Exploring the climates of undergraduate professionalism in a Saudi and a UK medical school

Aim: To explore the usefulness of an online inventory for tracking medical students’ understanding of the importance of lapses in academic integrity.

Method: Respondents were asked to recommend sanctions for lapses as a proxy of their understanding of the importance of the 34 types of poor professionalism.

Results: The data suggest that while there is congruence, there are also substantial differences between ratings of the importance of poor professionalism, particularly in relation to data integrity, between a cohort in Saudi Arabia and one in the UK.

Conclusion: This resource may be useful both for teaching and learning in individual schools, and particularly for the induction of doctors into organisational environments different from the one they were trained in.     

Comparison of recommended sanctions for lapses in professionalism of undergraduate medical students in a Saudi Arabian and a Scottish medical school

Background: Medical Professionalism is recognized as a cultural construct. We explore perceptions of the severity of lapses in professionalism of undergraduate medical students at two medical schools with different cultural contexts.

Methods: Respondents from two medical schools (Saudi Arabia & UK) recommended sanctions for the first time, unmitigated lapses in academic professionalism, using the Dundee Polyprofessionalism Inventory 1: Academic Integrity.

Results: While more than two-thirds of the recommended sanctions for the 30 items of poor professionalism were fully or nearly congruent among the 1125 respondents, there were substantial differences in recommended response for one-third of the items, with a strong tendency for the Saudi students to recommend more lenient sanctions than the Scottish students.

Conclusion: The strategy of using recommended sanctions as a proxy for the perception of the severity of different lapses in professionalism may be a useful tool in learning and teaching academic professionalism among medical students in different cultural contexts.     

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.     

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.     

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.     

Evidence-based medicine (EBM) for undergraduate medical students: A six-step,integrative approach

Abstract

Background: Nowadays, there is an increasing interest in practicing evidence-based medicine (EBM) to provide valid and up-to-date information about health problems and procedures for solving these problems. However, studying EBM among other medical education disciplines remains unsatisfactory.

Aim: To design and pilot a basic course on EBM for undergraduate medical students in order to raise the awareness of the Saudi medical education community about this discipline.

Subjects and methods: The developed course targeted undergraduate Year 4 medical students at Ibn Sina National College for Medical Studies in Jeddah, Saudi Arabia. The course was integrated longitudinally into ?Integrated Multisystem Module? of Year 4. Students and faculty perceptions were evaluated for program evaluation purposes. Course design was based on Kern et al. six-step approach for curriculum development.

Results: Students overall perception of this course was positive except for some points related to the time allocated and their training on using evidence databases. Faculty members who participated in implementing the course perceived it positively.

Conclusions: Teaching EBM is recommended and applicable. It is not resource-intensive, and can be conducted through developing and integrating EBM courses in the undergraduate medical curriculum. Students and teachers agree upon the need and importance of teaching such discipline.     

Awareness and usage of evidence-based learning strategies among health professions students and faculty

Abstract

Introduction: Learning is essential and life-long for faculty and students. Often students and teachers use ineffective learning strategies and are not aware of evidence-based strategies.

Methods: A multicenter, international, cross-sectional, online survey-based assessment of awareness of evidence-based learning strategies among health professions students (n?=?679) and faculty (n?=?205).

Results: Students endorsed many study habits which violate evidence-based principles, including studying whatever is due soonest (389/679, 57%), failing to return to course material once a course has ended (465/679, 68%), and re-reading underlined or highlighted notes (298.679, 44%). While the majority of faculty surveyed (125/157, 80%) reported recommending effective study strategies for their students, most students (558/679, 82%) said they did not study the way they do because of instruction from faculty. The majority of faculty (142/156, 91%) and students (347/661, 53%) believe students have different learning styles.

Discussion: The results of this study demonstrate health professions students continue to use many ineffective study strategies, and both students and faculty hold misconceptions about evidence-based learning. While planning a curriculum, medical educators should focus on teaching students how to learn and use higher order thinking procedures in addition to teaching content.     

Contextual attributes promote or hinder self-regulated learning: A qualitative study contrasting rural physicians with undergraduate learners in Japan

Background and objectives: Previous studies support the notion that East Asian medical students do not possess sufficient self-regulation for postgraduate clinical training. However, some East Asian physicians who are employed in geographically isolated and educationally underserved rural settings can self-regulate their study during the early phase of their postgraduate career. To explore the contextual attributes that contribute to self-regulated learning (SRL), we examined the differences in self-regulation between learning as an undergraduate and in a rural context in East Asia.

Methods: We conducted interviews and diary data collection among rural physicians (n?=?10) and undergraduates (n?=?11) in Japan who undertook self-study of unfamiliar diseases. We analyzed three domains of Zimmerman’s definition of SRL: learning behaviors, motivation, and metacognition using constructivist grounded theory.

Results: Rural physicians recognized their identity as unique, and as professionals with a central role of handling diseases in the local community by conducting self-study. They simultaneously found themselves being at risk of providing inappropriate aid if their self-study was insufficient. They developed strategic learning strategies to cope with this high-stakes task. Undergraduates had a fear of being left behind and preferred to remain as one of the crowd with students in the same school year. Accordingly, they copied the methods of other students for self-study and used monotonous and homogeneous strategies.

Conclusions: Different learning contexts do not keep East Asian learners from being self-regulated. Awareness of their unique identity leads them to view learning tasks as high-stakes, and to initiate learning strategies in a self-regulated manner. Teacher-centered education systems cause students to identify themselves as one of the crowd, and tasks as low-stakes, and to accordingly employ non-self-regulated strategies.     

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.     

The effectiveness of integration of virtual patients in a collaborative learning activity

Abstract

Background: Virtual patients (VPs) have been recently integrated within different learning activities.

Aim: To compare between the effect of using VPs in a collaborative learning activity and using VPs in an independent learning activity on students’ knowledge acquisition, retention and transfer.

Methods: For two different topics, respectively 82 and 76 dental students participated in teaching, learning and assessment sessions with VPs. Students from a female campus and from a male campus have been randomly assigned to condition (collaborative and independent), yielding four experimental groups. Each group received a lecture followed by a learning session using two VPs per topic. Students were administrated immediate and delayed written tests as well as transfer tests using two VPs to assess their knowledge in diagnosis and treatment.

Results: For the treatment items of the immediate and delayed written tests, females outperformed males in the collaborative VP group but not in the independent VP group.

Conclusion: On the female campus, the use of VPs in a collaborative learning activity is more effective than its use as an independent learning activity in enhancing students’ knowledge acquisition and retention. However, the collaborative use of VPs by itself is not enough to produce consistent results across different groups of students and attention should be given to all the factors that would affect students’ interaction.     

Longitudinal cohort study on medical student retention of anatomical knowledge in an integrated problem-based learning curriculum

Background: When modifying a curriculum to accommodate changes in the methods of subject matter presentation or fit within a shortened time frame, student retention of knowledge remains an important issue.

Aim: This study evaluates medical student retention of anatomical knowledge as they matriculate through an anatomy curriculum where the instruction hours are less than half of the current national average.

Method: Medical students completed an assessment tool developed to evaluate their baseline level of anatomical knowledge at the beginning of the first year. They then completed the instrument at the end of their 1st, 2nd, 3rd, and 4th years to assess their retention of anatomical knowledge during medical school. Data collection began in September 2010 and concluded in June 2015.

Results: Results demonstrate that students began medical school with a low level of anatomical knowledge (baseline), that knowledge increased during their first year (p?<?0.001), continued to increase during their second year (p?<?0.001), but was over 90% maintained through years 3 and 4.

Conclusion: In conclusion, an anatomy course with reduced hours (～60), using active learning methods, contextual learning, cadaver demonstrations, increased exposure to imaging, and longitudinal reinforcement can help students build a strong foundation of anatomical knowledge.     

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.     

Development and alignment of undergraduate medical curricula in a web-based,dynamic Learning Opportunities,Objectives and Outcome Platform (LOOOP)

Introduction: This study presents a web-based method and its interface ensuring alignment of all parts of a curriculum map including competencies, objectives, teaching and assessment methods, workload and patient availability. Needs, acceptance and effectiveness are shown through a nine-year study.

Methods: After a comprehensive needs assessment, the curriculum map and a web-based interface “Learning Opportunities, Objectives and Outcome Platform” (LOOOP) were developed according to Harden’s conceptual framework of 10-steps for curriculum mapping. The outcome was measured by surveys and results of interdisciplinary MCQ-assessments. The usage rates and functionalities were analysed.

Results: The implementation of LOOOP was significantly associated with improved perception of the curriculum structure by teachers and students, quality of defined objectives and their alignment with teaching and assessment, usage by students to prepare examinations and their scores in interdisciplinary MCQ-assessment. Additionally, LOOOP improved the curriculum coordination by faculty, and assisted departments for identifying patient availability for clinical training.

Conclusion: LOOOP is well accepted among students and teachers, has positive effect on curriculum development, facilitates effective utilisation of educational resources and improves student’s outcomes. Currently, LOOOP is used in five undergraduate medical curricula including 85,000 mapped learning opportunities (lectures, seminars), 5000 registered users (students, teachers) and 380,000 yearly page-visits.     

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.     

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.     

Legitimisation,personalisation and maturation: Using the experiences of a compulsory mobile curriculum to reconceptualise mobile learning

Background: Smartphone use is well established in society, with increasing acceptance in many professional workplaces. Despite the growth in mobile resources, how students and teachers benefit from these devices remains under-researched.

Aims: An exploration of student and educators views on the impact of mobile learning re-sources on placement learning experiences as part of the Leeds ‘MBChB Mobile’ programme.

Methods: Focus groups incorporating visual methodologies were undertaken with students from each year group; semi-structured interviews were undertaken with clinical teaching staff, including those who experienced the mobile programme as students themselves.

Results: Four key themes emerged. ‘Maturity of learning’, related to the way in which senior students use resources in a more nuanced way than junior colleagues. ‘Learning differently’, identified ‘personalisation’ and ‘just in time’ opportunities that mobile resources afforded. ‘Learning legitimately’ was identified by students as key to ensuring they adopted appropriate behaviours in relation to mobile learning. Using mobile resources at undergraduate level was found to ‘change learning patterns for life’.

Conclusions: There is a need to further develop the educational theory behind using mobile resources for learning. The results here suggest that mobile technologies are shaping learning behaviours, and are an indicator of learning maturity, reflecting the wider context of societal enculturation.     

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.     

The impact of WhatsApp use on academic achievement among Saudi medical students

Abstract

Purpose: The aim of this study is to examine the relationship between WhatsApp on academic performance among Saudi medical school students at the University of AlBaha and the University of Dammam.

Methods: A total of 160 students (79 students from AlBaha medical school and 81 students from Dammam medical school) with smartphones were surveyed on their use of social media services and their academic performance (October–December 2015). A Likert scale consisting of 14 items was used to measure the use of WhatsApp and its relationship with academic achievement. Factor analysis of the self-report data of the social media addiction items was conducted. Pearson’s correlations were examined to determine the relationship of WhatsApp use with academic achievement and symptoms of addiction.

Results: Nearly 99% of participants reported using WhatsApp (over 53% use for academic activities). There was no significant association between GPA and students who use WhatsApp. However, the time spent on WhatsApp usage was directly proportional to the symptoms of addiction.

Conclusions: WhatsApp usage showed no relationship with the academic performance among Saudi medical students in both the universities. However, the usage of WhatsApp could be cautioned to minimize the social media addiction on various aspects of life.     

How characteristic routines of clinical departments influence students’ self-regulated learning: A grounded theory study

Background: In clerkships, students are expected to self-regulate their learning. How clinical departments and their routine approach on clerkships influences students’ self-regulated learning (SRL) is unknown.

Aim: This study explores how characteristic routines of clinical departments influence medical students’ SRL.

Methods: Six focus groups including 39 purposively sampled participants from one Dutch university were organized to study how characteristic routines of clinical departments influenced medical students’ SRL from a constructivist paradigm, using grounded theory methodology. The focus groups were audio recorded, transcribed verbatim and were analyzed iteratively using constant comparison and open, axial and interpretive coding.

Results: Students described that clinical departments influenced their SRL through routines which affected the professional relationships they could engage in and affected their perception of a department’s invested effort in them. Students’ SRL in a clerkship can be supported by enabling them to engage others in their SRL and by having them feel that effort is invested in their learning.

Conclusions: Our study gives a practical insight in how clinical departments influenced students’ SRL. Clinical departments can affect students’ motivation to engage in SRL, influence the variety of SRL strategies that students can use and how meaningful students perceive their SRL experiences to be.