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Choosing Primary Care as a Profession: A Systematic Review 选择初级保健作为职业:系统回顾
Pub Date : 2018-01-01 DOI: 10.5455/jcme.20180625062031
McKinley Thomas, Jeff Jones
The importance of primary care as a means toward individual and community health is unchallenged. However, with the number of primary care physicians (PCPs) entering the field on the decline in the United States, a clear view of the career pipeline becomes crucial, especially with regard to the role of medical education. The literature posits a number of predictive variables as important determinants of career selection. Much of the research focused on career decisions is based upon preclinical ideation rather than occupational outcomes. We conducted a synthesis of the literature to explore factors most influential when selecting primary care as a profession. CINAHL, Web of Science, Ovid MEDLINE, and PubMed MEDLINE were explored from January 2008 to December 2017 to identify salient factors associated with a career decision to follow a primary care pathway. This review yielded 226 publications with 27 meeting our inclusion and quality criteria. Our analysis generated five overarching categories that best represent salient influences toward primary care as a career: general academic experiences, pipeline programs, student debt, characteristics of the educational institution, and student characteristics. We found that career decisions toward primary care were best supported by sound medical educational practice, remunerative expectations, and individual qualities such as familial background and preferred lifestyle. Our findings are congruent with earlier analyses in that academic experiences play an important role in career development toward primary care. However, our study did not capture rural experiences or demographic factors, both reported in previous studies in which preclinical students were queried. For medical educators, administrators, and students themselves, these outcomes represent largely modifiable factors when addressing the looming physician shortage.
初级保健作为实现个人和社区健康的一种手段的重要性是不容置疑的。然而,随着美国初级保健医生(pcp)进入该领域的人数不断下降,对职业发展渠道的清晰认识变得至关重要,特别是在医学教育的作用方面。文献假设了一些预测变量作为职业选择的重要决定因素。许多关于职业决策的研究都是基于临床前的想法,而不是职业结果。我们对文献进行了综合,以探索在选择初级保健作为职业时最具影响力的因素。从2008年1月到2017年12月,我们对CINAHL、Web of Science、Ovid MEDLINE和PubMed MEDLINE进行了研究,以确定与选择初级保健途径的职业决定相关的显著因素。本综述共纳入226篇文献,其中27篇符合我们的纳入标准和质量标准。我们的分析产生了五个最能代表对初级保健作为职业的显著影响的总体类别:一般学术经历、管道项目、学生债务、教育机构特征和学生特征。我们发现,良好的医学教育实践、薪酬预期和个人素质(如家庭背景和首选生活方式)最能支持初级保健的职业决定。我们的研究结果与早期的分析一致,即学术经历在初级保健的职业发展中起着重要作用。然而,我们的研究没有捕捉到农村经验或人口因素,这两者在之前的研究中都有报道,这些研究询问了临床前学生。对于医学教育工作者、管理人员和学生自己来说,这些结果在解决迫在眉睫的医生短缺问题时,在很大程度上代表了可修改的因素。
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引用次数: 0
Assessing Patient Ownership in clerkships: An exploratory study of student and clerkship directors' perceptions 评估病人所有权的办事员:一个探索性研究的学生和办事员主任的看法
Pub Date : 2018-01-01 DOI: 10.5455/JCME.20180613062630
T. Wyatt, Sarah Egan, Elena A Wood
Purpose: The phrase “take ownership of your patients” is commonly used by physicians to communicate the importance of demonstrating dedication and commitment to patients and their care. In an attempt to understand how patient ownership is supported in students’ clerkship experiences, this exploratory study collected data on students’ perceptions of ownership in their clerkships and the ways in which clerkship directors supported students in taking ownership. Method: An adapted survey on psychological ownership was distributed to 233 third-year medical students upon a clerkship completion. The survey assessed the students' perception of ownership and the extent to which clerkships supported its development patient care. Follow-up interviews with clerkship directors were conducted to interpret the data and understand how each of the clerkships support students’ development of patient ownership. Results: The results demonstrate differences between clerkship experiences. In those clerkships where students perceive the clerkship as developing their ownership, clerkship directors were intentional in setting up a system that supported this goal. Data suggest that when clerkship directors use consistent language across the clerkship, provide resident and faculty training to support students in taking ownership, and are explicit in their expectations for students’ to engage in patient ownership behavior, students perceive the clerkship as supporting their ability to take ownership. Conclusion: Clerkship directors have the ability to impact students’ ability to take ownership of their patients by being intentional in their development of the clerkship climate.
目的:“为你的病人负责”这句话通常被医生用来表达对病人及其护理的奉献和承诺的重要性。为了了解病人的所有权是如何在学生的见习经历中得到支持的,本探索性研究收集了学生在见习经历中对所有权的看法以及见习主任支持学生拥有所有权的方式的数据。方法:对233名实习结束的医学生进行心理归属调查。该调查评估了学生对所有权的看法,以及见习人员对其发展的支持程度。通过对实习主任的随访访谈来解释数据,并了解每个实习主任如何支持学生对病人所有权的发展。结果:结果显示了不同见习经历之间的差异。在那些学生认为实习是在发展他们的所有权的实习中,实习主任有意建立一个支持这一目标的系统。数据表明,当见习主任在整个见习过程中使用一致的语言,提供住院医师和教员培训以支持学生拥有自主权,并明确表示他们对学生参与病人所有权行为的期望时,学生就会认为见习支持了他们拥有自主权的能力。结论:见习主任有能力通过培养见习气氛来影响学生对病人的主人翁意识。
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引用次数: 5
Transformational magnetic play set as mind opener game in a Problem Based Learning workshop 在以问题为基础的学习工作坊中,转换磁性游戏是一种开启思维的游戏
Pub Date : 2018-01-01 DOI: 10.5455/jcme.20161127013430
Anand Srinivasan, Joan D. Bryant
BACKGROUND AND AIM Critical thinking and application are imperative skills for medical students as they learn to look for clinical features, interpret investigation, diagnose and treat patients. Many educational strategies exist to foster this process, one of which is Problem based learning (PBL). Though the concept of PBL looks lucid and uncomplicated, it requires understanding of the principles by faculties and students to make it more student oriented. We used a ‘Magnetic Building Set’ as a mind opener to orient the teaching faculty at RAK Medical and Health Sciences University (RAKMHSU) to the core concepts of PBL. The main aim of the workshop was to familiarize the faculty on various aspects of PBL especially the importance of identification of learning objectives; designing a problem on predesigned objectives and the relation of PBL to inquiry based learning. The study also depicts how a simple game can make the participants correlate with the principles behind PBL. METHODS A total of 17 new faculty members, some of them having previous exposure of teaching in a PBL curricula were included in the Medical Education orientation workshop on PBL. The faculty members were divided into groups and each group was given a magnetic building set, which consisted of metallic spheres and magnetic rods. Initially there were asked to make design of their choice using all the materials and later a second task was given asking them to make a specific structure. The game is then correlated to the key principles of PBL using a pre and post- game questionnaire. RESULTS After the game, the knowledge of the faculty regarding the concepts and efficient use of PBL increased dramatically. The post-game questionnaire showed all the faculty understood well about the concepts of PBL. CONCLUSION Various instructional strategies are employed in adult learning. Game based learning is one amongst them and the current study highlights how a simple game can be used as an innovative and effective approach to introduce the concepts of PBL.
背景和目的在医学生学习寻找临床特征、解释调查、诊断和治疗病人的过程中,批判性思维和应用是必不可少的技能。有许多教育策略可以促进这一过程,其中之一就是基于问题的学习(PBL)。虽然PBL的概念看起来清晰而简单,但它需要教师和学生对原则的理解,才能使其更加以学生为中心。我们使用“磁性建筑集”作为开路器,引导RAK医学与健康科学大学(RAKMHSU)的教学人员了解PBL的核心概念。讲习班的主要目的是使教师熟悉PBL的各个方面,特别是确定学习目标的重要性;基于预先设计目标的问题设计以及PBL与基于探究的学习的关系。该研究还描述了一个简单的游戏如何使参与者与PBL背后的原则联系起来。方法选取17名有PBL教学经验的新教师参加PBL医学教育培训。教职员工被分成几组,每组都有一套磁性建筑,由金属球体和磁性棒组成。最初,他们被要求使用所有材料进行选择设计,后来的第二个任务是要求他们制作一个特定的结构。然后使用赛前和赛后问卷将游戏与PBL的关键原则联系起来。结果游戏结束后,教师对PBL的概念和有效使用的知识显著增加。赛后问卷调查显示,所有教师对PBL的概念都有很好的理解。结论在成人学习中运用多种教学策略。基于游戏的学习就是其中之一,当前的研究强调了如何将一个简单的游戏作为一种创新和有效的方法来引入PBL的概念。
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引用次数: 0
Evaluating the Learning Experience of Web-Conferenced Case Based Learning - 基于案例的网络会议学习体验评价
Pub Date : 2018-01-01 DOI: 10.5455/jcme.20170819111733
P. Nicklen, J. Keating, S. Maloney
Objective: The objective of this study was to evaluate web-conferenced case-based learning (WCBL) through the student experience across a semester of learning. Learning was also evaluated via unit examination and compared to the previous year’s cohort, which did not include WCBL (F2F). Methods: This study took place over the first semester of the third year of a Bachelor of Physiotherapy program at Monash University, Australia, in 2014. Having experienced two years of weekly face-to-face case-based learning (F2F-CBL) activities since commencing the program, students were transitioned to WCBL for the duration of this study. Primary outcomes included measures of satisfaction, attendance, communication, issues with information technology, and perceived depth of learning, with data collected via a post-unit survey. The secondary outcome was student learning, evaluated with the unit examination results. Results: 76/78 students completed the post-unit survey (non-participation rate 2.6%). Although 95% of participants reported that WCBL was a valuable addition to the teaching activities of the unit, students reported a range of new challenges and rewards from the transition to small-group WCBL activities. Strong themes emerged encompassing adaptation of communication, increased responsibility for learning, technical difficulties, and learning in a remote environment. Overall, 92% of participants agreed that they were satisfied with WCBL. The unit exam result was comparable for the 2013 (F2F-CBL) and the 2014 (WCBL) cohorts (Mean (SD) 2013 (%) 75.97 (9.56) n = 73; 2014 (%) 76.74 (6.57) n = 78, effect size (95% C.I) = 0.09 (-0.23 – 0.41). Conclusion: Web conferencing may be a suitable medium for students to participate in collaborative case-based learning activities. Further study should evaluate the financial implications of implementing WCBL across an entire semester in regard to student and facility costs.
目的:本研究的目的是通过学生在一个学期的学习体验来评估网络会议案例学习(WCBL)。学习也通过单元考试进行评估,并与前一年的队列进行比较,其中不包括WCBL (F2F)。方法:本研究于2014年在澳大利亚莫纳什大学物理治疗学士课程第三年第一学期进行。自项目开始以来,学生们已经经历了两年的每周面对面案例学习(F2F-CBL)活动,在研究期间,学生们过渡到WCBL。主要结果包括满意度、出勤率、沟通、信息技术问题和感知学习深度,数据通过单元后调查收集。次要指标为学生学习情况,以单元考试成绩评价。结果:76/78名学生完成单元后调查(未参与率2.6%)。虽然95%的参与者报告说,WCBL是本单元教学活动的一个有价值的补充,但学生们报告了从小组WCBL活动过渡到一系列新的挑战和回报。出现了包括适应交流、增加学习责任、技术困难和在远程环境中学习在内的强烈主题。总体而言,92%的参与者对WCBL表示满意。2013年(F2F-CBL)和2014年(WCBL)队列的单元检查结果具有可比性(Mean (SD) 2013 (%) 75.97 (9.56) n = 73;2014 (%) 76.74 (6.57) n = 78,效应量(95% ci) = 0.09(-0.23—0.41)。结论:网络会议可能是学生参与合作案例学习活动的合适媒介。进一步的研究应该评估在整个学期中实施WCBL对学生和设施成本的财务影响。
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引用次数: 1
Should drawing be incorporated into the teaching of anatomy 解剖学教学中应该加入绘画吗
Pub Date : 2018-01-01 DOI: 10.5455/JCME.20180411105347
M. Borrelli, B. Leung, M. Morgan, S. Saxena, A. Hunter
Introduction: Art has played a pivotal role in the understanding and teaching of human anatomy for centuries, and the use of drawing as a teaching tool had been well documented. With the global modernization of medical education, the teaching of anatomy has diminished. We present a model of teaching anatomy through drawing, and assess its efficacy in improving students’ retention of anatomical knowledge. Methods: We designed a series of four anatomy drawing workshops (upper limb, lower limb, thorax, and head & neck) for students studying medicine, dentistry, and allied science degrees. Students were only allowed to attend one of the four workshops. Workshops were delivered by medically-qualified anatomy demonstrators using a combination of “whiteboard drawing demonstrations” and “cadaveric demonstrations and drawings.” A pre- and post-anatomy test consisting of 12 multiple choice questions (MCQs) and quantitative self-score questionnaires on “confidence in drawing anatomy” and “anatomical knowledge” were completed. Qualitative questionnaires on “reasons for attendance,” “skills learnt,” and “what improvements could be made” were also completed. Results: A total of 49 students attended the drawing workshops, the majority studied medicine (58.3%). Twenty-seven pre- and post-anatomy MCQ tests were completed, and demonstrated a significant mean improvement of 1.11 points (p = 0.001). “Confidence in drawing anatomy” and “Knowledge of anatomy” significantly improved by 43.2% and 41.4% (p = 0.001), respectively. Only 13% of students used drawing as their “main learning tool.” The most commonly reported barrier in using drawing as a revision tool was “time constraints.” Qualitative feedback was excellent. Students suggested that these workshops should be integrated into the core anatomy curriculum. Conclusion: Learning anatomy through drawing, is not only more engaging and fun, encourages students to visualize and better understand anatomical planes, thus, allowing them to retain anatomical knowledge easier. The two-part nature of our sessions enabled students to apply and translate the more conceptual knowledge from the “whiteboard drawing demonstration” onto the more “real-life” structures in the “prosection and cadaveric demonstration.” With the decline in anatomy teaching throughout universities, most prominently dissection, drawing may offer an alternative and economical way of training students to learn anatomy.
几个世纪以来,艺术在人体解剖学的理解和教学中发挥了关键作用,并且使用绘画作为教学工具已经得到了很好的记录。随着全球医学教育的现代化,解剖学的教学已经减少。我们提出了一种通过绘图教学解剖学的模式,并评估了其在提高学生解剖学知识记忆方面的效果。方法:我们为医学、牙科和相关科学学位的学生设计了一系列的四个解剖绘画工作坊(上肢、下肢、胸部和头颈部)。学生们只被允许参加四个工作坊中的一个。讲习班由具有医学资格的解剖演示人员提供,使用“白板绘图演示”和“尸体演示和绘图”的组合。完成了解剖前和解剖后的测试,包括12个选择题(mcq)和定量自我评分问卷,内容包括“绘制解剖的信心”和“解剖知识”。还完成了关于“出勤原因”、“学到的技能”和“可以做出哪些改进”的定性问卷调查。结果:共有49名学生参加了绘画工作坊,以医学专业为主(58.3%)。27个解剖前和解剖后的MCQ测试完成,结果显示平均改善1.11点(p = 0.001)。“绘制解剖学的信心”和“解剖学知识”分别显著提高了43.2%和41.4% (p = 0.001)。只有13%的学生将绘画作为他们的“主要学习工具”。使用绘图作为复习工具最常见的障碍是“时间限制”。定性反馈非常好。学生们建议将这些工作坊整合到核心解剖学课程中。结论:通过绘画来学习解剖学,不仅更吸引人,更有趣,还能让学生更好地想象和理解解剖平面,从而使他们更容易记住解剖知识。我们的课程分为两部分,使学生能够将“白板绘画演示”中的概念性知识应用和转化为“检控和尸体演示”中更“现实”的结构。随着大学解剖学教学的减少,尤其是解剖、绘画可能提供了另一种经济的方法来训练学生学习解剖学。
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引用次数: 16
How do newly-qualified doctors perceive empathy in medical trainingand practice? 新获得资格的医生如何看待医疗培训和实践中的同理心?
Pub Date : 2017-06-12 DOI: 10.5455/jcme.20170530064220
S. Agius, Jeremy M. Brown, E. Stratta, J. Hayden, P. Baker
Objective: Evidence exists of an apparent decline in empathy during medical training which may be detrimental to patient care. This qualitative study explores the reflections of a group of newly-qualified foundation doctors with regard to empathy in medical training and practice. Methods: Doctors in a UK Foundation Training Programme were invited to reflect on the subject of empathy in medical training and practice. Researchers obtained consent to access their anonymous reflective statements and analyze for recurring themes using framework analysis. Results: Coding of 65 trainees’ reflective statements resulted in identification of two thematic categories: (i) preparedness for empathic patient care and (ii) therapeutic effect of empathy. Conclusions: Trainees are aware of the value of empathy as a therapeutic tool. Many use it instinctively but not systematically. Clinical pressures can impact negatively on empathic dealings with patients and relatives. Targeted educational interventions and positive role modeling may assist foundation doctors enhance their skills in patient-centered care.
目的:有证据表明,在医疗培训期间,共情能力明显下降,这可能不利于患者护理。本定性研究探讨了一组新资格的基础医生在医疗培训和实践中关于移情的思考。方法:邀请参加英国基础培训项目的医生对医学培训和实践中的共情问题进行反思。研究人员获得同意访问他们的匿名反思陈述,并使用框架分析分析反复出现的主题。结果:对65名学员的反思性陈述进行编码,确定了两个主题类别:(i)对移情患者护理的准备和(ii)移情的治疗效果。结论:受训者意识到共情作为一种治疗工具的价值。许多人本能地使用它,但没有系统地使用它。临床压力会对患者和亲属的共情处理产生负面影响。有针对性的教育干预和积极的角色塑造可以帮助基金会医生提高他们以患者为中心的护理技能。
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引用次数: 2
Multi-source feedback in Dental post graduation - A qualitative research 多源反馈在牙科毕业后的定性研究
Pub Date : 2017-01-01 DOI: 10.5455/jcme.20170426112117
Usha Carounanidy, Sethuraman Kr, Ananthakrishnan Nilakantan, Narayan Ka
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引用次数: 1
Introduction of Objective Structured Clinical Examination, an assessment method for undergraduate students in a dental school - 口腔专科院校本科学生考核方法——客观结构化临床考核简介
Pub Date : 2017-01-01 DOI: 10.5455/jcme.20170216062547
I. A. Majid, F. K. Alikutty, S. Rahaman
Objective: Undergraduate education in a dentistry program aims to produce competent practitioners equipped with appropriate knowledge, behavior, attitudes and skills necessary to blend into independent dental practice. Assessment is crucial in the learning process of the students, and assessment drives learning is universally accepted. A number of traditional assessment methods are in common use; lately, Objective Structured Clinical Examination (OSCE) has been suggested to assess the clinical competencies and skills in health sciences. Argyris recommended developing an implementation strategy of advocacy and inquiry to encourage the acceptance of personal responsibility to overcome resistance (to changes being introduced into the existing assessment system). The purpose of this study was to investigate the effectiveness of implementation strategy by measuring the attitudes of both staff and students towards OSCE in a dental school. Methods: Following sequential steps of providing information, advocacy, participation to minimize resistance towards introduction of OSCE in the course of oral medicine, fourteen staff members and thirty six students participated in pilot/mini OSCE which included one rest and five test stations. Later, a more definitive final OSCE was designed with 10 test plus one rest station. After completion of both pilot/mini and final OSCE, a questionnaire adopted from a previously conducted study was answered by the staff and students. Results: The staff scores were significantly higher following the final OSCE for all the questions except “increase use”. In the student group, “increase use” and “difficulty/ease” improved from pilot to final OSCE, but the difference was statistically insignificant. Comparison between the groups revealed staff were significantly more enthusiastic, believed the use of OSCE to be increased and felt the test was relevant. Conclusion: Involvement, participation and joint control of the staff in designing and developing the OSCE stations and its implementation led to a successful implementation of the new assessment method.
目的:牙科本科教育旨在培养具备独立牙科实践所需的适当知识、行为、态度和技能的合格从业人员。评价在学生的学习过程中起着至关重要的作用,评价驱动学习已被普遍接受。一些传统的评估方法是常用的;最近,客观结构化临床检查(OSCE)被建议用于评估健康科学的临床能力和技能。Argyris建议制定一项宣传和调查的执行战略,以鼓励接受个人的责任,以克服(对现行评价制度进行改革的)阻力。本研究的目的是通过测量一所牙科学校的员工和学生对欧安组织的态度来调查实施策略的有效性。方法:按照提供信息、宣传、参与的顺序步骤,尽量减少在口腔医学课程中引入欧安组织的阻力,14名工作人员和36名学生参加了试点/迷你欧安组织,其中包括1个休息和5个试验站。后来,更明确的欧安组织最终设计了10个测试站和1个休息站。在完成试点/小型和最终欧安组织之后,工作人员和学生回答了一份从以前进行的研究中采用的问卷。结果:在最终的OSCE测试后,除€œincrease use €外,所有问题的员工得分均显著提高。在学生组中,从试点到最终的OSCE, €œincrease use €和€œdifficulty/ ease€有所改善,但差异无统计学意义。两组之间的比较显示,工作人员明显更加热情,认为欧安组织的使用将会增加,并认为测试是相关的。结论:工作人员参与、参与和共同控制欧安组织台站的设计和发展及其实施,使新的评估方法得以成功实施。
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引用次数: 2
What is an appropriate social scenario for staff and students at an Australian Rural Clinical School? A survey of 4th and 5th year medical student’s resident in rural Tasmania 对澳大利亚农村临床学校的教职员工和学生来说,什么是合适的社交场景?对塔斯马尼亚农村地区四、五年级医学生的调查
Pub Date : 2017-01-01 DOI: 10.5455/JCME.20170123025249
Emma Beddows, Harry Laughlin, Alana Easthaugh, D. Liew, Kim Robitschko, M. Buist
Introduction: The degree of comfort that medical students have in different social settings with staff and faculty has not been documented. Methods: We undertook in 2012 a survey of 53 fourth and fifth year medical students at the University of Tasmanian Rural Clinical School to determine the incidence of previous inappropriate social invitations/interactions and perceptions of comfort to 5 different hypothetical social scenarios of different appropriateness. Results: Two students had received what they considered to be an inappropriate invitation. Most students were comfortable with communal public social situations. However, in an overt “date” scenario 8 students were either completely at ease with or comfortable. Eighteen students although uncomfortable with this scenario would still attend and only 14 students would decline the invitation. Conclusion: There needs to be increased awareness that certain social interactions between health professionals when there is significant difference in hierarchy may not always be appropriate
引言:医学生在不同的社会环境中与教职员工的舒适程度尚未有文献记载。方法:我们于2012年对塔斯马尼亚大学农村临床学校的53名四年级和五年级医学生进行调查,以确定先前不适当的社交邀请/互动的发生率和对5种不同适当性的假设社交场景的舒适度。结果:两名学生收到了他们认为不合适的邀请。大多数学生都能适应公共社交场合。然而,在公开的“约会”场景中,学生们要么完全放松,要么很舒服。18名学生虽然对这种情况感到不舒服,但仍然会参加,只有14名学生拒绝了邀请。结论:当存在显著的等级差异时,卫生专业人员之间的某些社会互动可能并不总是合适的,这一点需要提高认识
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引用次数: 0
Relation of the final year performance in different assessment modalities in Final MBBS Pediatrics, College of Medicine, Bahri Universit Bahri大学医学院儿科学硕士结业课程中不同考核方式期末绩效的关系
Pub Date : 2017-01-01 DOI: 10.5455/JCME.20170426112130
M. Idris, N. Rahma, O. Elfaki, Waly Elfakey, K. Salih
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引用次数: 1
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Journal of contemporary medical education
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