BMC Medical Education最新文献

Background: For emergency medical services (EMS) clinicians, clinical judgment is a higher-order construct that encompasses the initial thought process (clinical reasoning) that assists clinicians in reaching conclusions (clinical decision making). Current theoretical frameworks of clinical judgment contain other higher order constructs (e.g., leadership, communication) which may play a significant role in delivery of care. It is unknown whether this definition of clinical judgment includes additional higher order constructs of leadership and communication. The goal of this evaluation was to determine whether leadership and communication overlap and are subsumed under the larger construct of clinical judgment.

Methods: Focus groups of experts in prehospital paramedic and advanced emergency medical technician levels of certification were recruited to generate tasks and their associated knowledge, skills, and abilities (KSAs) in for the domains of clinical judgment, communication, and leadership. These tasks and KSAs were then evaluated for commonality between the domains to evaluate whether communication and leadership are incorporated within clinical judgment.

Results: Task-KSA matrices were generated by focus groups for each domain and evaluated by certification level. There were no differences by certification level in the tasks-KSA matrices for the domains. A total of 77 tasks were identified, comprised of 392 KSAs across three domains (9 sub-domains). An analysis of commonality of tasks between the domains of communication and leadership with clinical judgment demonstrated that 61% of communication tasks were similar to the identified clinical judgment tasks. Similarly, in leadership, clinical judgment had a total of 79% commonality overall.

Conclusion: Clinical judgment was found to be a higher order construct that overlaps with and incorporates the domains of leadership and communication in the theoretical framework of EMS clinical judgment. This study provides validity evidence for the proposed clinical judgment theoretical framework. Future work should focus on pilot evaluations in simulated settings for building additional construct validity.

Objective: To review United States chiropractic state boards acceptance of chiropractic residencies and fellowships as continuing education (CE).

Methods: Between February 2024 and April 2024, board websites and accompanying policy documents for all 50 states and the District of Columbia were manually searched for content related to residencies and fellowships and whether they were considered CE. Information regarding CE credit requirements for new licensees was also collected. Results were tabulated in a spreadsheet and descriptive analysis was performed. Consensus among a minimum of 5 of 6 investigators was sought.

Results: Four states (Arizona, Indiana, Kansas, and Minnesota) accept residencies or fellowships for CE credit, 6 states possess unclear regulatory language regarding these programs, and 41 states make no mention of these training programs among approved CE. Twenty-one states required CE credits during a licensee's initial renewal period, 1 state was unclear based on website content alone, and 29 states did not mandate CE for initial license renewal. More than 90% (19/21) of states that require CE for a licensee's first renewal do not or are unclear if they accept residencies or fellowships for credit.

Conclusion: Few chiropractic state boards currently accept residencies and fellowships as approved CE. As the number of these postdoctoral training programs for chiropractors grow, more state boards may be asked to determine their CE policies on them.

Background: Interprofessional education (IPE) refers to a teaching and learning method in which students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. A systematic review was performed to investigate the current practice and the effectiveness of IPE in pharmacy education.

Methods: Databases including PubMed, Embase, Cochrane Library, Medline, China National Knowledge Infrastructure, VIP China Science and Technology Journal, and WanFang were searched from inception to September 20, 2024, using search terms such as interprofessional, interdisciplinary, multidisciplinary, IPE, pharmacy, and pharmaceutical education. Studies were screened and included if they were randomized controlled trials (RCTs) or cohort studies reporting the outcome differences between pharmacy students participating in IPE activities and those receiving lecture-based learning. Reporting quality was evaluated using the Cochrane Risk of Bias Assessment Tool 2 and the Newcastle Ottawa Scale. Detailed information including the studies' general information, research methods, and results were collected. Primary outcomes including pharmacy students' interprofessional competence, readiness for and attitudes towards IPE, class satisfaction, and professional knowledge were analyzed with meta-analysis or reported descriptively.

Results: Seven RCTs and seven cohort studies were included in the systematic review. Eight studies reported that IPE demonstrated a positive impact on pharmacy students' interprofessional competence (p < 0.05). Three studies showed that IPE enhanced students' readiness for participating in interprofessional learning (p < 0.05). Four studies revealed that IPE significantly improved the attitude of pharmacy students towards IPE (p < 0.0001). The meta-analysis of the two cohort studies showed that IPE significantly improved the Attitudes Towards Health Care Teams (ATHCT) scale scores (SMD = 0.41, 95% CI = 0.22-0.60). Students who participated in IPE activities were generally satisfied with the course (average score > 4.0 out of 5.0). Apart from embedded in courses, some novel IPE programs were conducted, such as outpatient clinics operated by interprofessional students.

Conclusions: The study revealed that IPE was widely used in pharmacy education. IPE enhanced pharmacy students' interprofessional competence, class satisfaction, and their readiness for and attitudes towards interprofessional learning. The effect of IPE on professional knowledge remained controversial across studies.

Background: Academic Burnout (ABO) is prevalent among medical students and is characterized by mental and physical exhaustion, cynicism, and a sense of inadequacy. Informal Peer-Assisted Learning (IPAL) is recognized as an effective strategy to enhance student wellness and mitigate ABO by fostering collaborative learning and support without direct faculty oversight. This study evaluates the effectiveness of IPAL in reducing ABO, focusing on the mediation of the observed variables and its impact on student well-being.

Methods: This study extends previous research using Structural Equation Modeling (SEM) to include mediation analysis of the observed variables within the latent constructs of Cynicism (CY) and Inadequacy (IN) that are thought to influence the relationship between IPAL and ABO. Data were sourced from a validated Student Burnout Inventory (SBI-8) across a sample of medical students with varied IPAL engagement levels. Our approach used General Linear Model (GLM) mediation models to explore both direct and indirect effects of IPAL on ABO.

Results: The indirect effect of IPAL on ABO is mediated through specific observed variables, including CY2 "loss of interest in academic work" (β = -0.092, CI, -0.174/-0.011, p = 0.027), IN1 "feeling of inadequacy" (β = -0.062, CI, -0.12/-0.005, p = 0.035), and IN2 "reduced academic expectations" (β = -0.042, CI, -0.079/-0.007, p = 0.025). The total effect of IPAL on ABO was significant (β = 0.170 CI, -0.326/-0.010, p = 0.034), the total indirect effect was significant (β = -0.197, CI, -0.338/-0.055, p = 0.006).

Conclusions: IPAL effectively addresses critical aspects of burnout, specifically through reducing feelings of cynicism and inadequacy among medical students. These results provide a valuable framework in designing targeted interventions to reduce ABO.

Background: The humanities can aid in the development of important skills for trainee physicians. Because of the nature of their work, palliative medicine residents are expected to apply humanities-based skills frequently in their clinical work and are also likely to use humanities-based skills to support their own self-care. Our project explored the role of the humanities in palliative medicine residency programs across Canada.

Methods: Each priority topic or objective of the current palliative medicine residency training standards in Canada was reviewed to determine whether they relate to the humanities. A cross-sectional survey was subsequently created using Qualtrics, with the target study population being current palliative medicine residents and palliative medicine staff physicians at academic centers in Canada.

Results: Multiple humanities objectives exist in Canadian palliative medicine training standards, primarily in the ethical, cultural, and spiritual domains. Eighty-seven people completed the cross-sectional survey, for a 17.4% response rate and 94.6% completion rate. The vast majority (90%) of survey participants felt that the humanities had an important role in medical training at the undergraduate and postgraduate levels, and more than 70% of participants felt that the humanities had an important role in palliative medicine residency training. In some areas, the humanities participants felt that their programs would most benefit from ethics, philosophy, and culture. Over 65% agreed or strongly agreed that their own palliative medicine program would benefit from more humanities content.

Conclusion: Canadian palliative medicine training standards require residents to demonstrate humanities-based skills. Most survey participants state that the humanities have an important role in medical training at the undergraduate and postgraduate levels, and that their own palliative medicine residency program would benefit from more humanities content. These results may guide future studies to better understand why and how more humanities content can be added to palliative medicine residency programs to optimize residents' learning experiences and better prepare them for careers in palliative medicine.

Background: Internal medicine (IM) residents face significant challenges when pursing subspecialty fellowships. This study determined the factors that differentiate IM residents entering pulmonary and critical care medicine (PCCM) fellowships from those pursuing other careers.

Methods: We completed a retrospective study of 12 classes of IM residents at a single institution completing residency between 2010 and 2021. Data included pre-residency characteristics, global residency performance, and PCCM-specific experiences. Logistic regression models examined associations between these variables and the primary outcome of matching into a PCCM fellowship within one year of completing IM residency.

Results: Among 522 residents, 10.3% matched into PCCM. Completing a pulmonary elective significantly increased the odds of matching into PCCM (OR 7.78, 99% CI 3.10-19.53, p < 0.0001). Residents who match into PCCM were more likely to have < 3 publications than 3 + (OR 3.51 (1.20-10.25), p = 0.003)." A stated intent to enter PCCM was positively associated with matching into PCCM in the univariable, but not the multivariable, model.

Conclusions: Matriculating into PCCM fellowship was significantly associated with completing a pulmonary elective during residency. PCCM-bound residents were less likely to achieve high numbers of publications, suggesting these residents' preferences for clinical learning and practice over scholarship. This study provides insights into characteristics of residents who match into PCCM and guides mentors as they counsel residents considering PCCM.

Background: Spaghetti knotting technology is an emerging technique that can reduce the visual field restriction of the operator in laparo-endoscopic single site (LESS) surgery. Multi-directional stitching technology has been proved to improve the accuracy of suturing in clinical application of LESS surgery. Therefore, we conducted a study to evaluate the teaching efficacy and the operation workload of spaghetti knotting technology and conventional knotting technology in LESS suture teaching based on the multi-directional stitching technology.

Methods: We selected forty junior residents to learn the skill of knot tying with single-hole laparoscopic simulators. The forty students were randomly and equally divided into control group and experimental group. The control group was trained by the conventional knotting method, and the experimental group was trained by the spaghetti knotting technology. The grades were calculated before and after the training program, including operation score of suturing time, trhead length, needle insertion accuracy, knotting stability, tissue integrity, tissue tightness and the cognitive workload score of mental, physical and temporal demands, performance, effort and frustration.

Results: There was no significant difference between two groups before training. After training, knotting skills and workload were significantly improved. There were significant differences between the two groups in knotting time (p = 0.001), thread length (p = 0.01), and tissue integrity(p = 0.003). The experiment group took less time, left longer thread and had higher tissue integrity. The workload of the experiment group was also accurately reduced. However, there was no significant difference between the two groups in needle insertion accuracy(p = 0.560), knotting stability(p = 0.059), and tissue tightness(p = 0.731).

Conclusion: In LESS suture teaching based on the multi-directional stitching technology, the training of spaghetti knotting techniques significantly improved students' learning efficacy and reduced their workload compared to training conventional knotting techniques. It suggested the combination of spaghetti knotting and multi-directional stitching technology could be a practicable method for laparoscopic skills teaching and a feasible clinical application value on spaghetti knotting technology in LESS surgery.

We read with great interest the recently published article by Amiri et al., titled "Medical, Dental, and Nursing Students' Attitudes and Knowledge Toward Artificial Intelligence: A Systematic Review and Meta-Analysis." We would like to offer comments on certain aspects of the findings that we believe warrant further discussion.

Background: Traditional puncture skills training for refresher doctors faces limitations in effectiveness and efficiency. This study explored the application of generative AI (ChatGPT), templates, and digital imaging to enhance puncture skills training.

Methods: 90 refresher doctors were enrolled sequentially into 3 groups: traditional training; template and digital imaging training; and ChatGPT, template and digital imaging training. Outcomes included theoretical knowledge, technical skills, and trainee satisfaction measured at baseline, post-training, and 3-month follow-up.

Results: The ChatGPT group increased theoretical knowledge scores by 17-21% over traditional training at post-training (81.6 ± 4.56 vs. 69.6 ± 4.58, p < 0.001) and follow-up (86.5 ± 4.08 vs. 71.3 ± 4.83, p < 0.001). It also outperformed template training by 4-5% at post-training (81.6 ± 4.56 vs. 78.5 ± 4.65, p = 0.032) and follow-up (86.5 ± 4.08 vs. 82.7 ± 4.68, p = 0.004). For technical skills, the ChatGPT (4.0 ± 0.32) and template (4.0 ± 0.18) groups showed similar scores at post-training, outperforming traditional training (3.6 ± 0.50) by 11% (p < 0.001). At follow-up, ChatGPT (4.0 ± 0.18) and template (4.0 ± 0.32) still exceeded traditional training (3.8 ± 0.43) by 5% (p = 0.071, p = 0.026). Learning curve analysis revealed fastest knowledge (slope 13.02) and skill (slope 0.62) acquisition for ChatGPT group over template (slope 11.28, 0.38) and traditional (slope 5.17, 0.53). ChatGPT responses showed 100% relevance, 50% completeness, 60% accuracy, with 15.9 s response time. For training satisfaction, ChatGPT group had highest scores (4.2 ± 0.73), over template (3.8 ± 0.68) and traditional groups (2.6 ± 0.94) (p < 0.01).

Conclusion: Integrating AI, templates and digital imaging significantly improved puncture knowledge and skills over traditional training. Combining technological innovations and AI shows promise for streamlining complex medical competency mastery.