Journal of Advances in Medical Education & Professionalism

Review article

Evolving Assessment in Medical Education: Exploring the Role of Open-Book Examinations

YASAR AHMED; SIMAA KHAYAL; MAJED WADI; MOHAMED ABUZAID

Volume 12, Issue 4 , October 2024, Pages 215-225

https://doi.org/10.30476/jamp.2024.102078.1955

Abstract

Introduction: The landscape of medical education has witnessed significant transformations over the past decades, particularly with the advent of active teaching methodologies. However, ... Read More Introduction: The landscape of medical education has witnessed significant transformations over the past decades, particularly with the advent of active teaching methodologies. However, despite these advancements, the traditional theoretical assessment methods have remained largely unchanged. This lack of evolution in assessment systems poses a challenge as it is crucial for assessment methods to evolve in tandem with teaching approaches to ensure a comprehensive and effective learning process in medical education. This paper reviews the integration and effectiveness of open-book examinations (OBEs) in medical education, reflecting their growing significance.Methods: An integrative review of the literature was conducted, drawing from a range of relevant publications over the last decade, sourced from databases such as PubMed, Web of Science, Scopus, and ERIC. The inclusion criteria focused on full-text articles in English, with search terms including “medicine,” “assessment,” “open book examination,” “open book exam,” and “open book assessment,” combined using Boolean operators. Thirteen publications were selected and critically appraised using The Critical Appraisal Skills Program checklist. Results: The analysis identified three primary thematic categories: “Teaching Strategy for Pandemic and Challenging Conditions,” “Tool of Learning & Educational Impact”, and “Operational Challenges & Future Directions”. These themes were explored to understand the role and impact of open-book examinations in medical education.Conclusion: The findings indicate that open-book examinations are a crucial component in the evolving landscape of medical education. While certain reservations remain, open-bookexaminations have shown significant potential in fostering critical thinking, argumentation skills, and lifelong learning among medical students. They reflect the ongoing evolution of knowledge in the medical field and contribute to the development of professionals’ adept at navigating and applying complex information. Further research is recommended to solidify these findings and expand the understanding of open-book examinations in medical education.

Original Article

Expectation and Needs of Medical Students Towards the Implementation of Virtual Simulation in Learning Rational Use of Medicine

DESAK GEDE BUDI KRISNAMURTI; ARIA KEKALIH; ADISTI DWIJAYANTI; DAVID CHRISTIANTA; NICHOLAS JASON WIJAYA; JUAN FELIX SAMUDRA; PRATIWI RAHADIANI

Volume 12, Issue 4 , October 2024, Pages 226-234

https://doi.org/10.30476/jamp.2024.102790.2010

Abstract

Introduction: The irrational use of medicines remains prevalent globally despite education efforts, leading to decreased treatment quality and increased healthcare costs. With the rise ... Read More

Original Article

Estimating Students’ Academic Success in the Preclinical Stage of Undergraduate Medical Education Using the Admission Test Approach

WIENTA DIARSVITRI; EFYLUK GARIANTO; ROOSTANTIA INDRAWATI; WIWIK SULISTIANI

Volume 12, Issue 4 , October 2024, Pages 235-242

https://doi.org/10.30476/jamp.2024.101936.1949

Abstract

Introduction: Medical schools face substantial challenges in objectively selecting the best applicants, and the admission process can impact medical students’ academic performance.This ... Read More

Original Article

Evaluating the Effect of Scenario-Based Learning on the Knowledge, Attitude, and Perception of Nursing and Midwifery Students about Patient Safety

SOMAYEH ALIREZAEI; MALIHEH SADEGHNEZHAD; MONIR RAMEZANI

Volume 12, Issue 4 , October 2024, Pages 243-250

https://doi.org/10.30476/jamp.2024.101869.1947

Abstract

Introduction: Patient safety is the most important priority in the healthcare system. Medical universities always attempt to find innovative and more effective educational methods to ... Read More Introduction: Patient safety is the most important priority in the healthcare system. Medical universities always attempt to find innovative and more effective educational methods to improvethe students’ abilities for clinical decision-making and quality and safe care. Thus, this study was designed to evaluate the effect of scenario-based learning on the knowledge, attitude, andperception of nursing students about patient safety.Methods: This quasi-experimental study was conducted between September 2023 and January 2024. The study sample comprised 78 nursing and midwifery students from the fourth and fifth semesters of their bachelor’s degrees, each of whom was systematically reviewed. The participants were allocated to the intervention (n=43) and control groups (n=35) randomly, using simple randomization. The educational content was presented via scenario-based learning for participants in the intervention group, while it was presented through lecture and discussion in the control group. The questionnaire was standardized and structured, and its validity and reliability were assessed. Data gathering was performed one month after the intervention using a knowledge, attitude, and practice questionnaire. Data were analyzed in SPSS software version 16 using descriptive statistical methods and inferential tests, including the chi-square test, independent T-test, paired T-test, and ANCOVA. Results: The study findings indicated that there were no significant differences in attitude (P=0.152) and perception (P=0.264) scores between the intervention and control groups before the intervention. However, after the intervention, a significant difference was observed (P<0.001). [Knowledge 14.97±3.70 vs. 19.37±3.31), attitude (31.74±5.38 vs. 34.62±9.59), perception(35.60±7.51 vs.38.95±8.21)].Conclusion: Scenario-based learning can be a more effective way to teach nursing and midwifery students about patient safety. Thus, researchers recommend that this educational method should be used by nursing and midwifery instructors to improve the students’ ability to provide safer care for patients.

Original Article

Investigating the Effectiveness of Formative OSCE Combined with Visual Feedback in Improving Clinical Competence among Iranian Nurse Anesthesia Students: A Quasi-experimental study

ALI KHALAFI; AKBAR ABBASI; NOOSHIN SARVI SARMEYDANI; MASOUMEH ALBOOGHOBEISH

Volume 12, Issue 4 , October 2024, Pages 251-260

https://doi.org/10.30476/jamp.2024.102318.1969

Abstract

Introduction: Lack of clinical competence can endanger the patient’s safety and reduce the quality of providing health care services. The aim of this study was to examine the ... Read More

Original Article

Iranian English as a Foreign Language (EFL) teachers’ professional development needs in educational contexts: Exploring the challenge of reflective practice

NASRIN SHOKPOUR; NEDA ESLAMPANAH; VAHID ASADI; SHIRLEY O’NEILL; CHRISTOPHER DANN; JENNY WANG

Volume 12, Issue 4 , October 2024, Pages 261-271

https://doi.org/10.30476/jamp.2024.103180.1995

Abstract

Introduction: This study investigated Iranian, English as a foreign language (EFL) teachers’ attitudes toward reflective teaching compared with their classroom assessment preferences ... Read More Introduction: This study investigated Iranian, English as a foreign language (EFL) teachers’ attitudes toward reflective teaching compared with their classroom assessment preferences and up-take of strategy based instruction. It compared their views in the two key higher education provider contexts of the university and institute.Methods: In this cross-sectional correlational study, a total of 90 teachers, half drawn from each university in a major city in Iran, were selected using controlled quota sampling. Data were collected through a four-part survey. Besides gathering demographic data (Part A), the survey drew upon three established instruments that used a Likert Scale format. Part B comprised the Teacher Reflectivity questionnaire, and Part C focused on the Classroom Assessment Preferences Survey Questionnaire for Language Teachers. Also, part D administered the Teachers’ Beliefs Inventory for Strategy Instruction. The reliability of this and the CAPSQ-LT was confirmed by the researchers using Cronbach’s alpha at 0.842 and 0.951, respectively. A total of 90 questionnaires were distributed, with 72 fully completed (80%) and returned. the Statistical Package for Social Sciences (SPSS) was employed to analyze the data, using the independent sample t-test and ANOVA. Also, Pearson productmoment correlations were used to measure the association between the variables. A p-value less than 0.05 was considered as significant. Results: As shown in Table 2, a statistically significant and positive correlation was found between the teachers’ reflective teaching scores and classroom assessment preference scores (r=0.473, P=0.001). This correlation was moderately high and positive, thus supporting that higher teacher reflective practices reflect a broader application of classroom assessment. The Table also shows that there was no significant correlation between the teachers’ attitudes toward reflective teaching and their uptake of strategy-based instruction (r=0.094; P=0.434). Similarly, there was no statistically significant correlation between the teachers’ attitudes toward classroom assessment preferences and their beliefs about strategy-based instruction (r=0.038, P=0.752). As shown, no statistically significant difference was observed between the teachers’ attitudes toward reflectiveteaching and their uptake of strategy-based instruction (P<0.05).Conclusion: This study draws attention to the need for teachers in EFL contexts, such as this, to have access to professional development opportunities that deeply engage and guide them to be reflective practitioners who can make the connections between assessment techniques, strategy-based instruction, and students’ improved language learning outcomes.

Letter to Editor

Replacing “Artificial Intelligence” with “Augmented Intelligence” for a more Informed and Responsible Use of Technology in Medical Education

KRISHNA MOHAN SURAPANENI

Volume 12, Issue 4 , October 2024, Pages 272-273

https://doi.org/10.30476/jamp.2024.103484.2008

Abstract

NA Read More

Letter to Editor

The Importance of Modification: An Imperative to Incorporate Machine Learning in Medical Education

FATEME JAVAHERI; NASRIN - KHAJEALI

Volume 12, Issue 4 , October 2024, Pages 274-275

https://doi.org/10.30476/jamp.2024.101389.1926

Abstract

Considering the increasing usage of Artificial Intelligence (AI) and Machine Learning (ML) in various specializations of medicine, it seems necessary to instruct our medical students ... Read More

Effectiveness of Gamification in Enhancing Learning and Attitudes: A Study of Statistics Education for Health School Students

MEHRNOOSH KHOSHNOODIFAR; ASIEH ASHOURI; MAHDOKHT TAHERI

Volume 11, Issue 4 , October 2023, , Pages 230-239

https://doi.org/10.30476/jamp.2023.98953.1817

Abstract

Introduction: Gamification is the use of game design elements in non-game contexts. It is considered a student-centeredinstructional design to motivate student learning and academic ... Read More Introduction: Gamification is the use of game design elements in non-game contexts. It is considered a student-centeredinstructional design to motivate student learning and academic behavior. In this study, the effects of gamification on learning statistics (hypothesis testing issue) and attitude toward statistics in comparison with the common e-learning approach were investigated. The students’ experience and critical elements of gamification on learning statistics were assessed, too.Methods: In a before and after trial, in a census manner, 64 health faculty students of Guilan University of Medical Sciences, Rasht, Iran, non-randomly were assigned to the intervention (n=42) and control (n=22) groups. Learning activities were gamified in the intervention group, while the control group received traditional problem-solving in the learning management system. Narrative, avatar, level, point, progress bar, scoreboard, challenge and feedback elements were used in the game experience. The implementation of gamification was applied based on Landers’ theory of gamified content. Valid and reliable Persian version of the Survey Attitude toward Statistics questionnaire measuredthe students’ attitude before and after the intervention. The EGameFlow questionnaire and a valid and reliable researchermade exam measured the users’ experience of gamified content and learning hypothesis testing after the intervention. The independent samples T-test, analysis of covariance and the partial eta-squared effect size were calculated by SPSS software, version 26.Results: Compared to the control group, the intervention group had a more positive attitude toward learning difficulty (moderate partial eta-squared 0.099), value and cognitive competency (weak partial eta-squared=0.01 and 0.05). Learning between the two groups was not different (P=0.522). There was a significant correlation between learning and the students’ perceived experience with feedback (r=0.583, P<0.001), concentration (r=0.509, P=0.005), and challenge (r=0.421, P=0.023) of the gamified content.Conclusion: It suggests using gamification on learning statistics while optimizing the design with more focus on the feedback, challenge and concentration elements.

Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study

IRAWATY DJAHARUDDIN; IRWIN ARAS; RINA MASADAH; IRAWAN YUSUF; IRFAN IDRIS; HAERANI RASYID; BERTY NELWAN

Volume 11, Issue 4 , October 2023, , Pages 213-221

https://doi.org/10.30476/jamp.2023.98987.1821

Abstract

Introduction: Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions ... Read More Introduction: Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions involved (doctors, nurses, and pharmacists) in an interprofessional collaboration system is needed in providing such service. Factors influencing interprofessional collaboration is unique to each health care center. The purpose of this study was to determine the factors that influence the implementation of interprofessional collaborative practice among health workers in Dr. Wahidin Sudirohusodo General Hospital.Methods: This is a mixed-method explanatory sequential design study, utilizing quantitative and qualitative data. Quantitative data were obtained from the Indonesian-validated Collaborative Practice Assessment Tool (CPAT) questionnaire. CPAT in Indonesian language has been validated in previous research by Findyartini, et al. in 2019 in Indonesian population. The questionnaire was internally validated with the study population with Cronbach alpha of 0.812. All health care professionals meeting the selection criteria were enrolled for the quantitative study. Thequestionnaire was given to 152 health professionals enrolled as research subjects, including nutritionists, nurses, doctors, pharmacists, and medical rehabilitation specialists serving in Dr. Wahidin Sudirohusodo Hospital for >3 years. Five participants with highest and lowest CPAT score from each profession were invited for FGD entitled “Exploring factors involved in interprofessional collaboration in Wahidin Sudirohusodo General Hospital” and divided into 2 groups according to the CPAT score. The score from each subscale in the questionnaire is obtained for each research subjects and the median is compared among each profession group using Kruskall-Wallis test significant to a p-value of <0.05. Qualitative data as recording transcript is acquired from FGD; the transcript was then coded into several general themes by 2 of the authors and was discussed using thematic analysis using MaxQDA.Results: Research subjects were predominantly women (121 respondents (79.6%)), 32.9% were nurses, and most of the healthcare professional (81 subjects (55.1%)) have been working for >10 years. Among profession groups (Doctors, Pharmacists, Medical Rehabilitation Specialists, Nutritionists, and Nurses), difference in score distribution (P<0.05) wasfound in relationships among team members (40 vs 39 vs 39.5 vs 36 vs 42, P<0.001), barriers to team collaboration (10 vs 18.5 vs 14 vs 18 vs 10, P<0.001), and leadership (20 vs 20 vs 23 vs 20 vs 20, p 0.045). From the FGD, factors influencing interpersonal collaborative practice are leadership factors, system/rule factors, and personal factors.Conclusion: This research showed that personal, system/organizational and leadership factors influence the implementation of interprofessional collaboration. In this study, there is a different perception regarding relationships among team members, barriers to team collaboration, and leadership among profession group.

Prevalence of Persons with Disability Enrolled in Undergraduate Medical Schools in Brazil, 2019

MARIA NASCIMENTO; RHIAN TORRES; AMANDA HOROCHOVSKI; BRUNO BIRMANN; BRUNO TAKAHARA; LUIS SOUZA; KLYNSMAN RIBEIRO; BILLY MCBENEDICT

Volume 11, Issue 4 , October 2023, , Pages 205-212

https://doi.org/10.30476/jamp.2023.99332.1840

Abstract

Introduction: The affirmative policies in Brazil guarantee the provision of undergraduate medical education to People with Disability (PWD). The objective was to estimate the prevalence ... Read More Introduction: The affirmative policies in Brazil guarantee the provision of undergraduate medical education to People with Disability (PWD). The objective was to estimate the prevalence of PWD undergraduate medical students in Brazil in 2019.Methods: This is an exploratory, descriptive study that used census data from the total population of the undergraduatemedical students (N=183,646) who were enrolled at the Brazilian medical schools, in 2019. The data are secondary, unidentified and accessed online, and were originally collected by the Higher Education Census conducted by Anísio Teixeira National Institute of Educational Studies and Research (INEP), which used a questionnaire designed to capture information from students and medical courses. The descriptive analysis was based on absolute and relative frequencies.Results: The prevalence of medical students that were PWD was 0.80% (1,460/183,646), and this includes both Brazilian and foreign students. The latter includes people from 76 different countries. Foreign students who are PWD came from eight different countries: Bolivia, Burundi, Cabo Verde, Republic of Congo, Paraguay, Philippines, Singapore and Spain. Most of the PWD were male (51.37%), aged 20 to 24 years (46.78%) and of non-white ethnicity (52.26%). Most students were enrolled in public medical schools (73.97%). A fraction of PWD students (6.51%) was enrolled in medical schools with no specific resource or assistance for PWD. The highest prevalence was the physical disability (39.11%), followed by low vision accuracy (24.45%), intellectual (15.41%), low hearing (14.11%), blindness (3.97%), multiple disabilities (2.47%) and deafness (1.51%).Conclusions: The prevalence of PWD medical students in Brazil is low, and is dominated by students with physical and sensory disabilities but lacks the deaf-blind. Despite the existence of legal regulations favoring PWD to study medicine, some medical schools have not done adequate adjustments to accommodate them. This suggests that affirmative policies for the inclusion of PWD in higher education, particularly in medicine, still need improvement.

Teaching Professionalism during and Posta Pandemic to Surgical Trainees: A Survey of the Impact of a Workshop on Trainers and Trainees

NEIL ASHWOOD; EDWARD STANHOPE; IAN LAHART; ANDREW P DEKKER; JAMIE HIND; AMTUL CARMICHAEL

Volume 11, Issue 4 , October 2023, , Pages 193-204

https://doi.org/10.30476/jamp.2023.98395.1800

Abstract

Introduction: Focussed professionalism training improves surgical trainees’ communication, information gathering, and counselling skills. This study reviews the impact of a professionalism ... Read More Introduction: Focussed professionalism training improves surgical trainees’ communication, information gathering, and counselling skills. This study reviews the impact of a professionalism workshop for surgical trainees within a large trust in the United Kingdom developed during the pandemic to support the trainees and help them develop resilienceand appropriate behaviours during the time of increased pressure.Methods: A workshop involving case-based discussions and reflections on professionalism was developed from the themes and methods of training noted to be effective on a literature search of Medline, EMBASE, and PsycINFO databases carried out in May 2020. The impact of Covid on surgical trainees and educator’s professionalism training and the techniques of training preferred by trainees was evaluated by a survey of trainees and trainers after the intervention to evolve future training initiatives. During the workshop, a behavioural marker checklist was used to improve feedback on the observed behaviours.Results: 83 trainers and trainees were surveyed following a professional behaviour workshop training 63 surgeons at various stages of training. Surgical list availability had reduced by at least 5-10 a month for all the trainees within the trust during the pandemic. Most trainees surveyed (49 (60%)) felt that this had reduced the opportunities to train technical skills and develop professional non-technical skills like teamwork and communication skills, adversely impacting the trainee’s clinical performance. The increased support offered by the workshop helped 50 trainees (80%) to improve non-technical skill performance objectively by referencing to behavioural markers and this was felt to have become embedded in practice when surveyed 4 weeks later in 38 trainees (60%). The majority of those surveyed (47 (75%)) felt trainers and trainees had acted professionally during the pandemic and subsequently. The workshop discussions also helped (56 (67%)) trainers and trainees to consider how best to engage professionally with new ways of working as work, and training switched to virtual or telemedicine platforms during the pandemic.Conclusion: Professionalism-based education facilitates surgical trainee development, making them stronger team members and helping to restore team working skills and embrace new working practices.

The Effect of Mentoring Novice Clinical Educators on the Perception of Nursing Students from the Clinical Learning Environment

FATEMEH HESHMATI NABAVI; FATEMEH SHARIAT SAFA; MOHAMMAD RAJABPOUR

Volume 11, Issue 4 , October 2023, , Pages 252-261

https://doi.org/10.30476/jamp.2023.99480.1844

Abstract

Introduction: Creating a supportive clinical learning environment (CLE) is one of the characteristics of an effective clinical instructor in nursing. Perhaps empowering novice clinical ... Read More Introduction: Creating a supportive clinical learning environment (CLE) is one of the characteristics of an effective clinical instructor in nursing. Perhaps empowering novice clinical educators using mentorship method can reduce or resolve this problem. The aim of this study was to determine the impact of the mentorship program for novice clinical educators on the nursing students’ actual and preferred understanding of CLE.Methods: This quasi-experimental study on three groups was conducted as post-intervention with the participation of 139 undergraduate nursing students of Mashhad University of Medical Sciences. Sampling was done via stratified and multistage method. Students were placed in three groups: expert clinical educator (n=47), novice clinical educator (n=51), and mentorship (n=41). In the novice and expert clinical educator groups, training was conducted through the conventional method. In the mentorship group, a novice clinical educator (mentee) and an expert clinical educator (mentor) had a mentoring relationship for two weeks. The Chan (2001) CLE inventory was completed at the end of the first and second weeks of externship. Data were analyzed through SPSS v. 16 software using one-way ANOVAand paired t-tests.Results: The students of the three groups were homogeneous in terms of gender (P=0.101) and level of interest in the field (P=0.278). According to the result of the paired t-test, the difference in the mean score of the actual and preferred CLE at the end of the first week was statistically significant in the novice clinical educators (P=0.008) and the mentorship group (P=0.04); however, after the implementation of mentorship program (at the end of the second week), the difference was significant only in the novice educators group (P=0.001).Conclusion: The implementation of the mentorship program for novice clinical educators (as with the expert educators group) could lead to a reduction in the mismatch between the actual and preferred views of students about the CLE. Thus, it is recommended that this method should be used under conditions of shortage of expert educators to create a supportive CLE.