Long-term benefits by a mind–body medicine skills course on perceived stress and empathy among medical and nursing students

Background: A significant number of medical students suffer from burnout symptoms and reduced empathy. This controlled, quasi-experimental study aimed to investigate whether a mind–body medicine (MBM) skills course could reduce perceived stress and increase empathy and self-reflection in medical and nursing students.

Methods: The MBM course (consisting of experiential sessions of mind–body techniques and group reflections) was piloted among Dutch medical students and Swedish nursing students. Main outcome variables were perceived stress (PSS), empathy (IRI subscales perspective taking, fantasy, empathic concern, and personal distress), and self-reflection (GRAS). Participating and control students completed questionnaires at baseline, post-intervention, at 6 and 12 months follow-up.

Results: Seventy-four medical and 47 nursing students participated in the course. Participating medical students showed significantly increased empathic concern [1.42 (95% CI 0.05, 2.78), p?=?0.042], increased fantasy [3.24 (95% CI 1.58, 4.90), p?p?=?0.010] compared to controls until 12 months follow-up. Participating nursing students showed significantly decreased levels of perceived stress [?5.09 (95% CI ?8.37, ?1.82), p?=?0.002] and decreased personal distress [?5.01 (95% CI ?6.97, ?3.06), p?Conclusions: This study demonstrated long-term beneficial effects of the MBM course on perceived stress and empathy in medical and nursing students.     

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.     

The association between Situational Judgement Test (SJT) scores and professionalism concerns in undergraduate medical education

Abstract

Introduction: Situational judgement tests (SJTs) are widely used in selecting medical students and doctors. Emerging evidence suggests SJTs are capable of testing an individual’s ability to respond to role-relevant professionalism scenarios, however, evidence is lacking for their use in identifying students with concerning professional behaviours.

This study aimed to determine the association between medical student professionalism-based SJT scores and recorded professionalism concerns during training.

Methods: A cross-sectional study was conducted utilising SJT scores from second-year medical students and occurrences of student professionalism concerns. Concerns were reviewed and mapped to General Medical Council standards. Multivariate logistic regression was used to determine associations between SJT scores and professionalism concerns.

Results: 247 students were included in the study. For every point increase in SJT score, students were 10% less likely to have multiple professionalism concerns [OR (95% CI) 0.90 (0.83–0.97); p?=?.007].

Students scoring below 1 and 2 standard deviations from the mean score were 4 and 11-times more likely to have multiple concerns [OR (95% CI) 4.52 (1.12–18.25); p?=?.034] and [OR (95% CI) 11.45 (1.72–76.15); p?=?.012].

Conclusion: Lower SJT scores were significantly associated with an increased risk of professionalism concerns. These findings support the potential for SJT exams to identify medical students that may require closer supervision and remediation during undergraduate education.     

Speed and quality goals in procedural skills learning: A randomized experiment

Abstract

Purpose: Compare time (speed) and product quality goals in a surgical procedural task.

Methods: Secondary school students participating in a medical simulation-based training activity participated in a randomized experiment. Each participant completed eight repetitions of a blood vessel ligation. Once, between repetitions four and five, each participant received a randomly-assigned speed goal or quality goal. Outcomes included time and leak-free ligatures.

Results: 80 students participated. The speed-goal group performed 18% faster on the final repetition than the quality-goal group, with adjusted fold change (FC) 0.82 (95% confidence interval [CI], 0.71, 0.94; p?=?0.01). Conversely, the speed-goal group had fewer high-quality (leak-free) ligatures (odds ratio [OR] 0.36 [95% CI, 0.22, 0.58; p?<?0.001]). For the quality-goal group, leaky ligatures took longer post-intervention than leak-free ligatures (FC 1.09 [95% CI, 1.02, 1.17; p?=?0.01]), whereas average times for leaky and leak-free ligatures were similar for the speed-goal group (FC 0.97 [95% CI, 0.91, 1.04; p?=?0.38]). For a given performance time, the speed-goal group had more leaks post-intervention than the quality-goal group (OR 3.35 [95% CI, 1.58, 7.10; p?=?0.002]).

Conclusions: Speed and quality goals promote different learning processes and outcomes among novices. Use of both speed and quality goals may facilitate more effective and efficient learning.     

The impact of socially-accountable,community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce

Introduction: Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities.

Aim: To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location.

Methods: Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum.

Results: SHS-Palo graduates had significantly (p?p?p?=?0.032) or in rural government health services (p?p?p?=?0.028) and their current position (p?Conclusions: SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.     

An analysis of reflective writing early in the medical curriculum: The relationship between reflective capacity and academic achievement

Objective: To examine the relationship between reflection, gender, residency choice, word count, and academic achievement among medical students.

Methods: A modified version of the Reflection Evaluation for Learners’ Enhanced Competencies Tool (REFLECT) was developed and used for this study (Cronbach’s alpha of 0.86 with an intraclass correlation coefficient [ICC] of 0.68). This was applied to writing samples about professionalism in gross anatomy from first-year medical students between 2005 and 2011. Four analysts reviewed and scored written reflections independently. Composite reflection scores were compared with gender, residency choice, length of written reflection, NBME® Gross Anatomy and Embryology Subject Examination scores, and final gross anatomy course.

Results: Total of 319 written reflections were evaluated. Female students who pursued medicine specialties had the highest composite reflection scores (87 [27.2%]). Word count frequently correlated with reflection score (p?<?0.0001). Students who performed well on the NBME® Gross Anatomy and Embryology Subject Examination tended to achieve high anatomy course grades (p?<?0.0001). There was no statistically significant relationship between composite reflection scores and NBME® Gross Anatomy and Embryology Subject Examination scores (p?=?0.16) or anatomy course grades (p?=?0.90).

Conclusions: This study suggests there are likely no correlations between reflective capacity and academic performance on tests of medical knowledge administered early in the medical curriculum.     

Medical students’ perception of behaviors in the clinical learning environment evolve with increasing clinical exposure as measured with situational video vignettes

Abstract

This cross-sectional study involved matriculating, mid-level and graduating medical students (n?=?723) who participated in specific transition courses in our medical school curriculum between August 2016 and March 2019. We used a mixed-methods approach (survey and analysis of narrative comments) to study the evolution in perception of the learning environment by medical students with increasing clinical exposure using four different video vignettes. Differences in student perceptions of mistreatment exists at various levels of training. Compared to graduating students, matriculating students were more likely to perceive reprimanding a student on being late as appropriate behavior (80.5% vs 53.3%, p?=?0.001), whereas a significantly higher proportion of the graduating students (15.3%, p?=?0.001) perceived it as mistreatment. A majority of the matriculating students (84%, p?=?0.001) considered the case of an eager student as mistreatment, while a significantly higher proportion of the graduating students (59.5%, p?=?0.001) did not think it was mistreatment. Qualitative analysis of comments from students at different stages of training displayed an increased appreciation of their professional responsibilities and nuanced appreciation of body language and tone as contributing factors in determining whether a situation represented inappropriate behavior. Our results demonstrate that students’ perceptions of inappropriate behaviors evolve with increased clinical exposure.     

Describing medical student curiosity across a four year curriculum: An exploratory study

Background: Intellectual curiosity can be defined as a desire for knowledge that leads to exploratory behavior and consists of an inherent and stable trait (i.e. trait curiosity) and a variable context-dependent state (i.e. state curiosity). Although intellectual curiosity has been considered an important aspect of medical education and practice, its relationship to medical education has not been empirically investigated. The purpose of this exploratory study was to describe medical students’ intellectual curiosity across a four-year undergraduate program.

Methods: We employed a cross-sectional design in which medical students, across a four-year undergraduate program at McGill University, completed the Melbourne Curiosity Inventory as a measure of their state and trait intellectual curiosity. A Mixed Models ANOVA was used to compare students across year of training.

Results: Four hundred and two out of 751 students completed the inventory (53.5%). Trait curiosity was significantly higher than state curiosity (M?=?64.5, SD?=?8.5 versus M?=?58.5, SD?=?11.6) overall, and within each year of training.

Conclusions: This study is the first to describe state and trait intellectual curiosity in undergraduate medical education. Findings suggest that medical students’ state curiosity may not be optimally supported and highlight avenues for further research.     

Peer-assisted learning in a student-run free clinic project increases clinical competence

Background: Germany's first student-run free clinic (SRFC) for medically underserved patients has been established at the medical faculty of the Goethe-University, Frankfurt/Germany. Participating students are educated in a Peer Assisted Learning program (PAL). Little is known about the effectiveness of PAL in SRFCs.

Methods: We conducted a randomized, controlled, prospective study involving 50 participants. Students were either tested before or after receiving PAL. Knowledge and skill level were measured by theoretical and practical tests. In addition, curricular Objective Structured Clinical Examination (OSCE) results were compared between the groups.

Results: Students receiving PAL had significantly better results in theoretical (p?<?0.001) and practical (p?<?0.001) tests, as well as in the OSCE (p?<?0.01). A control test showed no significant difference (p?=?0.205) indicating similar prerequisites between the groups.

Conclusion: Improved results of the study group indicate an increase in the clinical knowledge and skills. PAL appears to be suitable for the training of basic medical skills and family medicine related knowledge and similar teaching projects could be based on it at other SRFCs.     

A unique flipped classroom approach shows promising results in physician assistant education

Abstract

Aims: The flipped classroom (FC) model utilizes pre-class foundational learning with in-class higher-order application exercises. FC approaches have reported positive perceptions and mixed academic performance outcomes in medical education; however, little evidence exists on their impact in the 56-week didactic curriculum of Physician Assistant (PA) education.

Methods: A 4-week FC curriculum was piloted in a PA behavioral medicine course (n?=?34). Before class, students completed online video modules. During class, students completed a pre-class quiz and answered clinical case-based questions in a think-pair-share format.

Results: Students rated in-class time higher than a lecture-based segment of the same course (p?=?0.028). Assessment of achievement emotions demonstrated increased enjoyment (p?=?0.028) and decreased boredom (p?<?0.001) in the FC curriculum with no difference in anxiety. The FC curriculum produced a 57.2?min increase in pre-class preparation time with no change in post-class studying time. Compared to historical lecture-based controls (n?=?35), students in the FC curriculum scored significantly higher on clinical vignette questions (p?=?0.019) with equivalent performance on other question formats.

Conclusions: This study offers the first positive outcomes of an FC approach in PA education and provides a framework for improving academic performance while scaling back in-class time.     

Changes in medical student implicit attitudes following a health equity curricular intervention

Purpose: This study assessed the: (1) effect of an LGBTQI?+?health equity curriculum (eQuality) on implicit attitudes among first (M1) and second year (M2) medical students and (2) utility of dedicated time to explore implicit bias.

Method: Implicit biases were assessed at baseline using implicit association tests (IAT) for all M2s and a random sample of first years (M1A). These students were then debriefed on strategies to mitigate bias. Following eQuality, all M1 and M2s completed post-intervention IATs. The remaining first years (M1B) were then debriefed. Paired sample t-tests assessed differences between pre/post. Independent sample t-tests assessed differences in post-IATs between M1 groups.

Results: IATs indicated preferences for “Straight,” “White,” and “Thin” at both pre and post. M2s demonstrated statistically significant improvements pre to post for sexuality (p?=?0.01) and race (p?=?0.03). There were significant differences in post-intervention IAT scores between M1As who received the IAT and debriefing prior to eQuality and M1Bs for sexuality (p?=?0.002) and race (p?=?0.046). There were no significant changes for weight.

Conclusion: eQuality reduced implicit preference for “Straight” and “White.” Differences in M1 post-intervention IAT scores between groups suggest dedicating time to debrief implicit attitudes enhances bias mitigation.     

The impact of informed self-assessment on the development of medical students’ learning goals

Purpose: This study investigates the contributions of self-assessment (SA) and external feedback on the development of learning goals (LG) and the influence on LG recall and implementation in medical students.

Methods: Following a standardized patient (SP) assessment, 168 pre-clinical medical students completed a SA, received SP feedback and created a LG. LG were categorized by source. Two weeks later, students recalled LG and described implementation. Chi-squared analyses were used to test the associations.

Results: SA influenced LG for 82.8% of students whereas SP feedback influenced LG for 45.9%. Students rarely generated LG based on SA when they received discordant feedback (5.4%), but sometimes incorporated feedback discordant from their SA into LG (14.9%). Students who created LG based on SP feedback were more likely to recall LG than those who created LG based on SA, 89.7 versus 67.6%, p?2(1)?=?5.3, p?=?0.017. Students who reported receiving effective feedback were more likely to implement their LG than those reporting adequate feedback, 60.9 versus 37.9%, χ²(1)?=?8.0, p?=?0.01.

Conclusions: SA is an essential part of goal setting and subsequent action. Perception of feedback plays a crucial role in LG implementation.     

Uncover it,students would learn leadership from Team-Based Learning (TBL): The effect of guided reflection and feedback

Context: Little is known about best practices for teaching and learning leadership through Team-Based learning? (TBL?) with medical students. We hypothesized that guided reflection and feedback would improve shared leadership and shared leadership capacity, and enhance team decision quality in TBL teams. We used the Kolb experiential learning theory as the theoretical framework.

Method: The study was conducted at Tehran University of Medical Sciences. Three TBL sessions with 206 students (39 teams) participated in the study. Using a quasi-experimental design, one batch received guided reflection and feedback on their team leadership processes (n?=?20 teams) and the other received only TBL (n?=?19 teams). Observers measured shared leadership using a checklist. Shared leadership capacity was measured using a questionnaire. Scores on a team application exercise were used to assess quality of team decisions.

Results: Evidence did not support our first hypothesis that reflection and feedback enhance shared leadership in TBL teams. Percentages of teams displaying shared leadership did not differ between intervention and control groups in sessions 1 (p?=?0.6), 2 (p?=?1) or 3 (p?=?1). The results did not support the second hypothesis. We found no difference in quality of decision making between the intervention and control groups for sessions 1 (p?=?0.77), 2 (p?=?0.23), or 3 (p?=?0.07). The third hypothesis that the reflection and feedback would have an effect on shared leadership capacity was supported (T?=??8.55, p?>?0.001 adjusted on baseline; T?=??8.55, p?>?0.001 adjusted on gender).

Discussion and conclusion: We found that reflection and feedback improved shared leadership capacity but not shared leadership behaviors or team decision quality. We propose medical educators who apply TBL, should provide guided exercise in reflection and feedback so that students may better understand the benefits of working in teams as preparation for their future roles as leaders and members of health care teams.     

Mixed reality as a time-efficient alternative to cadaveric dissection

Abstract

Objectives: The extent of medical knowledge increases yearly, but the time available for students to learn is limited, leading to administrative pressures to revise and reconfigure medical school curricula. The goal of the present study is to determine whether the mixed reality platform HoloAnatomy represents an effective and time-efficient modality to learn anatomy when compared to traditional cadaveric dissection.

Methods: This was a prospective, longitudinal study of medical students completing a musculoskeletal anatomy course at Case Western Reserve University School of Medicine. Participants were divided into two groups based on learning platform (HoloAnatomy versus traditional cadaveric dissection) and content area (upper limb versus lower limb anatomy). Time spent in lab and end of course practical exam scores were compared between groups.

Results: The average study time of 48 medical students who completed study requirements was 4.564?h using HoloAnatomy and 7.318?h in the cadaver lab (p?=?0.001). No significant difference was found between exam scores for HoloAnatomy and cadaver learners (p?=?0.185).

Conclusions: Our results indicate that HoloAnatomy may decrease the time necessary for anatomy didactics without sacrificing student understanding of the material.     

Sure,or unsure? Measuring students’ confidence and the potential impact on patient safety in multiple-choice questions

Background: Multiple-choice questions (MCQs) provide useful information about correct and incorrect answers, but they do not offer information about students’ confidence.

Methods: Ninety and another 81 medical students participated each in a curricular neurology multiple-choice exam and indicated their confidence for every single MCQ. Each MCQ had a defined level of potential clinical impact on patient safety (uncritical, risky, harmful). Our first objective was to detect informed (IF), guessed (GU), misinformed (MI), and uninformed (UI) answers. Further, we evaluated whether there were significant differences for confidence at correct and incorrect answers. Then, we explored if clinical impact had a significant influence on students’ confidence.

Results: There were 1818 IF, 635 GU, 71?MI, and 176 UI answers in exam I and 1453 IF, 613 GU, 92?MI, and 191 UI answers in exam II. Students’ confidence was significantly higher for correct than for incorrect answers at both exams (p?p?=?0.01). At exam II, students’ confidence was significantly higher for incorrect harmful than for incorrect benign (p?p?=?0.01).

Conclusions: We were pleased to see that there were more informed than guessed, more uninformed than misinformed answers and higher students’ confidence for correct than for incorrect answers. Our expectation that students state higher confidence in correct and harmful and lower confidence in incorrect and harmful MCQs could not be confirmed.     

The role of direct single monetary grants in residents’ choice of field of residency

Background: In an attempt to address severe medical manpower shortages in several medical disciplines, the Israeli Ministry of Health offered grants to residents who chose one of these fields.

Methods: A total of 220 residents from various disciplines were surveyed on demographic, academic, and professional data, and asked to rank considerations in the choice of their field of residency.

Results: Residents in targeted fields attributed significantly more importance to the grant in their decision-making process (U?=?3704.5, p?p?p?=?0.031) and attribution of significance to the working conditions compared to other residency fields (OR 1.69, 95%CI 1.23–2.32, p?=?0.001) were significantly associated with receptivity toward the grant in a multivariate analysis.

Discussion: Receptivity toward the offered grants correlated with real-life data shows a rise in physician in these fields, and the weak association between such receptivity and most variables tested may suggest that the grants were perceived as a property of the specific choice rather than a special bonus.

Conclusions: Grants may be useful in diverting medical manpower. Further analysis and modeling are required to determine causal relationship and budgetary feasibility.     

Exam anxiety in the undergraduate medical students of Taibah University

Abstract

Background and objectives: Assessment is perceived to create highly stressful environment among medical students. Several studies have reported exam-related anxiety symptoms but the contributing factors seem to differ across institutions. This study aimed to determine the prevalence of exam anxiety, gender differences and the variables that moderate exam anxiety among students of a Saudi medical school.

Methods: A cross-section study was done on 5th year medical students by administering a 12-statement self-administered questionnaire. The degree of exam anxiety was gauged by a visual analog scale.

Results: Of 125 students, 111 responded (response rate 89%). About 65% students experienced exam anxiety due to various reasons. Studying all night before exam (28 students; 25.2%) and extensive course load (26 students; 23.4%) were the major confounding factors. Female students experienced more stress due to extensive course load as compared with male students (p?=?.00).

Conclusions: The data about the identified risk factors for exam anxiety can help medical educators to deeply understand the reasons for exam anxiety. There is a need to reassess the amount of study material in undergraduate medical curricula and students need to organize their time management skills to cope with exam anxiety.     

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.     

Shedding light into the black box: A prospective longitudinal study identifying the CanMEDS roles of final year medical students’ on-ward activities

Introduction: To our best knowledge, a rigorous prospective analysis of final year medical students’ (FY medical students) activity profiles during workplace learning is lacking. The present study investigated the CanMEDS characteristics of all on-ward activities performed by internal medicine FY medical students. We tested the hypotheses that during FY medical student workplace training (I) routine activities are predominantly performed, while supervised, more complex activities are underrepresented with (II) FY medical students performing an insufficient number of autonomous activities and that (III) the CanMEDS roles of the Communicator and the Professional prevail.

Methods: During the second and the sixth week of their final year trimester at the University of Heidelberg Medical Hospital, N?=?34 FY medical students (73% female; mean age 26.4?±?2.4) were asked to keep a detailed record of all their on-ward activities and to document the duration, mode of action (active versus passive; independent versus supervised), estimated relevance for later practice, and difficulty-level in specially designed activity logbooks. CanMEDS roles were assigned to the documented activities via post-hoc expert consensus.

Results: About 4308 activities lasting a total of 2211.4?h were documented. Drawing blood (20.8%) was the most frequently documented medical activity followed by full admission procedures (9.6%). About 14.9% of the time was spent with non-medical activities. About 82.1% of all medical activities performed went unsupervised. The Communicator (42%), the Professional (38%), and the Collaborator (7%) were assigned as the top three CanMEDS roles.

Conclusions: The results call for increased efforts in creating more authentic learning experiences for FY medical students shifting towards more complex, supervised tasks, and improved team integration.