Journal of Advances in Medical Education & Professionalism

Students teaching students: A novel solution for teaching procedures via instruction on the corpse

CARLOS E GARCIA RODRIGUEZ; RAJ J SHAH; CODY SMITH; CHRISTOPHER J GAY; JARED ALVARADO; DOUGLAS RAPPAPORT; WILLIAM RT J ADAMAS-RAPPAPORT; RICHARD AMINI

Volume 7, Issue 2 , April 2019, Pages 51-55

https://doi.org/10.30476/jamp.2019.44708

Abstract

Introduction: Increased faculty and resident responsibilities have ledto the decreased time available for teaching clinical skills to medicalstudents. Numerous advances in education ... Read More Introduction: Increased faculty and resident responsibilities have ledto the decreased time available for teaching clinical skills to medicalstudents. Numerous advances in education and simulation haveattempted to obviate this problem; however, documented success islacking. Our objective was to describe a novel fresh cadaver-based,student-driven procedural skills lab and to compare the educationaleffectiveness of student instructors to the senior instructor (SI). Methods: This was a prospective study performed at an academic medical center. A pilot program, “Students Teaching Students,” was introduced where four trained first-year medical students (TMS)instructed 41 other untrained first-year medical students in technical procedures. This study compared the teaching evaluations of the SI with the TMS teaching equivalent procedures. Paired t-test was used to determine statistically significant changes in procedural confidence between pre- and post-training. Utilizing a post-training questionnaire, average post-training confidence improvement values and objective post-training test scores of the participants were compared between TMS and SI, using a 2 sample t-test. Statistical significance was considered as a pResults: Twenty-nine out of 39 (74%) students completed the questionnaire. Both groups demonstrated a statistically significant improvement in subjective confidence level in performing each procedure when pre- and post-training scores were compared, while there was no statistically significant difference found in cognitive knowledge between the groups (p=0.73). There was no statistically significant difference in the mean confidence improvement between the SI and TMS groups for chest tube insertion (2.06 versus 1.92 respectively, p=0.587), femoral line placement (2.00 versus 1.94 respectively, p=0.734) or student test score (88% versus 85% respectively).Conclusion: Our results demonstrate that first-year medical students well-trained in technical skills, such as our TMS, may be a valuable additional teaching resource. The Students Teaching Studentsprocedure lab employed in this study was effective at immediately increasing first-year medical students’ confidence and technical skill. First-year medical students well-trained in technical skills, such as our TMS, may be a valuable additional teaching resource.

Clinical procedural skills assessment during internship in ophthalmology

SUMITA SETHI; DINESH K BADYAL

Volume 7, Issue 2 , April 2019, Pages 56-61

https://doi.org/10.30476/jamp.2019.44709

Abstract

Introduction: Directly observed procedural skills (DOPS) is aunique method for assessment since it tests the trainee’s abilityto apply his knowledge and skills in performing a ... Read More Introduction: Directly observed procedural skills (DOPS) is aunique method for assessment since it tests the trainee’s abilityto apply his knowledge and skills in performing a particularprocedure and provides an assessment of the practical workperformed by the trainee on a ‘real’ patient under supervisionof an experienced faculty. The study aims to make use of DOPSrating for assessment and further improvement in proceduralskills in interns in Ophthalmology rotational posting. Methods: A prospective study was planned and 15 interns on 2weeks’ rotational posting in the department of Ophthalmologywere included by purposive sampling over a duration of 2months. Four clinical procedural skills were identified and in thesecond week of posting, the interns were assessed by three DOPSencounters at an interval of 2 days for each clinical skill. TheDOPS ratings were analyzed quantitatively using R-statisticalsoftware by repeated measure ANOVA and Banfuroni test. Results: A total of 180 DOPS were undertaken for 15 internsin 4 core areas of ophthalmic examination. The mean overallDOPS rating for DOPS-1 was 3.70±0.82, DOPS-2, 3.83±1.82and DOPS-3, 4.93±1.65; the difference in DOPS rating betweenthe first and second encounter was not statistically significant(p=0.497), between the second and the third and between the firstand the third were statistically significant (p=0.000 in both cases)using Banfuroni test. The overall difference was also statisticallysignificant (p=0.000) using repeated measure ANOVA. Both theassessor and intern satisfaction increased significantly from thefirst to the third DOPS, but not statistically significant between thefirst and the second and between the second and the third DOPS. Conclusions: We found significant improvement in interns’clinical skills through repeated DOPS and the method waswell accepted by both the students and the faculty. Internshipperiod can be well utilized for improving clinical skills andnovel performance assessment methods like DOPS might proveto be highly beneficial in ensuring adequacy of learning duringinternship and also to assess their readiness for acceptingprofessional responsibilities in future.

Identifying the challenges to good clinical rounds: A focus-group study of medical teachers

AMIN BEIGZADEH; KAMBIZ BAHAADINBEIGY; PEYMAN ADIBI; NIKOO YAMANI

Volume 7, Issue 2 , April 2019, Pages 62-73

https://doi.org/10.30476/jamp.2019.44710

Abstract

Introduction: The use of clinical rounds, as an integral part ofclinical teaching to help medical students acquire essential skillsof practicing medicine, is critically important. An ... Read More Introduction: The use of clinical rounds, as an integral part ofclinical teaching to help medical students acquire essential skillsof practicing medicine, is critically important. An understandingof medical teachers’ perceptions concerning the challenges ofclinical rounds can help identify the key areas of focus to betterfoster professional development of medical students. This studyexplored the opinions of medical teachers of Kerman Universityof Medical Sciences about the challenges embedded in clinicalrounds. There is a paucity of studies regarding the topic underinvestigation in our context. Methods: This qualitative study was conducted using aconventional content analysis method. We held a focus groupdiscussion with eight skilled bedside teachers, chosen usingpurposive sampling, from Kerman University of Medical Sciencesin February 2018. The focus group lasted for approximately2 hours. The session was audio-taped. We analyzed data byconsidering the verbatim transcribed document of the audiorecordeddiscussions using conventional content analysis methodfor theme development. Informed consent was obtained from theparticipants. Results: Medical teachers described many primary challenges toclinical rounds. Some of them were multiple students on roundingpractices, time constraints, priority of research and patient care toteaching, and lack of participation and enthusiasm. We categorizedthese varied challenges into 5 specific areas related to (1) system;(2) teachers; (3) learners; (4) patients; and (5) evaluation issues.Focus group participants expressed some suggestions to mitigatebarriers such as having fewer students on the rounds, addressingtime constraints through planning and flexibility, and the provisionof medical education award. Conclusion: Clinical round practices are valuable but repletewith a spectrum of problems. Many challenges affect the qualityof teaching in clinical rounds that should be taken into accountby bedside teachers in order to improve the quality of roundingpractices. The identified challenges can be used in redressingbedside teaching to have more efficient rounding practices.

Factors related to academic failure in preclinical medical education: A systematic review

SOLEIMAN AHMADY; NASRIN KHAJEALI; FARSHAD SHARIFI; ZOHRE SADAT MIRMOGHTADAEI

Volume 7, Issue 2 , April 2019, Pages 74-85

https://doi.org/10.30476/jamp.2019.44711

Abstract

Introduction: Identifying the learners’ problems early enoughand providing advice from the beginning is definitely an importantinvestment in the training and progress of future ... Read More Introduction: Identifying the learners’ problems early enoughand providing advice from the beginning is definitely an importantinvestment in the training and progress of future practitioners. Thecurrent review aimed at examining factors related to academicfailure of the preclinical medical students. Methods: The study was carried out as a systematic search ofpublications in the following databases published from January1987 to January 2018: PubMed, Web of Knowledge, EducationalResources, Information Center and Scopus. No language limitationwas set for searching the resources. As a comprehensive search, thefollowing keywords were used for the abstract, title and keywordsections: academic performance, academic failure, academicachievement, drop out, academic engagement, learning disorder,medical student, struggle student and problem learner. A valid tool(STROBE) was used to determine the quality of the articles. Results: Most articles discussed personal causes, 7 discussedlearning style, 7 discussed personality traits, 6 discussedmotivational strategies and self-efficacy, 4 discussed quality ofsleep, 4 discussed the effect of stress, 9 discussed demographicfactors, 3 discussed physical activity, 1 discussed copingstrategies, 2 discussed class attendance and 4 discussed studystrategy. Twenty-five articles described instructional designcause, 3 described teaching strategies, 2 described courseassessments, 1 described the course structure, 3 described criticalthinking, 3 described blended learning, 13 described predictivecourses, 14 described admission tests, 1 described the learningenvironment, 2 described curriculum planning and 3 describedthe pre-matriculation program. Conclusion: Medical teachers often do not know which studentsare problem learners or what causes academic failure. The goalof this systematic review was to determine the origin of problemsin learning to identify problem learners. The results indicatesthat managers, policymakers, instructors and counselors canmonitor student academic achievement by careful planning ofinstructional design, attention to an educational environment, useof active teaching methods, continuous assessment of studentsand consideration of personal factors.

Experiences of students and faculty members about using virtual social networks in education: A qualitative content analysis

ALI DEHGHANI; JAVAD KOJURI; MOHAMMAD REZA DEHGHANI; ABDOLKHALEGH KESHAVARZI; SEDIGHEH NAJAFIPOUR

Volume 7, Issue 2 , April 2019, Pages 86-94

https://doi.org/10.30476/jamp.2019.44712

Abstract

Introduction: Virtual social networks are increasingly beingused by academics and students in health sciences. It is necessaryto examine opportunities and challenges of these networks ... Read More

Needs assessment for standardized educational program for Iranian Medical Students in crisis and disaster management

RITA REZAEE; MAHMOUDREZA PEYRAVI; MILAD AHMADI MARZALEH; AMIR KHORRAM-MANESH

Volume 7, Issue 2 , April 2019, Pages 95-102

https://doi.org/10.30476/jamp.2019.44713

Abstract

Introduction: Early education and training are mandatory toraise the knowledge and awareness of the healthcare staff. Iranis a disaster prone area with a high number of emergencies.This ... Read More

Commentary

Multiple faces of narcissistic leadership in Medical Education

DINESH KUMAR V

Volume 7, Issue 2 , April 2019, Pages 103-105

https://doi.org/10.30476/jamp.2019.44705

Abstract

Narcissism, being the critical part of the toxic leadership paradigm,has its own impact in the education sphere. Contrastingly,leader’s narcissism cannot be simply underweighted ... Read More

Letter to Editor

Assessing patient satisfaction with Sudanese doctors

MOHAMED H. TAHA

Volume 7, Issue 2 , April 2019, Pages 106-107

https://doi.org/10.30476/jamp.2019.44706

Abstract

Dear editor Patients’ satisfaction has long been consideredas an important factor when gauging healthoutcome and quality of care in both developedand developing countries (1) ... Read More Dear editor Patients’ satisfaction has long been consideredas an important factor when gauging healthoutcome and quality of care in both developedand developing countries (1) and constitutes asubstantial indicator of the health care quality(2). Researches have shown that satisfiedpatients are more likely to develop a goodrelationship with the health system, leading toimproving compliance, continuity of care andultimately better health outcome (3).Identification of patient’ needs and evaluationof the health services provided are the startingpoints of a patient-centered approach in providinghealth care (4). In recent years, the health systemof Sudan has undergone some reforms and hasestablished an extensive health infrastructure inboth the public and private sectors (5). In Sudan,people of different social classes take treatmentfrom different health providers such as public,private, and military hospitals for differentreasons including economic condition, healthknowledge, and socio-demographic determinants.Cultural practices may influence people to choosethe particular healthcare service providers.We aimed, in this study, at assessing thepatients’ satisfaction with their treating doctors,in the internal medicine program, and identifyingthe areas that need more emphasis in the trainingof the residents. A cross-sectional facility-basedstudy was conducted on Wed Madani, a teachinghospital, 200 kilometre south to Khartoum,Sudan from June to September 2017.The patients were accessed through avalidated self-administered questionnaire. Theselection of the participants within the selectedtraining centers was done by systematic sampling.The sample size was 389 patients.All the respondents (n=389) agreed toparticipate in this study giving a response rateof 100%. The majority of patients under studywere women, two hundred thirty-eight (62.2%),and the greatest number of respondents belongedto the age group 46-52, (47.8%).The overall patients’ satisfaction rate was257 (66.1%), and the dissatisfaction rate was132 (33.9%). The areas for satisfaction werethe residents’ respect for what the patientssaid, 77.4% (n=301), maintaining privacy whenconducting physical examination, 68.4 (n=266),and the explanations that residents providedabout the results of their treatment 78.9%(n=307). The areas behind the dissatisfactionwere: residents did not listen carefully to theirpatients, 73.77% (n=287), residents did not makethe patients understand their instruction to takethe drugs, 85.8% (n=334), residents did not spendenough time on the patients 94.08% (n=366), andresidents did not explain to them the purpose ofthe investigation they requested 76.60% (n=298).This study showed that there was a relationshipbetween the level of education and satisfaction,where the satisfaction was low in highly educatedpatients. Females were less satisfied than males.There was no association between patients’satisfaction and the employment and maritalstatus. Regarding the monthly income, thosewith low income were most satisfied comparedto those with high income. This may be due tothe fact that those with high income took theirtreatment in the private sector, where there wasno crowdedness compared to that in the publichospitals most of the time.There are several factors that lead to patients’satisfaction. The findings are in agreement withanother study which showed that the reasonsbehind the high level of satisfaction wereresidents’ respect for what the patients say, andmaintaining the privacy and confidentialities oftheir patients (6).On the other hand, there are several reasonsthat decrease the level of satisfaction includingthe residents’ lack of spending adequate time forlistening to the patient’s complaints and medicalproblems. This is in accordance with the findingsof a similar study conducted in Pakistan (7).The results of this study could be very usefulin the planning and delivery of training forresidents in Sudan and the region.This study has some limitations, one ofwhich is that we depended on self-reports fromrespondents speaking for themselves or theirparents (for illiterate participants). This may haveintroduced surrogate bias.

Letter to Editor

Challenges of culturally and linguistically different healthcare students in learning environments

ALI ARASH ANOUSHIRVANI; FARZANEH GOLAGHAIE

Volume 7, Issue 2 , April 2019, Pages 108-109

https://doi.org/10.30476/jamp.2019.44707

Abstract

The increased number of international studentsin higher education systems is recognizedas beneficial not only economically but also interms of preparation of the workforce for theglobal ... Read More The increased number of international studentsin higher education systems is recognizedas beneficial not only economically but also interms of preparation of the workforce for theglobal environment. It is believed that diversityin the student cohort can also be beneficial fordomestic students in terms of increasing culturalawareness and achieving cultural competencygoals. Culturally and linguistically diversestudents (CALD) include students whose firstlanguage andor culture is not of the countrythey study in (1). There are 55,000 internationalstudents in Iran, of whom 26,000 have enrolled inuniversities affiliated to the Ministry of Science,10,000 in different branches of Islamic AzadUniversity, 2,000 in universities affiliated to theMinistry of Health, and 17,000 in AlmustafaInternational University (2). According to thelatest data from the UNESCO, more than 82%of the international students in Iran come fromAfghanistan, 8.7% Iraq, and 6% Syria, Lebanon,and Pakistan combined (3). Meanwhile, theMinistry of Health and Medical Educationfollows a plan for expanding internationalmedical education in eligible Iranian universitiesof medical sciences and, hence, concentrateson mechanisms to align the universities withinternational standards. Although economic,political, and societal factors in both the hostand home countries influence internationalstudents’ decision to select the host country, it isnecessary that the authorities address their needsand problems and then take some measures tosolve them in order to increase the number offoreign applicants in Iranian universities.International students’ difficulties havebeen reported as academically and socially,with cultural and language barriers impactingtheir capacity to integrate with domesticstudents. These students have problemswith language and communication, sufferfrom lack of confidence to speak out and askquestions, and approach the teaching staff.For some international students, adaptationto new environment gets so difficult andfailure to adjust will cause them to experiencepsychological symptoms such as feelings ofinferiority, confusion, homesickness, loneliness,and anxiety (4). Commonly cited key issuesaffecting international students in learningenvironments are communication difficulties,cultural differences, and lack of familiarity withsocial, educational, and professional health careenvironments (5). Most of the literature aboutinternational students comes from Englishspeaking countries, and thus challenges in theAsian and Islamic learning context have notbeen addressed enough in the existing evidence.According to the studies conducted in theinternational learning contexts, there is a greaterpower distance and uncertainty avoidance inthe Asian culture, and these cultural differencesmay create tense interrelationships among thetrainees, staff, and supervisors (6).There is a need to develop understanding,accepting and appreciating the studentsfrom diverse backgrounds in the learningenvironments. For health professional students,the challenges become particularly evident inclinical practice settings. Clinical placement isof vital importance for healthcare disciplinesand covers approximately 50% of the trainingactivities. While clinical learning experiencecan be stressful and anxiety-provoking for anystudent, evidence suggests that this situation issignificantly more complex for CALD students(7, 8). Support from the staff in the clinical areacan be a source of motivation to students andmakes them feel welcome and part of the team,thereby helping them with learning. On thecontrary, failure to provide adequate learningopportunities for these students could resultin graduates who have not met the requiredstandards and competencies of the profession(9). Therefore, the educational problems ofCALD students need to be searched and thereasons should be dealt with to increase theirmotivation for academic success. We suggestthat medical education studies should address theinternational healthcare students’ needs and findstrategies to meet their needs in the classroomand clinical learning situations.

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Volume & Issue: Volume 7, Issue 2, April 2019 (33)

Students teaching students: A novel solution for teaching procedures via instruction on the corpse

Abstract

Clinical procedural skills assessment during internship in ophthalmology

Abstract

Identifying the challenges to good clinical rounds: A focus-group study of medical teachers

Abstract

Factors related to academic failure in preclinical medical education: A systematic review

Abstract

Experiences of students and faculty members about using virtual social networks in education: A qualitative content analysis

Abstract

Needs assessment for standardized educational program for Iranian Medical Students in crisis and disaster management

Abstract

Multiple faces of narcissistic leadership in Medical Education

Abstract

Assessing patient satisfaction with Sudanese doctors

Abstract

Challenges of culturally and linguistically different healthcare students in learning environments

Abstract