A randomized controlled trial of high-fidelity simulation versus lecture-based education in preclinical medical students*

Purpose:?The purpose of this study was to compare the efficacy of simulation versus lecture-based education among preclinical medical students.

Methods:?Twenty medical students participated in this randomized, controlled crossover study. Students were randomized to four groups. Each group received two simulations and two lectures covering four different topics. Students were administered a pre-test, post-test and delayed post-test. The mean percentage of questions answered correctly on each test was calculated. The mean of each student’s change in score across the three tests was used to compare simulation- versus lecture-based education.

Results: Students in both the simulation and lecture groups demonstrated improvement between the pre-test and post-test (p?<?0.05). Students in the simulation group demonstrated improvement between the immediate post-test and delayed post-test (p?<?0.05), while students in the lecture group did not demonstrate improvement (p?>?0.05). When comparing interventions, the change in score between the pre-test and post-test was similar among both the groups (p?>?0.05). The change in score between the post-test and delayed post-test was greater in the simulation group (p?<?0.05).

Conclusions:?High-fidelity simulation may serve as a viable didactic platform for preclinical medical education. Our study demonstrated equivalent immediate knowledge gain and superior long-term knowledge retention in comparison to lectures.     

Cartoon versus traditional self-study handouts for medical students: CARTOON randomized controlled trial

Objective: The objective of this study is to compare the effectiveness of a “cartoon-style” handout with a “traditional-style” handout in a self-study assignment for preclinical medical students.

Methods: Third-year medical students (n?=?93) at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, took a pre-learning assessment of their knowledge of intercostal chest drainage. They were then randomly allocated to receive either a “cartoon-style” or a “traditional-style” handout on the same topic. After studying these over a 2-week period, students completed a post-learning assessment and estimated their levels of reading completion.

Results: Of the 79 participants completing the post-learning test, those in the cartoon-style group achieved a score 13.8% higher than the traditional-style group (p?=?0.018). A higher proportion of students in the cartoon-style group reported reading ≥75% of the handout content (70.7% versus 42.1%). In post-hoc analyses, students whose cumulative grade point averages (GPA) from previous academic assessments were in the middle and lower range achieved higher scores with the cartoon-style handout than with the traditional one. In the lower-GPA group, the use of a cartoon-style handout was independently associated with a higher score.

Conclusions: Students given a cartoon-style handout reported reading more of the material and achieved higher post-learning test scores than students given a traditional handout.     

Professional burnout among medical students: Systematic literature review and meta-analysis

Background: This systematic review and meta-analysis aim to summarize the available evidence on the prevalence of professional burnout among medical students.

Methods: The review was performed according to the PRISMA guidelines. Databases were systematically searched for peer-reviewed articles, reporting burnout among medical students published between 2000 and 2017. The meta-analysis was conducted on the available data on burnout rates in medical students measured with the Maslach Burnout Inventory (MBI-HSS).

Results: Fifty-eight out of 3006 studies were found eligible for inclusion. Twelve of these studies met the criteria for meta-analysis. Weighted mean values for the three sub-dimensions of the MBI–HSS were M?=?22.93 (SD?=?10.25) for Emotional Exhaustion, M?=?8.88 (SD?=?5.64) for Depersonalization, and M?=?35.11 (SD?=?8.03) for Personal Accomplishment. Prevalence rates for professional burnout ranged from 7.0% to 75.2%, depending on country-specific factors, applied instruments, cutoff-criteria for burnout symptomatology.

Conclusion: This review underlines the burden of burnout among medical students. Future research should explicitly focus on specific context factors and student group under investigation. Such efforts are necessary to control for context-dependent confounders in research on medical students’ mental health impairment to enable more meaningful comparisons and adequate prevention strategies.     

Enhancement of role modelling in clinical educators: A randomized controlled trial

Abstract

Introduction: Role models have an important impact on the professional behavior of medical students. Previous investigations help us understand how to improve role modelling. However, studies aiming at enhancing role modelling among clinical educators are very limited and generally lack comprehensive evaluations of the designed programs. We intended to gather robust evidence on the effectiveness of a longitudinal program for enhancing role modelling.

Methods: Clinical educators were divided into intervention and control groups. The longitudinal program, developed based on the exposure phase of the ‘Positive Doctor Role Modelling’ framework, was delivered during three months of onsite and online sessions. The effectiveness of the program was assessed in three levels of reaction, learning, and behavior.

Results: In the intervention group (N?=?18), the mean score of satisfaction was 4.7 (SD?=?0.5), and the learning (awareness about role modelling) improved significantly after the program (3.33–4.34), comparing to the control group (3.53–3.63). There was no significant difference in terms of behavior improvement between the two groups, before and after the program.

Conclusions: Our findings indicate that our longitudinal faculty development program on role modelling was highly appreciated by clinical educators, and improved their awareness and deliberate role modelling.     

Mindfulness interventions in medical education: A systematic review of their impact on medical student stress,depression, fatigue and burnout

Introduction: Mindfulness-based interventions (MBIs) have gained popularity in medical education. A systematic review was conducted to determine the effectiveness of MBIs for reducing psychological distress in undergraduate medical students.

Methods: A search protocol was conducted using online databases Embase, PubMed, PsycINFO, and MEDLINE. Articles were required to meet the following criteria to be included: (1) describe a MBI or use of mindfulness exercises as part of an intervention, (2) include at least one of: stress, burnout, fatigue, or depression, as an outcome, (3) include quantitative outcomes, and (4) published in English in a peer-reviewed journal.

Results: Twelve articles were reviewed. Seven studies reported improvements in at least one targeted outcome. Four of seven studies exploring the impact on stress reported improvements. Five articles studying depression reported reductions. One study exploring burnout reported a decrease on a single subscale. Only one study measured the impact on fatigue (no change reported). Half of studies reviewed included predominantly female samples.

Conclusions: Mixed evidence was found for the use of MBIs for reducing psychological distress in undergraduate medical students. Future work should aim to clarify the impact of mindfulness on burnout and fatigue, and explore the replicability of improvements in male medical students alone.     

The relationship between burnout,personality traits,and medical specialty. A national study among Dutch residents

Purpose: To examine the associations between residents’ personality traits, type of specialty, and symptoms of burnout.

Method: A cross-sectional online survey among Dutch residents was conducted (see Supplementary Material). The 20-item Dutch translation of the Maslach Burnout Inventory was used to ascertain burnout. Personality traits were assessed with the 44-item Dutch Big Five Inventory. Logistic regression analyses, including all five personality traits, were used to assess associations with burnout. Analyses were stratified by specialties.

Results: One thousand two hundred thirty one residents participated, 185 (15.0%) of whom met the criteria for burnout. Neuroticism was significantly associated with resident burnout in all specialties, more strongly in supportive (odds ratio (OR) 6.19, 95% CI 2.12–18.12) and surgical (OR 4.37, 95% CI 1.76–10.86) than in medical residents (OR 1.99, 95% CI 1.22–3.24). Extraversion was significantly associated with less burnout in surgical residents (OR 0.26, 95% CI 0.13–0.58). These findings remained highly significant after controlling for gender, overtime, autonomy at work, satisfaction between work and private life, and the perceived quality of the learning environment.

Conclusions: Burnout risk was associated with personality traits in residents. Consistently, residents scoring high on neuroticism reported more burnout. Extraverted surgical residents were less susceptible to burnout. Residents scoring high on neuroticism may require more intense monitoring during their training years.     

Use of the pause procedure in continuing medical education: A randomized controlled intervention study

During lectures, a pause procedure (the presenter pauses so students can discuss content) can improve educational outcomes. We aimed to determine whether (1) continuing medical education (CME) presentations with a pause procedure were evaluated more favorably and (2) a pause procedure improved recall. In this randomized controlled intervention study of all participants (N?=?214) at the Mayo Clinic Internal Medicine Board Review course, 48 lectures were randomly assigned to an intervention (pause procedure) or control (traditional lecture) group. The pause procedure was a 1-min pause at the middle and end of the presentation. Study outcomes were (1) presentation evaluation instrument scores and (2) number of recalled items per lecture. A total of 214 participants returned 145 surveys (response rate, 68%). Mean presentation evaluation scores were significantly higher for pause procedure than for traditional presentations (70.9% vs 65.8%; 95%CI for the difference, 3.5–6.7; p?p?=?.01). In a traditional CME course, presentations with a pause procedure had higher evaluation scores and more content was recalled. The pause procedure could arm CME presenters with an easy technique to improve educational content delivery.     

A randomized controlled trial of two different types of web-based instructional methods: One with case-based scenarios and one without

Background: Computer-based learning (CBL) is an effective form of medical education. Educators have developed recommendations for instructional design but there is only minimal research that evaluates these recommendations. Aim: To evaluate the effect of case-based questions contained in computer modules on learning efficacy. Methods: The authors conducted a randomized controlled trial in 124 medical students of two CBL PowerPoint modules-based on Medicare. The modules were identical except one contained 11 case-based scenarios followed by multiple choice questions. The primary outcome measurement was a previously validated, 11-item knowledge test taken at the end of the module and at the end of the academic year to test retention. Results: The students who studied the module with case-based questions answered one more item correctly in the first test (8.9 vs. 10.00 correct answers, p?=?0.001). This difference had disappeared by the time of the second test (4.2 vs. 4.7, p?=?0.095). Conclusions: This study shows that computer modules with case-based questions enhance learning in the short-term but at the expense of increased time and so decreased learning efficiency. This learning benefit was not maintained.     

Work engagement in medical students: An exploratory analysis of the relationship between engagement,burnout, perceived stress,lifestyle factors,and medical student attitudes

Abstract

There is a need to expand the current focus of burnout in medical trainees so that we can understand not only trainee distress but also trainee well-being. Work engagement as measured by the Utrecht Work Engagement Scale-15 (UWES-15) is a positive construct that is conceptually related to burnout and is a component of the Job Demands-Resources Model (JD-R). We sought to explore the relationship of work engagement to burnout, perceived stress, lifestyle factors, and medical student attitudes to testing whether work engagement could serve as a positive construct to study medical student well-being. We surveyed 287 1st and 2nd-year medical students at a large academic medical center in the United States. Our survey consisted of demographic measures, UWES-15, Burnout Measure short version, Perceived Stress Scale-4, lifestyle factors, and medical student attitudes. Statistical analysis revealed work engagement is negatively correlated with burnout and perceived stress. Work engagement and its subscales are correlated to exercise, sleep, drugs and alcohol use, maintaining relationships, and financial stress. Work engagement is negatively correlated with thoughts of dropping out and questioning the decision to enter medical school. Work engagement can be a useful measure to assess medical student well-being and identify areas for intervention.     

Development and evaluation of a concordance training course for medical practitioners

The authors sought to develop and evaluate a training course on the theory and methods of seeking 'concordance' with patients who are using medications inappropriately. Eight general practitioners were recruited to a four-day interactive course including factual materials, attitudinal challenge, skills development and assessment. Participants enjoyed the course and thought they had learned from it. Knowledge and skills improved significantly and attitudes showed a non-significant shift. The study demonstrated that concordance-related skills can be taught and measured, suggesting that trials to assess the impact of such training on patient outcomes may be feasible and worthwhile.