Advances in Medical Education and Practice最新文献

Purpose: Diet/nutrition is the first-line non-pharmacological therapy in the treatment of diabetes. Diet/nutrition counseling is infrequently provided by primary care providers (PCPs), who have limited nutrition education in both medical and advanced practice provider curricula. This quality improvement project aimed to improve knowledge and attitude, and frequency of diet/nutrition counseling by PCPs among patients with uncontrolled diabetes (glycosylated hemoglobin A1c ≥8%), by providing an online continuing medical education (CME) program on diabetes diet/nutrition.

Methods: At a community health center in New England, PCPs attended a live 50-minute online CME program that was developed internally, which taught PCPs current diet/nutrition guidelines and recommendations related to diabetes. Knowledge was assessed prior to and two weeks following the program, utilizing a 10-question tool, the Nutrition Management of Diabetes Assessment (NMDA). Similarly, attitude was evaluated using two subscales of the Nutrition in Patient Care Survey (NIPS): Nutrition in routine care and Physician efficacy. Chart audits of patients with uncontrolled diabetes were evaluated to assess PCPs documentation of diet/nutrition counseling four weeks prior to and six weeks following the CME program.

Results: In September 2023, PCPs (n = 29) completed the CME program. There was an improvement in knowledge in the NMDA amongst PCPs (36% difference, p < 0.001). Attitude scores from two subscales of the NIPS were evaluated and both showed improvement, however only physician efficacy was significant (15% difference, p < 0.01). There was a positive difference in the trend of diet/nutrition counseling after the education program (p < 0.05).

Conclusion: An online CME program improved diabetes diet/nutrition knowledge and attitude of PCPs and improved counseling practices for patients living with uncontrolled diabetes. The education program provided PCPs current standards of care guidelines/recommendations, which they can utilize when counseling patients with diabetes. PCPs would benefit from dedicated continuing education programs regarding diet/nutrition therapy for chronic illnesses.

Although the field of medicine has made significant progress in recent decades, low and middle-income countries continue to face significant difficulties in addressing the unprecedented obstacles to improving health. Medical schools should play a critical role in driving health services reform and take on a new leadership role in strengthening the health system. This paper discusses a conceptual framework and outlines the Academic Health Systems (AHS) agenda in Indonesia. A comprehensive analysis was conducted on the existing literature and frameworks regarding AHS, applying the system thinking method, which engages stakeholders actively. The findings and interpretations from interviews, focus groups, and collaborative workshops were consolidated and a set of proposed frameworks, fundamental principles, and a route for enhancing the health system in Indonesia were put forward. Our recommendations include transformative learning, community engagement, and translational research as pillar principles of AHS program. These recommendations have the potential to be modified and implemented in other low- and middle-income countries.

Background: International medical electives (IMEs) are considered high-impact practice in global health education. Nevertheless, international medical elective (IME) research remains scarce, with only a few new publications appearing each year. The discrepancy between the many unanswered questions regarding IMEs and the lack of opportunities to perform research in this field has been further aggravated by the COVID-19 pandemic. Elective databases cataloguing structured IME reports/testimonies could offer a viable solution here. This narrative review provides a balanced and objective evaluation of the strengths and weaknesses of elective databases, summarizing their potential usefulness in IME research.

Methods: The methodology employed was a multidisciplinary narrative review of the published and grey literature on databases cataloguing IME testimonies.

Results: Elective databases offer numerous benefits to the IME researcher. Their size allows for large analyses, built on hundreds of equally structured elective testimonies. Pre-defined outcomes, such as the elective destination, elective discipline or duration, are queried in a standardized way, allowing for a broad set of research questions. Elective databases are usually open-access, not confined to a single university, and free to use. Most databases also offer user-friendly filter functions, permitting targeted analyses centered around a particular outcome. A major drawback is that reports are rarely verified. Subject to several forms of bias (eg, recall and reporting bias), elective databases may not be suitable for all types of research questions, and the report quality is often inhomogeneous. Above all, they rarely allow for an informational depth that may result from qualitative face-to-face interviews.

Conclusion: Elective databases could be a valuable supplement to interview-based elective research, potentially allowing for larger and broader analyses not confined to single institutions.

Introduction: This study at the University of South Carolina School of Medicine Greenville examines medical students' preferences and concerns regarding exam scheduling, focusing on the schedule's impact on student academic performance and well-being.

Methods: A cross-sectional survey was administered to second, third, and fourth year medical students, receiving a 53% response rate. The survey, consisting of 11 multiple-choice questions and one open-ended question, assessed preferences for exam days, weeks, sequence of different types of exams, and the timing of schedule releases.

Results: Evaluation using descriptive statistics and thematic analysis revealed a strong preference for scheduling Biomedical Science (BMS) exams on Fridays, avoiding weeks with holidays, and separating BMS exams from Integrated Practice of Medicine (IPM) assessments. Students reported that concurrent IPM content delivery during BMS exam weeks negatively impacted their academic performance. Additionally, there was a significant demand for early release of exam schedules to better manage work-life balance.

Discussion: These findings highlight the critical role of exam scheduling in influencing medical students' academic success and overall well-being, suggesting the need for early communication of schedules and equitable assessment planning.

This study explores the implementation of Team-Based Learning (TBL) at Alfaisal University's College of Medicine through the lens of Complex Adaptive Systems (CAS) theory. The research question investigates how the application of CAS principles can enhance the implementation and effectiveness of TBL in medical education. The study employed a convergent parallel mixed methods longitudinal design, integrating quantitative performance metrics and qualitative themes. Quantitative analysis revealed modest improvements in individual and team-based learning scores, with a promising trend of students moving from the lower to the higher quartiles over time. Qualitative insights aligned with CAS principles, highlighting the adaptive implementation, emergent outcomes, self-organization, positive feedback loops, and depth of learning facilitated by TBL. The findings demonstrate the value of a CAS-informed approach in navigating the complexities of educational change and fostering a more resilient and adaptive educational model. The study contributes to the understanding of how CAS theory can guide the successful implementation of innovative pedagogies like TBL in medical education.

Purpose: Coaching is a well-described means of providing real-time, actionable feedback to learners. We aimed to determine whether dual coaching from faculty physicians and real inpatients led to an improvement in history-taking skills of clerkship medical students.

Patients and methods: Expert faculty physicians (on Zoom) directly observed 13 clerkship medical students as they obtained a history from 26 real, hospitalized inpatients (in person), after which students received immediate feedback from both the physician and the patient. De-identified audio-video recordings of all interviews were scored by independent judges using a previously validated clinical rating tool to assess for improvement in history-taking skills between the two interviews. Finally, all participants completed a survey with Likert scale questions and free-text prompts.

Results: Students' history-taking skills - specifically in the domains of communication, medical knowledge and professional conduct - on the validated rating tool, as evaluated by the independent judges, did not significantly improve between their first and second patient interviews. However, students rated the dual coaching as overwhelmingly positive (average score of 1.43, with 1 being Excellent and 5 being Poor), with many appreciating the specificity and timeliness of the feedback. Patients also rated the experience very highly (average score of 1.23, with 1 being Excellent and 5 being Poor), noting that they gained new insights into medical training.

Conclusion: Students value receiving immediate and specific feedback and real patients enjoy participating in the feedback process. Dual physician-patient coaching is a unique way to incorporate more direct observation into undergraduate medical education curricula.

Background: The COVID-19 pandemic has resulted in medical students' education being disrupted and a new direction of learning towards the online classroom, with students frequently learning to identify clinical signs via online conferencing platforms. Given this shift in student study techniques in the pandemic and post-pandemic era, we set out to analyse the confidence levels of students recognizing clinical signs in patients and the opinions and patterns of resources students would use to build up the knowledge and confidence for their future clinical practice.

Methods: OSCEazy, a student-led medical education organisation, delivered an online teaching session and disseminated a questionnaire containing ten-point Likert scales, multiple-choice questions and free text options.

Results: The majority (over 75%) of respondents reported using digital resources to learn physical examinations. Most respondents were somewhat confident with recognising clinical signs during physical examinations (Median 7, IQR 6-8). Kruskal-Wallis H-test on students' impression of the quality of current OSCE materials showed a statistically significant difference between cohorts (X²(2) = 14.209, p = 0.014). A large proportion of students (98.41%) agreed that an online resources bank would be beneficial for their learning. Wilcoxon rank test showed a statistically significant preference for learning physical examinations using clinical images rather than videos (p = 0.014). A 29% of respondents mentioned the use of physical textbooks as a resource, while online platforms such as OSCE revision websites, YouTube and Google Images had become the mainstream platforms.

Conclusion: The findings reported here suggest that there needs to be a greater emphasis on providing online image-based resources to support medical students in learning clinical signs. A resource containing these clinical signs would prove to be of benefit for students to access high-quality self-directed learning to identify and verify clinical signs.