A professionalism program in medical education and training – From broad values to specific applications: YLL School of Medicine,Singapore

Abstract

The process for introducing and developing a program for teaching medical professionalism at the National University of Singapore, School of Medicine is outlined. Professionalism was recognised as embracing ‘honesty and integrity,’ ‘responsibility and participation,’ ‘respect and sensitivity,’ and ‘compassion and empathy.’ Those broad values are expressed as specific attitudes and behaviours that are taught and assessed throughout the course. Honesty and integrity, for example, are demonstrated by ‘presenting original, authentic assignments’ (in medical education); and ‘accepting personal mistakes and honestly acknowledging them’ (in clinical training and practice). Values and items of behaviour were drawn from the literature, and reviewed and refined to address needs identified within the Medical School. A broad spectrum of pre-clinical and clinical teachers contributed to this development. The program was reassessed to determine the extent to which it has been implemented and has evolved following its adoption. The results are confirming in that: the majority of recommendations have been implemented; the program has developed further; and is supported by ancillary student enrichment activities. Medical professionalism has been given prominence through all phases of the course. Nevertheless, challenges remain and particularly in the extent to which medical professionalism is taught and assessed in various clinical postings.     

Fitting it all in: integration of 12 cross-cutting themes into a School of Medicine curriculum

Changing demographic, social, economic and technological trends have impacted the expectations of the Academic Health Center in preparing physicians to serve the needs of the American society, resulting in revisions to current curricula. In addition to the traditional basic sciences and clinical disciplines, accredited medical schools are required to provide curriculum exposure in behavioral health, communication skills, diversity and cultural awareness, ethics, evidence-based medicine, geriatrics, integrative medicine, pain management, palliative care, public health, socio-economic dynamics, and domestic violence. These themes are considered 'cross-cutting' since it is recognized these important curricular components apply across all years of medical school. In this article, the authors describe a strategic model developed at the University of New Mexico School of Medicine (UNMSOM) to integrate horizontally and vertically 12 cross-cutting themes as an evolving interdisciplinary curriculum reform process. These areas were defined through a combination of internal self-study, external requirements, and student and faculty interest. In the early stage of use of this model at UNMSOM, the authors describe the new cross-cutting themes that have been integrated. Minimal disruption and a spirit of cooperation and acceptance have characterized the curricular change that has been required. Preliminary assessment indicates that the program has been successful.     

The concept and practicability of a core curriculum in basic medical education

The core curriculum is defined as that which is common rather than essential. It is considered at different levels: institutional, national and global. As its size is inversely proportional to variability in healthcare needs, the core becomes smaller as the geographical unit becomes larger. A rationale for identifying the core is established at all three levels. The risk of stereotypy among curricula and dampening of innovation can be avoided if a significant part of the curriculum is elective, and if schools are free to determine how the core should be achieved. Focusing exclusively on the minimum discourages excellence. Many of the potential disadvantages of a core curriculum can be avoided if the core is combined with options. The core should emphasize higher-order cognitive and process skills and should be reviewed intermittently in the light of trends in healthcare and education. It should be developed in consultation with curriculum implementers using a competency-based approach. In developing international standards, societal relevance of the curriculum should not be sacrificed at the altar of standardization. The scientific bases of medicine, process skills and desirable practices in educating the basic doctor are fertile areas in which to look for international standards.     

Changes, trends and challenges of medical education in Latin America

This paper briefly reviews the current situation of Latin American medical schools and the search to improve the quality and professionalism of medical education through the region. Institutional evaluation and accreditation programs based on nationally ongoing developing standards have been accepted, now optimized and complemented by the framework of the Global & International Standards of Medical Education working jointly with the WFME. More recently, the process has evolved to look into the quality of the outcomes of the medicals as seen by examinations implemented at the end of medical studies and the initiation of medical practice. In addition, there is vision for the application of new programs such as the global minimum essential requirements advanced by the Institute for International Medical Education (IIME). The PanAmerican Federation of Associations of Medical Schools (PAFAMS), an academic, non-governmental organization, is fostering the exchange of ideas and experiences among members, associations and affiliated medical schools geared to focus on the quality and professionalism of the graduates of medical schools in Latin America. These actions also aim to consolidate databases of information on medical education and innovative endeavors in continuing professional education and development through e-learning projects in the region.     

Evolution of medical education in the Department of Medicine of the Complutense University of Madrid in the last decade

Abstract

Objectives: This paper aims to show changes in Medical Education in the Department of Medicine at the Complutense University of Madrid in the last 10–15 years.

Results: Medical education in the Department of Medicine at the Complutense University of Madrid has undergone significant changes in the last 10–15 years. An attempt to summarize these shows that radical change in the teaching of medicine for both teachers and students has taken place in three areas: 1. Progressive development of Patient-centered medical education. 2. Development of a competency-based training concerned with the mastering of knowledge and skills and their evaluation through objective and structured clinical assessment tests. 3. Introducing simulation techniques and virtual reality in the teaching of clinical practice aimed at improving our students' training and enhancing patient safety.

Conclusions: We believe that the changes applied have pleased students as well as teachers and even patients and are helping to improve the training of our students.     

A decade of reform in medical education: Experiences and challenges at Tehran University of Medical Sciences

Abstract

Purpose: In this paper, we present the major curricular reform in MD program of Tehran University of Medical Sciences, the oldest and the largest medical university in Iran, initiated about a decade ago.

Materials and methods: Following a comprehensive program evaluation, many of the basic challenges of the traditional curriculum were revealed, namely, lack of pre-defined competencies for graduates, over-reliance on teacher-centered teaching methods, over-emphasis on knowledge base in student assessments, and focusing solely on biomedical aspects of patient care. In 2010, a vision statement for reform was created and approved by the University Council. The new curriculum was launched in 2011.

Results: The changes included: revising the content of the courses, assimilating horizontal and vertical integration, emphasizing clinical skills, encouraging active involvement in patient management, providing more opportunity for supervised practice, integrating behavioral and psychosocial topics into the curriculum, incorporating interactive teaching methods, assessing students’ higher levels of cognition, and strengthening workplace assessments. To evaluate the changes, data were continuously collected and analyzed from the beginning.

Conclusions: Changing the curriculum of an MD program is a laborious task which should be planned and undertaken carefully and cautiously. It is an endless, yet invaluable and satisfying endeavor toward better future.     

A case-based medical curriculum for the 21st century: The use of innovative approaches in designing and developing a case on mental health

The introduction of case-based learning (CBL) by the School of Medicine at Cardiff University has encouraged innovation in medical teaching and learning. During years one and two of the modernized MBBCh program, students complete 17 cases as part of the newly developed C21 curriculum that emphasizes a patient-oriented and student-centered approach to learning. The mental health case, which is presented in year 2, incorporates a number of novel teaching resources that aim to enhance the students’ learning experience and to further reinforce the patient-oriented and community-based philosophy of C21. These include the use of fictionalized video diaries, virtual patient cases, e-learning workbooks, an interactive practical session, and community placements. Novel teaching methods and resources were evaluated by students in terms of effectiveness and value as learning resources through the administration of a structured mixed questionnaire. The results revealed that students valued the inclusion of these resources, which they evaluated as having contributed to their understanding of the subject area. Furthermore, the case was found to have had an impact on student interest in psychiatry as a specialty as well as a career choice. The positive student evaluation of this case supports the innovations in teaching delivery inspired by C21.     

Nurses in medical education: A unique opportunity

Medical students are expected to learn certain procedural skills in addition to clinical skills, such as assessment and decision making. There is much literature that shows proficiency in procedural skills translated to improved outcomes and cost-saving. Given the time constraints placed by increasing clinical demands, physicians have less time to work with students in teaching technical skills. There is a unique opportunity to utilize nurses in clinical clerkships to teach procedural skills. A dedicated nurse educator can provide a consistent curriculum, work with learners to achieve proficiency, and provide measurable outcomes. Future research should explore the role played by nurses in medical education and the comparison of instructional effectiveness.     

A case study in the globalization of medical education: assisting overseas-born students at the University of Melbourne

Over the past decade there has been a remarkable increase in ethnic diversity among Australian medical students. This phenomenon has been driven by two forces: the disproportionate school-level academic success achieved by first-generation migrant and refugee-origin youth, and the rapid globalization of Australia's tertiary education system, in a context where reduced government funding has accelerated the development of 'academic capitalism' (Slaughter & Leslie, 1997 ). This paper briefly examines each trend, prior to exploring select pedagogical implications of these changes for the University of Melbourne, the destination of choice by 2001 for 30% of all international students electing to study medicine in Australia. Two key questions are addressed: (1) What are the potential problems in delivering Western-style medical education to culturally and linguistically disparate groups?; (2) What model of international student support has been developed by the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne? The paper suggests the model may have potential relevance for other universities, in the context of the accelerating globalization of medical education.     

Eye-tracking technology in medical education: A systematic review

Background: Eye-tracking technology is an established research tool within allied industries such as advertising, psychology and aerospace. This review aims to consolidate literature describing the evidence for use of eye-tracking as an adjunct to traditional teaching methods in medical education.

Methods: A systematic literature review was conducted in line with STORIES guidelines. A search of EMBASE, OVID MEDLINE, PsycINFO, TRIP database, and Science Direct was conducted until January 2017. Studies describing the use of eye-tracking in the training, assessment, and feedback of clinicians were included in the review.

Results: Thirty-three studies were included in the final qualitative synthesis. Three studies were based on the use of gaze training, three studies on the changes in gaze behavior during the learning curve, 17 studies on clinical assessment and six studies focused on the use of eye-tracking methodology as a feedback tool. The studies demonstrated feasibility and validity in the use of eye-tracking as a training and assessment method.

Conclusions: Overall, eye-tracking methodology has contributed significantly to the training, assessment, and feedback practices used in the clinical setting. The technology provides reliable quantitative data, which can be interpreted to give an indication of clinical skill, provide training solutions and aid in feedback and reflection. This review provides a detailed summary of evidence relating to eye-tracking methodology and its uses as a training method, changes in visual gaze behavior during the learning curve, eye-tracking methodology for proficiency assessment and its uses as a feedback tool.     

Humanistic and social education for physicians: the experience of the Colombian School of Medicine

Medical education at the Colombian School of Medicine has undergone a reconceptualization and reorganization so as to encompasses three fundamental elements of medical practice: 1) development of general abilities and standards necessarky for appropriate professional medical practice; 2) technical education which makes it possible to utilize the bases that science and technology have provided for the development and application of knowledge, and in turn, to expand this base through research and development; and 3) humanistic education to guide students into ethical professional practice.     

Transforming medical education in Kazakhstan: Successful case of internationalization from Karaganda State Medical University

Abstract

Background: Medical education in Kazakhstan has been literally transformed in the past 10 years. Kazakhstan inherited the Soviet-time discipline-based teacher-centered system of education when no decisions could be made independently. The curriculum was mostly governed in a traditional way, with lectures being the core, little use of e-learning tools, and assessment through oral exams and multiple-choice questions. Most of the universities still preserve the subject-based curriculum with elements of integrated learning.

Methods: Being the most active member of International Space Education, Karaganda State Medical University (KSMU) took the initiative to adapt the full integrated curriculum mostly based on problem-based, team-based learning, and use of virtual patient cases. The given approach was chosen because of active involvement of our University in nine Tempus and Erasmus+projects including reforming of Public Health and Nursing curriculum, human resources development, active learning, credit mobility, and move towards autonomy of medical schools.

Results: KSMU became the coordinator of two of these projects, taking its active position in internationalization of medical education. We actively use technology-based medical education, pro-actively adapting deliberate practice in acquiring essential practical skills, for which KSMU was recognized by an ASPIRE-to-Excellence Award in simulation.

Conclusions: Kazakhstan hopes to become the leader in medical education in Central Asia and suggests other Universities in the area to adopt its approach to internationalization of medical education.     

A descriptive analysis of medical education in China

A highly trained medical profession is vital to a country's economic development. With the development of a growing economy in China and the increasing impact of globalization, the recent outbreak of new infectious diseases including SARS and the lethal avian influenza have highlighted the importance of medicine and medical care. Ultimately, the health of the public depends on the quality of the medical education programmes. This article outlines the various educational policies in China, points out deficiencies in the medical education of China when compared to the American model of medical education and makes suggestions of changes that need to be made to Chinese medical education programmes.     

How we implemented an integrated professionalism curriculum to 2nd year medical students at the National University of Ireland Galway Medical School, with examples from students' final output

Since the introduction of professionalism in medical curricula worldwide, little evidence has been published to exemplify good educational practice. The Medical school at the National University of Ireland Galway teaches professionalism in an interdisciplinary manner, integrating the learning objectives of health informatics, understanding health & illness in society, medical law and ethics. Students work in small groups on clinical cases. Enquiry-based learning is used as the teaching method following a few introductory lectures on specific objectives. Students present their work in the format of a scientific essay. The latter is assessed by a board of reviewers. The purpose of this article is to demonstrate evidence of excellent professional output and illustrate the benefits to a fully integrated professionalism curriculum.