Sustainability of a Curriculum-based Intervention on Dietary Behaviours and Physical Activity among Primary School Children in Trinidad and Tobago

Objectives:

Childhood obesity and poor lifestyle practices are emerging as major public health challenges in the Caribbean. Given the fact that a significant part of childhood is spent at school, curriculum-based interventions aimed at improving good dietary and physical activity patterns may provide a useful vehicle for mass inculcation of long-term healthy lifestyle practices. In this study, we evaluated the long-term impact of a brief curriculum based intervention on dietary behaviour, physical activity and knowledge level of primary schoolchildren.

Methods:

The study was a randomized, controlled, school-based nutrition education and physical activity intervention. One hundred students each were then randomly assigned to the intervention (IVG) and non-intervention (NIVG) groups and followed-up for 18 months. Participants in the IVG group were exposed to a curriculum consisting of six one-hour modules followed by school-based activities geared at fostering healthy behaviours. Students in the non-intervention group did not receive any modules and were subject to the information available at school on a regular basis.

Results:

In multivariate regression equations controlling for age, gender, body mass index (BMI) and baseline values, intervention was associated with lower intake of fried foods and sodas (p < 0.05) and higher knowledge scores (p < 0.01) 18 months later but not significantly associated with improved physical activity or lower BMI.

Conclusions:

In this study, participants in the intervention group reported significantly lower intakes of fried foods and sodas and higher knowledge scores than participants in the control group some 18 months post-intervention independent of age, gender, BMI, ethnicity and the intakes at baseline.     

Psychological Well-being of Medical Students

Background

Training in medicine is emotionally demanding. Psychological well being of medical students is a matter of concern. There is lack of Indian studies in this area.

Methods

A total of 105 medical student of one batch were assessed utilizing psychophysiological state inventory, Institute for personality and ability testing (IPAT) anxiety and depression scale, achievement motivation scale, scale for locus of control and 16 PF in three phases at one-year intervals.

Result

Majority of the students had average achievement, motivation and adaptability. Anxiety and depression scores fell within normal limits. In personality profile factor ‘B’, ‘M’ and ‘Q4₁’ had changed significantly. Achievement motivation showed significant decreases and CSS1 and PO1 scores showed significant increase during the years of medical education.

Conclusion

The results demonstrate that over satisfaction and relaxed attitude may have poor academic outcome.Key Words: Psychological well-being, Anxiety, Depression, Achievement motivation     

Objective structured clinical examination vs traditional clinical examination: An evaluation of students’ perception and preference in a Nigerian medical school

Background:

Method of testing clinical competence of medical students in this setting has been controversial. This report evaluates the perceptions and preferences of 5^th and 6^th year medical students about traditional clinical examination (TCE) and objective structured clinical examination (OSCE).

Materials and Methods:

A cross-sectional study using a structured questionnaire, administered to 156 students, who had been previously exposed to TCE and OSCE.

Results:

There were 110 (70.5%) males and 46 (29.5%) females, with median age group of 26–30 years. One hundred and thirty-one respondents (84%) felt TCE is more difficult and 20 (12.8%) felt OSCE was more difficult. One hundred and forty-two (91%) felt OSCE was easier to pass, 8 (5.1%) felt TCE was easier to pass and 6 (3.8%) were undecided. Majority of the 5^th and 6^th year students (95.5% and 100%, respectively) preferred OSCE for assessment. In relation to validity and reliability of OSCE, 124 (79.5%) of all the students felt it provides a true measure of essential clinical skills, 130 (83.3%) felt its scores are standardised, 143 (91.7%) felt it is a practical and useful experience and 135 (86.5%) felt students’ personality, ethnicity and gender will not affect OSCE scores. Overall, there were no significant differences in preference and perceptions between 5^th and 6^th year students and between males and females.

Conclusion:

Students preferred OSCE as method of assessing clinical competence and considered it a more valid and reliable method of examination.     

Secondary School Students' Knowledge of Physical Therapy: The Trinidadian Scenario

Objective:

Research in regions outside of the Caribbean shows that high school and college students'' knowledge of physical therapy is lacking. There are no data reported to date for students in the Caribbean region. This study sought to evaluate Trinidadian secondary school students'' knowledge of physical therapy, identify sources of knowledge and examine the relationship between knowledge and selected factors.

Methods:

A non-experimental cross-sectional analysis of relationships was conducted with 1427 students attending schools that were randomly selected from rural and urban locations in Trinidad. A questionnaire which required the students to identify selected tasks performed by physical therapists, grade the skill level associated with each task and identify sources of information was utilized.

Results:

A total of 1353 questionnaires were returned, of which 1236 were eligible for analysis. The mean number of correct responses regarding knowledge of tasks conducted by a physical therapist was 6.47 ± 2.05 out of a total of 11. More than 50% of the respondents had incorrect responses for questions related to the skill level associated with each task. Seniors and students who were interested in health careers had significantly higher scores for knowledge of tasks performed by physical therapists (6.72 ± 1.94; 6.7 ± 1.81) than juniors and those who were interested in non-health careers (6.4 ± 2.07; 6.52 ± 1.99). The two most common sources of information from all categories of respondents were television (74.8%) followed by internet (54.6%).

Conclusion:

Students attending secondary schools in Trinidad are not well informed about physical therapy and strategies must be developed to address this.     

Student attitude towards communication skills learning in a Caribbean medical school

Background

Medical student attitudes towards communication skills are important for curriculum planners and teachers. Xavier University School of Medicine (XUSOM) is a private medical school admitting students mainly from the United States and Canada.

Aims

Attitude of students towards communication skills has not been previously studied in the institution. Hence the present study was carried out.

Method

The study was carried out among the first, second, third and fourth semester undergraduate medical (MD) students at XUSOM, Aruba during July 2013 using the communication skills attitude scale (CSAS). Respondents’ age, gender, nationality, occupation of parents, place of residence of family, semester of study were noted. The positive and negative attitude scale scores were calculated and compared among different subgroups of respondents (p<0.05).

Results

Fifty-one of the seventy-three students (69.9 per cent) participated. The majority were between 20 to 25 years of age, of American nationality, from metro cities and had excellent or good self-perceived verbal and written communication skills. The mean positive attitude scale (PAS) score was 47.65 (maximum being 65) and the mean negative attitude scale (NAS) score was 31.06 (maximum 65). PAS score was significantly higher among respondents whose fathers were not in health related professions. NAS scores were significantly lower among the third and fourth semester respondents.

Conclusion

Students overall had a positive attitude towards communication skills but negative attitudes were also noted Based on results of the study and a review of literature we are planning to start communication skills learning in the institution right from the first semester and students will be provided opportunities for supervised practice during early clinical exposure, hospital observership and with standardised patients. The medical humanities module will be expanded and communication skills learning will continue during the clinical years with higher order skills being taught.     

Automated concept-level information extraction to reduce the need for custom software and rules development

Objective

Despite at least 40 years of promising empirical performance, very few clinical natural language processing (NLP) or information extraction systems currently contribute to medical science or care. The authors address this gap by reducing the need for custom software and rules development with a graphical user interface-driven, highly generalizable approach to concept-level retrieval.

Materials and methods

A ‘learn by example’ approach combines features derived from open-source NLP pipelines with open-source machine learning classifiers to automatically and iteratively evaluate top-performing configurations. The Fourth i2b2/VA Shared Task Challenge''s concept extraction task provided the data sets and metrics used to evaluate performance.

Results

Top F-measure scores for each of the tasks were medical problems (0.83), treatments (0.82), and tests (0.83). Recall lagged precision in all experiments. Precision was near or above 0.90 in all tasks.

Discussion

With no customization for the tasks and less than 5 min of end-user time to configure and launch each experiment, the average F-measure was 0.83, one point behind the mean F-measure of the 22 entrants in the competition. Strong precision scores indicate the potential of applying the approach for more specific clinical information extraction tasks. There was not one best configuration, supporting an iterative approach to model creation.

Conclusion

Acceptable levels of performance can be achieved using fully automated and generalizable approaches to concept-level information extraction. The described implementation and related documentation is available for download.     

Impact of focused training on communication skills of final-year medical students in a medical school in India

Background

Although communication skills are important for a good physician-patient relationship, Indian medical curricula give very little emphasis on training medical students in this aspect.

Aims

To determine the change in communication skills of final-year medical students following focused training.

Methods

This was an educational interventional study done at Pondicherry Institute of Medical Sciences, a tertiary care teaching hospital in South India, to assess communication skills among final-year MBBS students. Fifty-two students (24 males and 28 females) participated in the study. A pre-test was conducted in the form of an objectively structured clinical examination (OSCE), followed by focused training for four hours. The same OSCE was administered as post-test. A comparison between the pre-test and post-test scores was done using Wilcoxon Signed Ranks Test.

Results

Ninety-six per cent of participants (50 out of 52) showed improvement in their performance after the focused training. The mean marks of the pre-test and post-test were 10.77± 3 and 18.04±2, respectively, out of a maximum mark of 20 (p<0.05). One out of 52 participants did not show any improvement, and one participant scored less in the post-test compared to the pre-test. There was no significant difference in the performance between male and female students.

Conclusion

Focused training can enhance the communication skills of medical students. Hence, it may be included in the curriculum of undergraduate medical teaching programmes in India.     

Does user-centred design affect the efficiency,usability and safety of CPOE order sets?

Background

Application of user-centred design principles to Computerized provider order entry (CPOE) systems may improve task efficiency, usability or safety, but there is limited evaluative research of its impact on CPOE systems.

Objective

We evaluated the task efficiency, usability, and safety of three order set formats: our hospital''s planned CPOE order sets (CPOE Test), computer order sets based on user-centred design principles (User Centred Design), and existing pre-printed paper order sets (Paper).

Participants

27staff physicians, residents and medical students.

Setting

Sunnybrook Health Sciences Centre, an academic hospital in Toronto, Canada.

Methods

Participants completed four simulated order set tasks with three order set formats (two CPOE Test tasks, one User Centred Design, and one Paper). Order of presentation of order set formats and tasks was randomized. Users received individual training for the CPOE Test format only.

Main Measures

Completion time (efficiency), requests for assistance (usability), and errors in the submitted orders (safety).

Results

27 study participants completed 108 order sets. Mean task times were: User Centred Design format 273 s, Paper format 293 s (p=0.73 compared to UCD format), and CPOE Test format 637 s (p<0.0001 compared to UCD format). Users requested assistance in 31% of the CPOE Test format tasks, whereas no assistance was needed for the other formats (p<0.01). There were no significant differences in number of errors between formats.

Conclusions

The User Centred Design format was more efficient and usable than the CPOE Test format even though training was provided for the latter. We conclude that application of user-centred design principles can enhance task efficiency and usability, increasing the likelihood of successful implementation.     

Web 2.0 technologies for undergraduate and postgraduate medical education: an online survey

Objectives

To identify the current familiarity and use of Web 2.0 technologies by medical students and qualified medical practitioners, and to identify the barriers to its use for medical education.

Methods

A semi‐structured online questionnaire survey of 3000 medical students and 3000 qualified medical practitioners (consultants, general practitioners and doctors in training) on the British Medical Association''s membership database.

Results

All groups had high familiarity, but low use, of podcasts. Ownership of digital media players was higher among medical students. There was high familiarity, but low use, of other Web 2.0 technologies except for high use of instant messaging and social networking by medical students. All groups stated that they were interested in using Web 2.0 technologies for education but there was lack of knowledge and skills in how to use these new technologies.

Conclusions

There is an overall high awareness of a range of new Web 2.0 technologies by both medical students and qualified medical practitioners and high interest in its use for medical education. However, the potential of Web 2.0 technologies for undergraduate and postgraduate medical education will only be achieved if there is increased training in how to use this new approach.     

The effectiveness of self-directed learning (SDL) for teaching physiology to first-year medical students

Background

Self-directed learning (SDL) has become popular in medical curricula and has been advocated as an effective learning strategy for medical students to develop competence in knowledge acquisition.

Aims

The primary aim was to find out if there was any benefit of supplementing self-directed learning activity with a traditional lecture on two different topics in physiology for first-year medical students.

Method

Two batches of first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) (Batch A and Batch B) comprising 125 students each, received an SDL session on Morphological classification of anaemia. The students belonging to Batch A received a one-hour lecture on the same topic three days prior to the SDL session. The students were given a 10 multiple choice questions (MCQ) test for a maximum of 10 marks immediately following the SDL session. The next topic, Conducting system of the heart, disorders and conduction blocks was taught to both batches in traditional lecture format. This was followed by an SDL session on the same topic for Batch A only. The students were evaluated with a MCQ test for a maximum of 10 marks.

Results

The mean test scores on the first topic were 4.38±2.06 (n=119) and 4.17±1.71 (n=118) for Batch A and Batch B, respectively. The mean test scores on the second topic were 5.4± 1.54 (n=112) and 5.15±1.37 (n=107) for Batch A and Batch B, respectively. There was no significant difference between the groups.

Conclusion

For first-year medical students, SDL is an effective teaching strategy for learning physiology. However, no additional benefit is gained by supplementing SDL with a lecture to facilitate learning physiology.     

Effectiveness of early cardiology undergraduate learning using simulation on retention,application of learning and level of confidence during clinical clerkships

INTRODUCTION

This study aimed to assess the effectiveness of the use of a cardiopulmonary patient simulator in the teaching of second-year medical students. Effectiveness was measured in terms of the extent of knowledge retention and students’ ability to apply the skills learned in subsequent real-life patient contact.

METHODS

In this study, ten third-year medical students who had previously undergone simulator training as part of their second-year curriculum underwent an objective structured clinical examination (OSCE) and a multiple-choice question (MCQ) test to assess their ability to apply the knowledge gained during the simulator training when dealing with real patients. The performance of this group of students was compared with that of a group of ten fourth-year medical students who did not undergo simulation training.

RESULTS

Although the third-year medical students performed well in the OSCE, they were outperformed by the group of fourth-year medical students, who had an extra year of clinical exposure. The MCQ scores of the two groups of students were similar. Post-simulation training survey revealed that students were generally in favour of incorporating cardiopulmonary simulator training in the preclinical curriculum.

CONCLUSION

Cardiopulmonary simulator training is a useful tool for the education of preclinical medical students. It aids the translation of preclinical knowledge into real-life clinical skills.     

Teaching Medical Students,what do Consultants think?

Background:

The approach to and delivery of medical student education has undergone significant change within the last decade. There has been a shift away from didactic lectures to small group tutorials, facilitated by clinicians. Anecdotally there is an impression that enthusiasm for teaching is waning. The aim of this qualitative study is to assess the current attitudes of consultants, across all specialities, to teaching medical students in small group settings.

Methods:

A Likert scale questionnaire, relating to teaching medical students in small group tutorials, was distributed via email to all consultants working in one region. Questions considered the categories: attitudes to teaching, financial considerations, time constraints and attitudes to students.

Results:

367 responses were received. 72% of responders were actively involved in teaching. 72% of respondents indicated that medical students should be taught by consultants and 80% felt that teaching medical students was enjoyable. 60% felt they were not financially remunerated for teaching and 50% indicated teaching was not included in job plans; despite this a significant proportion of these respondents remain involved in teaching (68%). Non-teachers were more likely to indicate that teaching was not paid for (p=0.003). 78% indicated consultants do not have adequate time to teach medical students. 82% felt that medical students appreciate consultant led teaching but only 55% felt students had an appropriate level of enthusiasm for learning.

Conclusion:

Consultants in this Deanery are actively involved in medical student teaching and enjoy it. Consultants perceive that they are not adequately financially rewarded but for the most part this is not a deterrent. Time constraints are an issue and there is a desire to have teaching included in job plans to counteract this. Most consultants are complimentary about student attitudes but there is a perception that medical students need to contribute more to their own learning.     

Research and applications: The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals

Background

Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness.

Objectives

To describe the effects of different communication interventions and their problems.

Design

Prospective observational case study using a mixed methods approach of quantitative and qualitative methods.

Setting

General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals.

Participants

Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards.

Methods

Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010.

Results

We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories.

Conclusions

Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.     

Openness of patients' reporting with use of electronic records: psychiatric clinicians' views

Objectives

Improvements in electronic health record (EHR) system development will require an understanding of psychiatric clinicians'' views on EHR system acceptability, including effects on psychotherapy communications, data-recording behaviors, data accessibility versus security and privacy, data quality and clarity, communications with medical colleagues, and stigma.

Design

Multidisciplinary development of a survey instrument targeting psychiatric clinicians who recently switched to EHR system use, focus group testing, data analysis, and data reliability testing.

Measurements

Survey of 120 university-based, outpatient mental health clinicians, with 56 (47%) responding, conducted 18 months after transition from a paper to an EHR system.

Results

Factor analysis gave nine item groupings that overlapped strongly with five a priori domains. Respondents both praised and criticized the EHR system. A strong majority (81%) felt that open therapeutic communications were preserved. Regarding data quality, content, and privacy, clinicians (63%) were less willing to record highly confidential information and disagreed (83%) with including their own psychiatric records among routinely accessed EHR systems.

Limitations

single time point; single academic medical center clinic setting; modest sample size; lack of prior instrument validation; survey conducted in 2005.

Conclusions

In an academic medical center clinic, the presence of electronic records was not seen as a dramatic impediment to therapeutic communications. Concerns regarding privacy and data security were significant, and may contribute to reluctances to adopt electronic records in other settings. Further study of clinicians'' views and use patterns may be helpful in guiding development and deployment of electronic records systems.     

Introducing geriatric health in medical training in Ajman,United Arab Emirates: A co-curricular approach

Background

Medical students’ knowledge and understanding of the elderly will affect the quality of care to the rising population of older adults which points to a need to identify geriatric health training methods appropriate for the region and curriculum. Therefore the study assessed the effect of a co- curricular introductory workshop on knowledge regarding geriatric health and attitude towards the elderly among fourth year medical students in a medical university

Method

A quasi-experimental before-after study, with control was conducted at Gulf Medical College among 60 medical students from discipline-based curriculum in year IV during May-June 2010 of whom 16 had opted (attendees) to undergo the introductory course, a five day workshop of 10 hours duration. Pre- and post-testing used self-administered questionnaires for demographic variables: age, gender, nationality, close contact with older people; a quiz on old people’s health, and Kogan’s Old People Scale (KOPS) for attitude. The difference in scores on quiz and KOPS were compared for the attendees and 26 non-attendees who participated in both pre and post testing.

Results

The attendees group had 38% male and 62% female participants and the non-attendees group had 21% and 79% respectively. The groups were not significantly different in age, sex, nationality and close contact with the elderly. The scores on the quiz and KOPS showed no statistically significant difference between the two groups before or after the workshop. Almost all the participants evaluated the workshop very positively especially the interaction with healthy elderly and inmates of old people’s home.

Conclusion

A 10-hour introductory co-curricular workshop made no significant change in the knowledge on geriatric health or attitude of fourth year medical students though they reported it as a very enriching experience. A reflective report may have been a better assessment tool and the impact on their clinical practice cannot be predicted.     

Medical students’ education on organ donation and its evaluation during six consecutive years: results of a voluntary,anonymous educational intervention study

Background

One of the main reasons for organ shortage is insufficient education on organ donation. Knowledgeable medical students could share the information with friends and families resulting in a positive attitude to organ donation of the general public.

Methods

During six consecutive years (2009 to 2014), we conducted a voluntary, anonymous educational intervention study on organ donation among fourth year medical students in the course of the main surgery lecture at the University of Essen, Germany.

Results

Questionnaires of 383 students were analyzed. Prior to the specific lecture on organ donation, 64% of the students carried a signed organ donor card with the intention to donate. Further information regarding organ donation was required by 37% of the students. The request for further information was statistically significantly higher among students without a donor card compared to organ donor card carriers (P < 0.0001). After the lecture, the number of students requiring further information decreased statistically significantly to 19% (P < 0.0001).

Conclusions

Already a 45-minute lecture for fourth year medical students significantly decreases their request for further information on organ donation and improves their attitude to organ donation. Continued training on organ donation will help medical students to become disseminators for this important topic in our society.     

Perceptions towards private medical practitioners' attachments for undergraduate medical students in Malawi

Objective

To describe perceptions of medical students, recent medical graduates, faculty of the College of Medicine, University of Malawi and private medical practitioners (PMPs) towards an attachment of undergraduate medical students in private medical doctors'' offices.

Method

Qualitative cross sectional study conducted in Blantyre, Malawi in 2004 using in-depth key informant interviews and content analysis.

Results

In general, private medical practitioners were favourable to the idea of having medical students within their consulting offices while the majority of students, recent graduates and faculty opposed, fearing compromising teaching standards. The lack of formal post-graduate qualifications by most private medical practitioners, and nationally-approved continued medical education programs were mentioned as reasons to suspect that private medical practitioners (PMPs) could be outdated in skills and knowledge. Private medical practitioners however reported participation in credible continued professional development (CPD) programs although these were not necessary for re-registration. Students and faculty suggested that the need for privacy in private institutions unlike in the public teaching hospitals as one reason why patients may not be willing to participate in the teaching in PMPs facilities. The fact that the patients profiles with regard to disease presentation (mostly ambulatory) and higher socio-economic status may be different from patients attending the public, free for service teaching hospital was not seen as a desirable attribute to allocate students to PMPs clinics.

Conclusion

Faculty, medical students and recent graduates of the Malawi College of Medicine do not perceive PMPs as a resource to be tapped for the training of medical students.     

Waterpipe (narghile) smoking among medical and non-medical university students in Turkey

Objectives

This investigation was performed in order to determine the prevalence rate of waterpipe smoking in students of Erciyes University and the effects of some socio-demographic factors.

Methods

A total of 645 students who study the first three grades of the medical faculty and the engineering faculty of Erciyes University were enrolled in the study. A questionnaire including 48 questions was applied. Chi-square test and logistic regression method were performed for the statistical analyses.

Results

The total prevalence rate of waterpipe smoking was found to be 32.7%. The prevalence rate of waterpipe smoking was 28.6% in the medical and 37.5% in the non-medical students. It was determined that 41.6% of the males and 20.2% of the females currently smoke waterpipe. Gender, cigarette smoking, and the presence of waterpipe smokers among family members and friends have significant effects on the prevalence of waterpipe smoking. Residence and economical status of the family and with whom the students live have no significant effect on the prevalence rate.

Conclusions

Approximately one-third of the students currently smoke waterpipe. Smoking of both cigarette and waterpipe was frequently found. The measures against all tobacco products should be combined.