatrics. This study examines reflective essays written by 3^rd-year medical students on required clinical rotations. Using content analysis, the authors analyzed the essays’ thematic content. The authors then used chi-squared analysis to compare themes with geriatric patients (age 60+) to themes with other age groups. One hundred twenty out of 802 essays described a geriatric patient. The most common geriatric themes were (1) death and dying, (2) decision making, (3) meaningful physician–patient interactions, (4) quality of care, and (5) professional development. Geriatric essays were more likely to discuss death/dying and risk–benefit themes and less likely to discuss abuse. Geriatric essays were more likely to describe students’ moral distress. Geriatric essays with moral distress were more likely to include empathy themes compared to geriatric essays without moral distress. Geriatric patients may pose unique ethical challenges for early clinical students.     

Nursing students’ experience using an escape room for training clinical skills and competencies on emergency care: A qualitative observational study

Game-based learning is increasing in nursing education. Also, the assessment of the utility of the escape room game is growing. To explore nursing students’ opinion about the escape room as an evaluation game, a qualitative observational study with nursing students was carried out. An ad hoc questionnaire with open questions was sent after the game learning experience. The escape room included knowledge and techniques from different specialties. The escape room learning game was a positive experience for the students. The main highlighted characteristics were fun, dynamic, and motivating way to study and learn. Other interesting variables were: “Working as a team and under pressure” (It’s a group activity in which everyone must work together. It is a good challenge to learn how to work in urgent situations) and “Different way to assess students´ learning” (In this type of game, I can show more things and not only theoretical knowledge). Game-based learning is increasing in nursing education, as well as the assessment of the utility of the escape room game. Using an escape room for assessing nursing students’ knowledge is a positive experience. This learning experience can be also used with nurses in different specialties to promote teamwork and working under pressure.     

医护一体化+微信互动延续性护理干预对妊娠期糖尿病患者自我管理水平及护理服务满意度的影响

目的 探讨医护一体化+微信互动延续性护理干预对妊娠期糖尿病患者自我管理水平及护理服务满意度的影响.方法 选择该院于2017年12月—2019年12月期间收治的妊娠期糖尿病患者98例作为资料,随机分组各49例,对照组行常规护理,观察组医护一体化+微信互动延续性护理干预,测定患者护理前,护理后血糖水平,评价两组自我管理水平...     

Multisite Geriatrics Clerkship for Fourth-Year Medical Students: A Successful Model for Teaching the Association of American Medical Colleges' Core Competencies

As the population ages, it is important that graduating medical students be properly prepared to treat older adults, regardless of their chosen specialty. To this end, the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation convened a consensus conference to establish core competencies in geriatrics for all graduating medical students. An ambulatory geriatric clerkship for fourth-year medical students that successfully teaches 24 of the 26 AAMC core competencies using an interdisciplinary, team-based approach is reported here. Graduating students (N=158) reported that the clerkship was successful at teaching the core competencies, as evidenced by positive responses on the AAMC Graduation Questionnaire (GQ). More than three-quarters (80–93%) of students agreed or strongly agreed that they learned the seven geriatrics concepts asked about on the GQ, which cover 14 of the 26 core competencies. This successful model for a geriatrics clerkship can be used in many institutions to teach the core competencies and in any constellation of geriatric ambulatory care sites that are already available to the faculty.     

Impact of Participation in a Community-Based Intimate Partner Violence Prevention Program on Medical Students: A Multi-Center Study

Background  Physicians are generally poorly trained to recognize, treat or refer adolescents at risk for intimate partner violence (IPV). Participation in community programs may improve medical students’ knowledge, skills, and attitudes about IPV prevention. Objective  To determine whether the experience of serving as educators in a community-based adolescent IPV prevention program improves medical students’ knowledge, skills, and attitudes toward victims of IPV, beyond that of didactic training. Participants  One hundred and seventeen students attending 4 medical schools. Design  Students were randomly assigned to didactic training in adolescent IPV prevention with or without participation as educators in a community-based adolescent IPV prevention program. Students assigned to didactic training alone served as community educators after the study was completed. Measurement  Knowledge, self-assessment of skills and attitudes about intimate partner violence and future plans to pursue outreach work. Results  The baseline mean knowledge score of 10.25 improved to 21.64 after didactic training (p ≤ .001). Medical students in the “didactic plus outreach” group demonstrated higher levels of confidence in their ability to address issues of intimate partner violence, (mean = 41.91) than did students in the “didactic only” group (mean = 38.94) after controlling for initial levels of confidence (p ≤ .002). Conclusions  Experience as educators in a community-based program to prevent adolescent IPV improved medical students’ confidence and attitudes in recognizing and taking action in situations of adolescent IPV, whereas participation in didactic training alone significantly improved students’ knowledge. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. At the time of this study, Dr. Bigby and Dr. Miller were with the Harvard Medical School Center of Excellence in Women’s Health.     

Effect of a New Longitudinal Interprofessional Geriatric Medicine Educational Track on Knowledge and Attitude of Medical Students: A Controlled Cohort Study

A new interprofessional geriatric medicine curriculum was recently introduced at a large undergraduate Asian medical school. A longitudinal controlled interventional cohort study was conducted to evaluate the effect of the new curriculum on the knowledge and attitudes of medical students. The medical students under the new curriculum formed the intervention cohort, and those under the former curriculum formed the control cohort. To test knowledge, the University of California at Los Angeles (UCLA) geriatrics knowledge test (GKT) was used in Year 2 and the University of Michigan GKT in Year 5. Geriatrics attitudes were evaluated using the UCLA geriatrics attitudes test in Years 2 and 5. Not surprisingly, geriatrics knowledge at the end of Year 5 of medical school was enhanced to a greater degree in the intervention cohort than the control cohort, although improvements in geriatrics attitudes in each cohort were of similar magnitude by the end of Year 5, suggesting that factors other than a formal geriatrics curriculum influenced the improvements in geriatrics attitudes. This article is one of few published on the effectiveness of geriatrics curricular innovations using validated knowledge and attitude outcomes in a longitudinal controlled study design and will be useful to other medical institutions seeking to improve the geriatrics knowledge and attitudes of their students.     

Self-Confidence in and Perceived Utility of the Physical Examination: A Comparison of Medical Students,Residents, and Faculty Internists

BACKGROUND AND OBJECTIVES Little is known about the differences in attitudes of medical students, Internal Medicine residents, and faculty Internists toward the physical examination. We sought to investigate these groups’ self-confidence in and perceived utility of physical examination skills. DESIGN AND PARTICIPANTS Cross-sectional survey of third- and fourth-year medical students, Internal Medicine residents, and faculty Internists at an academic teaching hospital. MEASUREMENTS Using a 5-point Likert-type scale, respondents indicated their self-confidence in overall physical examination skill, as well as their ability to perform 14 individual skills, and how useful they felt the overall physical examination, and each skill, to be for yielding clinically important information. RESULTS The response rate was 80% (302/376). The skills with overall mean self-confidence ratings less than “neutral” were interpreting a diastolic murmur (2.9), detecting a thyroid nodule (2.8), and the nondilated fundoscopic examination using an ophthalmoscope to assess retinal vasculature (2.5). No skills had a mean utility rating less than neutral. The skills with the greatest numerical differences between mean self-confidence and perceived utility were distinguishing between a mole and melanoma (1.5), detecting a thyroid nodule (1.4), and interpreting a diastolic murmur (1.3). Regarding overall self-confidence, third-year students’ ratings (3.3) were similar to those of first-year residents (3.4; p = .95) but less than those of fourth-year students (3.8; p = .002), upper-level residents (3.7; p = .01), and faculty Internists (3.9; p < .001). CONCLUSIONS Self-confidence in the physical exam does not necessarily increase at each stage of training. The differences found between self-confidence and perceived utility for a number of skills suggest important areas for educational interventions.     

Key aspects of teaching that affect perceived preparedness of medical students for transition to work: insights from the COVID-19 pandemic

Background

The self-perceived preparedness of medical students to transition into practising junior doctors has implications for patient safety, graduate well-being and development of professional identity.

Aims

To examine the impact of changes to final-year education and placements and determine key elements that contribute to self-perceived preparedness for transition to work.

Methods

An online survey among final-year medical students at one Australian medical school in 2020 (the cohort most affected by the coronarvirus disease 2019 [COVID-19] pandemic), exploring overall self-perceived preparedness and specific competencies, including questions in previous Australian Medical Council/Medical Board of Australia annual national surveys. Quantitative and qualitative content analyses were performed.

Results

Thirty-three percent of eligible participants completed the survey. There was a significant decline in overall self-perceived preparedness among participants (mean preparedness, 3.55 ± 0.88) compared with 2019 graduates from the same medical school (mean preparedness, 4.28 ± 0.64, P < 0.001) and the national average (mean preparedness, 3.81 ± 0.93, P = 0.04). There was a decline in self-perceived preparedness for all specific competencies, with complex competencies more greatly affected. Qualitative content analysis of free text responses identified limitations of an online compared with a face-to-face formal education program and specific aspects of placements, which contribute to perceived preparedness.

Conclusion

The current study highlights key aspects of clinical placements and formal teaching programs that contribute to perceptions of preparedness for transition to clinical practice. Relevant experiential learning in the clinical setting, opportunities for deliberate practice of necessary skills (in simulation and the clinical setting) and reflective opportunities from formal teaching programs contribute to perceived preparedness and are important elements to be included in the final phase of any medical program.     

Systematic Review: Helping the Young to Understand the Old. Teaching Interventions in Geriatrics to Improve the Knowledge,Skills, and Attitudes of Undergraduate Medical Students

It is unclear whether geriatrics‐specific educational interventions lead to improvement in students' knowledge, skills, and attitudes and whether successful interventions possess any consistent features. This review examines the effect of educational interventions on undergraduate knowledge, skills, and attitudes in geriatric medicine and concludes that a wide range of innovative designs have the potential to improve each of these parameters, although evidence of interventions that improve student skills is lacking, and further research is necessary to confirm the efficacy of specific teaching strategies in geriatrics.     

Teaching Feedback to First-year Medical Students: Long-term Skill Retention and Accuracy of Student Self-assessment

BACKGROUND  Giving and receiving feedback are critical skills and should be taught early in the process of medical education, yet few studies discuss the effect of feedback curricula for first-year medical students. OBJECTIVES  To study short-term and long-term skills and attitudes of first-year medical students after a multidisciplinary feedback curriculum. DESIGN  Prospective pre- vs. post-course evaluation using mixed-methods data analysis. PARTICIPANTS  First-year students at a public university medical school. INTERVENTIONS  We collected anonymous student feedback to faculty before, immediately after, and 8 months after the curriculum and classified comments by recommendation (reinforcing/corrective) and specificity (global/specific). Students also self-rated their comfort with and quality of feedback. We assessed changes in comments (skills) and self-rated abilities (attitudes) across the three time points. MEASUREMENTS AND MAIN RESULTS  Across the three time points, students’ evaluation contained more corrective specific comments per evaluation [pre-curriculum mean (SD) 0.48 (0.99); post-curriculum 1.20 (1.7); year-end 0.95 (1.5); p = 0.006]. Students reported increased skill and comfort in giving and receiving feedback and at providing constructive feedback (p < 0.001). However, the number of specific comments on year-end evaluations declined [pre 3.35 (2.0); post 3.49 (2.3); year-end 2.8 (2.1)]; p = 0.008], as did students’ self-rated ability to give specific comments. CONCLUSION  Teaching feedback to early medical students resulted in improved skills of delivering corrective specific feedback and enhanced comfort with feedback. However, students’ overall ability to deliver specific feedback decreased over time. An abstract of this study was presented at a poster session at the AAMC Annual Meeting, Washington DC, November 2007.     

Faculty development for the 21st century: lessons from the Society of General Internal Medicine-Hartford Collaborative Centers for the Care of Older Adults

In this review of a recent set of faculty development initiatives to promote geriatrics teaching by general internists, nontraditional strategies to promote sustained change were identified, included enrolling a limited number of "star" faculty, creating ongoing working relationships between faculty, and developing projects for clinical or education program improvement. External funding, although limited, garnered administration support and was associated with changes in individual career trajectories. Activities to enfranchise top leadership were felt essential to sustain change. Traditional faculty development programs for clinician educators are periodic, seminar-based interventions to enhance teaching and clinical skills. In 2003/04 the Collaborative Centers for Research and Education in the Care of Older Adults were funded by the John A. Hartford Foundation and administered by the Society of General Internal Medicine. Ten academic medical centers received individual grants of $91,000, with required cost sharing, to develop collaborations between general internists and geriatricians to create sustained change in geriatrics clinical teaching and learning. Through written and structured telephone surveys, activities designed to foster sustainability at funded sites were identified, and the activities and perceived effects of funding at the 10 funded sites were compared with those of the 11 highest-ranking unfunded sites. The experience of the Collaborative Centers supports the conclusion that modest, targeted funding can provide the credibility and legitimacy crucial for clinician educators to allocate time and energy in new directions. Key success factors likely include high intensity and duration, integration into career trajectories, integration into clinical programs, and activities to enfranchise institutional leadership.     

医护一体化康复护理干预对老年糖尿病肾病腹膜透析患者生活质量的影响分析

目的针对老年糖尿病肾病患者在进行腹膜透析治疗过程中展开医护一体化康复护理干预对提升患者生活质量等的作用进行分析。方法随机抽选该院2018年2月—2019年12月接诊的100例患者为研究对象,按照随机分配的方式,对照组50例在治疗过程中对应护理方式按照常规形式进行展开,观察组50例采用医护一体化康复护理干预。分析两组生活质量、并发症、心理状态及护理满意度方面的差异。结果观察组生存质量、并发症、心理状态及护理满意度均优于对照组,差异有统计学意义(P<0.05)。结论在老年糖尿病肾病患者接受腹膜透析的过程中及时展开医护一体化康复护理干预,能够对该部分患者生活质量进行有效提升,有助于患者恢复。     

Measuring Continuing Medical Education Outcomes: A Pilot Study of Effect Size of Three CME Interventions at an SGIM Annual Meeting

BACKGROUND  The ACCME is phasing in new criteria for accreditation from 2008 to 2012. These criteria require CME providers to assess the impact of their interventions. OBJECTIVES  To assess the feasibility of measuring outcomes at a national meeting, the SGIM evaluation committee conducted a pilot assessment of two workshops and one precourse. DESIGN AND PARTICIPANTS  Session coordinators prepared a five-item questionnaire to assess the knowledge and confidence of participants. The questionnaire was administered pre, immediately post, and 9 months after the educational sessions. MEASUREMENTS  Changes in performance were calculated as a standardized difference, or effect size. RESULTS  All three sessions demonstrated initial knowledge acquisition with effect sizes ranging from 0.39 (small) to 0.99 (large) immediately after the sessions. One session demonstrated sustainment of knowledge over the subsequent 9 months while the other two demonstrated decay. Confidence levels decreased following one of the sessions with an effect size of −0.72 (modest effect). CONCLUSIONS  Effect size measurement of sessions provides quantitative information about their impact on learning and is one way to achieve ACCME compliance. The method, however, poses methodological and logistical challenges that raise questions about the feasibility of tracking learning and retention following a national meeting. The opinions or assertions contained herein are the private views of the author and should not be construed as official or as necessarily reflecting the views of the United States Army or the Department of Defense.     

E‐Learning Module on Chronic Low Back Pain in Older Adults: Evidence of Effect on Medical Student Objective Structured Clinical Examination Performance

The Institute of Medicine has highlighted the urgent need to close undergraduate and graduate educational gaps in treating pain. Chronic low back pain (CLBP) is one of the most common pain conditions, and older adults are particularly vulnerable to potential morbidities associated with misinformed treatment. An e‐learning case‐based interactive module was developed at the University of Pittsburgh Center of Excellence in Pain Education, one of 12 National Institutes of Health–designated centers, to teach students important principles for evaluating and managing CLBP in older adults. A team of six experts in education, information technology, pain management, and geriatrics developed the module. Teaching focused on common errors, interactivity, and expert modeling and feedback. The module mimicked a patient encounter using a standardized patient (the older adult with CLBP) and a pain expert (the patient provider). Twenty‐eight medical students were not exposed to the module (Group 1) and 27 were exposed (Group 2). Their clinical skills in evaluating CLBP were assessed using an objective structured clinical examination (OSCE). Mean scores were 62.0 ± 8.6 for Group 1 and 79.5 ± 10.4 for Group 2 (P < .001). Using an OSCE pass–fail cutoff score of 60%, 17 of 28 Group 1 students (60.7%) and 26 of 27 Group 2 students (96.3%) passed. The CLBP OSCE was one of 10 OSCE stations in which students were tested at the end of a Combined Ambulatory Medicine and Pediatrics Clerkship. There were no between‐group differences in performance on eight of the other nine OSCE stations. This module significantly improved medical student clinical skills in evaluating CLBP. Additional research is needed to ascertain the effect of e‐learning modules on more‐advanced learners and on improving the care of older adults with CLBP.