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المؤلفون: Clarissa Brierley, Emily Róisín Reid, Leila Ellis
المصدر: Medical Education. 56:365-373
مصطلحات موضوعية: medicine.medical_specialty, Medical curriculum, Complete data, Students, Medical, Education, Medical, business.industry, education, MEDLINE, General Medicine, humanities, Confidence interval, Education, Peer assisted learning, Meta-analysis, Physical therapy, Educational Status, Humans, Medicine, Curriculum, business, Inclusion (education), Schools, Medical, Student's t-test
الوصف: OBJECTIVES The prevalence of peer-assisted learning (PAL) featuring alongside the core medical curriculum is increasing; however, the evidence base for PAL's efficacy on academic performance is limited. This systematic review of randomised studies of PAL in medical school sets out to assess the impact of PAL on academic outcomes in medical school and evaluate whether PAL confers a benefit in specific educational contexts. METHODS A literature search was conducted across MEDLINE, Ovid Embase, Web of Science and Education Research Complete. Titles and abstracts were screened, and records were selected following strict eligibility criteria. Following full-text assessment for eligibility, two reviewers independently extracted data from the final selection of records and a meta-analysis was performed. Studies were classified using a modified version of Kirkpatrick's levels of learning. Student test scores were standardised by calculating the standardised mean difference (SMD). RESULTS Twenty-seven randomised controlled trials were eligible for inclusion, and twenty-one provided sufficient and complete data to enable meta-analysis. There was a significant improvement in the academic performance of medical students who received PAL compared with those in the control group (SMD = 0.52 [95% confidence interval 0.18-0.85]; p = .003). The impact of PAL was greater amongst clinical medical students (SMD = 0.63; p = .02) than preclinical medical students (SMD = 0.39; p = .08) and when used for teaching practical skills (SMD = 0.69; p = .001) compared with theory (SMD = -0.11; p = .21). Students taught by PAL also achieved better results in assessments conducted more than four weeks after course completion (SMD = 1.20; p = .04). [Correction added on 8 November 2020 after first publication. The data values in the Results section have been corrected in this version.] CONCLUSIONS: Medical students experiencing PAL benefit in terms of academic performance, relative to those not receiving PAL. PAL is of greatest value in the clinical stages of training and for practical skills. The long-term outcomes of PAL remain a priority for future research.
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المؤلفون: Matthew Richard McGrail, Belinda O'Sullivan
المصدر: Medical Education. 54:364-374
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Students, Medical, education, MEDLINE, Context (language use), Education, Sex Factors, Physicians, Surveys and Questionnaires, medicine, Humans, Duration (project management), Career Choice, Professional Practice Location, Australia, Clinical Clerkship, General Medicine, Odds ratio, Middle Aged, Workforce development, Test (assessment), Family medicine, Workforce, Cohort, Female, Rural Health Services, Psychology, Education, Medical, Undergraduate
الوصف: Context The implementation of rural undergraduate medical education can be improved by collecting national evidence about the aspects of these programmes that work well and the value of investing in national policies. Objectives This study aimed to explore how different durations, degree of remoteness and number of rural undergraduate medical training placements relate to working rurally, and to investigate differences after the introduction of formal national training policies that fund short- and long-term rural training experiences for medical students. Methods A cohort of 6510 Australian-trained doctors who completed the Medicine in Australia: Balancing Employment and Life survey recalled their participation in rural undergraduate medical training. Responses were categorised by duration, remoteness as defined by the Modified Monash Model levels 3-4 and 4-7 compared with 1, and total number of placements. Multivariate regression was used to test associations with working rurally in 2017, and differences between cohorts of students who graduated pre- and post-2000, of which the latter were exposed to formal national training policies. Results Any rural undergraduate training was associated with working rurally (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3-1.9) with incrementally stronger associations for longer duration (>1 year: OR 3.0, 95% CI 2.3-4.0), greater remoteness (OR 1.8, 95% CI 1.5-2.1) and three placements (OR 2.4, 95% CI 1.9-3.0) compared with none. Rural background (OR 2.6, 95% CI 2.3-3.0) and general practice (OR 2.6, 95% CI 2.2-2.9) were independently associated with working rurally; being female was negatively associated with rural work (OR 0.7, 95% CI 0.6-0.8). The cohort of doctors who trained in a period when national rural training policies had been implemented included more graduates with a rural background and experience of undergraduate rural training but returned equivalent proportions of rural doctors to pre-policy cohorts, and included proportionally more women and fewer general practitioners. Conclusions Rural undergraduate training should focus on multiple dimensions of duration, remoteness and number of rural undergraduate training experiences to grow the rural medical workforce. Formal national rural training policies may be an important part of the broader system for rural workforce development, but they rely on the uptake of general practice and the participation of female doctors in rural medicine.
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المؤلفون: George P. Kim, Charles Penner, José François, Karlyne Dufour, Marsha Giesbrecht, Lillian Au, Greg Malin, Aaron Jattan, Douglas Archibald
المصدر: Medical Education. 54:162-170
مصطلحات موضوعية: Adult, Male, Canada, medicine.medical_specialty, Urban Population, 020205 medical informatics, media_common.quotation_subject, education, MEDLINE, Context (language use), 02 engineering and technology, Education, Young Adult, 03 medical and health sciences, 0302 clinical medicine, 0202 electrical engineering, electronic engineering, information engineering, medicine, Humans, 030212 general & internal medicine, Curriculum, media_common, Teaching, Professional Practice Location, Internship and Residency, Reproducibility of Results, Preceptor, General Medicine, Education, Medical, Graduate, Family medicine, Service (economics), Preceptorship, Structured interview, Female, Rural Health Services, Rural area, Thematic analysis, Family Practice, Psychology
الوصف: CONTEXT Medical schools of geographically large nations have expanded into rural areas to facilitate the development of a sustainable rural pipeline of physicians. Preceptor, or clinical teacher, recruitment at these sites has been an ongoing challenge. However, residents-as-teachers (RaT) curricula have not been modified to support the development of rural teachers. This study aimed to compare teaching opportunities between rural and urban family medicine residents and to identify mechanisms underlying potential differences. METHODS Year-1 and Year-2 family medicine residents at seven Canadian institutions participated in a mixed-methods study utilising a quantitative survey and a qualitative interview. Rural and urban residents rated the quantity and types of teaching opportunities available during their training, from which a chi-squared analysis was completed. Volunteer respondents participated in a structured interview, from which a thematic analysis was performed. RESULTS Rural family medicine residents had fewer opportunities to teach compared to their urban colleagues. This discrepancy was seen across multiple domains, including informal opportunities when on family medicine rotations, χ2 (4, n = 242) = 45.26, P
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المصدر: Medical Education
مصطلحات موضوعية: medicine.medical_specialty, 020205 medical informatics, MEDLINE, 02 engineering and technology, Session (web analytics), Education, 03 medical and health sciences, 0302 clinical medicine, Treatment plan, Clinical information, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Humans, Medical physics, 030212 general & internal medicine, Mri brain, Radiological imaging, Clinical teaching, Education, Medical, business.industry, Teaching, Medical Education Adaptations, General Medicine, Laboratory results, business, Education, Medical, Undergraduate
الوصف: This was followed by an interactive discussion of investigation and management plan. Appropriate radiological imaging such as an MRI brain scan was shown to the group using the “share‐screen” function. Other clinical information such as laboratory results can likewise be displayed. The session was completed after thorough discussion on the appropriate treatment plan with respect to the patient’s scenario.
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المؤلفون: Cara Theoret, Xue Ming
المصدر: Medical Education
مصطلحات موضوعية: 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, MEDLINE, Education, Betacoronavirus, Pandemic, medicine, Humans, Pandemics, biology, Education, Medical, Viral Epidemiology, SARS-CoV-2, COVID-19, Internship and Residency, General Medicine, biology.organism_classification, medicine.disease, Student education, Telemedicine, Pneumonia, Family medicine, Commentary, Clinical Competence, Psychology, Coronavirus Infections
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المؤلفون: Adam D Baim
المصدر: Medical Education. 52:816-825
مصطلحات موضوعية: medicine.medical_specialty, Visual perception, 020205 medical informatics, 02 engineering and technology, Participant observation, Education, Interviews as Topic, 03 medical and health sciences, 0302 clinical medicine, Ophthalmology, Health care, 0202 electrical engineering, electronic engineering, information engineering, Sociocultural anthropology, medicine, Humans, Narrative, 030212 general & internal medicine, Medical diagnosis, Anthropology, Cultural, business.industry, Communication, Internship and Residency, General Medicine, Acculturation, Education, Medical, Graduate, Visual Perception, Observational study, Clinical Competence, Psychology, business
الوصف: Objectives Visual interpretation is essential in many fields of health care. Although diagnostic competency can be measured as an educational outcome, few accounts have addressed tacit aspects of visual interpretation in clinical training; these include the disciplining of the trainee's attentions and the trainee's acculturation into expected styles of communicating visual interpretations to others. This paper describes values and dispositions that are taught to ophthalmology trainees as they learn to reason through visual information, and explores how these qualities are evaluated during residency training. Methods The project was based on 6 months of ethnographic participant observation and interviews in an ophthalmology residency programme. Observational notes and interview transcripts pertaining to visual interpretation were isolated for qualitative analysis in the tradition of sociocultural anthropology, guided by literature on communication in medical education and the socialisation of health professionals. Results Residents and faculty members identified visual interpretation as one of the most challenging skills expected of ophthalmology trainees. They expressed a belief that 'systematic' approaches, where visual information is parsed in a stepwise fashion, reduce the chance of trainees overlooking or misinterpreting key diagnostic features. This sensory discipline was represented in narrative form when faculty members asked residents to interpret images aloud, as residents were expected to follow prescribed sequences for describing the content of images before commenting on possible diagnoses. Conclusions Sensory processing is ordinarily opaque to outside observers, but the ritual of describing images in highly regimented narratives allows residents to demonstrate how they gather and reason through visual information. The form of these narratives reflects values that residents are expected to embody during their training, such as being thorough and methodical; it may also serve a pedagogical function by entrenching those values. Further research is needed to characterise how the performance of speech genres shapes the interpretive skills of medical trainees.
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المؤلفون: Jusie-Lydia Siega-Sur, Andre-Jacques Neusy, Fortunato Cristobal, Carole Reeve, Simone Ross, Torres Woolley, Servando D Halili
المصدر: Medical Education. 52:391-403
مصطلحات موضوعية: medicine.medical_specialty, Maternal-Child Health Services, 020205 medical informatics, Philippines, education, Context (language use), 02 engineering and technology, Family income, Vulnerable Populations, Measles, Education, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Surveys and Questionnaires, 0202 electrical engineering, electronic engineering, information engineering, Humans, Medicine, 030212 general & internal medicine, Child, Social Responsibility, Education, Medical, business.industry, General Medicine, medicine.disease, Health equity, Poliomyelitis, Family medicine, Community health, Workforce, Female, Rural Health Services, business
الوصف: Socially accountable health professional education (SAHPE) is committed to achieving health equity through training health professionals to meet local health needs and serve disadvantaged populations. This Philippines study investigates the impact of SAHPE students and graduates on child and maternal health services and outcomes.This is a non-randomised, controlled study involving a researcher-administered survey to 827 recent mothers (≥1 child aged 0-5 years). Five communities were serviced by SAHPE medical graduates or final-year medical students (interns) in Eastern Visayas and the Zamboanga Peninsula, and five communities in the same regions were serviced by conventionally trained (non-SAHPE) graduates.Mothers in communities serviced by SAHPE-trained medical graduates and interns were more likely than their counterpart mothers in communities serviced by non-SAPHE trained graduates to: have lower gross family income (p 0.001); have laboratory results of blood and urine samples taken during pregnancy discussed (p0.001, respectively); have first pre-natal check-up before 4th month of pregnancy (p = 0.003); receive their first postnatal check-up7 days of birth (p 0.001); and have a youngest child with normal (2500 g) birthweight (p = 0.003). In addition, mothers from SAHPE-serviced communities were more likely to have a youngest child that: was still breastfed at 6 months of age (p = 0.045); received a vitamin K injection soon after birth (p = 0.026); and was fully immunised against polio (p 0.001), hepatitis B (p 0.001), measles (p = 0.008) and diphtheria/pertussis/tetanus (p 0.001). In communities serviced by conventional medical graduates, mothers from lower socio-economic quartiles (20 000 Php) were less likely (p 0.05) than higher socio-economic mothers to: report that their youngest child's delivery was assisted by a doctor; have their weight measured during pregnancy; and receive iron syrups or tablets.The presence of SAHPE medical graduates or interns in Philippine communities significantly strengthens many recommended core elements of child and maternal health services irrespective of existing income constraints, and is associated with positive child health outcomes.
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المؤلفون: Loai Albarqouni, Tammy Hoffmann, Paul Glasziou
المصدر: Medical Education. 52:161-170
مصطلحات موضوعية: medicine.medical_specialty, Evidence-based practice, 020205 medical informatics, Psychological intervention, MEDLINE, Alternative medicine, 02 engineering and technology, computer.software_genre, Education, 03 medical and health sciences, 0302 clinical medicine, Citation analysis, 0202 electrical engineering, electronic engineering, information engineering, medicine, Humans, 030212 general & internal medicine, Randomized Controlled Trials as Topic, Research evidence, Education, Medical, business.industry, General Medicine, Checklist, Evidence-Based Practice, Family medicine, Data mining, Periodicals as Topic, Educational interventions, business, computer
الوصف: Context Complete reporting of intervention details in trials of evidence-based practice (EBP) educational interventions is essential to enable clinical educators to translate research evidence about interventions that have been shown to be effective into practice. In turn, this will improve the quality of EBP education. Objectives This study was designed to examine the completeness of reporting of EBP educational interventions in published studies and to assess whether missing details of educational interventions could be retrieved by searching additional sources and contacting study authors. Methods A systematic review of controlled trials that had evaluated EBP educational interventions was conducted using a citation analysis technique. Forward and backward citations of the index articles were tracked until March 2016. The TIDieR (template for intervention description and replication) checklist was used to assess the completeness of intervention reporting. Missing details were sought from: (i) the original publication; (ii) additional publicly available sources, and (iii) the study authors. Results Eighty-three articles were included; 45 (54%) were randomised controlled trials (RCTs) and 38 (46%) were non-RCTs. The majority of trials (n = 62, 75%) involved medical professionals. None of the studies completely reported all of the main items of the educational intervention within the original publication or in additional sources. However, details became complete for 17 (20%) interventions after contact with the respective authors. The item most frequently missing was ‘intervention materials’, which was missing in 80 (96%) of the original publications, in additional sources for 77 (93%) interventions, and in 59 (71%) studies after contact with the authors. Authors of 69 studies were contacted; 33 provided the details requested. Conclusions The reporting of EBP educational interventions is incomplete and remained so for the majority of studies, even after study authors had been contacted for missing information. Collaborative efforts involving authors and editors are required to improve the completeness of reporting of EBP educational interventions.
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المؤلفون: Algene G Agustin, Anthony M Paluso, Aaron W Spaugy, Bethany S Kobza, Akram Khan, James Bordley, Jonathan S. Emens, Raeesa Khalid, Mohamed A Ahmed, Sima S. Desai
المصدر: Medical Education. 51:1241-1249
مصطلحات موضوعية: medicine.medical_specialty, Cross-sectional study, Perceived Stress Scale, Context (language use), Workload, Education, 03 medical and health sciences, 0302 clinical medicine, Sleep debt, Physicians, Surveys and Questionnaires, Work Schedule Tolerance, Ambulatory Care, Internal Medicine, medicine, Humans, 030212 general & internal medicine, business.industry, Epworth Sleepiness Scale, Internship and Residency, Actigraphy, General Medicine, Intensive Care Units, Cross-Sectional Studies, Education, Medical, Graduate, Cohort, Ambulatory, Workforce, Physical therapy, Sleep Deprivation, Female, business, 030217 neurology & neurosurgery
الوصف: Context Block scheduling during residency is an innovative model in which in-patient and ambulatory rotations are separated. We hypothesised that this format may have a positive impact on resident sleep and wellness in comparison with a traditional format. Methods We performed a single-centre, cross-sectional, observational study of residents rotating in the medical intensive care unit (MICU). Residents were observed for 4 weeks at a time: internal medicine (IM) residents were observed for 3 weeks in the MICU followed by 1 week in an ambulatory context, and non-IM residents were observed for 4 weeks in the MICU. We monitored daily total sleep time (TST) utilising actigraphy, and wellness measures with weekly Epworth Sleepiness Scale (ESS) and Perceived Stress Scale (PSS) questionnaires. Results A total of 64 of 110 (58%) eligible residents participated; data for 49 of 110 (45%) were included in the final analysis. Mean ± standard deviation (SD) daily TST in the entire cohort was 6.53 ± 0.78 hours. Residents slept significantly longer during the ambulatory block than during the MICU block (mean ± SD TST 6.97 ± 1.00 hours and 6.43 ± 0.78 hours, respectively; p
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المؤلفون: Dane Shafer Klink, Samina Yunus, Robert Cain
المصدر: Medical Education
مصطلحات موضوعية: medicine.medical_specialty, Telemedicine, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, MEDLINE, Education, Betacoronavirus, Pandemic, medicine, Humans, Pandemics, Education, Medical, biology, SARS-CoV-2, Clinical Clerkship, COVID-19, General Medicine, biology.organism_classification, Really Good Stuff, Family medicine, Coronavirus Infections, Family Practice, Psychology
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