A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners

Introduction: Stress and burnout are highly prevalent among medical doctors, and are associated with negative consequences for doctors, patients, and organizations. The purpose of the current study was to examine the effectiveness of a mindfulness training intervention in reducing stress and burnout among medical practitioners, by means of a Randomised Controlled Trial design.

Methods: Participants were 44 intern doctors completing an emergency department rotation in a major Australian hospital. Participants were randomly assigned to either an active control (one hour extra break per week) or the 10-week mindfulness training intervention. Measures of stress and burnout were taken pre-, mid- and post intervention.

Results: Participants undergoing the 10-week mindfulness training program reported greater improvements in stress and burnout relative to participants in the control condition. Significant reduction in stress and burnout was observed for participants in the mindfulness condition. No such reductions were observed for participants in the control condition.

Conclusions: Mindfulness interventions may provide medical practitioners with skills to effectively manage stress and burnout, thereby reducing their experience of these symptoms. It is likely that doctors would benefit from the inclusion of such a training program as a part of their general medical education.     

Twelve tips for effective body language for medical educators

Background: A significant proportion of human communication is nonverbal. Although the fields of business and psychology have significant literature on effectively using body language in a variety of situations, there is limited literature on effective body language for medical educators.

Aim: To provide 12 tips to highlight effective body language strategies and techniques for medical educators.

Method: The tips provided are based on our experiences and reflections as clinician-educators and the available literature.

Results: The 12 tips presented offer specific strategies to engage learners, balance learner participation, and bring energy and passion to teaching.

Conclusions: Medical educators seeking to maximize their effectiveness would benefit from an understanding of how body language affects a learning environment and how body language techniques can be used to engage audiences, maintain attention, control challenging learners, and convey passion for a topic. Understanding and using body language effectively is an important instructional skill.     

Twelve tips for medical students to make the best use of ward-based learning

Background: With a multitude of healthcare professionals willing to teach, a placement on a ward is an invaluable learning opportunity; yet as students, we often struggle to maximize this placements’ potential.

Aim: This article provides 12 tips for medical students to optimize their learning in a ward-based environment.

Methods: Current literature and personal experiences of the authors were used to develop the tips.

Results: The 12 tips are (1) prepare yourself, (2) identify knowledge, skills, and attributes, (3) engage in peer-to-peer learning, (4) get to know the interprofessional team, (5) talk to the patient first, (6) present findings and gain feedback, (7) tap into seniors’ experience, (8) immerse yourself and be proactive, (9) check patient notes, (10) manage the clock, (11) enhance your CV, and (12) embrace the spirit of lifelong learning.

Conclusion: These tips will enable us to effectively improve our learning and positively shape us into outstanding future doctors.     

Twelve tips for teaching brief motivational interviewing to medical students

Background: Shifting from paternalistic to patient-centred doctor-patient relationships has seen a growing number of medical programs incorporate brief motivational interviewing training in their curriculum. Some medical educators, however, are unsure of precisely what, when, and how to incorporate such training.

Aims: This article provides educators with 12 tips for teaching brief motivational interviewing to medical students, premised on evidence-based pedagogy.

Methods: Tips were drawn from the literature and authors’ own experiences.

Results: The 12 tips are: (1) Set clear learning objectives, (2) Select experienced educators, (3) Provide theoretical perspectives, (4) Share the evidence base, (5) Outline the “spirit”, principles, and sequence, (6) Show students what it looks like, (7) Give students a scaffold to follow, (8) Provide opportunities for skill practice, (9) Involve clinical students in teaching, (10) Use varied formative and summative assessments, (11) Integrate and maintain, and (12) Reflect and evaluate.

Conclusions: We describe what to include and why, and outline when and how to teach the essential components of brief motivational interviewing knowledge and skills in a medical curriculum.     

Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45

Background: Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments.

Aim: To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training.

Method: Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included.

Results: Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings.

Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment.

Conclusions: While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.     

Changing the culture of medical training: An important step toward the implementation of competency-based medical education

Objective: The current medical education system is steeped in tradition and has been shaped by many long-held beliefs and convictions about the essential components of training. The objective of this article is to propose initiatives to overcome biases against competency-based medical education (CBME) in the culture of medical education.

Materials and methods: At a retreat of the International Competency Based Medical Education (ICBME) Collaborators group, an intensive brainstorming session was held to determine potential barriers to adoption of CBME in the culture of medical education. This was supplemented with a review of the literature on the topic.

Results: There continues to exist significant key barriers to the widespread adoption of CBME. Change in educational culture must be embraced by all components of the medical education hierarchy. Research is essential to provide convincing evidence of the benefit of CBME.

Conclusions: The widespread adoption of CBME will require a change in the professional, institutional, and organizational culture surrounding the training of medical professionals.     

International infectious diseases teaching to undergraduate medical students: A successful European collaborative experience*

Context: The emerging global-health paradigm requires medical teaching to be continuously redefined and updated; to this end, transnational approaches should be encouraged and medical training harmonized. Infectious diseases (ID) teaching in the current context of emerging infections, fast-increasing bacterial resistance and large-scale human migration, was chosen to develop a common international course.

Objective: We report the successful implementation of a joint European undergraduate course aiming to (i) develop a common ID core curriculum among European medical schools; (ii) promote mobility among teachers and students (iii) promote international cooperation among European teachers.

Methods: The course was built around teachers’ mobility. It was delivered in English by a team of European medical educators from Paris Descartes University, Università Cattolica del Sacro Cuore in Rome and the University of Edinburgh to groups of 25–30 undergraduate medical students at each university. Partner Institutions officially recognized the course as substitutive of or additive to the regular curriculum.

Results: The course has been running for 3 years and received excellent satisfaction scores by students and staff as regards to scientific content, pedagogy and international exchanges.

Conclusion: This cooperative approach demonstrates the feasibility of a harmonized European undergraduate medical education, having ID as a test experiment for future developments.     

Simulation-based trauma education for medical students: A review of literature

Background: Medical students often do not feel prepared to manage emergency situations after graduation. They experience a lack of practical skills and show significant deficits in cognitive performance to assess and stabilize trauma patients. Most reports in the literature about simulation-based education pertain to postgraduate training. Simulation-based trauma education (SBTE) in undergraduate medical education could improve confidence and performance of recently graduated doctors in trauma resuscitation. We reviewed the literature in search of SBTE effectiveness for medical students.

Methods: A PubMed, Embase and CINAHL literature search was performed to identify all studies that reported on the effectiveness of SBTE for medical students, on student perception on SBTE or on the effectiveness of different simulation modalities.

Results: Eight studies were included. Three out of four studies reporting on the effectiveness of SBTE demonstrated an increase in performance of students after SBTE. SBTE is generally highly appreciated by medical students. Only one study directly compared two modalities of SBTE and reported favorable results for the mechanical model rather than the standardized live patient model.

Conclusion: SBTE appears to be an effective method to prepare medical students for trauma resuscitation. Furthermore, students enjoy SBTE and they perceive SBTE as a very useful learning method.     

Twelve tips on how to establish a new undergraduate firm on a critical care unit

Background: Little is known about undergraduate teaching in critical care unit (CrCU) and many undergraduate curricula lack placements in CrCU.

Aims: To describe how our CrCU succeeded in developing a novel placement for Year 3 undergraduate medical students.

Methods: Particular emphasis was placed on a robust timetable incorporating a variety of activities, a dedicated and thorough induction, and a mix of teaching methods such as formal and informal, consultant-led, and skills. Services allied to CrCU were also utilized.

Results: Our new firm has exceeded all expectations and, based on student feedback, received the “Firm of the Year” award for several years in succession. It now serves as a model of undergraduate teaching in our hospital.

Conclusions: Educationalists and intensivists should work together to unlock the full potential of this rich learning environment. Professional societies in critical care medicine should take the opportunity to develop more interest in undergraduate medical education.     

Peer assessment in the objective structured clinical examination: A scoping review

Background: The objective structured clinical examination (OSCE), originally designed with experts assessing trainees’ competence, is more frequently employed with an element of peer assessment and feedback. Although peer assessment in higher education has been studied, its role in OSCEs has not reviewed.

Aims: The aim of this study is to conduct a scoping review and explore the role of peer assessment and feedback in the OSCE.

Methods: Electronic database and hand searching yielded 507 articles. Twenty-one full records were screened, of which 13 were included in the review. Two independent reviewers completed each step of the review.

Results: Peer-based OSCEs are used to assess students’ accuracy in assessing OSCE performance and to promote learning. Peer examiners (PE) tend to award better global ratings and variable checklist ratings compared to faculty and provide high-quality feedback. Participating in these OSCEs is perceived as beneficial for learning.

Conclusions: Peer assessment and feedback can be used to gauge PE reliability and promote learning. Teachers using these OSCEs must use methodology which fits their purpose. Competency-based education calls for diversification of assessment practices and asks how assessment impacts learning; the peer-based OSCE responds to these demands and will become an important practice in health professions education.     

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.     

Graduate medical education competencies for international health electives: A qualitative study

Background: Residency programs offer international health electives (IHEs), providing multiple educational benefits. This study aimed to identify how IHEs fulfill the Accreditation Council for Graduate Medical Education (ACGME) core competencies.

Methods: We conducted a thematic analysis of post-rotation reflective reports from residents who participated in IHEs through the Mayo International Health Program. We coded reports using a codebook created from the ACGME competencies. Using a constant comparative method, we identified significant themes within each competency.

Results: Residents from 40 specialties participated in 377 IHEs in 56 countries from 2001 to 2014. Multiple themes were identified within each of the six ACGME core competencies: Patient Care and Procedural Skills (4), Medical Knowledge (5), Practice-Based Learning and Improvement (3), Interpersonal and Communication Skills (5), Professionalism (4), and Systems-Based Practice and Improvement (3). Themes included improving physical exam and procedural skills, providing care in resource-limited setting, gaining knowledge of tropical and non-tropical diseases, identifying socioeconomic determinants of health, engaging in the education of others, and increasing communication across cultures and multidisciplinary teams.

Conclusions: Through IHEs, residents advanced their knowledge, skills, and attitudes in each of the six ACGME competencies. These data can be used for development of IHE competencies and milestones for resident assessment.     

Essential competencies in global health research for medical trainees: A narrative review

Introduction: Participation in short-term educational experiences in global health (STEGHs) among medical trainees is increasingly accompanied by interest in conducting research while abroad. Because formal training in both global health and research methods is currently under-represented in most medical curricula, trainees are often unfamiliar with the knowledge, attitudes, and skills necessary to design and conduct research successfully. This narrative review identifies essential global health research competencies for medical trainees engaged in STEGHs.

Methods: The authors searched the literature using the terms global health, competency, research, research methods/process/training, scholarly project, medical student, and medical education/education. Because articles directly addressing global health research competencies for medical trainees were limited, the authors additionally drew on the broader literature addressing general research competencies and global health competencies.

Findings: Articles yielded by the literature search, combined with established guidelines in research ethics and global health ethics, were used to identify six core domains and twenty discrete competencies fundamental to global health research at a level appropriate for medical trainees enrolled in STEGHs. Consideration was given to diverse research modalities, varying levels of training, and the availability of mentoring and on-site support.

Discussion: Research may provide important benefits to medical trainees and host partners. These competencies provide a starting point; however, circumstances at any host site may necessitate additional competencies specific to that setting. These competencies are also limited by the methodology employed in their development and the need for additional perspectives from host partners.

Conclusions: The competencies identified outline basic knowledge, attitudes, and skills necessary for medical trainees to conduct limited global health research while participating in STEGHS. They may also be used as a basis for curriculum development, assessment, and research capacity development.     

Public health matters: Innovative approaches for engaging medical students

Background: Public health faces the paradox of being increasingly emphasized by the key health and social care regulators and stakeholders, while remaining a largely under-represented discipline in the context of medical curricula. Enhancing medical student engagement in public health teaching is one way to address this concern.

Methods: We discuss four key solutions to the challenges faced by public health educators in medical schools, and present five case studies which demonstrate innovative approaches to engaging medical students in our discipline.

Results: Four different approaches have been piloted by members of the Public Health Educators in Medical Schools (PHEMS) network: (i) ensuring social accountability, (ii) demonstrating clinical relevance, (iii) mapping the core curriculum, and (iv) using technology enhanced learning. Preliminary student feedback suggests that these approaches can be used to position public health as an enabler of modern medical practice, and promote a more holistic understanding of medicine by linking patient-centred care to the population level.

Conclusions: The zeitgeist in both academia and the healthcare system supports the teaching of public health within the medical curriculum; there is also consensus at the political and pedagogical level. The challenge of ensuring engagement now needs to be met at the student–teacher interface.     

Medical migration: A qualitative exploration of the atypical path of Japanese international medical graduates

Background: International Medical Graduates (IMGs) are commonly understood to move from low to high resource countries with motivations including improved financial situations and cultures of emigration. A presumable exception to the above themes would be the Japanese IMG population. The aim of this study was to develop an understanding of the Japanese IMG experience.

Methods: Using a grounded theory approach, we interviewed 19 Japanese IMGs working in the US and 16 Japanese IMGs working in Japan who had completed US clinical training. Questions addressed decision-making to pursue US clinical training, goals for the training, and career decision-making upon completing the training. Data collection and constant comparative analysis were conducted iteratively to identify emerging themes.

Results: The emerging model of the Japanese IMG experience is focused around pivotal experiences that often include dissatisfaction with the quality of Japanese clinical training and personal exposures to US clinical education. Further decision-making in the pursuit of US residency is influenced by educator training quality, and clinical training and career opportunities. The desire to improve Japanese clinical training commonly influences career decision-making after US training.

Conclusions: The Japanese IMG experience contrasts numerous perceptions of international physician migration and, in turn, enhances understanding of this paradigm.     

Preparing teachers for competency-based medical education: Fundamental teaching activities

Introduction: The move to competency-based medical education has created new challenges for medical teachers, including the need to reflect on and further develop their own competencies as teachers. Guidance is needed to ensure comprehensive and coherent programs of faculty development to meet the needs of teachers.

Methods: The Working Group on Faculty Development of the College of Family Physicians of Canada developed a new concept, Fundamental Teaching Activities (FTAs), to describe the day-to-day work of teachers. These activities are intended to guide teacher professional development. Using task analysis and iterative reviews with teachers and educational leaders, these FTAs were organized into a framework for teachers to identify the actions involved in various teaching tasks, and to reflect on their teaching performance and next steps in personal development.

Results: In addition to use by teachers for personal development, the framework is being employed to guide the development of comprehensive faculty development offerings and curriculum, and to organize the beginnings of a national repository of teaching tools.

Conclusions: Designed to support and aid teachers and those charged with faculty development, the Fundamental Teaching Activities Framework holds promise for all teachers in health sciences education.     

A collaborative comparison of objective structured clinical examination (OSCE) standard setting methods at Australian medical schools

Background: A key issue underpinning the usefulness of the OSCE assessment to medical education is standard setting, but the majority of standard-setting methods remain challenging for performance assessment because they produce varying passing marks. Several studies have compared standard-setting methods; however, most of these studies are limited by their experimental scope, or use data on examinee performance at a single OSCE station or from a single medical school. This collaborative study between 10 Australian medical schools investigated the effect of standard-setting methods on OSCE cut scores and failure rates.

Methods: This research used 5256 examinee scores from seven shared OSCE stations to calculate cut scores and failure rates using two different compromise standard-setting methods, namely the Borderline Regression and Cohen’s methods.

Results: The results of this study indicate that Cohen’s method yields similar outcomes to the Borderline Regression method, particularly for large examinee cohort sizes. However, with lower examinee numbers on a station, the Borderline Regression method resulted in higher cut scores and larger difference margins in the failure rates.

Conclusion: Cohen’s method yields similar outcomes as the Borderline Regression method and its application for benchmarking purposes and in resource-limited settings is justifiable, particularly with large examinee numbers.     

Comparing a longitudinal integrated clerkship with traditional hospital-based rotations in a rural setting

Context: Longitudinal integrated clerkships (LIC) are widely used as an educational method, particularly in rural areas. They are good for facilitating hands-on learning and deep relationships between student, patients, and supervisors.

Objectives: This study sought to examine and compare learning experience of third-year rural medical students studying specialties (women’s health, aged care, child and adolescent heath, mental health, general practice) by either a traditional hospital-based rotation or a LIC in a rural general practice setting.

Methods: Data was collected from two groups of rural students (LIC; traditional hospital-based) over two academic years, utilizing focus groups to investigate general experiences of living and learning rurally, within the different educational models.

Results: Results reaffirmed that there was no perceived academic disadvantage to studying medicine rurally. Studying medicine in a rural area provides increased access to patients, more hands-on experience, and close relationships with patients and colleagues. LIC students reported increased confidence in clinical skills, felt better prepared for internship, however experienced more social isolation than students in hospital-based rotations.

Conclusions: Students undergoing a rural LIC feel more confident in their clinical skills and preparedness for practice than other rural students. This study supports the use of LICs as a powerful educational tool.     

Twelve tips for the recruitment and retention of general practitioners as teachers of medical students

Background: Primary care physicians have become a fundamental aspect of teaching in modern medical school curricula worldwide with a significant proportion of undergraduate teaching taking place in primary care. There are calls for this to increase with more patient care occurring in the community but teaching capacity in primary care is a potential challenge. Medical schools, therefore, need strategies to be able to increase their primary care physician teaching workforce.

Methodology: We asked all Heads of General Practice Teaching in UK medical schools to share their three top tips for recruiting and retaining GPs to teach undergraduate students. The majority (two-thirds) of medical schools responded and we have summarized the answers into the following twelve tips.

Results: Although the twelve tips are varied and comprehensive, including broad topics such as finances and training, one clear theme running through the majority of tips is good communication and relationships between education teams and GPs.

Conclusions: The solutions to recruiting and retaining GPs to teach undergraduate medical students are clearly multifactorial and complex. We hope that by presenting suggestions from UK GP heads of teaching as these twelve tips provides some helpful, thought-provoking ideas and inspiration for both the UK and internationally.