Medical Education Online最新文献

Background: Medical Humanities (MH) curricula integrate humanities disciplines into medical education to nurture essential qualities in future physicians. However, the impact of MH on clinical competencies during formative training phases remains underexplored. This study aimed to determine the influence of MH curricula on internship performance.

Methods: The academic records of 1364 medical students across 8 years of admission cohorts were analyzed. Performance in basic sciences, clinical skills, MH, and internship rotations were investigated, including the subgroup analysis of MH curricula. Ten-fold cross-validation machine learning models (support vector machines, logistic regression, random forest) were performed to predict the internship grades. In addition, multiple variables regression was done to know the independent impact of MH on internship grades.

Results: MH showed the important roles in predicting internship performance in the machine learning model, with substantially reduced predictive accuracy after excluding MH variables (e.g. Area Under the Curve (AUC) declining from 0.781 to 0.742 in logistic regression). Multiple variables regression revealed that MH, after controlling for the scores of other subjects, has the highest odds ratio (OR: 1.29, p < 0.0001) on internship grades. MH explained 29.49% of the variance in internship grades as the primary variable in stepwise regression. In the subgroup analysis of MH curricula, Medical Sociology and Cultural Studies, as well as Communication Skills and Interpersonal Relationships, stood out with AUC values of 0.710 and 0.705, respectively, under logistic regression.

Conclusion: MH had the strongest predictive association with clinical competence during formative internship training, beyond basic medical sciences. Integrating humanities merits greater prioritization in medical curricula to nurture skilled, compassionate physicians. Further research should investigate the longitudinal impacts of humanities engagement.

Background: The practice of evidence-based medicine (EBM) has become pivotal in enhancing medical care and patient outcomes. With the diffusion of innovation in healthcare organizations, EBM can be expected to depend on medical professionals' competences with digital health (dHealth) and artificial intelligence (AI) technologies.

Objective: We aim to investigate the effect of dHealth competences and perceptions of AI on the adoption of EBM among prospective physicians. By focusing on dHealth and AI technologies, the study seeks to inform the redesign of medical curricula to better prepare students for the demands of evidence-based medical practice.

Methods: A cross-sectional survey was administered online to students at the University of Montreal's medical school, which has approximately 1,400 enrolled students. The survey included questions on students' dHealth competences, perceptions of AI, and their practice of EBM. Using structural equation modeling (SEM), we analyzed data from 177 respondents to test our research model.

Results: Our analysis indicates that medical students possess foundational knowledge competences of dHealth technologies and perceive AI to play an important role in the future of medicine. Yet, their experiential competences with dHealth technologies are limited. Our findings reveal that experiential dHealth competences are significantly related to the practice of EBM (β = 0.42, p < 0.001), as well as students' perceptions of the role of AI in the future of medicine (β = 0.39, p < 0.001), which, in turn, also affect EBM (β = 0.19, p < 0.05).

Conclusions: The study underscores the necessity of enhancing students' competences related to dHealth and considering their perceptions of the role of AI in the medical profession. In particular, the low levels of experiential dHealth competences highlight a promising starting point for training future physicians while simultaneously strengthening their practice of EBM. Accordingly, we suggest revising medical curricula to focus on providing students with practical experiences with dHealth and AI technologies.

Interprofessional teaching rounds are a practical application of interprofessional education in bedside teaching, yet there is a lack of research on how interprofessional teaching rounds should be implemented into medical education. This study aimed to describe our experience in developing and implementing interprofessional teaching rounds during a clerkship rotation for medical students, and compares its strengths and weaknesses relative to traditional teaching rounds. Medical students were assigned to either the interprofessional teaching round group (n = 24) or the traditional teaching round group (n = 25), and each group participated in their assigned type of teaching round. A quiz including medical knowledge of gynecological and obstetric diseases was used to assess the students' diagnostic and treatment abilities after teaching rounds. Additionally, a survey was conducted among students to evaluate whether the interprofessional teaching rounds were helpful. The results showed that when using interprofessional teaching rounds, the test score for medical knowledge related to the diagnosis and treatment of gynecological and obstetric diseases was significantly higher than the traditional teaching round group (85.5 ± 11.2 vs 78.3 ± 12.5, p = 0.038). Additionally, the interprofessional teaching rounds significantly enhanced understanding of clinical application, identification, and appropriate problem-solving in cases, as well as examination of different disciplinary aspects of a case, and improvement of interdisciplinary collaboration skills compared to traditional teaching rounds. Our study demonstrates that interprofessional teaching rounds can serve as an effective teaching method for enhancing medical students' ability to collaborate interprofessionally and to solve clinical problems comprehensively.

Background: Texas is one of the states with the lowest access to usual sources of primary care; most critically, family medicine (FM) has been projected to have the greatest physician shortage increase between 2018 and 2032. Texas Tech University Health Sciences Center (TTUHSC) School of Medicine developed the Family Medicine Accelerated Track (FMAT), a 3-year curriculum that culminates in the MD degree and links medical students to FM residency programs at TTUHSC campuses in Lubbock, Amarillo or the Permian Basin. This article reflects on 10 years of experience with the program, and particularly its impact on the primary care physician workforce in Texas.

Curriculum design: TTUHSC medical students in the traditional curriculum complete the Phase 1 pre-clinical curriculum in Lubbock and are distributed for Phases 2 and 3 (MS3/MS4 years) among campuses in Lubbock, Amarillo and the Permian Basin. Similarly, FMAT students complete Phase 1 in Lubbock. For Phase 2 clinical clerkships, their curriculum is delivered on the campus (which may include Lubbock) where they will typically complete 3 years of FM residency training.

Program outcomes: In the 2 years prior to the graduation of the first FMAT class, just over 11% of the graduating class matched into FM. In the decade since, the numbers have varied from year to year (often as high as 17-19% of the class matching into FM) but have always exceeded the pre-FMAT numbers. For the classes 2013 through 2023, 115 students began FMAT training; 90 of them (78%) graduated in 3 years with the MD degree and began FM residency training. Of those 90, 56 have now graduated from residency and taken positions in the primary care physician workforce. Of that group, 86% are practicing in Texas, 64% are in West Texas, and 69% are in rural or underserved communities.

Purpose: At LUMC, a Small Private Online Course (SPOC) was developed complementary to the clinical learning environment of the internal medicine clerkship. The developers used the self-determination theory in the design of the SPOC's assignments aiming to improve learners' intrinsic motivation. This study investigates the impact of the SPOC and its specific assignments on student motivation.

Methods: The study uses a mixed-methods approach. The authors describe a quantitative analysis of students' responses on an intrinsic motivation inventory (IMI), and a qualitative thematic analysis of semi-structured group interviews, respectively.

Results: Seventy-eight students (response rate 42%) filled out the IMI. Their scores were (7-point Likert scale): interest/enjoyment 3.76, competence 4.02, choice 3.53, value/usefulness 4.20, relatedness 3.85. Thematic analysis of the interviews (14 students) revealed seven themes: collaboration with peers, usefulness, SPOC-related factors, workload, motivation, and performance.

Conclusions: Motivation could be optimized creating useful, authentic cases that train skills that are directly transferrable to clinical practice. Challenging, interesting and student-generated assignments positively influenced students' autonomy and motivation. Lack of awareness of online performance negatively affected the feeling of competence. Perceptions of online collaboration were suboptimal. The study can be helpful for other teachers to enhance motivation while developing online courses.

Introduction: The integration of online learning in health professions education has grown rapidly, offering flexibility to learners worldwide. Asynchronous online learning allows residents to engage with educational content at a time convenient for them, accommodating their demanding schedules. This study aims to reveal how residents approach asynchronous online learning during their residency training.

Methods: The Resident Study Log, an asynchronous learning tool, was introduced in a teaching hospital in Japan. This tool facilitated residents to share daily reflections on their learning experiences, allowing supervising physicians outside of their regular clinical teams to provide feedback. Posts shared between April 2020 and July 2021 were reviewed. The outcome measured included the frequency and timing of posts as well as residents' satisfaction and perceived burden, which were assessed through anonymous surveys.

Results: A total of 31 residents participated during the study period, posting 599 entries on the Resident Study Log, averaging one post per resident every two days. Participants reported an average satisfaction score of 5.3 out of 6.0 (6-point Likert scale, where 1 indicated 'not satisfied at all' and 6 indicated 'very satisfied'), while the perceived burden averaged 4.0 out of 6.0 (6-point Likert scale, where 1 indicated 'not burdensome at all' and 6 indicated 'very burdensome'). Notably, posting activity peaked at around 23:00, with 17.4% of posts created between midnight and 5:00.

Conclusion: The Resident Study Log was a simple, low-cost tool, with high satisfaction levels among residents. However, the late-night posting pattern raises concerns about resident well-being and sleep hygiene. As asynchronous learning is increasingly more prevalent, it is crucial to ensure it does not inadvertently impose hidden burdens on learners' overall well-being.

When clinician-educators and medical education researchers use and discuss medical education research, they can advance innovation in medical education as well as improve its quality. To facilitate the use and discussions of medical education research, we created a prefatory visual representation of key medical education research topics and associated experts. We conducted one-on-one virtual interviews with medical education journal editorial board members to identify what they perceived as key medical education research topics as well as who they associated, as experts, with each of the identified topics. We used content analysis to create categories representing key topics and noted occurrences of named experts. Twenty-one editorial board members, representing nine of the top medical education journals, participated. From the data we created a figure entitled, Medical Education Research Library. The library includes 13 research topics, with assessment as the most prevalent. It also notes recognized experts, including van der Vleuten, ten Cate, and Norman. The key medical education research topics identified and included in the library align with what others have identified as trends in the literature. Selected topics, including workplace-based learning, equity, diversity, and inclusion, physician wellbeing and burnout, and social accountability, are emerging. Once transformed into an open educational resource, clinician-educators and medical education researchers can use and contribute to the functional library. Such continuous expansion will generate better awareness and recognition of diverse perspectives. The functional library will help to innovate and improve the quality of medical education through evidence-informed practices and scholarship.

India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.

Academics in medicine are frequently asked to serve on panels to discuss their clinical, research, education, administrative or personal expertise. While panel discussions are often the highlight of a conference or event, in the medical literature, there is very little published on how an individual can effectively prepare and present as an expert panelist. This paper offers guidelines that will enable academics to prepare, deliver, and engage in active dialogue during a panel discussion. Specific tactics include how to accept invitations to serve on a panel, conducting pre-panel conference meetings and background research, preparing concise opening statements and new insights, connecting with the audience, answering questions in a collaborative spirit, and debriefing after the panel. These guidelines will be valuable to any individual invited to serve on a panel discussion and will promote future panelists in engaging in constructive and fulfilling dialogue, with the ultimate goal of leaving the audience with a greater understanding of the topic of discourse.