BMC Medical Education最新文献

Background: In-service training is critical for achieving organizational goals and developing the health workforce. Therefore, this study aimed to identify contextual factors that significantly impact the implementation of in-service training policies for the health workers.

Methods: This study employed an inductive qualitative approach, utilizing semi-structured interviews as the data collection method. The target group consisted of human resources managers and experts. Purposeful sampling was conducted using the snowball method. A total of 23 interviews were conducted, and data saturation was achieved. Framework analysis was performed using MAXQDA10 software to analyze the data. To enhance the credibility of the findings, interview transcripts, and the initially extracted codes were shared with participants for verification. Additionally, various methods were employed to ensure the accuracy and reliability of the data, including seeking input and additional comments from two colleagues and one expert familiar with qualitative research, as well as sending the interview transcripts and extracted codes to each participant for correction during the data collection phase.

Results: The analysis of the data identified seven themes and 16 subthemes related to the implementation of in-service training for healthcare workers. These themes include social factors, personal characteristics, economic and political factors, crises and epidemics, organizational factors, and legal factors. Social factors, such as social crises and demographic characteristics, can affect the type of training provided. Personal characteristics, including motivation, age, job position, and gender, can influence the implementation of training. Political and economic factors, such as government policies and budget constraints, also play a role. Crises and epidemics present opportunities for relevant training. Organizational factors, such as top management commitment and organizational culture, determine the success of training. Legal factors, including restrictive laws and incentives, impact the implementation of training.

Conclusions: The implementation of policies cannot be considered in isolation from contextual factors. Therefore, decision-makers and policymakers should thoroughly identify and analyze the relevant contextual factors when formulating and implementing policies. This approach will enable them to make informed decisions based on the specific context.

Background: Internship is a phase of training wherein medical graduates acquire the skills and competencies required to function independently. It has been reported that interns lack confidence in performing common procedures, as these skills are often learnt through self-learning or performing without supervision. This type of learning endangers patient safety and fails to instil the required confidence in the student. Training in skills laboratories provide opportunity to learn clinical skills in a safe environment. However, skills laboratories are resource-intensive, and there is limited information on different training approaches, such as blended learning, and how the trainees perceive their usefulness. Hence, we conducted this pilot study to assess the perceived usefulness of a blended learning approach for skills training among medical interns.

Methods: This mixed methods study was conducted in the skills laboratory of an apex medical institute in India, among 42 interns posted for the Interns Skill-based Clinical Induction Program (ISCIP). In this training, a blended learning approach was adopted, which comprised of two components - an online e-learning module, followed by a hands-on training session. The trainees were asked to complete a feedback form and grade different components of the online session, and hands-on session on a five-item Likert-based scale. The scores were expressed as the mean (SD) of a maximum possible score of 5 for each of the components. In order to gain insight of the perceived usefulness of skills training among learners, focused group discussions (FGDs) were conducted.

Results: The mean (SD) score for perceived importance ranged from 5 (0) to 4.9 (0.2) for various skills. The proportion of interns who felt confident in performing the skill after the training was 88.1% for IV cannulation to 97.6% handwashing, and gloving and gowning. The findings of the qualitative component revealed that interns found the training to be useful and interesting. It was perceived to be more ethical, uniform, well-structured, and provided an opportunity to practice a skill repeatedly.

Conclusions: The blended learning approach was perceived to be useful among the medical interns. Further research may be conducted in other medical institutes to assess the effectiveness of skills training.

Clinical trial registration number: Not applicable, as the study is not a trial.

Background: The ability of healthcare providers to access and use published research correctly is crucial for the quality of healthcare services, enabling selection of the most effective treatment modalities, and avoidance of medical errors. Physicians need strong critical appraisal (CA) skills to manage rapidly evolving medical knowledge.

Methods: A standard peer-teaching module was prepared for medical residents on CA. The module included topic-specific educational materials, discussion articles, and question sets and was pilot-tested among medical residents, allowing for revisions based on participants' feedback. Training module was prepared by a senior epidemiologist and a community medicine (public health) resident, based on the context of a similar graduate course; the resident underwent four months of personal training preceding the pilot testing, which was conducted as a 12-week program in September-November 2023, supervised by experts. Online training extended our reach to resident working nationwide. Recruitment was enabled via social media and various medical specialty organizations. Evaluations included initial, session-specific, and final tests for measuring progress in knowledge on CA, based on participants' self-assessments, and external auditors' scoring of the process.

Results: A total of 52 residents from 19 universities and nine specialty programs participated in pilot testing. Of these, 48 completed the program through the post-test, with 83% (n = 40) scoring above 65%, received a certificate of achievement. Median scores showed a 32% increase in knowledge, a 75% increase in confidence in CA skills, and a 50% decrease in stress-related to CA practice. Additionally, 82.5% (n = 33) of those who completed the module expressed interest in offering similar training sessions to their local peers.

Conclusion: The online peer teaching of the CA module successfully increased participants' knowledge and self-confidence in critical appraisal.

Clinical trial number: Not applicable.

Background: Chinese medical students face rigorous academic demands and exacting professional challenges, which lead to significant psychological stress. Understanding perceived stress and psychological resilience is key to enhancing emotional regulation and empathy. This study explores the hypothesis that psychological resilience impacts the perceived stress of medical students, with the Optimistic Intelligence Quotient (OQ) and the Adversity Quotient (AQ) acting as serial mediators, thereby promoting students' mental health.

Methods: A questionnaire survey was conducted to assess psychological resilience, perceived stress, OQ, and AQ among students from the top 20 medical colleges in mainland China. Using random sampling, 60 students per institution were selected, yielding 1,024 valid responses from 1,200 distributed questionnaires. Data were analyzed using correlation and mediation analysis.

Results: The results showed a significant negative correlation between psychological resilience and perceived stress. OQ was significantly associated with reduced stress and enhanced overall well-being, while AQ was related to stress management skills.A serial mediation pathway was identified from psychological resilience to OQ and AQ, forming a chain influencing perceived stress.

Conclusions: This study highlights the current psychological stress among Chinese medical students and the serial mediating roles of OQ and AQ. Tailored interventions in medical education should focus on enhancing psychological resilience to reduce perceived stress. Future research should explore alternative frameworks in positive psychology and develop new stress management intervention models.

Background: Psychological phenomena such as impostor phenomenon (IP) and low work-related satisfaction increase the risk of burnout among medical professionals. The prevalence of these contributory risk factors among South Asian medical professionals has not been examined thus far. This study aims to assess the prevalence, severity and associations of IP, including self-reported satisfaction with training, in a cohort of postgraduate doctors in Sri Lanka.

Methods: This cross-sectional study was conducted among medical and surgical postgraduate trainees enrolled at Post Graduate Institute of Medicine, University of Colombo. A self-administered questionnaire including the Clance Impostor Phenomenon Scale was used for data collection. SPSS version 26 was used for analysis, and associations were analysed using Chi Square and logistic regression.

Results: The response rate was 75.3% (n = 201). Of the study population, 9% (n = 18) experienced few impostor characteristics, 51.7% (n = 104) experienced moderate impostor characteristics, 38.8% (n = 78) experienced frequent impostor characteristics and 0.5% (n = 1) experienced intense impostor characteristics. The mean IP value was 55.55 (SD-12.03), in the category of moderate IP. Significant associations were seen between IP and sociodemographic factors of being single, lack of friendships outside medicine and improvement in financial status related to medical profession (p < 0.05); academic factors such as satisfaction with pursuing postgraduate training and satisfaction with academic performance (p < 0.05); work-related factors such as early stages of postgraduate training, lack of confidence in communicating with superiors and other specialties, receiving criticism from the team and sense of guilt regarding patient outcomes (p < 0.05). Self-reported satisfaction with postgraduate training was expressed by 79.1% (n = 159) of trainees, with 59.2% (n = 119) self-reporting poor work-life balance. Self-reported satisfaction with training was associated with satisfaction with chosen specialty, self-reported satisfaction with academic performance, good work-life balance, confidence in interpersonal interactions, financial stability and family support (p < 0.05).

Conclusions: A significant number of Sri Lankan medical and surgical postgraduate trainees experienced IP. This phenomenon is significantly associated with sociodemographic, academic and work-related factors. Self-reported trainee satisfaction with postgraduate training was high and associated with positive psychosocial factors.

The ongoing war crisis in Khartoum, Sudan, has created significant challenges for medical students, impacting their education. A cross-sectional study involving 224 medical students was conducted in Khartoum state to explore the challenges faced by medical students during this crisis, using a structured Google Form questionnaire. The majority of participants were female (65.6%), fourth-year students (36.6%), and aged between 22 and 25 years (66.8%). Notably, 92% of the participants had been displaced from Khartoum. The study found that a majority of participants reported experiencing physiological distress, with study distractions (65.2%), anxiety (51.8%), and depression (49.1%). Significant gender differences were observed, with females reporting higher psychological distress compared to males (p-value = 0.04). Additionally, 45% of participants noted that the war led to a shortage of experienced teaching staff, and 56.6% raised concerns about the potential decline in the quality standards of their university's curriculum. Nearly 48% of participants expressed a desire to collaborate with international or local universities in stable regions to continue their education. However, 20.2% believed that online learning can effectively maintain the continuity of their education. A significant correlation was found between university type and the ability to resume activities online or outside of Khartoum State (p-value = 0.01). The study concludes that the war crisis in Khartoum State has had significant, negative consequences for medical students, impacting their mental well-being, access to necessary resources, and overall learning experiences. Immediate interventions, psychological support, and increased coordination and collaboration among international and regional academic institutions are needed.

Background: Well-designed escape room games engage students with complex problems and challenge clinical and teamwork skills, but their impact on learning has been uncertain. This study aimed to estimate the effect size of escape room game on performance in a broad knowledge test.

Methods: During clinical rotation in reproductive endocrinology and infertility (REI), medical students participated in a 3-hour small-group class. For 2 semesters, groups had traditional patient visits and case discussions, and for 3 semesters, patient visits and an escape room game including debrief. The game was set up in the outpatient clinic, the puzzles were taken from clinical problems in REI, and challenges included operating an ultrasound scanner on a mannequin. Mid-semester, students completed a test of general knowledge in REI. To estimate the effect of small group class on declarative knowledge, test scores of students who had already had the class (exposed) were compared to scores of those who had not yet had the class (control).

Results: Students were highly satisfied with gamified teaching. Those who attended the small group class without the escape room game achieved similar scores on knowledge test than control students (Cohen's d = 0.05, 95%CI -0.58 to 0.68, n = 71). Students who played the escape room game achieved marginally higher score than respective controls (Cohen's d = 0.22, 95%CI -0.1 to 0.53, n = 182).

Conclusions: Escape room game may improve learning outcome of a traditional small group class, but the effect of a single game session on declarative knowledge is modest and is unlikely to exceed related instructional methods like simulation.

Background: This study utilizes a Knowledge, Attitude, and Practice (KAP) questionnaire to investigate the awareness of medical professionals in the Ningxia region regarding research integrity and their attitudes towards academic misconduct. A comprehensive analysis of the factors contributing to academic misconduct is performed, with the aim of providing insights for the formulation of policies to enhance research integrity.

Methods: This study is a cross-sectional study. It performed between May 2023 and October 2023, and the questionnaires were distributed and collected through Wenjuanxing and WeChat platforms. The research employs a self-designed KAP survey questionnaire distributed online for clinical doctors and nurses in hospital, faculty members in medical higher education institutions, and undergraduates enrolled in medical schools in the Ningxia region.

Results: A total of 1013 valid questionnaires were collected, with a majority of participants (76.2%) having received training in research integrity. The survey results indicate that a significant majority of participants (75.04%) cannot tolerate academic misconduct. More than 70% of respondents believe that the main reasons for academic misconduct are a lack of understanding of academic ethical norms, a deficiency in personal integrity awareness, individual inadequacy in research capabilities, and excessive pressure. When it comes to measures for academic misconduct reduction, over 70% of individuals believe that strengthening research integrity training, improving the assessment methods for research outcomes, and enhancing personal research capabilities can decrease instances of academic misconduct. Most respondents demonstrated a basic understanding of research integrity and maintained a resistant attitude towards academic misconduct. However, there exists an insufficient awareness of certain forms of academic misconduct. The study recommends implementing multifaceted measures to enhance the ethical awareness and attitudes of researchers.

Conclusion: In this study, a KAP questionnaire was administered to clinicians, nurses, medical faculty and students to find out their understanding of research integrity and their attitudes towards academic misconduct. Most of the respondents had a negative attitude towards academic misconduct, but their understanding of research integrity could be improved. Furthermore, university teachers' understanding of research integrity and their attitudes towards academic misconduct were better than other groups, and university students had lower scores in this area, so it is recommended to take various measures to improve their understanding of research integrity.

Background: Regarding the evidence-based practice (EBP) process, nurses tend to perceive that critical appraisal of research articles is challenging. Though critical appraisal in EBP has been a frequent topic in medical education, implementing and disseminating existing EBP education for nurses are challenging in countries with limited EBP educational resources. This study aimed to evaluate changes in practice, attitude, knowledge and skills of EBP before and after an EBP workshop focused on critical appraisal among advanced practice nurses.

Methods: This study was a before and after educational intervention study. The workshops were provided in small groups in 2017 and 2018. The targeted nurses were certified nurse specialists (CNSs) who provide patient care and are certified as advanced practice nurses. The workshop was designed to include at least one CNS in each group. The Japanese version of the Evidence-based Practice Questionnaire, with four subscales-practice, attitude, and knowledge and skills of research and practice-was evaluated four times: baseline, immediately after the workshop, and 3 and 6 months after the workshop. At the end of the workshop, the participants wrote their learning objectives and plans for improving their critical appraisal of EBP. A self-reflection questionnaire was distributed 3 months after the workshop, and a qualitative descriptive analysis was used.

Results: Eleven CNSs participated in this study. Only the score of the knowledge and skills of research showed a statistically significant change. Many participants did not perform critical appraisal of research articles after the workshop. The facilitators were to have a role in integrating research evidence into practice and the barriers to being too busy, personnel transfers, and insufficient conditions.

Conclusions: Self-efficacy for critical appraisal in EBP might increase through the EBP education workshop. Even nurses interested in EBP require ongoing learning opportunities and organizational support for EBP activities.

Trial registration: This study was retrospectively registered with University hospital Medical Information Network Clinical Trial Registry (UMINCTR) on 09/14/2018 (Registration Number. UMIN000034146).

Background: Utilising ultrasound technology has resulted in higher success and lower complication rates during regional anaesthesia (RA) procedures. Proper training is necessary to accurately identify structures, optimise images, and improve hand-eye coordination. Simulation training using immersive virtual environments and simulation models has enabled this competency training to be conducted safely before performing on patients. We conducted a study to compare the simulator performance and users' feedback on a Blue Phantom Regional Anaesthesia Ultrasound Training Block and NeedleTrainer™.

Methods: Forty-seven participants were recruited via convenient sampling during a RA workshop for novice practitioners. They were divided into the N or B group and then crossover to experience using both Blue Phantom and NeedleTrainer model. Time-to-reach-target, first-pass success rate, and complication rate were assessed, while the learning and confidence scores were rated using six-item and three-item questionnaires, respectively, via a 5-point Likert scale.

Results: Blue Phantom model has a longer time-to-target as compared to the NeedleTrainer model (16 ± 8 vs 8 ± 3 s, p < 0.001), higher first- pass success rate (100% vs 80.9%), and lower complication rate (0% vs 19.1%). Higher overall learning satisfaction scores (28 ± 4 vs 25 ± 4, p = 0.003) and confidence scores after training (13 ± 2 vs 12 ± 2, p < 0.001) were recorded for the Blue Phantom model.

Conclusions: We postulated that the artificial intelligence structure recognition software enables NeedleTrainer users to attain shorter time-to-target. That being said, Blue Phantom provides better operator learning satisfaction, improved confidence, higher success and lower complication rates among novice RA practitioners, possibly due to greater tactile feedback during the simulated training.