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.     

Spaced learning using emails to integrate psychiatry into general medical curriculum: Keep psychiatry in mind

Objectives: Traditionally, medical students on clinical rotations receive instruction on principles of mental health only during the psychiatry clerkship. We used emails to insert teaching of psychiatric concepts beyond the psychiatry clerkship into other rotations using the method of spaced learning, the delivery of brief morsels of information repeated over time intervals. We predicted that the intervention would improve attitudes and confidence towards the integration of psychiatry and knowledge retention.

Methods: We developed and distributed a series of emails relating key psychiatric concepts targeted to the other core clerkships.

Results: In a cluster-randomized trial over one academic year (intervention group n?=?71, control group n?=?61), scores on the Attitudes and Confidence in the Integration of Psychiatry scale and on the knowledge quiz did not differ significantly. Students who actively engaged with the emails demonstrated significantly higher scores on the knowledge test. Email users valued the timing, format of delivery and application of psychiatric principles outside the psychiatric setting. Participants recommended simplifying the format and previewing the benefits of spaced learning to increase utilization.

Conclusion: Delivering spaced learning through emails, within a curriculum designed to foster engagement, may provide an efficient means of addressing the widely-recognized but elusive goal of integrating teaching across medical disciplines.     

Incorporation and evaluation of serial concept maps for vertical integration and clinical reasoning in case-based learning tutorials: Perspectives of students beginning clinical medicine

Abstract

Background: Concept maps and case-based learning (CBL) are recognized and useful strategies to enhance undergraduate medical learning. However, research on the use of a mixed approach is limited.

Aims: To incorporate serial concept mapping (CM) into CBL tutorials, to explore students’ perspectives on the worth of the method to better understand patients’ problems and elicit diagnoses, and to assess the student’s learning.

Methods: We designed a four-phase method of CBL that incorporated serial mapping to assist students in the process of knowledge construction regarding the underlying principles of the patients’ present complaints, the recognition of disease patterns and the eliciting of diagnostic hypotheses. Students worked both individually and collaboratively. We used a questionnaire to explore the students’ perspectives of the method and a score system to assess end-of-course performance.

Results: The students perceived that serial CM was useful to integrate previous knowledge into new clinical information for case analysis and to elicit diagnoses. They also reported an increase in content-related knowledge. The end-of-course scores were high for most students.

Conclusions: Novice medical students perceived serial CM in CBL tutorials as an effective strategy for learning. End-of-course examination scores indicated that they improved case analysis and clinical reasoning skills.     

Assisting the integration of social media in problem-based learning sessions in the Faculty of Medicine at King Abdulaziz University

Abstract

Purpose: Issues related to traditional Problem-Based Learning (PBL) at King Abdulaziz University Faculty of Medicine (KAU-FOM), including lack of student interaction between sessions and outdated instructional materials have led to the examining the use of social media. This study examines factors affecting the implementation of social media into PBL sessions

Methods: Mentored social media activities were incorporated between PBL sessions to third year medical students. Ground rules were set, and students were kept on track with learning objectives and authentic references. An online survey consisting of 18 questions were administered to measure the impact of the social media model embedded between PBL sessions.

Results: Feedback showed major improvements in students’ learning process as well as identifying areas for improvement. The highest ratings were in participation and communication, knowledge and information gathering, and cooperation and team-building.

Conclusions: This paper indicates that incorporating social media could facilitate learning between PBL sessions. Furthermore, guidelines are proposed to help educators implement a social media model into their PBL sessions.     

Students’ perception of portfolio as a learning tool at King Abdulaziz University Medical School

Abstract

Background: Medical education has a longstanding tradition of using logbooks to record activities. The portfolio is an alternative tool to document competence and promote reflective practice. This study assessed the acceptance of portfolio use among Saudi undergraduate medical students.

Methods: Portfolios were introduced in the 2nd through 5th years at King Abdulaziz University over a two-year period (2013–2015). At the end of each academic year, students completed a mixed questionnaire that included a self-assessment of skills learned through the use of portfolio.

Results: The results showed a difference in focus between basic and clinical years: in basic years students’ focus was on acquiring practical skills, but in clinical years they focused more on acquiring complex skills, including identifying and managing problems. The questionnaire responses nonetheless revealed a positive trend in acceptance (belief in the educational value) of portfolios among students and their mentors, across the years of the program.

Conclusions: Using portfolios as a developmental learning and formative assessment tool in the early undergraduate years was found to contribute to students’ ability to create their own clinical skills guidelines in later years, as well as to engage in and appreciate reflective learning.     

Reflecting on exchange students’ learning: Structure,objectives and supervision

Abstract

Background and aim: The increasing opportunities for medical students to participate in international electives may improve students’ professionalism and cultural competence. However, the students’ overall experiences may be unpredictable, unstructured and lack supervision. There is scant evidence with respect to their learning outcomes. These reflections demonstrate that short-term supervised elective can provide students with structured learning experiences to achieve specific learning objectives.

Methods: We carried out daily debriefs and a weekly summary with seven Curtin Medical School students from Perth, Australia during an 18-days supervised elective in the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. The daily debriefs and the weekly summary in different disciplines become the content of the reflections discussed in this article.

Results: The main themes identified in the feedback were as follows: Skills in history taking and physical examination; clinical reasoning; diagnosis and management of diseases rarely seen in Australia; awareness of clinical ethics; merits and demerits of different systems of healthcare; sensitivity to issues in doctor-patient relationships; work ethics; enhancement of cultural competence; and personal development.

Conclusions: These reflections provide insight into how overseas electives may be structured to improve students’ clinical reasoning skills in this hospital. These students achieved their learning outcomes under joint supervision from both institutions. The clinical skills learned from these experiences enhanced the students’ professionalism and cultural competence, giving students the opportunities to appreciate the multitude healthcare model of bio-psycho-social-political-economical-spiritual dimensions.     

Tools for structured team communication in pre-registration health professions education: a Best Evidence Medical Education (BEME) review: BEME Guide No. 41

Introduction: Calls for the inclusion of standardized protocols for information exchange into pre-registration health professions curricula have accompanied their introduction into clinical practice. In order to help clinical educators respond to these calls, we have reviewed educational interventions for pre-registration students that incorporate one or more of these ?tools for structured communication?.

Methods: Searches of 10 databases (1990?2014) were supplemented by hand searches and by citation searches (to January 2015). Studies evaluating an intervention for pre-registration students of any clinical profession and incorporating at least one tool were included. Quality of included studies was assessed using a checklist of 11 indicators and a narrative synthesis of findings undertaken.

Results: Fifty studies met our inclusion criteria. Of these, 21 evaluated the specific effect of a tool on educational outcomes, and 27 met seven or more quality indicators.

Conclusions: Pre-registration students, particularly those in the US, are learning to use tools for structured communication either in specific sessions or integrated into more extensive courses or programmes; mostly ‘Situation Background Assessment Recommendation’ and its variants. There is some evidence that learning to use a tool can improve the clarity and comprehensiveness of student communication, their perceived self-confidence and their sense of preparedness for clinical practice. There is, as yet, little evidence for the transfer of these skills to the clinical setting or for any influence of teaching approach on learning outcomes. Educators will need to consider the positioning of such learning with other skills such as clinical reasoning and decision-making.     

Medical students' perception of test anxiety triggered by different assessment modalities

Abstract

Objectives: Test anxiety is well known among medical students. However, little is known about test anxiety produced by different components of exam individually. This study aimed to stratify varying levels of test anxiety provoked by each exam modality and to explore the students perceptions about confounding factors.

Methods: A self-administered questionnaire was administered to medical students. The instrument contained four main themes; lifestyle, psychological and specific factors of information needs, learning styles, and perceived difficulty level of each assessment tool.

Results: A highest test anxiety score of 5 was ranked for “not scheduling available time” and “insufficient exercise” by 28.8 and 28.3% students, respectively. For “irrational thoughts about exam” and “fear to fail”, a highest test anxiety score of 5 was scored by 28.8 and 25.7% students, respectively. The highest total anxiety score of 1255 was recorded for long case exam, followed by 975 for examiner-based objective structured clinical examination. Excessive course load and course not well covered by faculty were thought to be the main confounding factors.

Conclusions: The examiner-based assessment modalities induced high test anxiety. Faculty is urged to cover core contents within stipulated time and to rigorously reform and update existing curricula to prepare relevant course material.     

Self-regulated learning and academic performance in medical education

Content: Medical schools aim to graduate medical doctors who are able to self-regulate their learning. It is therefore important to investigate whether medical students’ self-regulated learning skills change during medical school. In addition, since these skills are expected to be helpful to learn more effectively, it is of interest to investigate whether these skills are related to academic performance.

Methods: In a cross-sectional design, the Self-Regulation of Learning Self-Report Scale (SRL-SRS) was used to investigate the change in students’ self-regulated learning skills. First and third-year students (N?=?949, 81.7%) SRL-SRS scores were compared with ANOVA. The relation with academic performance was investigated with multinomial regression analysis.

Results: Only one of the six skills, reflection, significantly, but positively, changed during medical school. In addition, a small, but positive relation of monitoring, reflection, and effort with first-year GPA was found, while only effort was related to third-year GPA.

Conclusions: The change in self-regulated learning skills is minor as only the level of reflection differs between the first and third year. In addition, the relation between self-regulated learning skills and academic performance is limited. Medical schools are therefore encouraged to re-examine the curriculum and methods they use to enhance their students’ self-regulated learning skills. Future research is required to understand the limited impact on performance.     

Medical students as feedback assessors in a faculty development program: Implications for the future

Abstract

Background: Little is known about simulated students’ ability in assessing feedback received in Objective Structured Teaching Encounters (OSTEs). We aimed to assess to which extent students’ perceptions matched objective analysis regarding quality of received feedback, to explore what elements of feedback they emphasized and what they learned about feedback.

Methods: In this mixed-method study, 43 medical students participated as simulated residents in five OSTEs at Geneva University Hospitals. They assessed quality of feedback from faculty using a 15-item questionnaire and gave written/oral comments. Videotaped feedbacks were assessed using an 18-item feedback scale. During four focus groups, 25 students were asked about what they learned as feedback assessors.

Results: 453 students’ questionnaires and feedback scale were compared. Correlations were moderate for stimulating self-assessment (0.48), giving a balanced feedback (0.44), checking understanding (0.47) or planning (0.43). Students’ feedback emphasized elements such as faculty’s empathy or ability to give concrete advice. They reported that being a feedback assessor helped them to realize importance of making the learner active and that giving effective feedback required structure and skills.

Conclusion: Medical students may identify quality of feedback. Involving them in OSTEs could be interesting to train them to become valid raters of supervisors’ teaching skills.     

Electronic assessment of clinical reasoning in clerkships: A mixed-methods comparison of long-menu key-feature problems with context-rich single best answer questions

Background: It remains unclear which item format would best suit the assessment of clinical reasoning: context-rich single best answer questions (crSBAs) or key-feature problems (KFPs). This study compared KFPs and crSBAs with respect to students’ acceptance, their educational impact, and psychometric characteristics when used in a summative end-of-clinical-clerkship pediatric exam.

Methods: Fifth-year medical students (n?=?377) took a computer-based exam that included 6–9 KFPs and 9–20 crSBAs which assessed their clinical reasoning skills, in addition to an objective structured clinical exam (OSCE) that assessed their clinical skills. Each KFP consisted of a case vignette and three key features using a “long-menu” question format. We explored students’ perceptions of the KFPs and crSBAs in eight focus groups and analyzed statistical data of 11 exams.

Results: Compared to crSBAs, KFPs were perceived as more realistic and difficult, providing a greater stimulus for the intense study of clinical reasoning, and were generally well accepted. The statistical analysis revealed no difference in difficulty, but KFPs resulted more reliable and efficient than crSBAs. The correlation between the two formats was high, while KFPs correlated more closely with the OSCE score.

Conclusions: KFPs with long-menu exams seem to bring about a positive educational effect without psychometric drawbacks.     

Can revisiting pre-clinical coursework at the end of medical school enhance learning for near-peer teachers?

Many medical schools have integrated early clinical skills courses to ease the “pre-clinical” to “clinical” transition for medical students. However, it may also be beneficial for medical students to revisit the pre-clinical basic sciences after their core clerkship rotations to foster a deeper understanding of causal pathways of disease that often take a backseat to clinical management principles during the clerkship experience. To this point, the author reflects on the learning benefits she experienced at the end of medical school when she served as a near-peer teacher in an integrated, organ-based physiology and pathophysiology course for first-year medical students. “Teaching to learn” as a senior medical student may be a way to consolidate and foster deeper understanding of medical knowledge in the post-clerkship period of medical school.     

Group observed structured encounter (GOSCE) for third-year medical students improves self-assessment of clinical communication

Objectives: This study assesses the effectiveness of a GOSCE in teaching medical students clinical communication, as well as group collaboration and peer feedback.

Methods: The GOSCE was administered during the Internal Medicine clerkship. Groups consisted of 4–6 students and one faculty member. Students completed pre- and post-GOSCE surveys to assess confidence in clinical communication and a GOSCE evaluation to rate the overall experience. Pre- and post-GOSCE program survey scores were compared, and the mean score and standard deviation of the GOSCE evaluation was calculated.

Results: Students perceived improvement in their general (Mean 4.49–4.57, p?p?p?Conclusions: A GOSCE is a valuable resource for use in formative assessment of clinical communication, and it offers the benefit of group collaboration and peer feedback. These findings support the broader use of GOSCEs in undergraduate medical education.     

The multiple mini-interviews as a predictor of peer evaluations during clinical training in medical school*

Background: Multiple Mini-Interviews (MMI) is an admissions tool being used for more than a decade by medical schools worldwide to assess non-cognitive skills. In Israel, in addition to the MMI tool, two questionnaires are given to the candidates. It has been necessary to find a relevant criterion to examine the predictive validity of the MMI test. The measure developed in this study was a peer assessment tool which was filled out during clerkship.

Aims: The study aims at evaluating the predictive validity of the MMI and two questionnaires when compared with the peer assessment tool.

Method: Ninety nine fourth-year medical students were included in this study. All of them went through the MMI test before the beginning of their studies. The students participated in two clinical rotations and were divided into 10 groups, each consisting of 9–12 students. This study is based on assessments given to 99 students. Every member of a group evaluated his fellow members on a number of attribute. The questionnaire included 10 statements, related to a particular attributes. In addition two concluding questions were included. Pearson correlations were used to test the relationships between pre-admission variables (MMI and two questionnaires) and the peer assessments.

Results: Statistically significant, moderate correlations between the general MOR and MIRKAM scores and the sum of the questionnaire assessments were 0.39 and 0.37, respectively (P-value <0.05).

Conclusions: The study provides important evidence for the validity of the MMI. Additional studies are required to reevaluate the predicted validity of the MMI.     

Empowering future physicians to advocate for health equity: A blueprint for a longitudinal thread in undergraduate medical education

Abstract

In light of a growing body of evidence demonstrating pervasive health disparities, medical schools are increasingly incorporating educational programs on social medicine in undergraduate and graduate medical curricula. In 2015, we significantly restructured the cultural competency instruction for medical students at our institution, focusing on achieving greater health equity through caring for vulnerable populations and acknowledging and addressing bias and stereotyping. In order to facilitate educational sustainability while students were immersed in clinical care, a key element of our approach included extending teaching into the clerkship year. The resulting longitudinal thread, Health Equity and Social Justice, empowers future physicians with the knowledge and skills to work towards greater health equity. This article discusses the lessons learned in the implementation of this novel educational program. Our approach can serve as a model for other institutions considering similar instructional reform.     

Undergraduate medical students’ perceptions of their learning experience in pediatric rotation at King Abdulaziz University Medical College in Jeddah,Saudi Arabia

Abstract

Aim: This study aimed to evaluate fifth-year medical students' perception of their learning experience during pediatric rotation at the medical college of King Abdulaziz University (KAU), Jeddah, Saudi Arabia.

Method: This cross-sectional study was conducted by distributing a questionnaire to fifth-year students who attended the pediatric rotation at KAU, during 2013–2014.

Results: Three hundred fifty-six out of 360 students agreed to participate, representing a response rate of 99%. More than 90% were satisfied with the module, and 80% reported the usefulness of the orientation session. The mean scores for the usefulness of morning experience and afternoon activities were 7.20?±?2.40 and 6.40?±?2.70, respectively. A significant difference in the mean scores for supervision was observed between the clerkship sites (p?=?.0001), with the highest score for consultants’ supervision (7.01?±?2.90) and lowest for interns’ supervision (4.81?±?3.30).

Conclusions: Overall, although the program was satisfactory to the majority of participants, areas of concern were identified. Students reported more effective learning and development of clinical skills , during the morning rounds, when supervised by consultants and senior specialists, and in activities that involved examining patients, presenting cases, and participating in discussions.     

Comparing a longitudinal integrated clerkship with traditional hospital-based rotations in a rural setting

Context: Longitudinal integrated clerkships (LIC) are widely used as an educational method, particularly in rural areas. They are good for facilitating hands-on learning and deep relationships between student, patients, and supervisors.

Objectives: This study sought to examine and compare learning experience of third-year rural medical students studying specialties (women’s health, aged care, child and adolescent heath, mental health, general practice) by either a traditional hospital-based rotation or a LIC in a rural general practice setting.

Methods: Data was collected from two groups of rural students (LIC; traditional hospital-based) over two academic years, utilizing focus groups to investigate general experiences of living and learning rurally, within the different educational models.

Results: Results reaffirmed that there was no perceived academic disadvantage to studying medicine rurally. Studying medicine in a rural area provides increased access to patients, more hands-on experience, and close relationships with patients and colleagues. LIC students reported increased confidence in clinical skills, felt better prepared for internship, however experienced more social isolation than students in hospital-based rotations.

Conclusions: Students undergoing a rural LIC feel more confident in their clinical skills and preparedness for practice than other rural students. This study supports the use of LICs as a powerful educational tool.