Journal of Advances in Medical Education & Professionalism

Impact of immediate feedback on the learning of medical students in pharmacology

DINESH K BADYAL; SUMAN BALA; TEJINDER SINGH; GAURAV GULREZ

Volume 7, Issue 1 , January 2019, Pages 1-6

https://doi.org/10.30476/jamp.2019.41036

Abstract

Introduction: Providing feedback to students is an essentialcomponent in medical education and has been shown to improvethe students’ learning. The purpose of this study is to ... Read More Introduction: Providing feedback to students is an essentialcomponent in medical education and has been shown to improvethe students’ learning. The purpose of this study is to evaluatethe effect of computer-based immediate feedback on the medicalstudents’ learning in a pharmacology course. Methods: In this prospective intervention study some feedbackmodules in pharmacology (FMP) were prepared in two topics:the cardiovascular system (CVS) and chemotherapy, using blanktemplates on “Hot Potatoes” software. The FMP included MCbasedquestions and two versions were developed: one withfeedback (FMP-1) and the other without feedback (FMP-2). TheFMP-1 module provided immediate feedback for each option thestudent chose. The students (n=48) were randomized by computergenerated random number table to two groups A and B to receivethe module in CVS, i.e., FMP-1 and FMP-2, respectively. A crossoverdesign was adopted to expose all students to immediatefeedback modules. The test scores were compared and feedbackwas obtained from students and faculty using a validatedquestionnaire. A focus group discussion was conducted to clarifythe issues raised by the students. Results: The module with immediate feedback was much better appreciated by the students than the module without feedback. The students spent more time on FMP-1 (42±7.00 minutes vs 27±12.36 minutes; p<0.001 in chemotherapy and 40±12.11 minutes vs 24±6.01 minutes; p<0.001 in CVS). However, there was no statistically significant difference in mean test scores. The qualitative data collected provided important information on the value of immediate feedback. The students believed that immediate feedback was an excellent way for self-assessment and improved their deeper understanding of content areas. They also felt that it supplemented their traditional learning habitsand stimulated them to read more. The students enjoyed its nonthreatening nature.Conclusion: Immediate feedback improved the deeper understanding of pharmacology and its relevance to medicine for the two topics although immediate feedback did not improve test scores. Overall, immediate feedback had a positive impact on the students’ self-directed learning.

Assessing clinical reasoning skills using Script Concordance Test (SCT) and extended matching questions (EMQs): A pilot for urology trainees

SYED MUHAMMAD NAZIM; JAMSHEER J. TALATI; SHEILA PINJANI; SYED RAZIUDDIN BIYABANI S; MUHAMMAD HAMMAD ATHER; JOHN J. NORCINI

Volume 7, Issue 1 , January 2019, Pages 7-13

https://doi.org/10.30476/jamp.2019.41038

Abstract

Introduction: Clinical reasoning skill is the core of medicalcompetence. Commonly used assessment methods for medicalcompetence have limited ability to evaluate critical thinking andreasoning ... Read More Introduction: Clinical reasoning skill is the core of medicalcompetence. Commonly used assessment methods for medicalcompetence have limited ability to evaluate critical thinking andreasoning skills. Script Concordance Test (SCT) and Extended Matching Questions (EMQs) are the evolving tests which areconsidered to be valid and reliable tools for assessing clinicalreasoning and judgment. We performed this pilot study to determinewhether SCT and EMQs can differentiate clinical reasoning abilityamong urology residents, interns and medical students. Methods: This was a cross-sectional study in which an examinationwith 48 SCT-based items on eleven clinical scenarios and four themedEMQs with 21 items were administered to a total of 27 learners atthree differing levels of experience i.e. 9 urology residents, 6 internsand 12 fifth year medical students. A non-probability conveniencesampling was done. The SCTs and EMQs were developed fromclinical situations representative of urological practice by 5 contentexperts (urologists) and assessed by a medical education expert.Learners’ responses were scored using the standard and the graduatedkey. A one way analysis of variance (ANOVA) was conducted tocompare the mean scores across the level of experience. A p-value of <0.05 was considered statistically significant. Test reliability was estimated by Cronbach α. A focused group discussion with candidates was done to assess their perception of test. Results: Both SCT and EMQs successfully differentiated residents from interns and students. Statistically significant difference in mean score was found for both SCT and EMQs among the 3 groups using both the standard and the graduated key. The mean scores were higher for all groups as measured by the graduated key compared to the standard key. The internal consistency (Cronbach’s α) was 0.53 and 0.6 for EMQs and SCT, respectively. Majority of the participants were satisfied with regard to time, environment, instructions provided and the content covered and nearly all felt that the test helped them in thinking process particularly clinical reasoning.Conclusion: Our data suggest that both SCT and EMQs are capable of discriminating between learners according to their clinical experience in urology. As there is a wide acceptability by all candidates, these tests could be used to assess and enhance clinical reasoning skills. More research is needed to prove validity of these tests.

Online-learning: exploring practices among Foundation doctors

FLORENCE KUDZAI KASHORA; DEBBIE-ANNE CHARLES

Volume 7, Issue 1 , January 2019, Pages 14-19

https://doi.org/10.30476/jamp.2019.41040

Abstract

Introduction: Postgraduate medical education involves the use ofonline-learning tools. However, there is a paucity of data on theuse of online-learning among doctors who are in their ... Read More

Analysis of Iran’s National Medical Education Evolution and Innovation Plan using the Michelle and Scott’s model of policymaking

ATA POURABBASI; HAMID AKBARI; AMIR AHMAD AKHVAN; ALI AKBAR HAGHDOOST; ZAHRA KHEIRY; REZA DEHNAVIEH; HAMED RAHIMI; SOMAYEH NOORI HEKMAT; BAGHER LARIJANI

Volume 7, Issue 1 , January 2019, Pages 20-26

https://doi.org/10.30476/jamp.2019.41041

Abstract

Introduction: Lack of a clear policy for the development of healthhuman resources has created inconsistencies. These imbalancesare threats to the health system to achieve its goals. ... Read More

Exploration of faculty members’ perceptions about virtual education challenges in medical sciences: a qualitative study

MOHAMMAD HASAN KESHAVARZI; SEYED KAMRAN SOLTANI ARABSHAHI; BANAFSHEH GHARRAHEE; ZOHREH SOHRABI; MARJAN MARDANI HAMOOLEH

Volume 7, Issue 1 , January 2019, Pages 27-34

https://doi.org/10.30476/jamp.2019.41042

Abstract

Introduction: Virtual education is among the important factorsimproving the learning of medical students. This study aimed toexplain the perceptions of faculty members towards the challengesof ... Read More

The influence of role-modeling on the clinical empathy of medical interns: A qualitative study

NAHID AHMADIAN YAZDI; SHOALEH BIGDELI; KAMRAN SOLTANI ARABSHAHI; SAEIDEH GHAFFARIFAR

Volume 7, Issue 1 , January 2019, Pages 35-41

https://doi.org/10.30476/jamp.2019.41043

Abstract

Introduction: Clinical empathy ascertains the quality of doctorpatientrelationship and entails beneficial outcomes for bothparties. Role-modeling is a major factor in promoting clinicalempathy ... Read More

Commentary

Good, bad and ugly: Exploring the Machiavellian power dynamics of leadership in medical education

DINESH KUMAR V

Volume 7, Issue 1 , January 2019, Pages 42-46

https://doi.org/10.30476/jamp.2019.41035

Abstract

Introduction: Medical education requires participation of variousstakeholders and this contributes to power dynamics operating atmultiple levels. Personality traits of an individual ... Read More

Letter to Editor

Change as an opportunity - Collaborative research in a fluctuating global landscape

MICHAEL Y MAHGEREFTEH; NIKHIL V MATH; AVI A KORMAN

Volume 7, Issue 1 , January 2019, Pages 47-48

https://doi.org/10.30476/jamp.2018.41037

Abstract

Dear Editor, We note with great enthusiasm the advancesto the medical field that have been broughtabout by international collaboration betweenmedical researchers in different countries.Collaboration ... Read More Dear Editor, We note with great enthusiasm the advancesto the medical field that have been broughtabout by international collaboration betweenmedical researchers in different countries.Collaboration occurs when “2 or more entitieswork together to produce a desired and sharedoutcome” (1). Literature on the topic notesspecifically the strategic alignment of globalpartnerships with global health priorities, (2)and how international collaboration advancesthese goals through research teams workingtogether on such projects. Indeed, it is not onlyin research, but also in medical practice andeducation where important strides are oftenmade by observing and importing the healthcareand education practices of other countries (3).The medical community in Iran hascontributed admirably to the global advancementof medicine. According to the Scopus index, in2015 Iran ranked first for the number of scientificpapers published and number of citations, bothin its region and among all Islamic countries (4).Furthermore, the research ranking of IranianUniversities has been consistently high andimproving over time (5).However, in a constantly fluctuating globallandscape, it may become increasingly difficultfor Iranian institutions to maintain internationalcollaborative efforts over time, and to buildnew ones. With the introduction of US travelrestrictions for Iranians (amongst others), travelto the US for conferences, research projects,observerships, etc. have become significantlymore problematic (6). Naturally, this is likely tonegatively affect the Iranian medical communityin its efforts and advancements. The networksand connections made at international meetingsthroughout the world can act as a gateway tocollaborative projects and research. In reducingthe capacity for Iranian scientists to involvethemselves, there is an inherent risk to thecapacity for progression of medical research andpractice in Iran.Considering the value of the Iranian medicalcommunity and the challenges it faces, we urgestrengthening of the efforts for collaborationamong its scientists and medical practitionersand the rest of the world. An opportunity existsfor ties to be formed and relationships to bestrengthened where they previously were weakor non-existent. At Imperial College London,we note wholeheartedly the many members offaculty and frontline medical staff who havecome from Iran, bringing tangible advances totheir specialist fields. We believe there is now achance to reinforce this scientific relationship.Cross-collaboration through medical conferences,mutual travel grants to other countries, andactive participation of scientists and cliniciansof Iranian descent can all be utilised to fortifythis relationship. One particular aspect that maybe used is the strength of Iran within medicalbiotechnology (7). Moreover, partnershipsin newer fields, such as remote healthcareprocedures and services, represent anotherchance to overcome the difficulties in travel facedby Iranian scientists.

Letter to Editor

A one-day visit of the EEG and EMG/NCV departments during neurology course for medical students of Shiraz University of Medical Sciences

MARYAM POURSADEGHFARD; ALIREZA NIKSERESHT

Volume 7, Issue 1 , January 2019, Pages 49-50

https://doi.org/10.30476/jamp.2019.41039

Abstract

Dear editor Today, an important part of the patients’diagnostic activities includes paraclinicaltests and procedures, which follow theircompleted history-taking and clinicalexaminations, ... Read More Dear editor Today, an important part of the patients’diagnostic activities includes paraclinicaltests and procedures, which follow theircompleted history-taking and clinicalexaminations, in such a way that many medicalscience sources in different fields considerthem to be follow-up activities of clinicalexaminations. This is also the case in the field ofneurology and many of its specialized subfields.For example, in a patient suspected of seizureand epilepsy, an EEG not only helps to identifythe real patient’s problem or disease, but also todiagnose the type of the disease and contributesto decision-making on the type of the drugto use. The EMG/NCV is also necessary forpatients with a possible peripheral neuropathicinvolvement. In most cases, paraclinicalactivities are performed outside the educationalsettings, such as in laboratories or specialprocedure rooms, and students, residents andlearners are only informed about the results ofthose activities without observing how they areactually performed, so they will not learn thatdiagnostic method and will not gain a deepunderstanding of it, to the point that they may beunfamiliar with the necessity of doing that evenduring their practice. This leads in many casesto unnecessary requests or its postponementin essential conditions. Unfortunately, theabove-mentioned problem is found among bothstudents and residents. Moreover, we foundfew appropriate and useful studies in this areadue to the learners’ unfamiliarity with thisscientific area and their lack of interest andmotivation for research in this regard. For theabove reasons, the educational deputy of theNeurology Department of Shiraz University ofMedical Sciences decided to solve this problemthrough a new training course. During the aboveeducational process, the sixth year studentsof medicine in Shiraz University of MedicalSciences, who are receiving training during theirone-month course of neurology, were dividedinto groups of six to eight members, and eachgroup, together with a resident, visited the EEGand EMG/NCV departments of Imam RezaClinic affiliated to Shiraz University of MedicalSciences as a tour lasting for a few hours outsidethe clinical departments and listened to a fulldescription from doctors, personnel and otherprofessionals in these departments. In addition,they closely visited the patients as well as thedevices used in these departments.Investigations show that different units ofmedical education at Iranian universities ofmedical sciences have regularly been visited,but no periodical and regular visits have beenperformed as part of a predetermined curriculum.However, a relatively similar study conducted atShiraz University of Medical Sciences in 2017reported that holding a short-term (one day anda half) practical laboratory training course couldsignificantly increase the students’ experienceand training (1).Other published studies have been in theform of short-term training courses in thelaboratory or pathological sciences rather thanone-or-two-day visits. However, these studies aresimilar to our educational process in that bothare held during a short term with the aim of thestudents’ further familiarity and readiness. Forexample, a study was conducted on fourth-yearmedical students, in which a one-and-a-half-daycourse was designed to familiarize the studentswith paraclinical methods and help them gainexperience in this regard. The results of thisstudy showed that this one-day course was agreat incentive for the training of some selectedparts of medical education (2). Another study wascarried out in 1987 on medical students, showingthat the students’ preliminary familiarity withthe clinical stages can be very effective if thesestages are held in short terms, in small groups,and with a focus on basic issues (3).The Neurology Department of ShirazUniversity of Medical Sciences hopes to achievethe following goals by implementing the abovementionedtraining course:1. Understanding of the above-mentionedprocesses better by attending the patients’ bedsideand observing the processes closely,2. Familiarizing the students with the reasonsfor requesting each of the two above-mentionedprocedures to prevent unnecessary requestsduring the future years of practice,3. Motivating and encouraging the studentsto study the related subjects better and moreaccurately,4. Encouraging the students to do research ineach of the two above-mentioned areas,5. Familiarizing the students with the difficultyof work and possible problems when doing theabove-mentioned investigations and taking theminto consideration in future years of practice, and6. Familiarizing them with the personnel andusing their experiences.

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Volume & Issue: Volume 7, Issue 1, January 2019 (32)

Impact of immediate feedback on the learning of medical students in pharmacology

Abstract

Assessing clinical reasoning skills using Script Concordance Test (SCT) and extended matching questions (EMQs): A pilot for urology trainees

Abstract

Online-learning: exploring practices among Foundation doctors

Abstract

Analysis of Iran’s National Medical Education Evolution and Innovation Plan using the Michelle and Scott’s model of policymaking

Abstract

Exploration of faculty members’ perceptions about virtual education challenges in medical sciences: a qualitative study

Abstract

The influence of role-modeling on the clinical empathy of medical interns: A qualitative study

Abstract

Good, bad and ugly: Exploring the Machiavellian power dynamics of leadership in medical education

Abstract

Change as an opportunity - Collaborative research in a fluctuating global landscape

Abstract

A one-day visit of the EEG and EMG/NCV departments during neurology course for medical students of Shiraz University of Medical Sciences

Abstract