How medical students’ perceptions of instructor autonomy-support mediate their motivation and psychological well-being

Abstract

Purpose: Medical student well-being is an increasing concern in medical education. Understanding the role instructors and programs have in supporting well-being is an important puzzle piece. This study explores the relationship between medical students’ perceptions of instructor autonomy-support, motivation, and well-being. Using self-determination theory, we aim to provide a practical framework through which medical instructors can support student autonomy and well-being in the learning environment.

Materials and methods: Students from the University of Saskatchewan completed a survey measuring perceptions of the learning climate (LC) (instructor autonomy-support), satisfaction/frustration of basic motivational needs (autonomy, competence, relatedness), and psychological well-being. Multiple linear regression was used to determine whether age, gender, and year of study affected students’ well-being, before a mediation model was tested to assess the direct effect of the LC and indirect effects of students’ basic need fulfillment on their well-being.

Results: The response rate was 183/400 (46%). Higher ratings of autonomy-support significantly predicted better student well-being. This was mediated completely by students’ feelings of basic need fulfillment. Relatedness satisfaction contributed most to ratings of instructor autonomy-support.

Conclusions: Cultivating autonomy-support for medical students is critical to their well-being. Learning environments that optimize autonomy-support will also support students’ feelings of relatedness and competence.     

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.     

Pre-exchange training – Developing ethical and cultural competencies in medical students

Abstract

Background: The International Federation of Medical Students’ Associations (IFMSA) organizes over 15,000 international medical exchanges per year in over 100 countries. In the past, there was no standardized Pre-Departure Training (PDT) for participants. A PDT is important to protect patient safety and prepare students for their exchange.

Objective: To determine whether a two-hour case-based Pre-Departure Training can increase self-reported level of comfort on competencies in basic medical ethics, cultural competence, research ethics, and recognizing the limits of one’s level of skill in medical students.

Methods: In 2017, the PDT was implemented in nine countries for medical students prior to their IFMSA exchange. Participants self-evaluated their competencies in an online questionnaire before and after the PDT.

Results: 234 students from 32 countries completed the pre-PDT evaluation and 104 completed both evaluations. Participants demonstrated statistically significant improvements in self-reported competencies in 16 out of 18 items including voicing lack of skill to a supervisor (p?<?0.001) and recognizing personal cultural biases (p?<?0.001).

Conclusions: A case-based PDT can improve participants’ self-reported comfort in treating patients from different cultural backgrounds and help maintain high ethical standards abroad. The PDT was implemented at large within IFMSA in 2018.     

The stories they tell: How third year medical students portray patients,family members,physicians, and themselves in difficult encounters

Background: Physicians have long had patients whom they have labeled “difficult”, but little is known about how medical students perceive difficult encounters with patients.

Methods: In this study, we analyzed 134 third year medical students’ reflective essays written over an 18-month period about difficult student–patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students’ observations and reflections.

Results: Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed “nonmedical” problems; fearful, worried, withdrawn, or “disinterested” in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in “standard” behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions.

Conclusions: These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.     

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.     

Learning methods and strategies of anatomy among medical students in two different Institutions in Riyadh,Saudi Arabia

Abstract

Background: Anatomy instructors adopt individual teaching methods and strategies to convey anatomical information to medical students for learning. Students also exhibit their own individual learning preferences. Instructional methods preferences vary between both instructors and students across different institutions.

Aims: In attempt to bridge the gap between teaching methods and the students’ learning preferences, this study aimed to identify students’ learning methods and different strategies of studying anatomy in two different Saudi medical schools in Riyadh.

Materials and Methods: A cross-sectional study, conducted in Saudi Arabia in April 2015, utilized a three-section questionnaire, which was distributed to a consecutive sample of 883 medical students to explore their methods and strategies in learning and teaching anatomy in two separate institutions in Riyadh, Saudi Arabia.

Results: Medical students’ learning styles and preferences were found to be predominantly affected by different cultural backgrounds, gender, and level of study. Many students found it easier to understand and remember anatomy components using study aids. In addition, almost half of the students felt confident to ask their teachers questions after class. The study also showed that more than half of the students found it easier to study by concentrating on a particular part of the body rather than systems. Students’ methods of learning were distributed equally between memorizing facts and learning by hands-on dissection. In addition, the study showed that two thirds of the students felt satisfied with their learning method and believed it was well suited for anatomy.

Conclusions: There is no single teaching method which proves beneficial; instructors should be flexible in their teaching in order to optimize students’ academic achievements.     

Scholar outcomes for dental internship research program in Saudi Arabia: A qualitative evaluation

Abstract

Objective: To explore the potential, challenges and needs for internship research activities in achieving scholar outcomes among graduates.

Methods: A qualitative general needs assessment and evaluation of an internship research program was conducted at King Abdulaziz University, Faculty of Dentistry (KAUFD), KSA, from December 2014 to February 2015 using focus groups and interviews. The participants included: administrates, faculty, and internship students. Data were transcribed and analyzed following the grounded theory.

Results: The participants were two administrative personnel, 21 faculty members, and 16 internship students. Results were clustered around five main domains; curriculum design, faculty, students, administrative, and institutional domain. Reported potentials included: a multi-faceted educational intervention approach, and building evidence-based skills and inquiry minds among graduates. Time, load, and incentives were major challenges reported by faculty. Interesting and achievable research topics were major challenges reported by students. Areas that needed development included: equipped research personnel, aligned administrative and institutional support, faculty skills, students’ knowledge and skills, aligned curriculum, and clear program goals, objectives, and outcomes.

Conclusion: Curriculum design, faculty and students’ skills; as well as administrative and institutional support were found to play major roles in the success of the current internship research program at KAUFD.     

Reforms in VUmc School of Medical Sciences Amsterdam: Student engagement,a Minor elective semester and stakeholder collaboration in improving the quality of assessments

Abstract

Background: At VUmc School of Medical Sciences, major curricular reforms occurred in 2005 and 2015, related to the introduction of a Bachelor-Master structure, a new legislation from the Ministry of Education, the changing societal context, and taking note of students’ and teachers’ needs.

Summary of work: Along with the introduction of the Bachelor-Master system, the period between 2005 and 2009 saw the movement from traditional lecture-based teaching to small group teaching in a competency-based curriculum, in which the students were responsible for their learning. Student engagement grew through students’ designing learning modules and conducting some of the teaching. In the Bachelor program, an elective “Minor”, was designed to broaden and deepen the knowledge of our students beyond the core learning outcomes, in a discipline of their choice. The examination board (EB), responsible for maintaining the quality of assessment, was split into the General EB, which handled overall strategy issues, and the Executive EB, which handled student requests and monitored the quality of assessments.

Lessons learned: Students develop a sense of what education is about if they are provided opportunities in designing teaching and conducting it. A Minor elective in the medical study can provide the students with an opportunity to learn outside the medical field. Collaborative working between different stakeholders in a medical school is crucial for safeguarding the quality of assessments. Curricular reforms need time to be accepted and integrated into the culture of the medical school. The educational vision needs to be refreshed regularly in alignment with the changing societal context.     

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.     

Supporting motivation in teams working remotely: The role of basic psychological needs

Abstract

The current disruptive and abrupt transition to remote activities that educational institutions are facing represents a major challenge for the entire academic community. While most concerns have centred on how learning activities may successfully transit from face-to-face to remote delivery, little attention has been given to how educators can be supported in this new unchartered territory. In this article, we discuss the crucial role of team leaders and how their management and leadership style may have great potential to support educators’ motivation. Based on Self-determination Theory, we offer a framework through which team leaders may contribute to create optimal remote working environments for educators. We argue that educators’ autonomous motivation depends on how they perceive their remote work environment as supportive of their basic psychological needs of autonomy, competence and relatedness. Then, we highlight a series of practical recommendations by which team leaders may be more needs-supportive. Working from home requires space, trust, open communication and flexibility, especially considering that team members may have different clinical or personal circumstances. We therefore hope these suggestions are helpful to cultivate educators’ autonomous motivation, which is beneficial not only for themselves but also for others in their institution, including their co-workers and students.     

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.     

Simulation-based mastery learning in medical students: Skill retention at 1-year follow up

Context: Deficits in basic skill performance and long-term skill retention among medical students and novice doctors are a persistent problem. This controlled study tested whether the addition of a mastery learning component to simulation-based teaching is associated with long-term retention and performance of peripheral venous catheter insertion.

Methods: Fourth-year medical students were assigned to receive either the control (simulation without mastery learning, n?=?131) or the intervention (simulation?+?mastery learning, n?=?133) instruction in peripheral venous catheter insertion. Performance was assessed at one year post-instruction. Eighty-four students from the control group and 71 from the intervention group participated in the assessment.

Results: Students who received the mastery learning instruction achieved higher overall test scores than did controls (median mastery learning score: 20.0, IQR 2.0; median control score 19.0, IQR 3.0; Mann–Whitney U test, p?<?0.001, effect size d?=?0.82). Pass rates also differed significantly between the groups, with 74.5% (n?=?53) of the intervention group passing compared with 33% (n?=?28) of the control group (p?<?0.001).

Conclusions: Mastery learning is an effective means of teaching practical skills to medical students, and is associated with higher scores at a 1-year follow up.     

Can communication skills training improve empathy? A six-year longitudinal study of medical students in Japan

Background: Empathy is an important component of overall clinical competence; thus, enhancing empathy in medical education is essential for quality patient care.

Aim: This longitudinal study was designed to address the following questions: 1. Can a targeted educational program in communication skills training enhance empathy in medical students? and 2. Can such a program have a sustained effect?

Methods: Study participants included 116 students who entered Okayama University Medical School in 2011. Students participated in a communication skills training program aimed to enhance their empathy, and completed the Jefferson Scale of Empathy (JSE) five times: at the beginning of medical school, prior to participation in the program, immediately after the program, and in last years of medical school. A total of 69 students, representing 59% of the cohort, completed the JSE in all five test administrations.

Results: Students’ total scores on the JSE and its two factors (Perspective Taking and Compassionate Care) increased significantly (p?Conclusions: Targeted educational programs to enhance empathy in medical students can have a significant effect; however, additional reinforcements may be needed for a sustained effect.     

From personal to global: Understandings of social accountability from stakeholders at four medical schools

Aim: This paper addresses the question of how social accountability is conceptualised by staff, students and community members associated with four medical schools aspiring to be socially accountable in two countries.

Methods: Using a multiple case study approach this research explored how contextual issues have influenced social accountability at four medical schools: two in Australia and two in the Philippines. This paper reports on how research participants understood social accountability. Seventy-five participants were interviewed including staff, students, health sector representatives and community members. Field notes were taken and a documentary analysis was completed.

Results: Overall there were three common understandings. Socially accountable medical education was about meeting workforce, community and health needs. Social accountability was also determined by the nature and content of programs the school implemented or how it operated. Finally, social accountability was deemed a personal responsibility. The broad consensus masked the divergent perspectives people held within each school.

Conclusion: The assumption that social accountability is universally understood could not be confirmed from these data. To strengthen social accountability it is useful to learn from these institutions’ experiences to contribute to the development of the theory and practice of activities within socially accountable medical schools.     

How we tackled the problem of assessing humanities,social and behavioural sciences in medical education

Background: Assessment serves as an important motivation for learning. However, multiple choice and short answer question formats are often considered unsatisfactory for assessment of medical humanities, and the social and behavioural sciences. Little consensus exists as to what might constitute ‘best’ assessment practice.

What we did: We designed an assessment format closely aligned to the curricular approach of problem-based learning which allows for greater assessment of students’ understanding, depth of knowledge and interpretation, rather than recall of rote learning.

Conclusion: The educational impact of scenario-based assessment has been profound. Students reported changing their approach to PBL, independent learning and exam preparation by taking a less reductionist, more interpretative approach to the topics studied.     

Community of practice and student interaction at an acute medical ward: An ethnographic study

Background: A deeper understanding is needed of the acute medical care setting as a learning environment for students.

Aim: To explore workplace culture of an acute medical ward and students’ interactions within this community.

Method: An ethnographic design was applied. Medical and nurse students’ interactions were observed and informal questioning performed. Field notes were transcribed and analysed qualitatively, inspired by Wengers’ “Community of practice” theory.

Results: We identified four characteristics that regulated how students adapt and interact in the community of practice. Complex and stressful situations were stabilized by routines and carriers of culture. Variable composition and roles of community members were a part of the daily routine but did not seam obvious to students. Transitions through community boundaries were confusing especially for new students. Levels of importance and priority: Hierarchies and orders of priority were present as regulators of roles, routines and interactions, and of how staff approach different patient groups.

Conclusion: The culture shaped a pattern for, and created prerequisites that challenged students’ adaptation and created a space for learning. Students’ task on arrival was to enter the semipermeable membrane of the community of practice and to understand and adapt to its culture, and try to become accepted.