Advances in Medical Education and Practice最新文献

Background: Numerous challenges exist in effectively bridging theory and practice in the teaching and assessment of clinical reasoning, despite an abundance of theoretical models. This study compares clinical reasoning practices and decisions between medical students and expert clinicians using a problem-solving framework from the learning sciences, which identifies clinical reasoning as distinct, observable actions in clinical case solving. We examined students at various training stages against expert clinicians to address the research question: How do expert clinicians and medical students differ in their practices and decisions during the diagnostic process?.

Methods: We developed a questionnaire about a pediatric infectious disease case based on the problem-solving framework from the learning sciences to probe clinical reasoning decisions. The questionnaire had four sections: medical history, physical examination, medical tests, and working diagnosis. The questionnaire was administered at Stanford University between January 2019 and June 2023 to collect data from 10 experts and 74 medical students. We recruited participants through maximum variation sampling. We applied deductive content analysis to systematically code responses to identify patterns in the execution of the practices and decisions across the questionnaire.

Results: This research introduces a highly detailed, empirically developed framework that holds potential to bridge theory and practice, offering practical insights for medical instructors in teaching clinical reasoning to students across various stages of their training. This framework involves nine practices, with a total of twenty-nine decisions that need to be made when carrying out these practices. Differences between experts and students centered on ten decisions across the practices: Differential diagnosis formulation, Diagnostic plan and execution, Clinical data reassessment, and Clinical solution review.

Conclusion: We were able to identify nuanced differences in clinical reasoning between students and expert physicians under one comprehensive problem-solving framework from the learning sciences. Identifying key clinical reasoning practices and decision differences could help develop targeted instructional materials and assessment tools, aiding instructors in fostering clinical reasoning in students.

Introduction: This study aimed to investigate how dental students at King Abdulaziz University Faculty of Dentistry transitioned from pre-clinical to clinical instruction and how this change affected their learning outcomes. Understanding this transition was crucial to identify the challenges faced by students and the support they required.

Methods: A mixed-methods approach was utilized, combining qualitative insights from focus group discussions with quantitative data from surveys. Focus groups gathered detailed student experiences regarding their transition, while surveys measured workloads, anxiety levels, and perceptions of clinical competence.

Results: The results showed that students have a lot of difficulties because of their heavier workloads, higher levels of anxiety, and the need for better integration of academic knowledge with practical abilities. Concerns over clinical competence and the necessity of improving communication with patients and healthcare teams are other characteristics of the transition phase. The findings highlighted how important structured support networks are for reducing transition-related stress and improving students' readiness for clinical duties. These networks include peer mentorship, orientation programs, and customized curriculum modifications.

Discussion: The study emphasized the value of early exposure to clinical settings and the inclusion of soft skill development in the curriculum, such as empathy and communication. The research advocated for comprehensive reforms in dental education, emphasizing the need for a holistic approach that addresses both the academic and emotional well-being of students. Dental faculties can contribute to the development of more competent and self-assured dental practitioners by improving support systems and incorporating practical experiences earlier in the educational timeline.

Introduction: Improving the quality of teaching placements in family medicine practice (FMP) could help to address the shortage of primary care physicians. This study aims to investigate students' evaluations of first-exposure FMP placements, to identify clusters of FMPs that might need to improve their placement quality, and to analyze students' perceptions of the FMP as a learning environment.

Methods: The design was a cross-sectional survey study, including all fourth-year undergraduate medical students at the University of Zurich, Switzerland, who completed a mandatory placement in FMP during 2019-2022. The placements consisted of individual teaching and training in the same FMP for 8 half days within an academic year. The primary outcome was the student Likert scale rating of the 14 key questions as indicators of teaching placement quality. Based on these indicators, cluster analysis was used to identify groups of FMPs with the potential for quality improvement. A framework analysis was used to analyze the students' perceptions.

Results: A total of 713 students (response rate 81%) and 249 FMPs (median [interquartile range]: 2 [1,4] students per FMP) were included. Overall, 86% of the students were satisfied with the placement, and 95% reported that the placement gave them realistic insight into FMP work. A cluster of 25 (10%) FMPs that may improve placement quality was identified. Students most liked the opportunity to gain FMP skills, insight into FMP work, and establishment of patient relationships.

Conclusion: Our study described students' experiences with FMP and a method for teaching evaluation to identify FMPs that may benefit from interventions to improve their learning environment. This could upgrade the medical education offered and increase the interest in family medicine as a response to the shortage of primary care physicians.

Background: Herbal medicine is integral to Saudi Arabia's Vision 2030, which seeks to improve the healthcare system and promote alternative practices while ensuring safety through education and research. This study aims to evaluate medical students' knowledge and perceptions regarding herbal medicine in Saudi Arabia.

Methods: A cross-sectional study was conducted among medical students in three medical colleges in Saudi Arabia over a six-month period from 1 February to 31 July 2024. Descriptive statistics were used to describe the participants' characteristics, and categorical variables were reported as frequencies and percentages. A chi-square test was used to test the relationships between variables. A p-value of < 0.05 was taken to indicate statistical significance.

Results: In total, 592 participants were included in the study. Females represented 65.7% of the participants. While 72.6% of the students agreed that medical students lack proper knowledge about the use of herbal medicines, 64.9% preferred having an elective course in complementary medicine (including herbal medicine). Also, 40.9% of students use herbal medicine believing they do not require expert knowledge and can safely experiment with various herbs, and 22.3% use it because they perceive it as having no side effects due to its natural ingredients. The most reported sources of information included family and friends (53.2%), whereas traditional herbalists (Attar) were the most reported sources of herbs (49.3%). The most used herbs among medical students were ginger (83%), turmeric (48.1%), chamomile (46.3%), and myrrh (26.5%). Only 37.7% of students who used herbs had an overall good knowledge and perception of them (P = 0.001). Gender showed a significant relationship with herb use among the students: 95.4% of female students used herbs, compared with 92.6% of male students (P = 0.049).

Conclusion: A considerable proportion of medical students demonstrated insufficient knowledge and perception regarding the use of herbal medicine. To improve their understanding, it is essential to integrate comprehensive courses, organize workshops led by experts, promote research and clinical experiences, and establish patient education initiatives.

Purpose: To determine the level of uptake of telemedicine among postgraduate obstetrics and gynaecology (O&G) trainees in London, and how they perceive its impact on their training.

Methods: A mixed-methods survey aimed at exploring trainee perspectives of telemedicine use in clinical practice and its implications for training. Study participants were O&G specialist doctors on the London (UK) training programme. The survey was distributed to the 2022 cohort via Email communication facilitated by Health Education England.

Results: The response rate was 46.3% (118/255). Of respondents, 96% (113/118) had experience of telemedicine, in a range of clinical environments; 91% (106/117) felt telemedicine should become embedded in O&G practice (the most frequent reported advantage was time-saving and a barrier was language translation); 43% of trainees (50/116) stated that they were unable to attain effective clinical training during telemedicine appointments; and 70% (81/116) indicated a preference for remote online teaching. The majority of trainees (75%) had some level of experience in the use of technology in clinical training, encompassing various modalities including surgical and ultrasound simulation, remote real-time training and virtual reality patient consultations. Trainee responses, on the whole, reflected a lack of confidence in their ultrasound skills; 79.5% (74/93) of trainees responsible for acute gynaecology admissions reported that at least 25% of admissions were for deferred ultrasound scanning investigation. Most trainees anticipated that real-time remote supervision for both USS and laparoscopy would enhance training opportunities and expedite time to patient diagnosis and management. Anticipated barriers included concerns regarding the uptake of technology and connectivity issues.

Conclusion: Telemedicine for clinical care has been demonstrated to be well-received by most O&G trainees. However, it is necessary to consider effective O&G training when delivering telemedicine. Technology gives rise to a number of training opportunities, with the development of online teaching, telementoring and simulation. Trainees report both advantages and disadvantages which should be carefully considered to optimise postgraduate O&G training.

Purpose: Multiple choice questions (MCQs) are the mainstay in examinations for medical education, physician licensing, and board certification. Traditionally, MCQs tend to test rote recall of memorized facts. Their utility in assessing higher cognitive functions has been more problematic to determine. This work evaluates and compares the difficulty and long-term retention of factual versus conceptual knowledge using multiple-choice questions in a longitudinal study.

Patients and methods: We classified a series of MCQs into two groups to test recall/verbatim and conceptual/inferential thinking, respectively. We used the MCQs to test a two-part hypothesis: 1) scores for recall/verbatim questions would be significantly higher than for concept/inference questions, and 2) memory loss over time would be more significant for factual knowledge than conceptual understanding compared with a loss in the ability to reason about concepts critically. We first used the MCQs with pre-clinical medical students on a summative exam in 2020, which served as a retrospective benchmark of their performance characteristics. After two years, the same questions were re-administered to volunteers from the same cohort of students in 2020.

Results: Retrospective analysis revealed that recall/verbatim questions were answered correctly more frequently (82.0% vs 60.9%, P = 0.002). Performance on concept/inference questions showed a significant decline, but a larger decline was observed for recall/verbatim questions after two years. Performance on concept/inference questions showed a slight decline across quartiles, while two years later, recall/verbatim questions experienced substantial performance loss. Subgroup analysis indicated convergence in performance on both question types, suggesting that the clinical relevance of the MCQ content may have influenced a regression toward a baseline mean.

Conclusion: These findings suggest conceptual/inferential thinking is more complex than rote memorization. However, the knowledge acquired is more durable in a longitudinal fashion, especially if it is reinforced in clinical settings.

Objective: This study evaluates the adoption of blended teaching models by faculty and students at Hubei University of Medicine. It aims to assess their willingness to adopt hybrid learning and identify the factors influencing their choices. The goal is to provide a theoretical foundation for reforming teaching models.

Methods: We distributed questionnaires to 235 faculty members and 1501 students at Hubei Medical College to assess their preferences for various teaching models. We analyzed the results using multiple logistic regression analysis.

Results: Among the participants, 34.5% of teachers and 33.7% of students preferred the hybrid teaching model. Influential factors for selecting this model included the quality of online teaching (OR=1.601, 95% CI: 1.221-2.100) and teacher-student interaction (OR=2.568, 95% CI: 1.230-5.361) for teachers. For students, significant factors included online learning tools (OR=1.894, 95% CI: 1.002-3.580), a single teaching method (OR=1.390, 95% CI: 1.042-1.856), low learning efficiency (OR=2.154, 95% CI: 1.673-2.774), and the effectiveness of online learning (OR=1.257, 95% CI: 1.181-1.339).

Conclusion: The blended teaching model has gained popularity among faculty and students in higher education. Universities should leverage advancements in information technology to address challenges in hybrid teaching. Maximizing students' sense of academic achievement and satisfaction is recommended to enhance and support the blended teaching approach.

Purpose: The primary objective of this study was to assess the various coping strategies that medical students at Alfaisal College of Medicine use to adapt to stressors and adversities faced in a medical school environment.

Methods: This cross-sectional study utilized an online questionnaire distributed to medical students (aged 18+) at Alfaisal University from March 15 to April 30, 2023. Inclusion criteria focused on College of Medicine students from Years 1 to 5. The survey assessed stressors and coping strategies, with a modified Brief COPE scale for relevance. A target sample of 240-290 participants was calculated for a 95% confidence level. Data were analyzed using SPSS, applying descriptive statistics and Chi-Square tests. Ethical approval was obtained from the Institutional Review Board, ensuring confidentiality and voluntary participation.

Results: The most common stressors were high parental expectations, academic workload, frequent examinations, self-esteem issues, and sleep deprivation. The most frequently employed coping strategies included spiritual, religious beliefs and practices, stress acceptance, emotional support from family and friends, and humor. This study highlights the coping mechanisms adopted by medical students in Saudi Arabia to address academic challenges.

Conclusion: Understanding the preferred coping techniques in Alfaisal University medical students and recognizing the importance of spiritual well-being and social support can inform interventions to improve both academic performance and mental well-being in this population.