Alternative learning environments: what do they contribute to professional development of medical students?

Special study modules provide opportunities for students to develop lifelong learning skills and develop areas of interest. The GMC also recommends opportunities to study topics not included in the core medical curriculum. This paper reports the evaluation of modules based within alternative learning environments developed to provide students with experiences outside traditional medical, scientific or academic cultures. The attachment was highly rated as contributing to professional development, provided novel learning experiences, and was stimulating for both students and supervisors. All students achieved new skills that they felt were pertinent to their personal development. Assessment was by standardized pro forma, including generic transferable skills and module specific outcomes. Whilst overall assessment grades were comparable to similar course components, unease amongst both students and supervisors was expressed reflecting anxieties in the diversity of workloads and assessment. Attempts to standardize assessment across the diversity of modules did not reduce anxieties and potentially detracted from the learning experiences.     

Training medical students for the twenty-first century: Rationale and development of the Utrecht curriculum “CRU+”

Abstract

Aim: The aim of this report, written for the 40th anniversary issue of Medical Teacher, is to document 20 years of development of the Utrecht undergraduate medical curriculum, as both to exhibit accountability and to inform the community of the process and choices that can be made in long-term curriculum development.

Methods: We used the SPICES model, created by Medical Teacher’s Editor Ronald Harden and colleagues in 1984.

Results: The Utrecht six-year program, now called “CRU+”, has many distinct features that were introduced, most of which are well documented. A limited selection includes

• ???A new 3+3 years Bachelor-Master structure following the EU Bologna rules leading to MD registration for cohorts of about 300.

• ???Horizontally integrated classroom teaching of basic sciences with clinical disciplines predominantly in groups of 12 and limited lectures.

• ???Mandatory knowledge retention tests, retesting the clinically relevant core knowledge from block tests of semesters one through four.

• ???Vertical integration not only linking clinical experience with background knowledge, but also exemplified by a stepwise increase in health care responsibilities throughout the curriculum.

• ???A final year focussing on growth towards the level of a primary responsible physician in a 12-week sub-internship for a limited number of patients and beds, in a chosen specialty. The student is called a semi-physician in the clerkship of this transitional year to residency.

• ???Teaching skills training for all medical graduates, an elective teaching rotation and various peer-teaching arrangements throughout the curriculum.

• ???Integrated semi-longitudinal clerkships with an assessment focus on entrustment decisions for Entrustable Professional Activities.

Conclusion: UMC Utrecht has made a continuous attempt to both develop its medical curriculum and to study and report on its development in the literature, regarding new methods found and insights derived. UMC Utrecht will remain committed to developing training to meet twenty-first century demands of medical graduates.     

Twelve tips for implementation of “student-as-teacher” programs

Much has been written about the learning benefits of peer teaching for medical trainees. What remains less certain is how practically to implement “Student-as-teacher” (SaT) programs combining teacher-skills training with hands-on teaching experiences for medical students to prepare them for their roles as teachers in residency and beyond. In this article, we address this gap by outlining twelve tips for the implementation of SaT programs based on review of the literature and our experience implementing SaT curricula at our institution. We have organized the tips into three domains (i.e. preimplementation, implementation and postimplementation) to encourage SaT coordinators to iteratively consider how to continually enhance SaT programs before, during and after their implementation.     

Tensions in mentoring medical students toward self-directed and reflective learning in a longitudinal portfolio-based mentoring system – An activity theory analysis

Background: In medical education, students need to acquire skills to self-direct(ed) learning (SDL), to enable their development into self-directing and reflective professionals. This study addressed the mentor perspective on how processes in the mentor–student interaction influenced development of SDL.

Methods: n?=?22 mentors of a graduate-entry medical school with a problem-based curriculum and longitudinal mentoring system were interviewed (n?=?1 recording failed). Using activity theory (AT) as a theoretical framework, thematic analysis was applied to the interview data to identify important themes.

Results: Four themes emerged: centered around the role of the portfolio, guiding of students’ SDL in the context of assessment procedures, mentor-role boundaries and longitudinal development of skills by both the mentor and mentee. Application of AT showed that in the interactions between themes tensions or supportive factors could emerge for activities in the mentoring process.

Conclusion: The mentors’ perspective on coaching and development of reflection and SDL of medical students yielded important insights into factors that can hinder or support students’ SDL, during a longitudinal mentor–student interaction. Coaching skills of the mentor, the interaction with a portfolio and the context of a mentor community are important factors in a longitudinal mentor–student interaction that can translate to students’ SDL skills.     

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.     

Exploring the feasibility and acceptability of using tactical decision games to develop final year medical students’ non-technical skills

Introduction: Clinical decision-making, situation awareness, task management, and teamwork are key non-technical skills (NTS) required by junior doctors. Tactical decision games (TDGs) are low-fidelity classroom-based activities designed to develop proficiency in NTS. This study aimed to explore the feasibility and acceptability of using TDGs as a novel teaching method for final year medical students.

Methods: Final year medical students at the University of Edinburgh participated in a single TDG session. Focus groups were then used to explore students’ perceptions of participating in the TDG session and transcribed data from the focus groups was thematically analyzed.

Results: Six key themes emerged from the data: “the value of non-medical games”; “giving and receiving feedback”; “observing and reflecting”; “recognizing and understanding NTS”; “dealing with uncertainty and ambiguity”, and “introducing TDGs into the curriculum”.

Conclusions: TDGs are an easy-to-use, low-fidelity method of teaching medical students about the importance of NTS. Medical students view TDGs as a valuable learning activity that appears to increase awareness and understanding of the importance of NTS.     

Reliability of personality and values tests: The effects of “high stakes” selection conditions,and of four years in medical school

This study investigated if scores on tests of personal qualities are affected by whether they will determine selection decisions (“high stakes”) or not; and whether they are stable for individuals and groups across a four-year medical course. Two tests, one assessing values and one assessing components of personality, were administered either at the same time as a medical university entrance exam (first cohort; N?=?216), or after entry was confirmed (second cohort; N?=?142). Both cohorts took the tests again after four years of medical school. Analysis of variance was used to compare group mean scores and interactions, and correlation coefficients to measure temporal reliability. The high stakes cohort initially presented themselves in a significantly more positive light on the personality test. After four years of medical school scores on both tests changed significantly, towards more communitarian values and less empathic attitudes. Thus, personality scores were affected by both the conditions under which the initial tests were conducted and by the passage of time, but values only by the passage of time. Before and after scores were significantly correlated.     

Can students' reasons for choosing set answers to ethical vignettes be reliably rated? Development and testing of a method

Although ethics is an important part of modern curricula, measures of students' ethical disposition have not been easy to develop. A potential method is to assess students' written justifications for selecting one option from a preset range of answers to vignettes and compare these justifications with predetermined 'expert' consensus. We describe the development of and reliability estimation for such a method -- the Ethics in Health Care Instrument (EHCI). Seven raters classified the responses of ten subjects to nine vignettes, on two occasions. The first stage of analysis involved raters' judging how consistent with consensus were subjects' justifications using generalizability theory, and then rating consensus responses on the action justification and values recognition hierarchies. The inter-rater reliability was 0.39 for the initial rating. Differential performance on questions was identified as the largest source of variance. Hence reliability was investigated also for students' total scores over the nine consensus vignettes. Rater effects were the largest source of variance identified. Examination of rater performance showed lack of rater consistency. D-studies were performed which showed acceptable reliability could nevertheless be obtained using four raters per EHCI. This study suggests that the EHCI has potential as an assessment instrument although further testing is required of all components of the methodology.     

Effect of an educational intervention in “spirituality and health” on knowledge,attitudes, and skills of students in health-related areas: A controlled randomized trial

Background: To date there have been no randomized studies that assess whether “Spirituality and Health” (S/H) programs are, indeed, effective, or not. We sought to evaluate if an intervention in teaching S/H fosters competence changes in healthcare students.

Methods: A randomized controlled trial was carried out. Students were randomized into two groups: an Intervention Group (a theoretical-practical course in S/H) and a control group (waiting list). Students’ S/H knowledge, attitudes, and skills (through a simulated patient) were assessed.

Results: A total of 49 students were evaluated. Students in the intervention group received higher scores on knowledge tests, felt more comfortable and prepared to talk about religious/spiritual beliefs with patients, more readily recognized importance of hospital chaplains, and more frequently held the opinion that addressing spirituality is important. Furthermore, a breaking down of S/H barriers was identified. Students also demonstrated more ability in obtaining a patient’s spiritual history when compared to the control group.

Conclusions: There were some differences on knowledge, attitudes, and spiritual history skills between students who participated in the S/H teaching strategy and students who have not been exposed to the theme. These results might foster discussion for the development of new educational strategies about the subject.