BMC Medical Education最新文献

Background: A mastery of life-threatening trauma procedures is important for medical students aiming to become proficient physicians. Thus, this study compares the effectiveness of deliberate practice with that of conventional lecture methods in teaching such students these essential skills.

Methods: A randomized controlled trial was conducted with 48 first- to third-year medical students at the Faculty of Medicine Vajira Hospital at Navamindradhiraj University (Thailand). The participants were randomly assigned to either the deliberate practice group (n = 24) or the conventional lecture group (n = 24). The primary outcome was the students' scores on the Objective Structured Clinical Examination (OSCE), whereas the secondary outcome was their overall grades. Moreover, analysis of covariance (ANCOVA) was used to control for the impacts of gender and academic year.

Results: The deliberate practice group had significantly higher OSCE scores (mean = 69.79, SD = 9.49) than did the conventional lecture group (mean = 51.38, SD = 14.59), with a p value of 0.000002. Additionally, the deliberate practice group had no clear failures or seven good passes, whereas the conventional lecture group had five clear failures and no good passes. Moreover, the ANCOVA results indicated that the type of training had a significant positive effect on the students' examination scores, independent of gender and academic year (F (4, 43) = 7.44, p = 0.0001).

Conclusion: Deliberate practice is significantly more effective than the conventional lecture method in teaching life-threatening trauma procedures to medical students. The implication of these findings is that implementing deliberate practice in medical education can enhance the competencies of students, improve their preparedness for real-world clinical settings, and produce better patient outcomes. However, future research should examine the broader applications and long-term benefits of this method in medical training.

Trial registration: TCTR20240816009.

Background: Telehealth is gaining importance in improving healthcare access and outcomes, particularly in underserved regions. Despite its potential, healthcare providers in developing countries struggle to effectively utilize telehealth tools, highlighting the need for structured training. This study aims to develop and validate a specialized tool to assess the telehealth educational environment, addressing the unique challenges of integrating clinical, technological, and interpersonal skills in telehealth education.

Objectives: (1) To develop a tool for measuring the telehealth educational environment, addressing the unique aspects of telehealth education. (2) To evaluate the validity and reliability of the tool.

Method: This mixed-methods exploratory study had two phases. In Phase 1, the THEEM tool was developed through a literature review and expert feedback. In Phase 2, the tool was validated using content validity, response process validity via cognitive interviews, and construct validity through Exploratory factor analysis (EFA). Reliability was assessed using Cronbach's alpha. Participants included telehealth physicians, selected via purposive sampling. Data analysis involved calculating the content validity index for items (CVI-I) and the scale (CVI-S), with values ≥ 0.7. For factor analysis, eigenvalues > 1 and factor loadings ≥ 0.50 were retained. Cronbach's alpha for internal consistency was considered acceptable at ≥ 0.7.

Results: The Preliminary THEEM tool consisted of 35 items. Following content validity through expert validation, the number of items was reduced to 32 based on I-CVI values. S-CVI was 0.86. Exploratory factor analysis yielded three factors with a further reduction in the item number to 30. Internal consistency of the final tool with 30 items was calculated as 0·9, suggesting excellent internal consistency of the tool.

Conclusion: The THEEM tool provides a valuable, reliable, and valid instrument for assessing the telehealth educational environment. Its development fills a significant gap in existing measurement tools, specifically addressing the needs of telehealth education.

Background: Training programs grounded in educational theory offer a systematic framework to facilitate learning and outcomes. This scoping review aims to map the educational approaches documented for manual wheelchair training and to record intended learning outcomes and any relationships between learning theories, instructional design and outcomes.

Methods: Eight databases; Cochrane's Library, EMBASE, CINAHL, PubMed, Scopus, EmCare, Medline, ProQuest Nursing and Allied Health Database and grey literature were searched in September 2023, with citation chaining for relevant papers. Included papers related to manual wheelchair training programs/protocols describing intended wheelchair training outcomes for adults and/or caregivers. Data extracted included study characteristics, type of intervention, explicit learning theories, instructional design principles and intended learning outcomes. The International Classification of Functioning and Kirkpatrick's evaluation framework were used to organise intended outcomes.

Results: Of the forty-four articles included in this review, only fourteen explicitly used a learning theory in the instructional design of training. Training outcomes most commonly related to changes in knowledge/skills of manual wheelchair users (Level 2b of Kirkpatrick's evaluation (n = 43), with less emphasis on participatory outcomes. Training designs incorporating Social Cognitive Theory (n = 8) were more likely to explore long term training outcomes, compared with other training designs.

Conclusion: Wheelchair training programs that are designed using learning theory are more likely to produce learning outcomes that are retained and meaningfully applied. Such longer terms outcomes could have systemic cost and efficiency implications, such as reduction in wheelchair falls and readmissions to hospital. Deliberate integration of learning theory into manual wheelchair training design is recommended to support broad outcomes and long-term learning. This design could synergise different learning theories.

Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person based on individual characteristics. Early evaluation of implicit bias in medical training can prevent long-term adverse health outcomes related to racial bias. However, to our knowledge, no present studies examine the sequential assessment of implicit bias through the different stages of medical training. The objective of this narrative review is to examine the breadth of existing publications that assess implicit bias at the current levels of medical training, pre-medical, graduate, and postgraduate. Protocol for this study was drafted using the Scale for the Assessment of Narrative Reviews (SANRA). Keyword literature search on peer-reviewed databases Google Scholar, PubMed, Ebsco, ScienceDirect, and MedEd Portal from January 1, 2017, to March 1, 2022, was used to identify applicable research articles. The online database search identified 1,512 articles. Full screening resulted in 75 papers meeting the inclusion criteria. Over 50% of extracted papers (74%) were published between 2019 and 2021 and investigated implicit bias at the post-graduate level (43%), followed by the graduate level (34%), and pre-medical level (9.4%). Fourteen percent were classified as mixed. Studies at the medical and medical graduate level identified an implicit preference towards white, male, non-LGBTQIA+, thin, patients. Study findings highlight notable gaps within the sequential assessment of implicit bias, specifically at the pre-medical training level. Longitudinal epidemiological research is needed to examine the long-term effect of implicit biases on existing healthcare disparities.

Introduction: The Ministry of Health, Treatment and Medical Education in Iran has tried integrating the primary science curriculum with the clinical program. This means educational reform has been implemented in most medical schools in Iran. In the study of the medical entomology Discipline, prioritization of educational needs, and determination of appropriate solutions to improve the status of the entomology Discipline in the Faculty of Medicine and Health, the basis of experts' opinions were examined and analyzed.

Objetivo: Insert the subject of medical entomology into the Medicine Discipline at the Faculty of Medicine and Health.

Methodology: The Nominal Group Technique (NGT), which was the papers for recording the opinions of the professors, was done after the focus group. In the focus group, the professors discussed the results obtained from the NGT. This method used the Delphi technique to exchange opinions (disagreement and consensus of experts).

Results: According to the findings of this study, after two technical sessions of the Nominal group, the weak and strong points and required subjects for revision of the chapters of the medical entomology curriculum were determined. Medical entomology in Iranian universities of medical sciences is one of the important topics of medical parasitology Disciplines for general medical students because it provides information about Disease-vector insects and ways to control them (Results two rounds of Delphi).

Conclusion: The educational program of the entomology Discipline needs to be revised and evaluated after the implementation of the revised program.

Background: Central venous catheter placement has been associated with mechanical complications, some of which can be life-threatening. Recent studies have shown that simulation-based education on ultrasound-guided central venous catheter placement improves puncture success rates; however, its effect on reducing mechanical complications remains unclear. This observational study examined how outcome-based simulation training for ultrasound-guided central venous catheter placement affects the incidence of mechanical complications in a clinical setting.

Methods: The Safe Central Venous Catheter Placement and Management Committee established a reporting system to monitor central venous catheter placement. In 2016, a skill assessment of ultrasound-guided central venous catheter placement was conducted. Outcome-based simulation training was introduced in 2017. Skills were evaluated using the skill assessment tool developed by the Japanese Society for Medical Simulation.

Results: After implementing skill assessment and outcome-based simulation training, the mechanical complication rate decreased from 2.2% in 2015 to 1.2% in 2023.

Conclusions: A recent meta-analysis reported a 2.3% mechanical complication rate during ultrasound-guided central venous catheter placement. In comparison, the 1.2% complication rate at our institution is notably lower. This study suggests that outcome-based simulation training for ultrasound-guided central venous catheter placement may help reduce the incidence of mechanical complications in clinical settings.

Background: A significant gap exists in understanding the effectiveness of intra-class (same-class) level peer mentorship programmes designed to enhance academic performance, well-being, and student involvement among underperforming medical students. This study assessed the effectiveness of intra-class (same-class) peer mentorship programme on the academic performances, subjective well-being and school engagement of academically underperforming medical students in Nigeria.

Methods: This was a quasi-experimental research consisting of the pretest-posttest control design at Nnamdi Azikiwe University, Awka, Nigeria. Preclinical medical students from same class level were categorised into three groups: 7 academically underperforming students (mentees) scoring below 45% on the continuous assessment test (CAT), 12 mentors scoring 70% or above, and 30 controls scoring between 50% and 70%. Participants completed the Subjective Vitality Scale (SVS) and the self-University Student Engagement Inventory (USEI) before and after the 6-month programme, led by an experienced educationist. A post-programme CAT assessed academic performance, and quantitative data were analysed using paired-samples t-tests to evaluate changes in academic performance, SVS and USEI. The dimensions of students' subjective vitality and the school engagement were considered in the analysis.

Results: A total of 49 students were included in the study, with 7 (14.3%) in the mentee group, 12 (24.3%) in the mentor group and 30 (61.2%) in the control group. The same-class peer mentorship intervention led to a significant improvement in CAT scores for the mentee group, with their median score rising from 40.0 to 70.0% (p = 0.003), while the control group's median slightly decreased. The mentee group's SVS (p = 0.722) and USEI (p = 0.388) scores non-significantly improved post-intervention. However, specific USEI items revealed significant post-intervention improvements in mentees' classroom engagement or increased participation in discussions (p = 0.001) and enjoyment of school (p = 0.031). SVS items showed non-significant differences between groups post-intervention.

Conclusion: The same-class peer mentorship intervention significantly improved CAT scores among academically underperforming medical students, with modest gains in SVS and USEI scores. While overall vitality and engagement changes were not significant, classroom engagement improved. These findings support intra-class peer mentorship in medical education.

Background: To gain culturally appropriate awareness of First Nations, Inuit and/or Métis Health, research suggests that programs focus on sending more trainees to First Nations, Inuit and/or Métis communities Working within this context provides experiences and knowledge that build upon classroom education and support trainees' acquisition of skills to engage in culturally safe healthcare provision. This study examines residents' and faculty members' perceptions of how residency training programs can optimize First Nations, Inuit and/or Métis health training and support residents in gaining the knowledge, skills, and experiences for working in and with First Nations, Inuit and/or Métis communities.

Methods: A qualitative approach was used, guided by a relational lens for collecting data and a constructivist grounded theory for data interpretation. Theoretical sampling was used to recruit 35 participants from three main study sites across two western Canadian provinces. Recruitment, data collection, and analysis using constructivist grounded theory occurred concurrently to ensure appropriate depth of exploration.

Results: Our data analysis revealed five themes: Five themes were generated: Complexity of voluntourism as a concept; Diversity of knowledge representation required for developing curriculum; Effective models of care for First Nations, Inuit and/or Métis health; Essential traits that residents should have for working in First Nations, Inuit and/or Métis communities; and Building relationships and trust by engaging the community.

Conclusions: First Nations, Inuit and/or Métis Health should be prioritized within Canadian postgraduate medical education. Equipping trainees to provide holistic care, immersing in and learning from First Nations, Inuit and/or Métis communities is essential for developing the next generation of clinicians and preceptors. We present educational recommendations for residency programs to optimize First Nations, Inuit and/or Métis health educational experiences and provide residents with skills to provide effective and culturally safe care.

Through progressive policies, Rwanda has made significant strides in promoting girls' education and empowerment. However, female enrollment in Bachelor of Medicine and Bachelor of Surgery (MBBS) programs remains disproportionately low. This cross-sectional study investigates the influence of gender stereotypes and girls' self-perceptions on female engagement in MBBS programs in Rwanda. The data analyzed for this study has been used and published in BMC Medical Education in a study with a different but clearly related focus, under the title "Gender-based support systems influencing female students to pursue a bachelor of medicine, bachelor of surgery (MBBS) in Rwanda" (Neil KL, BMC Med Educ 24:641,2024). While the previous analysis focused on the presence and gaps in gender-based support systems, the current research has a new focus on gender based self-perceptions influence in girls interest in pursuing medical school training. Conducted across 13 secondary schools and 3 universities offering MBBS degrees, the study engaged 8-12 students, parents/guardians, and teachers in each focus group discussion in a total of thirty-four focus group discussions and sixteen semi-structured interviews. Twenty-eight discussions took place at the secondary school level, and six were conducted at the MBBS level. Data analysis utilized inductive coding to identify recurring themes. The study identified three overarching themes: society's role in shaping gendered expectations about domestic and professional roles, girls' self-perceptions regarding their ability to pursue sciences and MBBS within these norms, and internalized stereotypes affecting girls' career aspirations. Drawing on gender schema and social cognitive theory, the research underscores how societal expectations and stereotypes shape and constrain girls' career choices. The findings highlight the necessity of dismantling gender-based perceptions that hinder girls' participation in scientific disciplines, including MBBS.

Objective: Despite the growth of Emergency Medicine (EM) globally, shortages of EM-trained physicians persist in many countries, disproportionately affecting lower middle/low-income countries (LMIC/LIC). This study examines the career paths of graduates of an Emergency Medicine residency-training program established in Lebanon with the aim of building local capacity in EM.

Design and patients: This descriptive study utilizes secondary data sourced from an alumni database that includes nine cohorts of graduates from an Emergency Medicine residency program at the American University of Beirut Medical Center in Lebanon.

Measurements and main results: Within 12 years since the EM residency program establishment a total of 9 cohorts, including 44 physicians had completed their residency training in EM, with 40.9% being female and 95.5% Lebanese citizens. After graduation, almost half of our graduates (47.7%) enrolled in fellowship training programs and 40.9% joined the workforce. Fellowships in Trauma (19%) and Oncologic Emergencies (19%) were the most commonly pursued. Initial employment destinations predominantly included Lebanon, the United Arab Emirates and the Kingdom of Saudi Arabia, (61.1, 33.3 and 5.6% respectively). However, retention within the local market declined with time, with a median time spent in Lebanon of 1 year and a mean of 3.3 years of practice in Lebanon prior to emigration. Presently, graduates are mostly dispersed across the Gulf Cooperation Council region (38.6%), the USA (25%), and Lebanon (20.5%).

Conclusion: Building Emergency Medicine expertise to match the growing population needs for specialized acute care remains a challenge globally, especially in low-middle income and low-income countries. Our study highlights the challenge of retaining specialized medical graduates in LMIC. Understanding and addressing the root-causes of out-migration of highly specialized medical workforce is an essential component of addressing local workforce challenges that needs to be coupled with capacity building initiatives for meaningful impact.