Medical Teacher最新文献

Purpose: Objective Structured Clinical Examination (OSCE) is a stressful exam assessing medical competencies. Stress coping strategies are expected to enhance students' performance during OSCE. The objective was to determine the effect of short preventive coping interventions on performance of medical students.

Materials and methods: Double-blinded, randomized controlled trial with multiple arms and a superiority hypothesis. Enrolment was proposed to each fourth-year undergraduate medical student convened to the Lyon Est University OSCE in 2022. There was no exclusion criterion. Students were randomized to one of four groups: standardized breathing with cardiac biofeedback (BFB), mindfulness-based intervention (MBI), positive psychology intervention (PPI), or control (CTRL). Each intervention was video-guided, lasted six minutes, and occurred just before starting the OSCE. The primary outcome was the academic OSCE score, assessed through specific grids by university examiners blinded to the interventions. Secondary outcomes included specific performance scores, and student perception of the influence of the intervention on their performance.

Results: A total of 482 students were included. No difference was found between BFB (-0.17 [95%CI, -1.20 to 0.86], p = .749), MBI (0.32 [95%CI, -0.71 to 1.36], p = .540), or PPI groups (-0.25 [95%CI, -1.29 to 0.79], p = .637) on the academic OSCE score compared to the control group, nor regarding the specific performance scores. Compared to the control group, the students perceived that the intervention influenced more positively their performance (BFB +3 [95%CI, 0-8]), p < .001; MBI +4 [95%CI, 1-9], p = .040; PPI +1 [95%CI, 0-4], p = .040]).

Conclusions: A single six-minute cardiac biofeedback, mindfulness, or positive psychology intervention performed by fourth-year medical students just before an OSCE did not improve their following academic performance. Still, students reported that the interventions helped them to enhance their performance. Future research should aim to further explore the perception of intervention on performance and potential long-term effects for students.

Trial registration: The study protocol was registered on ClinicalTrials.gov Identifier: NCT05393219.

Purpose: A mixed-methods study to evaluate Bystander Intervention Training (BiT), a simulation-based small-group training programme designed to teach skills to tackle discrimination.

Materials and methods: Norwich Medical School delivered the intervention online between January 2020 and June 2023 to medical students, physician associate trainees, and qualified doctors. A sample of 569 participants was used in the main analysis. Participants completed pre- and post-training and follow-up evaluations.

Results: Paired post-training scores were significantly different (all p < 0.001) from the pre-training scores for all 12 questions, in favour of the post-training scores. Of the 159 participants who completed follow-up questionnaires, 27 (17.9%) reported having the opportunity to be an active bystander; of those, 23 (85%) intervened. Scores in the follow-up questionnaire were significantly higher than those in the pre-training survey and significantly lower than those in the post-training questionnaire (p < 0.001). Participants had an increased sense of responsibility to be an active bystander and were empowered to challenge discrimination. Participants from marginalised groups expressed positive views about the training.

Conclusions: Interventions that allow open discussion and carefully supported personal disclosure in safe spaces, where difficult and uncomfortable discussions can occur, with an opportunity to change behaviour, must be developed to tackle discrimination.

Purpose: Medical education requires competent faculty members with the ability to create change in medical education. The focus on teacher competency are emerged as the results of medical education movements toward learner competency. The purpose of this study was to identify medical faculties competencies in their main roles and to provide a competency framework.

Method: The integrative review approach was utilized for identifying competencies and expert opinions was conducted to assigned competencies to roles and academic ranks. The search strategies were conducted in online databases including PubMed, Scopus, WOS and Eric to detect studies published from May 2003 to May 2023.

Results: The identified competencies were classified to four themes including (1) essential personal competencies, (2) technical/functional competencies, (3) enabling competencies, and (4) meta-competencies.

Conclusion: According to the results, a competency framework was proposed which is a valuable tool for various important decisions related to faculty, such as promotions and tenurship.

Uncertainty is a fundamental aspect of medical practice, necessitating incorporation into undergraduate medical training. The integrative model of uncertainty tolerance (UT) developed by Hillen and Han serves as a comprehensive framework for exploring clinical uncertainty. While studies have extensively examined UT dimensions, including sources, responses, and moderators, the factors influencing the perception of uncertainty stimuli remain underexplored. However, students' ability to perceive uncertainty and their approach to uncertain stimuli play a crucial role in enabling them to develop adaptive responses to uncertainty, necessary for their comfort in these situations. Defining uncertainty as a metacognitive state suggests significant variability in its perception among individuals and within an individual over time. Moreover, several studies have demonstrated the substantial influence of various individual and contextual factors on how individuals perceive and respond to uncertainty. In this paper, the authors present multiple hypotheses to address the question of whether students genuinely perceive uncertainty stimuli when they should. The authors argue that students' personal relationship with their knowledge is essential in their ability to identify clinical uncertainty, particularly concerning the limits of medical knowledge. Therefore, they propose that an academic culture fostering doubt, through exposing students to a variety of perspectives, would enhance their ability to identify uncertainty zones in a clinical situation at an early stage. Drawing on Dewey's situational theory, the authors emphasize the importance of better understanding, in a work setting, the influence of contextual and situational characteristics on individual perceptions of uncertainty. In line with this idea, ethnographic studies would offer valuable insights into identifying the relationship between the students, their work environment, and their perception of clinical uncertainty.

Virtual patients (VPs) have long been used to teach and assess clinical reasoning. VPs can be programmed to simulate authentic patient-clinician interactions and to reflect a variety of contextual permutations. However, their use has historically been limited by the high cost and logistical challenges of large-scale implementation. We describe a novel globally-accessible approach to develop low-cost VPs at scale using artificial intelligence (AI) large language models (LLMs). We leveraged OpenAI Generative Pretrained Transformer (GPT) to create and implement two interactive VPs, and created permutations that differed in contextual features. We used systematic prompt engineering to refine a prompt instructing ChatGPT to emulate the patient for a given case scenario, and then provide feedback on clinician performance. We implemented the prompts using GPT-3.5-turbo and GPT-4.0, and created a simple text-only interface using the OpenAI API. GPT-4.0 was far superior. We also conducted limited testing using another LLM (Anthropic Claude), with promising results. We provide the final prompt, case scenarios, and Python code. LLM-VPs represent a 'disruptive innovation' - an innovation that is unmistakably inferior to existing products but substantially more accessible (due to low cost, global reach, or ease of implementation) and thereby able to reach a previously underserved market. LLM-VPs will lay the foundation for global democratization via low-cost-low-risk scalable development of educational and clinical simulations. These powerful tools could revolutionize the teaching, assessment, and research of management reasoning, shared decision-making, and AI evaluation (e.g. 'software as a medical device' evaluations).

Purpose: Serious games (SGs) have great potential for pediatric medical education. This study evaluated the efficacy of a SG in improving learner satisfaction, knowledge, and behavior.

Materials and methods: This was an investigator-blinded randomized controlled trial (RCT) comparing a SG against two controls: (i) adaptive tutorial (AT), and (ii) low-stimulus control (LSC). SG is a highly immersive role-playing game in a virtual hospital. AT delivers interactive web-based lessons. LSC is paper-based clinical practice guidelines. Metropolitan senior medical students at UNSW were eligible. A total of 154 enrolled and were block randomized to one intervention. Participants had access to one intervention for 8 weeks which taught pediatric acute asthma and seizure assessment and management. Satisfaction was assessed with Likert-scale responses to 5 statements and 2 free-text comments. Knowledge was assessed with 10 multiple-choice questions (MCQs). Clinical behavior was assessed during a 30-point simulated clinical management scenario (CMS). Primary analysis was performed on a modified intention-to-treat basis and compared: (1) SG vs. AT; and (2) SG vs. LSC.

Results: A total of 118 participants were included in the primary analysis (modified intention-to-treat model). No significant differences in MCQ results between the SG and control groups. SG group outperformed the LSC group in the CMS, with a moderate effect (score out of 30: 20.8 (3.2) vs. 18.7 (3.2), respectively, d = 0.65 (0.2-1.1), p = 0.005). No statistically significant difference between SG and AT groups in the CMS (score: 20.8 (3.2) vs. 19.8 (3.1), respectively, d = 0.31 (-0.1 to 0.8), p = 0.18). A sensitivity analysis (per-protocol model) was performed with similar outcomes.

Conclusions: This is the first investigator-blinded RCT assessing the efficacy of a highly immersive SG on learner attitudes, knowledge acquisition, and performance in simulated pediatric clinical scenarios. The SG demonstrated improved translation of knowledge to a simulated clinical environment, particularly compared to LSC. SGs show promise in pediatric medical education.