MedEdPublish (2016)最新文献

Background: Accreditation in medical education has existed for more than 100 years, yet the impact of accreditation remains inconclusive. Some studies have shown the effects of accreditation on student outcomes and educational processes at medical schools. However, evidence showing the impact of accreditation on continuous quality improvement of undergraduate medical education programs is still in its infancy. This scoping review explores the impact of accreditation on continuous quality improvement (CQI).

Methods: This scoping review followed the methodology of the Preferred Reporting Items of Systematic Reviews and the Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist outlined by Arksey and O'Malley (2005). Databases, including PubMed, Medline, ERIC, CINHAL, and Google Scholar, were searched to find articles from 2000 to 2022 related to the accreditation of undergraduate medical education programs and continuous quality improvement.

Results: A total of 35 full-text articles were reviewed, and ten articles met our inclusion criteria. The review of the full-text articles yielded four themes: Accreditation and its standards in general, Accreditation and its impact on student outcomes, Accreditation and its impact on medical school's educational processes, Accreditation and CQI. However, the literature evidence suggesting the impact of accreditation on CQI is minimal. The quality assurance approach is based on meeting the standards of accreditation. The quality improvement approach is based on striving for excellence. Literature suggests a requirement to move from student outcomes to CQI measures. CQI requires everyone in the organization to take responsibility and accountability, considering quality as the result of every single step or process and leaders supporting improvements in data collection and data analysis for quality improvement.

Conclusions: The literature on accreditation and CQI are limited in number. More research studies are required to enhance undergraduate medical education accreditation practices' value to medical students, educators, academic leaders, programs, and the public. It was recommended that medical schools embrace the culture and vision perpetuated by the CQI process.

Background: Medical educational societies have emphasized the inclusion of marginalized populations, including the lesbian, gay, bisexual, transgender and queer (LGBTQ+) population, in educational curricula. Lack of inclusion can contribute to health inequality and mistreatment due to unconscious bias. Little didactic time is spent on the care of LGBTQ+ individuals in emergency medicine (EM) curricula. Simulation based medical education can be a helpful pedagogy in teaching cross-cultural care and communication skills. In this study, we sought to determine the representation of the LGBTQ+ population in EM simulation curricula. We also sought to determine if representations of the LGBTQ+ population depicted stigmatized behavior.

Methods: We reviewed 971 scenarios from six simulation case banks for LGBTQ+ representation. Frequency distributions were determined for major demographic variables. Chi-Squared or Fisher's Exact Test, depending on the cell counts, were used to determine if relationships existed between LGBTQ+ representation and bank type, author type, and stigmatized behavior.

Results: Of the 971 scenarios reviewed, eight (0.82%) scenarios explicitly represented LGBTQ+ patients, 319 (32.85%) represented heterosexual patients, and the remaining 644 (66.32%) did not specify these patient characteristics. All cases representing LGBTQ+ patients were found in institutional case banks. Three of the eight cases depicted stigmatized behavior.

Conclusions: LGBTQ+ individuals are not typically explicitly represented in EM simulation curricula. LGBTQ+ individuals should be more explicitly represented to reduce stigma, allow EM trainees to practice using gender affirming language, address health conditions affecting the LGBTQ+ population, and address possible bias when treating LGBTQ+ patients.

Background: At the conclusion of residency candidate interview days, faculty interviewers commonly meet as a group to reach conclusions about candidate evaluations based on shared information. These conclusions ultimately translate into rank list position for The Residency Match. The primary objective is to determine if the post-interview discussion influences the final scores assigned by each interviewer, and to investigate whether interviewer characteristics are significantly associated with the likelihood of changing their score. Based on Foucault's 'theory of discourse' and Bourdieu's 'social capital theory,' we hypothesized that interviewer characteristics, and the discourse itself, would contribute to score changes after a post-interview discussion regarding emergency medicine residency candidates.

Methods: We conducted a cross-sectional observational study of candidate scores for all candidates to a four-year emergency medicine residency program affiliated with Yale University School of Medicine during a single application cycle. The magnitude and direction of score changes, if any, after group discussion were plotted and grouped by interviewer academic rank. We created a logistic regression model to determine the odds that candidate scores changed from pre- and post-discussion ratings related to specific interviewer factors.

Results: A total of 24 interviewers and 211 candidates created 471 unique interviewer-candidate scoring interactions, with 216 (45.8%) changing post-discussion. All interviewers ranked junior to professor were significantly more likely to change their score compared to professors. Interviewers who were women had significantly lower odds of changing their individual scores following group discussion (p=0.020; OR 0.49, 95% CI 0.26-0.89).

Conclusions: Interviewers with lower academic rank had higher odds of changing their post-discussion scores of residency candidates compared to professors. Future work is needed to further characterize the influencing factors and could help create more equitable decision processes during the residency candidate ranking process.

Background: The rapid transition to online delivery of medical curriculum has facilitated the continuation of medical education during the COVID-19 pandemic. Whilst active learning approaches, including Team-Based Learning (TBL), are generally more supportive of the learner's needs during such transition, it remains elusive how different learning environments affect a learner's motivation, engagement, and perceived learning over a prolonged period. We leveraged on Self-Determination Theory (SDT) and key learners' characteristics to explore the levels of student's engagement and perceived learning in two TBL learning environments, online and in-person, over an extended period. We hypothesize that students' self-reported perceptions of engagement and learning will be lower in online compared to in-person TBL classes.

Methods: This is a mixed methods study with 49 preclinical graduate medical students completing the same questionnaire twice for each learning environment, online TBL and in-person TBL, over an eight-month period. Quantitative data were collected on learners' characteristics, basic psychological needs satisfaction, motivation, student's engagement and perceived learning. The final questionnaire also explored participants' perception on which learning environment better supported their learning.

Results: We found that autonomy support, perceived competence and needs satisfaction, and perceived learning were higher in-person than online. Additionally, most learners felt that in-person TBL was better for learning, as the concepts of learning space and the community of practice were mediated by being in-person.

Conclusions: TBL, being an active instructional method, can maintain students' engagement because it supports many aspects of SDT constructs and perceived learning. However, online TBL is unable to fully support the students' needs and perceived learning. Hence, we strongly advocate for any in-person opportunities to be included in a course, as in-person classes best supports students' engagement and perceived learning.

Background: In low- and middle-income countries like Bangladesh, where medical education faces a range of challenges-such as lack of infrastructure, well-trained educators, and advanced technologies, abrupt changes in methodologies without adequate preparation are more challenging than in higher-income countries. This was worsened during the COVID-19 pandemic and these challenges have resulted in a change in medical education methodology. This study assesses the medical education procedure, impacts and adaptation strategies and challenges of the COVID-19 pandemic in the medical education system of Bangladesh from learners' as well as educators' perspectives.

Methods: The study collected data from 22 Medical Colleges/Universities across 18 districts of eight divisions using quantitative and qualitative methods. A total of 408 samples were collected consisting of 316 from students and 92 from medical teachers. Descriptive analysis and probit model were performed for obtaining results.

Results: The efficacy of online learning was questionable, but results showed that it was more effective for theory classes (92.4%) followed by clinical classes (75.63%) and the efficacy rate was low for practical classes (54.11%). All types of classes (theory, practical and clinical) are currently using mixed methods to some extent in medical education in Bangladesh. Regarding impacts and adaptation strategy, approximately 75.3% of the students surveyed expressed their acceptance of online education. Over 80% of the participants acknowledged the advantages of online learning, highlighting the freedom to learn from home, cost and time savings, and avoiding physical closeness with other students as major benefits.

Conclusions: To address future challenges like the COVID-19 pandemic in medical education in Bangladesh, a comprehensive policy approach such as strengthening technological infrastructure, promoting blended learning approaches, enhancing faculty training and support, integrating telemedicine into the curriculum, and continuously evaluating and improving policies and interventions can enhance the resilience of its medical education system, and prepare for future challenges.

Background: Controversy remains about whether e-learning can improve clinical competences. Our study aimed to compare the effects of e-learning versus traditional education on medical students' reasoning and how they applied their knowledge to clinical competences, assess factors associated with e-learning that might influence exam scores, and evaluate medical students' satisfaction with these two learning methods.

Methods: Prospective study of 299 medical students in two fourth-year pediatric clerkship cohorts (2016-17 and 2017-18) in Switzerland.

Results: We found no evidence of a difference in students' reasoning or how they applied their knowledge to competences in clinical case resolution, whether they had followed e-learning modules or attended traditional lectures. The number of quizzes taken and being female were factors associated with better scores. Even though overall satisfaction with the two learning methods was similar, students claimed that they learned more in e-learning than in traditional lectures and that e-learning explained learning objectives better.

Conclusions: E-learning could be used as a supplement or alternative to traditional face-to-face medical teaching methods without compromising teaching quality. E-learning modules should be better integrated into medical students' curricula but avoid the risk of curriculum overload, especially in case of repeated COVID-like context.

Background: Peer-assisted learning has been shown to be constructive in numerous aspects of undergraduate medical education. The purpose of this study was to evaluate the effectiveness of peer-assisted teaching of medical English skills to non-native English-speaking students.

Methods: A medical English conversation course was conducted at Damascus University by a group of students. Targeted participants were intermediate level fellow students from the same program. A longitudinal study was carried out between 1 ^st to 31 ^st March 2019 to assess changes in self-assessment of English language skills among course participants. Pre- and post-course appraisal involved a review of previous experience with medical English language, a self-assessment of five English language skills, and an objective measurement of medical English knowledge. In addition, participants were requested to respond to a set of statements related to the importance and the usefulness of peer-assisted teaching of medical English skills. Paired-sample Student t-test was used to compare pre- and post-course appraisal results.

Results: 42 students attended the course and completed pre- and post-course appraisals in full. Data analyses showed a statistically significant increase in participants' confidence in speaking medical English in public ( p<0.001) and using English in various medical settings (presenting and discussing cases, writing clinical reports, interviewing patients and reading English medical texts). Objective measurements of medical English knowledge confirmed a significant increase in participants' knowledge of methods of administration of therapeutics, knowledge of human body parts in English and familiarity with English medical abbreviations. Most participants agreed that peer-education was effective in teaching medical English skills to non-native English-speaking students and in increasing their confidence when using English in real-life medical scenarios.

Conclusions: The present study highlights the effectiveness of peer-assisted teaching of medical English skills to non-native English-speaking medical students. Further validation is required and should compare the effectiveness of traditional versus peer-assisted teaching approaches.

Background: The time spent on basic sciences, including clinical anatomy, is decreasing in many medical curricula. While dissection is often seen as a cornerstone of medical education, there is increasing pressure to ensure time spent undertaking dissection is an efficient use of student time. As part of an MBChB clinical anatomy course , 1 ^st year students were asked to complete 'dissection handover diaries', designed through evidence-based pedagogy on reflection and engagement, which encouraged them to reflect on the dissection session and consider clinical applications of the anatomy covered in the session. Student engagement with an activity is important for it to be beneficial to their educational experience. This engagement is often increased when students perceive the activity to be useful to their learning.

Methods: A survey was conducted, over two practical lab sessions on the final day of year one dissection in March 2023, using five Likert-type questions and one free-text question to evaluate student perceptions of the newly introduced dissection handover diaries. The survey was developed based on similar studies investigating student preference in dissection-based activities and questions were designed to elicit student perceptions on the usefulness of the diaries with respect to encouraging reflection, clinical application and student engagement in the sessions. Students were asked for constructive comments about the diaries in a free-text response question. Analysis was conducted using quantitative frequency distributions of survey responses as well as qualitative thematic analysis of the free text question.

Results: Of a total of 228 students, 64 participated in the survey, a response rate of 28%. The results were positive overall, with many respondents identifying the diaries as beneficial for reflection, consolidation, clinical application, and engagement.

Conclusions: Students perceived the dissection handover diaries to be useful to their anatomical learning, as well as encouraging reflection and application of knowledge.

Introduction: In an age of increasingly face-to-face, blended, and online Health Professions Education, students have more choices of institutions at which to study their degree. For an applicant, oftentimes, the first step is to learn more about a program through its website. Websites allow programs to convey their unique voice and to share their mission and values with others such as applicants, researchers, and academics. Additionally, as the number of master in health professions education (MHPE), or equivalent, programs rapidly grows, websites can share the priorities of these programs.

Methods: In this study, we conducted a website review of 158 MHPE websites to explore their geographical distributions, missions, educational concentrations, and various programmatic components.

Results: We compiled this information and synthesized pertinent aspects, such as program similarities and differences, or highlighted the omission of critical data.

Conclusions: Given that websites are often the first point of contact for prospective applicants, curious collaborators, and potential faculty, the digital image of MHPE programs matters. We believe our findings demonstrate opportunities for growth within institutions and assist the field in identifying the priorities of MHPE programs. As programs begin to shape their websites with more intentionality, they can reflect their relative divergence/convergence compared to other programs as they see fit and, therefore, attract individuals to best match this identity. Periodic reviews of the breadth of programs, such as those undergone here, are necessary to capture diversifying goals, and serves to help advance the field of MHPE as a whole.

Background: Globally, tertiary teachers are increasingly being pushed and pulled into online teaching. While most developments in online education have focused on the student perspective, few studies have reported faculty development (FD) initiatives for increasing online teaching capability and confidence from a staff perspective.

Methods: We designed and evaluated FD workshops, using five datasets, and the use of H5P software for interactive online teaching. We used educational theory to design our FD (Mayer multimedia principles, active learning) and evaluated our FD initiatives using the Best Evidence Medical Education (BEME) 2006 modified Kirkpatrick levels.

Results: Teaching staff reported that Communities of Practice were important for their learning and emotional support. Uptake and deployment of FD skills depended on the interactivity of FD sessions, their timeliness, and sufficient time allocated to attend and implement. Staff who applied FD learning to their online teaching created interactive learning resources. This content was associated with an increase in student grades, and the roll-out of an institutional site-wide H5P license.

Conclusion: This paper demonstrates an effective strategy for upskilling and upscaling faculty development. The use of H5P as a teaching tool enhances student learning. For successful FD, we make four recommendations. These are: provide just-in-time learning and allocate time for FD and staff to create online teaching material; foster supportive communities; offer personalized support; and design hands on active learning.