Journal of Advances in Medical Education & Professionalism

Abstract Introduction: The portfolio can be seen as a tool for assessmentof a variety of learning activities that differ in content, usage, andassessment. The portfolio not only meets the learner’s educationalneeds but also the political and public reassurance demand thatthe health professional has achieved the required competency ofthe curriculum that allows him or her to practice safely with orwithout supervision in the health organization.Methods: An in-depth search on Google Scholar, Medline andPubMed was conducted using the terms “reflection and portfolio”with especial emphasis on undergraduates. All the manuscriptscollected were critically reviewed regardless of the date ofpublication.Results: Even though the systematic review showed thelimited effect of the educational impact of the portfolio on theundergraduate, numerous benefits can be seen, e.g. improvementin the relationship between students and tutors, an increasein general knowledge, awareness and reflection. Reflectionfor medical undergraduates in portfolio per se was associatedwith improvement in communications skills, professionalismand better achievement in postgraduate studies and increase inexperiential learning. Interestingly, the portfolio was shown to beuseful for undergraduate and tutors in filling the gaps of learningin clinical surgery, urology and geriatric medicine. In addition,for dental and nursing students it was associated with an increasein professionalism, clinical competency, and self-confidence.Lack of integration of reflection throughout the curriculum of themedical school was considered one of the main problems.Conclusion: Further research is needed to address the followingquestions (i) it will be of interest to assess if there is anydifference in reflective portfolio between students from problembasedlearning (PBL) curriculum and those from traditionalcurriculum. (ii) Assess the difference in reflective portfoliobetween community-oriented and PBL curriculum and PBLand traditional curriculum (iii) if there is any difference in thereflective portfolio in these three curriculums, it will be of interesthow this can alter the evidence base of the educational effects ofthe portfolio. In other words, is there any curriculum that willconsistently produce evidence based educational effects of theportfolio?Keywords: Medical education, Reflection, Portfolio

Abstract Introduction: Classroom management is leading the class bysetting the class schedule, organizing the procedures, supervisingthe learners’ progress, and predicting and solving their problems.Students’ disruptive behaviors and classroom management arethe most important challenges and concerns of the teachers. Thecurrent review aimed to analyze the classroom managementtechniques and strategies used to cope with the students’disruptive behaviors.Methods: The present study was systematic review. The articlesin Science Direct, PubMed and Scopus databases and GoogleScholar search engine were searched using the keywords ofclassroom management, students’ disruptive behaviors, difficultstudents, and confrontation strategies during 2000-2017. A totalof 31 articles were included in the study for analysis.Results: The results showed all the techniques and strategiesused and teachers’ challenges in dealing with students’ disruptivebehaviors were included in conflict management strategies, whichwere classified into three categories, i.e. cooperative and problemsolving strategies, avoidance strategies and punishment strategies.Moreover, the studies mostly emphasized the use of cooperativeand problem solving strategies, and the most highlighted methodswere making effective mutual communication with studentsto correct their negative behavior, training and preparing theteachers for dealing with the students’ disruptive behaviors andusing various teaching methods and approaches based on theclassroom situation.Conclusion: To cope with the challenges of students’ disruptivebehaviors, the teachers can use different strategies. Also, sufficientknowledge and skills about teaching, familiarity with the relevantand influential disciplines in dealing with students and makingeffective communication in the class can be helpful in developingand enjoying more effective skills in classroom management.Keywords: Problem behavior, Learning, Problem solving, Punishment

Abstract Introduction: Medical schools face increasing challenges toaccommodate new health care needs. However, little has changedregarding the students’ education. In addition, educators face thechallenge of improving their teaching approach, making it suitableand effective for the new generation. The purpose of this work wasto describe and contextualize the application of active pedagogicalmethodologies using the virtual learning environment (VLE) as atool to improve the students’ performance.Methods: This research is a quantitative and qualitative casestudy, carried out in one faculty of medicine in the state ofAmazonas. Given a total population of senior students in thisfaculty, the number of participants corresponds to a proportionof 75% in the period of two years. This work required a paradigmshift, by focusing on interactive and technological teaching,professionalism, mentoring, communication, and feedback.Courses using virtual learning environment (VLE) should beprone to interaction, dialogue, collaboration and, asynchronously,autonomy. One of the key aspects of VLE content production isto select appropriate subject matters and texts to be discussed.It is through the VLE contents that the mediation of knowledgeconstruction process and the participants’ interaction takes place.Results: The improvement over the pre-test evaluation wasevident, ranging between 12.59 and 50.9%, depending on thesubject matter, to 81.31% in the final evaluation. In addition, thestudents expressed consistently positive opinions regarding theuse of VLE.Conclusion: The use of VLE as a pedagogical tool, in aninteractive format and appropriate to the transmission ofinformation and knowledge construction, was adequate for anevident improvement in the cognitive performance of the seniorstudents of medicine. In addition, the positive evaluation of thestudents regarding the pedagogical methodology used constitutesan added value of this approach.Keywords: Teaching, Education, Medical, User-computer interface

Abstract Introduction: Virtual reality is a new method for trainingdifferent medical groups. Based on this technology, professionalsand students of various medical sciences can determine their levelof competence for medical treatment before any performance onthe patient. Therefore, the aim of this study was to identify theapplications of virtual reality technology for training the medicalgroups.Methods: This is a scoping review study conducted in 2016.Articles were retrieved through the search of related keywords indatabases such as Pub Med, Scopus, Web of Sciences, Springer,and Google scholar. Then, after applying the entry criteria, 21papers were selected from a total of 1343. Data extraction was doneby a data collection form. The collected data were summarizedand reported using content analysis technique according to thestudy purpose.Results: The findings of the study indicated that 11 cases (48%)have used virtual education technology for laparoscopic surgerytraining. Using virtual reality has improved learning in 17 (74%)studies. A higher accuracy in medical practice by people trainedthrough VR has been reported in 20 (87%) studies.Conclusion: The results indicate that the application of virtualreality capabilities plays an important role in improving theperformance of different medical groups. According to the results,it can be suggested that virtual reality capabilities should be usedto train different medical groups based on their individual andcollective needs.Keywords: Virtual reality, Training, Clinical trials, Technology

Abstract Introduction: Nowadays according to competency basedcurriculum, selecting an appropriate assessment method isinevitable. This study aimed to investigate application of DirectObservation of Procedural Skills (DOPS) in undergraduatemedical students.Methods: This is a cross sectional study conducted duringemergency ward rotation in last year medical students usingconsensus sampling method. Each student performed 2 proceduresat least twice under the observation of 2 assessors using modifiedDOPS rating scales designed for each procedure simultaneously.Correlation between DOPS score and final routine exam wasmeasured. Face and content validity was determined by thepanel of experts. Moreover, through the test-retest and interraterreliability, the correlation of each score and total score wasinvestigated. The spent time was calculated too. The statisticalanalysis was carried out using SPSS version 18.Results: Totally 60 students did 240 procedures under DOPS.The face and content validity confirmed by an expert panel. Thefindings showed that there was a significant correlation betweenthe scores of each test and the total DOPS score (r1=0.736**,r2=0.793**, r3=0.564**, r4=0.685**; p<0.001). There was a significantcorrelation between the first and second scores of doing the sameprocedure (Pearson Cor.=0.74, p<0.001) and also between thescores of the two individual examiners when observing the sameprocedure (Pearson Cor.=0.84-0.94, p<0.001). The results showedthat there was no correlation (Pearson Correlation=0.018, p<0.89)between the scores of this test and the final routine ward examscores. The average time for doing DOPS test and the averagetime for providing feedback were 11.17±7.5 Max and 9.2±4.5 Min,respectively.Conclusion: The use of novel performance assessment methodssuch as DOPS is highly beneficial in order to ensure the adequacyof learning in medical students and assess their readiness foraccepting professional responsibilities. DOPS as a practical andreliable test with acceptable validation can be used to assessclinical skills of undergraduate medical students.Keywords: Reliability, Validity, Feasibility, Satisfaction, Undergraduate, Medicalstudent

Abstract Introduction: The standardized Patient Program (SPP) is astandard educational training method which provides the preclinicalstudents a better clinical foundation by linking the realmof clinical medicine to basic sciences. It incorporates a modernsimulation technique and enhances the ability of the studentswherein they can practice, apply and learn the basics of patientencounter. The main objective of this study was to analyze theimplementation and efficiency of the SPP in Avalon UniversitySchool of Medicine (AUSOM).Methods: A quasi-experimental “before-and-after” study designwas conducted among the 3rd Semester (MD3) medical studentsat AUSOM. 24 students voluntarily participated in the study. Theeffectiveness of the program was evaluated after comparing thesummative examination scores before and after implementationof the SPP (graded in 100 points system). Mean scores werecalculated and a comparison of the change in scores was made,using a paired t-test in Stata (©Stata corp).Results: The mean final summative clinical skills examinationscores of the students before and after the introduction of theSPP were 78.46±6.62 (SEM: 1.35, range: 89-70) and 86.54±6.41(SEM: 1.31, range: 98-65), respectively. There was a statisticallysignificant increment (t=5.5058, p=0.0001) in the scores of thestudents after the introduction of the SPP.Conclusion: Introduction and implementation of SPP at AUSOMat preclinical years increased the overall students’ performancein clinical skills. It is necessary that medical schools implementSPP early in preclinical years to strengthen learning and inoculatenecessary clinical skills in medical students.Education, Medical, Patient simulation, Clinical competence, Programevaluation

Abstract Dear Editor, Re-Orientation of Medical Education(ROME), a one month posting ofundergraduate students in department ofCommunity Medicine, is used not only to buildup the knowledge, attitude, communication andclinical skills, but also to make the physician incontact with the community efficiently. In 1977,the ROME scheme aimed at developing medicaldoctors for the rural community in the visionof medical education, which later envisagedtraining a basic doctor to serve better at the firstcontact with rural and urban community (1, 2).During the posting, the students conducted houseto house survey in rural and urban communitiesand prepared a detailed report of the researchactivities and planned intervention based on theneeds of the community.World consumption of paper has grown 400%in the last four decades. About 35% of the totaltrees cut around the world are used in paperindustries (3). To reduce the paper consumption,The Ugandan Ministry of Health advocated theuse of smart phones in integrated communitycase management approach for health careproviders for child health (4). Every year inROME more than thousands of pages of papersare used for data collection. As a small initiativeto save paper in this year (2018) ROME training,completely paper-less questionnaires were madeand used. Smart phones were used as a tool fordata collection and data entry. Even in the largescale surveys, data capture can be easily done(5). Epicollect5 software (developed by ImperialCollege London funded by the Wellcome trust)was used to collect data through a mobile app.The mobile based data collection has benefitsover paper-based approaches. The Epicollect5software enables the creators or managersto identify the errors and allows mid-coursecorrection in minimal time. The instances ofdata entry error/missing data can be avoidedby applying checks at the data entry point. Thedata are transferred to a central server near –instantaneously; therefore, the data are storedand backed up securely, and the risk of dataloss is minimal. Epicollect5 is available for bothAndroid (4.4+) and iOS (8+)-based mobile phonesin play store and app store, respectively. There arevarious resources for mobile phone-based datacollection solutions (6).As the students are familiar with the smart phones, training requirements were almostminimal. The students grasped it in almost realtime.It would be right to say the technology hasimbibed the younger generation more, than beinglearnt by them.Use of mobile phones was so convenient,feasible and user-friendly to capture data(data collection as well as data entry). By theend of day 5 of data collection by a group of40 undergraduate students, the total numbersof households covered were 963 and 3527individuals. During the survey period, a batchof 150 undergraduate students collected the dataof around 15575 individuals by using this mobileapp. This actually reduced the time and costsinvolved in acquiring or maintaining dedicatedtools for data capture. The app also gives anopportunity to collect audios, videos and GPSco-ordinates. As compared to previous years'ROME posting which were done in a similarsetting with paper-based questionnaire; the totalnumber of participants interviewed by a group of30-35 students were around 2200 to 2600 over aperiod of 10 days of data collection which wasfollowed by another 5 days of data entry in MSExcel/ EpiData software.Appropriate use of technology in researchhelped the students to minimize the hours spentin data collection and entry and provoked theirinterest in research since the app-based datacollection was more interesting as compared topaper-based approach for them.

Abstract Dear Editor, Extracurricular activities for the gifted andtalented students in Iran derive from thebelief that students with high potentials areexpected to make great help for the healthcare of the community. One of these activitiesis holding medical science Olympiads. In theprevious meeting report about medical scienceOlympiad in year 2011, a unique experienceof Islamic Republic of Iran was reported. TheOlympiad was held in three areas of basicsciences, clinical reasoning and management byparticipation of high rank medical students fromall over the country in two stages: individual andgroup (1-4).After performing 8 Olympiads in the country,the ninth Olympiad was held in September 2017in Tehran, Iran differently with more emphasison creativity and productivity.While creativity in health care is mostlysupposed to be innovations in surgical devices,medications, and procedures, we believed that italso relates to other health care disciplines likebasic sciences, medical education, philosophy ofmedicine and management. Creativity in thesefields is a newer concept that may result in findingnovel solutions to health care and educationalproblems and challenges such as improvingpatient care and coordinating care across multipledisciplines and difficult conditions.Shahid Beheshti University of MedicalSciences was the host of the Ninth NationalMedical Science Olympiad in September 2017under direct supervision of Ministry of Healthand Medical Education. This Olympiad was heldin five areas including basic sciences, clinicalmedicine, medical education, philosophy ofmedicine and health care management. All topranked students in medical sciences (such asmedicine, pharmacy, nursing, health management,dentistry, etc.) from all over the country had thechance of participating in this Olympiad. In Iranintegration of medical education and health caredelivery system has started in 50 universities ofmedical sciences all over the country (5). 2151students from these universities participated inthe individual Olympiad exam. Then 30 teamsin each of the five areas (total 450 teams) wereselected 55 experts in five scientific committeesconstructed the Olympiad questions in individualand team stages. A unique experience in the NinthOlympiad was using a novel and creative projectbased assignment for each team in each of thefive areas. These projects were Evidence-based decision making, public private partnership, earlyclinical exposure, medical futility and autonomicmodulation on the brain functional connectivityrelated to depression.75 percent of the students stated that theywere satisfied with these innovative and creativeprojects in different areas. 84 percent of thefaculties reported that this kind of Olympiadincreased students’ motivation and led themto compare issues friendly with each other ina scientific environment. 69.25 percent of thestudents reported that increasing the numberof teams in this Olympiad for problem solvingactivities was a very good experience for themand ascertained that such activities should beincluded in the formal curriculum of medicalschools.The main shortcoming in this Olympiadreported by the students was the competitivenature of the exam and subjectivity in scoringthe projects in some areas.Performing such Olympiads is essential indiscovering talented students and developingtheir capabilities to promote health systems.Although academic merit is not the onlyindicator of success in health science disciplines,designing additional programs for gifted andtalented students is warranted to help academicallytalented students to further their knowledge.