Physician perceptions of the role and value of basic science knowledge in daily clinical practice

Background: The role of basic science education in a clinical setting remains unclear. Research to understand how academic clinicians perceive and use this part of their education can aid curricular development. Aims: To assess physician's attitudes toward the value of science knowledge in their clinical practice. Methods: Academic physicians from three medical schools completed a questionnaire about the utility of basic science education in core clinical tasks and in practice-based learning and improvement. Results: A total of 109 clinical faculty returned the survey. Overall, 89% of the respondents indicated that basic science education is valuable to their clinical practice. When asked about the utility of basic science information in relation to direct patient care, greater than 50% of the doctors felt they use this when diagnosing and communicating with patients. This rose to greater than 60% when asked about choosing treatment options for their patients. Individuals also responded that basic science knowledge is valuable when developing evidence-based best practices. Specifically, 89% felt that they draw upon this information when training students/residents and 84% use this information when reading journal articles. Conclusions: This study shows that basic science education is perceived by responding academic physicians to be important to their clinical work.     

Preparation for clinical practice: a survey of medical students' and graduates' perceptions of the effectiveness of their medical school curriculum

This paper describes the perceptions of students and graduates of the Hebrew University-Hadassah medical school in Israel regarding the effectiveness of their medical education in preparing them for work in the clinical setting. The six-year curriculum consists of three years of mainly lecture-based Basic Science courses, and three years of clinical education, consisting of clinical clerkship rotations of various lengths. An anonymous questionnaire containing 114 items was distributed to 294 students (in their clinical years) and 500 graduates of the faculty. A total of 371 respondents completed the questionnaire (response rate 49%). Overall 60% of the respondents were generally satisfied with the medical training they received. However, respondents indicated many deficiencies in the curriculum, and in their competences. More than half of the respondents felt that Basic Science courses lacked clinical relevance. Almost 40% of the respondents reported that students were not taught sufficient clinical skills in preparations for clinical practice. At least 50% of the respondents reported that they had not received adequate exposure to 26 out of the 36 important clinical activities and skills during clerkships. Only 33% of the respondents agreed that the fundamental knowledge, skills, attitudes and values that medical students should possess at the time of graduation were made explicitly clear to them. Perspectives of students and graduates were compared. In many questions significantly more graduates tended to rate their learning experience better than students. This study illuminates many aspects of the curriculum the faculty needs to address in order to prepare physicians effectively and efficiently for clinical work. It also stresses the need to integrate better preclinical and clinical studies, and to change to active learning methods. This study demonstrates the necessity of gathering information from students and graduates to evaluate their medical education experience.     

Can nurses teach tomorrow's doctors? A nursing perspective on involvement in community-based medical education

The increasing importance of primary care suggests an important role for the whole primary healthcare team in the education of 'tomorrow's doctors'. Few studies have evaluated the contribution and views of staff other than general practitioners. We used a questionnaire survey to elicit the perspective of 65 community-based nurses involved in a new undergraduate medical course. Some 67% of the cohort had already undertaken training to teach others, and were confident of their teaching skills but were overly reliant on the general practitioners for information, and on the goodwill of colleagues for time to teach. The findings suggest a need for structural changes in the process of multidisciplinary medical education, supporting the need for teaching commitments to be coordinated at practice rather than individual tutor level. The high level of professional development for teaching among community nurses suggests that there is a sound basis for encouraging such valuable professional input into medical education in the future.     

A questionnaire survey of students' perceptions of nurse tutor teaching in a clinical skills learning programme

Changes in medical education and in the environments in which students learn have brought about new ways of learning in undergraduate medical curricula. Amongst these have been the establishment of courses in clinical skills learning to address concerns of deficient skills amongst newly qualified doctors. Curriculum reform at Liverpool, UK, included extensive and early learning of clinical skills. Nurse tutors provide full-time teaching support in a single Clinical Skills Resource Centre. They work alongside medically qualified tutors in delivering a clinical skills learning programme. This study aimed to explore students' opinion of nurses teaching clinical skills and to compare that to their opinion of teaching by medically qualified clinicians. A questionnaire survey was used to gain the views of 206 first-year medical students. Overall, students were strongly supportive in their opinion of nurse tutors. Some small statistically significant differences are probably of little or no educational significance. This role for nurses stresses the importance of interprofessional teachers in undergraduate healthcare education.     

Medical student healthcare consulting groups: A novel way to train the next generation of physician-executives

Meeting the challenges of the evolving healthcare environment requires leadership of physicians well-trained in clinical medicine and healthcare management. However, many physicians lack training in business and leadership. While some residency programs have management tracks, training at the medical school level is currently lacking. We developed the Hopkins Health Management Advisory Group, an extracurricular program at Johns Hopkins University School of Medicine that exposes medical students to healthcare management and fosters development of leadership skills. Teams of students work directly with health system executives on 3–6 month-long projects using management consulting principles to address problems spanning health system domains, including strategy, operations, and quality improvement. Since the program’s inception, 23 students have completed seven projects, with 13 additional students currently working on three more projects. Sponsors leading six out of seven completed projects have implemented recommendations. Qualitative survey respondents have found the program beneficial, with students frequently describing how the program has helped to develop professional skills and foster knowledge about healthcare management. These early assessments show positive impact for both students and the institution, and suggest that such programs can train students in management early and concurrently in their medication education by immersing them in team-based health system projects.     

Organizational commitment of a health profession faculty: dimensions, correlates and conditions

Health professions depend on their faculties to prepare new practitioners, conduct research and provide essential services. Organizational commitment is an important aspect of faculty effectiveness and job performance, and may impact on turnover, absenteeism and interpersonal trust. A survey of organizational commitment, including faculty demographics and workplace variables, was conducted. Respondents were full- and part-time chiropractic faculty working in the United States and Canada. More than 54% of the study population (n = 609) completed and returned the instrument. A large majority of the respondents were male (68.4%) and employed full-time (81.6%). Almost half (47.5%) of the respondents were assigned to the area of patient care at their institutions. This study provides an initial assessment of organizational commitment among chiropractic faculty. Tenure in higher education, gender and age were found to be the most important predictors of organizational commitment.     

Medical education in Albania: Challenges and opportunities

Albania is a small south-eastern European country still recovering from almost half a century of a fierce communist regime. While major reform and support have focused on healthcare and higher education (HE) in the past decade, there have not been major attempts to improve medical education. The time is now ready for medical education improvements created by increasing internal and external pressures as Albania aims to align its HE with the European Union standards and adapts the Bologna system. This article presents a summary of the current status of undergraduate, postgraduate and continuous medical education in Albania and suggests opportunities for development and partnerships that would help the country's medical education reform.     

Introducing undergraduate medical teaching into general practice: an action research study

Following the publication of Tomorrow's Doctors and as a result of increasing numbers of students recruited to medical school it is necessary to involve more general practitioners (family physicians) in undergraduate medical education. Students have responded positively regarding experiences in general practices with a broad spectrum of clinical conditions to be seen and greater involvement in clinical decision-making. This action research study followed a small group general practice in South Wales through the required preparation for undergraduate medical education and its first year of teaching. Preparatory work for the practice focused mainly on summarizing patient notes, setting up a practice library and arranging accommodation for the students. Members of the Primary Health Care Team (PHCT) found that having students in the practice gave them a sense of achievement and enhanced self-worth. Individuals within the practice felt more confident in their professional role and the team ethic within the practice was strengthened. Doctors' anxieties regarding the adequacy of their clinical skills proved unfounded. Patients were reported to feel more included in their care and to have enjoyed hearing their condition being discussed with the students. Students valued the one-to-one teaching, seeing common illnesses and a variety of consulting styles. It is hoped that this paper will be of value to those responsible for recruiting GP practices into undergraduate teaching. It demonstrates benefits for the primary health care team in terms of improved morale and sense of professional self-worth. Patients felt more involved in their care. Generalization from these findings is limited by only one practice having been involved. Undergraduate teaching offers advantages, particularly in terms of professional self-esteem and team morale.     

How we used a patient visit tracker tool to advance experiential learning in systems-based practice and quality improvement in a medical student clinic

Poorly designed healthcare systems increase costs and preventable medical errors. To address these issues, systems-based practice (SBP) education provides future physicians with the tools to identify systemic errors and implement quality improvement (QI) initiatives to enhance the delivery of cost-effective, safe and multi-disciplinary care. Although SBP education is being implemented in residency programs and is mandated by the Accreditation Council for Graduate Medical Education (ACGME) as one of its core competencies, it has largely not been integrated into undergraduate medical education. We propose that Medical Student–Faculty Collaborative Clinics (MSFCCs) may be the ideal environment in which to train medical students in SBPs and QI initiatives, as they allow students to play pivotal roles in project development, administration, and management. Here we describe a process of experiential learning that was developed within a newly established MSFCC, which challenged students to identify inefficiencies, implement interventions, and track the results. After identifying bottlenecks in clinic operations, our students designed a patient visit tracker tool to monitor clinic flow and implemented solutions to decrease patient visit times. Our model allowed students to drive their own active learning in a practical clinical setting, providing early and unique training in crucial QI skills.     

Medical ethics and tomorrow's physicians: an aspect of coverage in the formal curriculum

Medical ethics has created contentious issues and requires reforms in medical education such as renewed emphasis on formal instruction. The aim here was to review the current status of bioethics teaching in medical schools, determine Saudi students' perception of its coverage in the formal curriculum and make recommendations. Using a self-administered questionnaire in a cross-sectional study, undergraduate students' opinion about medical ethics coverage was obtained. Fourteen clinical departments and 201 students were studied. Only 46% of respondents were satisfied with the current coverage of ethical issues in the formal curriculum; 23% were unaware of the value of the subject. Students' approval rate was highest in Neurology and Psychiatry (70%). The study confirmed inadequate formal instruction on medical ethics in a developing country. Five recommendations are made. At admission, students' integrity and character should be assessed. Bioethics should be taught in clinical settings. In the Islamic world, medical curricula should include the Islamic code of medical ethics. Peers, nurses and patients should evaluate graduates' performance in ethics at the bedside. Evidence-based assessment and continuous quality improvement are required to maintain the requisite standard.     

Mobile technologies in medical education: AMEE Guide No. 105

Mobile technologies (including handheld and wearable devices) have the potential to enhance learning activities from basic medical undergraduate education through residency and beyond. In order to use these technologies successfully, medical educators need to be aware of the underpinning socio-theoretical concepts that influence their usage, the pre-clinical and clinical educational environment in which the educational activities occur, and the practical possibilities and limitations of their usage. This Guide builds upon the previous AMEE Guide to e-Learning in medical education by providing medical teachers with conceptual frameworks and practical examples of using mobile technologies in medical education. The goal is to help medical teachers to use these concepts and technologies at all levels of medical education to improve the education of medical and healthcare personnel, and ultimately contribute to improved patient healthcare. This Guide begins by reviewing some of the technological changes that have occurred in recent years, and then examines the theoretical basis (both social and educational) for understanding mobile technology usage. From there, the Guide progresses through a hierarchy of institutional, teacher and learner needs, identifying issues, problems and solutions for the effective use of mobile technology in medical education. This Guide ends with a brief look to the future.     

Medical students' experience in practical skills is far from stakeholders' expectations

This study compares medical graduates' experience in practical skills with a range of stakeholders' expectations. A questionnaire listing 58 practical skills was sent out to a group of graduating medical students. The medical students were asked to indicate their experience in each skill during medical school. A similar questionnaire was sent out to five groups of stakeholders asking for their expectations regarding graduates' experience. The stakeholders were: faculty members; consultants at clinical departments with interns in training; general practitioners; nurses; recently graduated junior doctors. A total of 472 questionnaires were sent out and 315 (67%) were returned. Medical graduates showed substantial variation in level of experience, and their experience was substantially lower than the expectations of the stakeholders. Nurses and junior doctors tended to have higher expectations compared with faculty members and consultants. Differences between our results and reports in the literature from elsewhere emphasize the importance of performing local needs assessments, and in this process stakeholders apart from faculty members should be involved.     

The role of medical education in the recruitment and retention of rural physicians

In many countries the sustainability of rural healthcare systems is being challenged by a shortage of rural physicians and difficulties in recruiting and retaining physicians in rural practice. There are numerous factors that influence efforts in rural physician recruitment and retention, many of which are beyond the scope of the academic medical centre and medical education. Nevertheless, there are strategies that medical schools can adopt to contribute to efforts to recruit and retain physicians in rural communities. Rural student recruitment, admissions policies, rural-oriented medical curriculum, rural practice learning experiences, faculty values and attitudes, and advanced procedural skills training are areas which the medical school has direct control of and which have been shown to influence the likelihood of medical students entering rural primary care practice. The purpose of this paper is to elaborate on some of the key strategies that have been identified in the literature.     

Assessment of competencies in physicians-in-training through the delivery of a community-based health curriculum using distance learning

Academic physicians must master the elements of curriculum development and evaluation specific to defined competencies in postgraduate medical education. Six fellows in primary care medicine, working as a peer group with a faculty mentor, designed and evaluated a distance-learning project that included resident physicians. Professionalism, interpersonal skills and systems-based medical practice skills were measured with original instruments designed by the peer group. By the process of evaluation and revision in a peer-group setting and with mentorship from program faculty, experiential learning enhanced the training of future academic physicians. This paper describes the background, process and statistical results of their work.     

The WAMI Program: 25 years later

The Washington, Alaska, Montana and Idaho (WAMI) Program is a four-state decentralized medical education program initiated at the University of Washington School of Medicine (UWSM) in 1972 with the goals of: (1) admitting more students to medical school from all states, (2) training more primary care physicians, (3) bringing the UWSM's resources to needy communities, (4) redressing the maldistribution of physicians by placing more MDs in predominantly rural states and (5) avoiding new construction costs. The program consists of a University Phase and a Community Phase, the latter extending to residency/postgraduate medical training. Thirty-three years on, and now renamed WWAMI (with the inclusion of the State of Wyoming), nearly 1200 students have been admitted to the program, with 5947 clerkship experiences and 2282 resident rotations, and the original goals of this experiment in decentralized medical education have been largely met. Almost half of all residents supported by the program return home to practice, and of graduates who underwent a part of their training in Alaska, Montana and Idaho, 64.7% returned home to practice. This paper reports on some lessons learned and speculates whether the WAMI program can keep pace with the rapid changes in medical education.     

Medical education in China's leading medical schools

This article gives a general overview of the evolution and present state of the undergraduate medical education system, programs, evaluation methods and conferred degrees in contemporary China. The publication is based on the information collected from on-site visits to the eight (8) leading medical universities, medical education conferences, visits to Ministries of Health and Education and their staff, and the contribution of Chinese medical education experts. As the Ministry of Education of the People's Republic of China (PRC) approves all tracks and strives for uniformity of educational programs as a cornerstone of quality, this overview reflects the general content of all five- and seven-year medical education programs that have provided the great majority of physicians since the founding of the People's Republic of China.     

Medical education state reform in Tajikistan: Between tradition and modernity

Abstract

After its post-independence economic and social transformation, the healthcare system of Tajikistan has been shifting from a centrally planned, hospital, and specialist-focused model to a primary oriented care delivery system. Since 2010 the government of the Republic of Tajikistan has been implementing the National Health Strategy aimed at improving the population’s health. Significantly reformed medical education is a major prerequisite for changing and defining a new landscape of Tajik medicine that could provide the local population with high-quality health care services. The ongoing medical education state reform involves the restructuring of undergraduate, postgraduate education, and continuing professional development programs in compliance with the recommendations of the World Medical Education Federation. This article gives a brief overview of the history and heritage of Persian-Tajik medicine and helps to retrace its evolution throughout the centuries until modern times. The authors describe the current state of the Tajik medical education system as well as the complexities and controversies, milestones, and the primary outcomes of the medical education reform implemented as part of the National Health Strategy.     

Attitudes among students and teachers on vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum

Important elements in the curriculum at the Faculty of Health Sciences in Link?ping are vertical integration, i.e. integration between the clinical and basic science sections of the curriculum, and horizontal integration between different subject areas. Integration throughout the whole curriculum is time-consuming for both teachers and students and hard work is required for planning, organization and execution. The aim was to assess the importance of vertical and horizontal integration in an undergraduate medical curriculum, according to opinions among students and teachers. In a questionnaire 102 faculty teachers and 106 students were asked about the importance of 14 different components of the undergraduate medical curriculum including vertical and horizontal integration. They were asked to assign between one and six points to each component (6 points = extremely important for the quality of the curriculum; 1 point = unimportant). Students as well as teachers appreciated highly both forms of integration. Students scored horizontal integration slightly but significantly higher than the teachers (median 6 vs 5 points; p=0.009, Mann-Whitney U-test), whereas teachers scored vertical integration higher than students (6 vs 5; p=0.019, Mann-Whitney U-test). Both students and teachers considered horizontal and vertical integration to be highly important components of the undergraduate medical programme. We believe both kinds of integration support problem-based learning and stimulate deep and lifelong learning and suggest that integration should always be considered deeply when a new curriculum is planned for undergraduate medical education.     

Doctor in the house: the medical student as academic,attendant and apprentice?

It is contended that change in the health services should be accompanied by a re-examination of medical education. Changes in professional roles and practices, specialist training and the location of patient care should be more central to informing change in undergraduate medical education. Although innovation in undergraduate curricula is taking place, much of this is in relation to improvement in educational methods. We would argue that these initiatives need to be more firmly linked to the realities of delivering healthcare today.     

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.