Journal of Advances in Medical Education & Professionalism

Critical appraisal skills training to undergraduate medical students: A Randomized Control Study

SARVIN SASANNIA; MITRA AMINI; MAHSA MOOSAVI; AMIR ASKARINEJAD; MANA MOGHADAMI; HASTI ZIAEE; FATEMEH VARA

Volume 10, Issue 4 , October 2022, , Pages 253-258

https://doi.org/10.30476/jamp.2022.94852.1610

Abstract

Introduction: Critical appraisal skills are presumed to perform a principal part in evidence-based health education and practice methods. This study aimed to design an educational intervention ... Read More Introduction: Critical appraisal skills are presumed to perform a principal part in evidence-based health education and practice methods. This study aimed to design an educational intervention around critical appraisal in this context, evaluate the efficacy of the teaching methods, and investigate critical appraisal skills training to undergraduate medical students.Methods: In this prospective Randomized Control Trial (RCT), 256 sixth-year undergraduate medical students from Shiraz University of Medical Science, Shiraz, Iran, participated. 124 of the students were not taught critical thinking methods as a control group, and 132 participants were taught critical thinking methods by multimedia and attended an online Critical Appraisal Skills (CAS) training workshop as an intervention group. We used the Critical Appraisal Skills Programme (CASP) questionnaire to evaluate students’ knowledge, attitude, confidence, and appraisal skills. This questionnaire was translated into Persian for the first time in Iran by Shokooh Varai, et al. They investigated its validity and reliability,the reliability of the questionnaire being obtained by the Richardson Index (0.75), and the validity being confirmed by some faculty members of Tehran Nursing and Midwifery School. To compare both control and intervention groups, we used an independent t-test and a Chi-Square test at a significance level of 5%, and to analyze the demographic information, we applied some descriptive statistics: frequency, frequency percentage, mean and standard deviation. Allof the statistical approaches were analyzed, using SPSS 22.Results: In all dimensions of the critical appraisal skills, medical students who completed the critical appraisal multi-media training and workshop performed better than those who did not (control group), and this difference was statistically significant (P<0.05). Moreover, the Chi-Square test results showed no statistical relationship between the groups regarding the demographic variables (P>0.05). Also, the Cohen’s D effect size values in the knowledge and confidencedimensions were greater than 0.5; this meant a large effect. Regarding the attitude and appraises Skill dimensions, the effect size was between 0.2 and 0.5, which meant a medium effect.Conclusion: Teaching critical appraisal skills through multi-media and CAS online workshops to medical students effectively improves the students’ knowledge and confidence in appraising articles. This teaching also indicated a medium effect on students’ attitudes and behavior. Our findings can justify implementing critical appraisal skills teaching modules in the undergraduate medical education curriculum.

The effectiveness of training on daily progress note writing by medical interns

IRANDOKHT SHENAVAR MASOOLEH; ELHAM RAMEZANZADEH; MARYAM YASERI; SEYYEDE SAHERE MORTAZAVI KHATIBANI; HANIEH SADAT FAYAZI; HEYDAR ALI BALOU; HOURVASH EBRAHIMI LOUYEH; FATEMEH ZAERSABET; HOSSEIN KHOSHRANG; IDEH DADGARAN

Volume 9, Issue 3 , July 2021, , Pages 168-175

https://doi.org/10.30476/jamp.2021.88747.1357

Abstract

Introduction: There is no formal education or training course about daily progress note writing in Iranian medical interns’curriculum. The current study aimed to assess the ... Read More Introduction: There is no formal education or training course about daily progress note writing in Iranian medical interns’curriculum. The current study aimed to assess the effectiveness of a training intervention on daily progress note writing by Iranian medical interns.Methods: This quasi-experimental study (pre- and post-test) was conducted on 150 medical interns selected through the census method at Razi Hospital of Rasht, north of Iran from October-2018to May-2019. In the baseline, daily progress notes written by 150 medical interns were assessed using a Subjective, Objective, Assessment, and Plan (SOAP)-based questionnaire by the expertpanel. Content validity of the questionnaire was confirmed by experts and internal consistency was determined using Cronbach’s alpha coefficient. In the intervention phase, training sessions (4one-hour sessions) on how to write the daily progress note, based on SOAP format and its importance, were held for the interns. All medical interns were given a week to meet the SOAP standards. Then, the same expert panel reviewed and assessed the newly written daily progress notes of the same medical interns. Finally, the scores from the evaluation of progress note writing, before and after the intervention, were compared with paired sample t-test.Results: The mean age of the medical interns was 23.1±5.2 years. The majority of them were male (56%). There was a significant improvement in all SOAP notes’ components written by medicalinterns between the pre- and post-intervention periods (general rules: 52.7±24.5 vs. 85.4±18.2, p <0.001; subjective: 21.2±18.3 vs. 61.7±24.3, p <0.001; objective: 25.3±18.3 vs. 71.3±25.2, p <0.001; assessment: 10.7±13.0 vs. 51.4±29.6, p <0.001; plan: 11.2±15.2 vs.49.6±27.5, p <0.001; total: 21.9±13.0 vs. 61.8±23.0, p <0.001). But the scores were still far from the desirable level after the training intervention.Conclusion: The finding of the present research suggests that a training intervention can lead to some improvements in the daily progress notes written by Iranian medical interns.

Multiple facets of learning a skill – Amalgamation of learning theories in cadaveric surgical skill lab

DINESH KUMAR. V; S.S.S.N RAJASEKHAR

Volume 9, Issue 3 , July 2021, , Pages 183-184

https://doi.org/10.30476/jamp.2020.84959.1155

Abstract

Psychomotor skills training includes three stages of learning. In the cognitive stage, there is a creation of awareness regarding the items to be learned; in the associative ... Read More Psychomotor skills training includes three stages of learning. In the cognitive stage, there is a creation of awareness regarding the items to be learned; in the associative stage, the refining of skills takes place, and in the autonomous stage, the proficiency in the skills is developed (1). One of the ways by which novice surgeons acquire mastery standards, before proceeding to perform surgical skills independently, is by practicing in cadavers. In contrast to the conventional pattern of learning,i.e. apprenticeship model whereby the trainees learn by ‘see one, do one and teach one’ adage,cadaveric skill lab ascertains the transformation/change of individual abilities in a structuredenvironment in pursuit of a task goal. The above statement could be substantiated by the study conducted by Zendejas et al. (2), where residents trained under simulated settings were able to complete the task goal, i.e. total extraperitoneal repair in lesser time and with reduced intra-operative and post-operative complications compared to the traditional training group.When we mean acquiring mastery standards, it means that all learners should attain the prescribedcompetency standards required for deliberate practice without much variation in the definedoutcomes. Nevertheless, it is well known that each individual does not necessarily have the samemotor learning dynamics, and they need not learn the same pattern even in similar task conditions(3). Notably, the surgical skill can be deciphered as a sequential motor skill learning, involving acombination of explicit and implicit processes, operating in a schema in order to accomplish thetask (4). Besides, this should be complemented by proprioceptive feedback, which harnessesthe motor accuracy and enables making quick adjustments in the authentic environment. In thiscontext, we wish to throw light upon two pertinent learning theories which medical educators shallreconcile while planning surgical skill programs.Let us consider the sequence of learning taking place while learning a surgical skill, for example, arthrocentesis in the cadaveric knee model. Comparing the Kovacs’ steps for procedural skill training (5), we could envisage that skill acquisition passes through four distinct stages. In the first step, the novice gains the cognitive knowledge required for the procedure (‘learn’ step). Secondly, he/she visualizes and contextualizes the procedure by observing while being performed by an expert (‘see’ step).Thirdly, the step of imitation begins where the participant performs the movements required for the skill with a certain degree of confidence, and this could be considered as trial and error (‘practice’ step). Finally, upon multiple cycles of practice, the trainee would master the movement patterns, tailor it according to tricky situations, and, if needed, create a new pattern of movements(‘do’ step). Subsequently, we shall reiterate upon two theories, which could be attributed to motor learning in the cadaveric skill lab.Schmidt’s schema theory is an open-loop controlled method of motor learning which does not involve feedback mechanism (6). It postulates the mechanism by which a novice learns a specific motor task which he or she has not performed previously. During the ‘learn’ and ‘see’ phase, a trainee observes a lot of co-ordinated movement patterns that get stored as schemas in a short memory system. When they practice, they learn by committing multiple errors, which also gets coded as schemas. For example, while performing laparoscopic procedures in cadavers, a surgeon needs to learn how to anticipate where and how far the instrument will pass through employing perceptual decisions made on the moment-moment basis. From short term memory, the information goes to a recall schema, where the specific response is selected, and then the recognition schema, where the response willbe evaluated, errors are realized, and followed by the generation of information on the correctresponse. This process helps in deciding a critical move or use a certain degree of force in specific situations for a co-ordinated motor pattern. This can be analogized to a cricketer who recalls the mistakes after the innings, interprets the sequence of movements, and corrects his future performances. Besides, schema theory emphasizes the value of variability in practice conditions for honing the learned skills in simulated settings. Thus, schema theory could still be considered to have a significant role in skill learning despite the criticism placed on it.Another major theory that has been posited for motor skill acquisition is Adam’s theory of learning, which is essentially a closed-loop method relying upon the sensory/perceptual feedback on the ongoing sequence of skilled movements (7).It involves a stimulus (input) that generates a perception of input resulting in a memory trace todecide as to which movement should be initiated. This will be followed by a perception trace, whichis an amalgamation of sensory consequences of previous similar movements and, finally, a motoraction (output). This can be compared with gaining experience of driving a car in crowded placeswhere the driver learns negotiation and adjustment abilities in stimulus-response reacting manner.The crux of this theory that supports the need for formative feedback in ‘practice’ sessions wherebymaking the learners know about the results is that it facilitates the identification/rectification of errors. To exemplify, a workshop where the placement of the endotracheal tube in cadaver bythe novice is confirmed by visualizing using the ultrasound transducer, the learners could assess theend-point by themselves and rectify accordingly.Performing the prescribed movement repetitively enables the learners to gain the correct perceptualtrace over time with the actual accomplishment of end-point, similar to hitting the bull’s eye duringshooting practice. Nevertheless, this motor theory of learning does not take into consideration thesalience of variability in practice while mastering a procedure.With the advent of soft embalming techniques, cadavers are increasingly used for teachingprocedural skills owing to their relatively higher fidelity, haptic parameters, and life-likesimulation compared to mannequins and virtual reality simulator. On the flip side, many cadaverbased workshops suffer a lack of structuring and sophisticated feedback. Feedback from cadaveric skill workshops should be structured to provide feedback regarding the knowledge of results and knowledge of performance to aid the mastery of standards. In this context, we emphasize the importance of knowledge about the theories involved in motor learning, which ideally shouldbe incorporated while designing surgical skill cadaveric workshops and in the absence of whichprocedural skill training might not effectively translate to the clinical environment. Supplementingthe established framework with learning theories will suffice the long-term outcomes of the skilltraining sessions, which is reaching mastery standards in performing that particular procedure.

Impact of International Training of Medical Specialists for underdeveloped Countries: Brazil– Angola experience

ADILSON JOSE MANUEL DE OLIVEIRA; MÁRIO FRESTA

Volume 8, Issue 1 , January 2020, , Pages 50-52

https://doi.org/10.30476/jamp.2019.81744.1030

Abstract

Introduction: Angola has about 28 million inhabitants and approximately 0.21 physicians/1,000 population. There is only one specialist in some medical fields in the whole ... Read More

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Keywords = Training

Critical appraisal skills training to undergraduate medical students: A Randomized Control Study

Abstract

The effectiveness of training on daily progress note writing by medical interns

Abstract

Multiple facets of learning a skill – Amalgamation of learning theories in cadaveric surgical skill lab

Abstract

Impact of International Training of Medical Specialists for underdeveloped Countries: Brazil– Angola experience

Abstract