Journal of Advances in Medical Education & Professionalism

Original Article

Implementation and Assessment of a Novel Telehealth Education Curriculum for Undergraduate Medical Students

JASMIN MAHABAMUNUGE; LAUREN FARMER; JOANNA PESSOLANO; NISHA LAKHI

Volume 9, Issue 3 , July 2021, Pages 127-135

https://doi.org/10.30476/jamp.2021.89447.1375

Abstract

Introduction: Despite its healthcare advantages and expanded use during the COVID-19 pandemic, telehealth is not included in many medical school curricula.Methods: In this ... Read More Introduction: Despite its healthcare advantages and expanded use during the COVID-19 pandemic, telehealth is not included in many medical school curricula.Methods: In this prospective mixed methods study (n=52), we created a novel Telehealth Education Curriculum (TEC) for the third year Obstetrics and Gynecology (Ob/Gyn) rotation at New York Medical College during COVID-19. The TEC included supervised telehealth patient encounters via video conference [and a virtual Objective Structured Clinical Encounter (vOSCE)] designed to simulate a telehealth encounter (Zoom Video Communications, Inc.). We measured student perceptions of theTEC via two 4-point Likert surveys, which included free response questions, administered via SurveyMonkey between April and June 2020. Participation was voluntary and responses were deidentified. We computed means and response distributions across survey questions using SPSS; IBM version 19.Results: The response rate was 92% for both the Telehealth (33/36) and vOSCE (48/52) surveys. Seventy-six percent (25/33) strongly or moderately agreed that telehealth and in-person patientencounters have similar educational value. Eighty-three percent (40/48) strongly or moderately agreed the vOSCE provided a valuable patient interaction. Ninety-seven percent (32/33) stronglyor moderately agreed the telehealth encounters should continue during COVID-19 restrictions versus 82% (27/33) agreeing they should be incorporated into the curriculum post COVID-19.Conclusion: Almost all students responded that the TEC should continue during COVID-19 and most agreed it should be incorporated into the Ob/Gyn clerkship permanently, after COVID-19. We found vOSCEs to be an effective method for teaching telehealth to medical students. Key challenges identified by students included adjusting to a virtual format, lack of body language, and communicating empathy virtually. Positive takeaways included practice with telemedicine and an opportunity for continued clinical education during COVID-19.

Original Article

Accreditation Council for Graduate Medical Education Milestones for Emergency Medicine Residency Training Incorporated into Firstand Second-Year Medical Student Elective

CHRISTINA Y. CANTWELL; JONATHAN B. LEE; SOHEIL SAADAT; NICHOLAS BOVE; SANGEETA SAKARIA; WARREN WIECHMANN; ALISA WRAY; SHANNON TOOHEY

Volume 9, Issue 3 , July 2021, Pages 136-143

https://doi.org/10.30476/jamp.2021.88982.1360

Abstract

Introduction: As part of its Next Accreditation System, the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine describe 6 competencies containing ... Read More Introduction: As part of its Next Accreditation System, the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine describe 6 competencies containing 23 sub-competencies graded by milestones ranging from level 1 (expected of an incoming intern) to level 5 (demonstrates abilities of an attending) that are used to track resident training progression. To the best of our knowledge, there have been no studies introducing a milestones-based curriculum to medical students prior to their introduction to the wards, so we sought to determine the effects that a pre-clinical Emergency Medicine Interest Group (EMIG) Milestones Elective would have on preparing the students interested in Emergency Medicine (EM) as a specialty to meet thelevel 1 milestones prior to their intern year.Methods: The elective hosted 15 events throughout the academic year, and pre- and post-curriculum surveys were administered. Thirteen first- and second-year medical students at our institution who completed the elective self-reported their perception of preparedness for each level 1 milestone in the 19 sub-competencies. A repeated measures design was used through identical pre- and post-curriculum surveys to determine any changes in self-reported preparedness for meeting level 1 milestones after completing the elective using Wilcoxon Signed Ranks Test.Results: There was a significant increase in the median scoring from 1 to 2 (P=0.027) in overall self-reported preparedness for meeting the level 1 milestones included in the elective, as well as significant increases in subcategories across competencies 1-4 outlined by the ACGME. There was no significant increase in preparedness for professionalism or interpersonal communicationcompetencies. There was no significant increase in interest in EM as a result of the elective.Conclusion: Implementing a milestones-based curriculum during the pre-clinical years shows improved self-reported preparedness of students interested in pursuing EM for meeting level 1 milestones prior to residency. Additionally, a specialtybased elective such as this one offered through EMIG may further increase interest in the field during pre-clinical years.

Original Article

Postgraduate Physiotherapy Training in a Quandary - Ramifications of Corona virus pandemic Lockdown: A Survey-based Study

SHAILESH GARDAS; SHRUTI NAIR; POTHIRAJ PITCHAI; VRUSHALI PANHALE

Volume 9, Issue 3 , July 2021, Pages 144-153

https://doi.org/10.30476/jamp.2021.89189.1367

Abstract

Introduction: Coronavirus disease-2019 (COVID-19) has disrupted clinical services and postgraduate training across the world. Hence, this survey was conducted to understand ... Read More Introduction: Coronavirus disease-2019 (COVID-19) has disrupted clinical services and postgraduate training across the world. Hence, this survey was conducted to understand the impact of pandemic on Physiotherapy post-graduate (PG) education.Methods: It was a cross-sectional, observational study. A total of 254 Physiotherapy PG trainees were recruited through snowball sampling from Physiotherapy colleges across the state of Maharashtra. A 34-item structured questionnaire was developed, based on available literature, to evaluate the impact of COVID-19 pandemic on four domains: academic training, clinical training, research activities, and concerns faced by a PG trainee. The face validity of this questionnaire was assessed by six academicians and their suggestions were examined. Subsequently, it was pilotedon five PG trainees before administering it to the participants. The validated questionnaire was then circulated via various social media platforms and personal contacts using Google form. Descriptive statistics were summarized as frequencies/percentages. McNemar’s test was used to determine the differences on a dichotomous dependent variable between the two related groups using SPSS software.Results: Overall 131 trainees provided complete responses. Although 85% (n=111) of them claimed they attended PG teaching activities through online mode, almost 67% (n=101) disagreed tohave achieved their learning objectives. A vast majority (91%,n=119) of them felt that their specialty related practical training was severely affected, and 98% (n=129) reported that reduced caseload had impacted their clinical learning. Also, 70% (n=54) of final year PGs had difficulty in recruiting new participants for their dissertation. Spread of infections to family (98%), commuting inpublic transport (98%), uncertainty about exam dates (91%), and competency development in specialty areas (96%) were some of their concerns.Conclusion: COVID-19 pandemic had impacted various domains of Physiotherapy PG program such as academic, clinical and research areas. Regulatory authorities should take serious consideration and devise strategies to overcome it.

Original Article

Acceptability on the use of crossword puzzle as one of methods for assessment in Pharmacology

PRITHPAL SINGH MATREJA; JASPREET KAUR; LALENDRA YADAV

Volume 9, Issue 3 , July 2021, Pages 154-159

https://doi.org/10.30476/jamp.2021.90517.1413

Abstract

Introduction: Didactic lectures lead to lack of attention and limited independent thinking with limited self-assessment, crossword puzzles having shown promising results and ... Read More Introduction: Didactic lectures lead to lack of attention and limited independent thinking with limited self-assessment, crossword puzzles having shown promising results and substantial usability. A thorough literature search showed that most of the studies done were on the introduction of crosswords as a tool of assessment in either medical or allied health sciences; hence, we planned this study to know the acceptability of crossword puzzles as a method of assessment.Methods: The subjects of this cross-sectional study to assess the acceptability of crossword puzzles were 5th semester students of the second professional MBBS (Bachelor of Medicine and Bachelor of Surgery). The study was conducted for three consecutive batches over a period of three months at the same time of the year from 2018 to 2020. The students had appeared for formative assessment and gave written informed consent. The crossword puzzles were given to the students, being followed by an anonymous feedback questionnaire and formative examination one week later. The feedback questionnaire was analyzed for coefficient of reliability by Cronbach’s Alpha, giving an internal consistency of 0.841.Results: A total of 425 students participated in the study. The crossword puzzles had an average percentage score of 62.7% across all the three years, which was significantly higher (p <0.05),as compared to the formative examination score of 45.2%. The same set of students appeared for both types of evaluation and the results were compared. The feedback given was that majorityof the students agreed that crosswords enhanced their knowledge of drugs, promoted active learning, and helped in remembering the topic.Conclusion: Crossword puzzles were an acceptable and effective tool for assessment as they gave better results and provided better understanding in comparison to the conventional formativeassessment as the feedback questionnaire showed. Most students agreed that the crosswords enhanced their knowledge of drugs, promoted active learning and helped in remembering the topic.

Original Article

Nursing educators’ perception of disruptive behaviors in the professional work environment: A qualitative study

MARYAM TOLYAT; SEYYED ABOLFAZL VAGHARSEYYEDIN; MARYAM NAKHAEI

Volume 9, Issue 3 , July 2021, Pages 160-167

https://doi.org/10.30476/jamp.2021.89703.1383

Abstract

Introduction: Disruptive behaviors among nursing educators are a globally recognized problem. They have detrimental effects on nursing educators, the nursing profession, students ... Read More

Original Article

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.

Brief report

Medical education during COVID-19: Response at one medical school

SATEESH BABU ARJA; LANNY WILSON; SAMIR FATTEH; PRAVEEN KOTTATHVEETIL; AMIN FATEH; SIREESHA BALA ARJA

Volume 9, Issue 3 , July 2021, Pages 176-182

https://doi.org/10.30476/jamp.2020.88744.1351

Abstract

Introduction: The COVID-19 pandemic has caused a significant toll on healthcare across the globe. The pandemic caused many other consequences, including economic implications ... Read More

Letter to Editor

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.

Letter to Editor

Anxious, depressed: Should medical schools screen their students?

DEEBAN RATNESWARAN; MUHAMMED KERMALI; TECK K KHONG

Volume 9, Issue 3 , July 2021, Pages 185-186

https://doi.org/10.30476/jamp.2020.86182.1224

Abstract

Our informal survey prompted us to suggest a more radical approach; whereby, at peak levels of stress, students are screened with validated anxiety and depression scores. This would ... Read More

Letter to Editor

A student’s perspective on the effectiveness of strategies to overcome barriers of critical thinking in medical students’ curriculum

KHULAT SAQI; SAMINEH YOUSEFI; ZOYA MEHDI; LAILA HAZARA

Volume 9, Issue 3 , July 2021, Pages 187-188

https://doi.org/10.30476/jamp.2020.86346.1232

Abstract

We read and appreciated the article by Kasalaei et al. titled 'Barriers of critical thinking in medical students' curriculum from the viewpoint of medical education experts: A qualitative ... Read More

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Volume & Issue: Volume 9, Issue 3, July 2021, Pages 127-188

Implementation and Assessment of a Novel Telehealth Education Curriculum for Undergraduate Medical Students

Abstract

Accreditation Council for Graduate Medical Education Milestones for Emergency Medicine Residency Training Incorporated into Firstand Second-Year Medical Student Elective

Abstract

Postgraduate Physiotherapy Training in a Quandary - Ramifications of Corona virus pandemic Lockdown: A Survey-based Study

Abstract

Acceptability on the use of crossword puzzle as one of methods for assessment in Pharmacology

Abstract

Nursing educators’ perception of disruptive behaviors in the professional work environment: A qualitative study

Abstract

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

Abstract

Medical education during COVID-19: Response at one medical school

Abstract

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

Abstract

Anxious, depressed: Should medical schools screen their students?

Abstract

A student’s perspective on the effectiveness of strategies to overcome barriers of critical thinking in medical students’ curriculum

Abstract