Dujeepa D Samarasekera1, Shuh Shing Lee1, Su Ping Yeo1, Julie Chen2, Ardi Findyartini3,4, Nadia Greviana3,4, Budi Wiweko3,5, Vishna Devi Nadarajah6, Chandramani Thuraisingham7, Jen-Hung Yang8,9, Lawrence Sherman10
1Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 2Department of Family Medicine and Primary Care/ Bau Institute of Medical and Health Sciences Education, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; 3Medical Education Center, Indonesia Medical Education & Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 4Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 5Department of Obstetrics and Gynaecology, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 6IMU Centre of Education and School of Medicine, International Medical University, Kuala Lumpur, Malaysia; 7Department of Family Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia; 8Medical Education and Humanities Research Center and Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan; 9Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; 10Meducate Global, LLC, Florida, USA
Abstract
Introduction: Continuing medical education and continuing professional development activities (CME/CPD) improve the practice of medical practitioners and allowing them to deliver quality clinical care. However, the systems that oversee CME/CPD as well as the processes around design, delivery, and accreditation vary widely across countries. This study explores the state of CME/CPD in the East and South East Asian region from the perspective of medical practitioners, and makes recommendations for improvement.
Methods: A multi-centre study was conducted across five institutions in Hong Kong, Indonesia, Malaysia, Singapore and Taiwan. The study instrument was a 28-item (27 five-point Likert scale and 1 open-ended items) validated questionnaire that focused on perceptions of the current content, processes and gaps in CME/CPD and further contextualised by educational experts from each participating site. Descriptive analysis was undertaken for quantitative data while the data from open-ended item was categorised into similar categories.
Results: A total of 867 medical practitioners participated in the study. For perceptions on current CME/CPD programme, 75.34% to 88.00% of respondents agreed that CME/CPD increased their skills and competence in providing quality clinical care. For the domain on pharmaceutical industry-supported CME/CPD, the issue of commercial influence was apparent with only 30.24%-56.92% of respondents believing that the CME/CPD in their institution was free from commercial bias. Key areas for improvement for future CME/CPD included 1) content and mode of delivery, 2) independence and funding, 3) administration, 4) location and accessibility and 5) policy and collaboration.
Conclusion: Accessible, practice-relevant content using diverse learning modalities offered by unbiased content providers and subject to transparent and rigorous accreditation processes with minimal administrative hassle are the main considerations for CME/CPD participants.
Keywords: Medical Education, Health Profession Education, Continuing Professional Development, Continuing Medical Education, Accreditation
Uzma Khan
Department of Clinical Sciences, College of Medicine, Al Rayan Colleges, Saudi Arabia
Abstract
Objectives: To compare the cut scores and pass/fail rates achieved by arbitrary 60% method and Hofstee method in an undergraduate year 4 end semester objective structured clinical examination (OSCE) and check the possibility of using Hofstee method of standard setting in future exams.
Method: 102 medical students of year 4 underwent a 10 station OSCE exam conducted in a state of art simulation lab in 3 cycles. The cut scores were calculated using arbitrary method aiming at 60% of task achievement and by Hofstee method. The student’s obtained scores were compared for cut scores and pass rates for individual stations and the entire exam.
Results: The arbitrary and Hofstee methods of standard setting leads to different cut scores. For the individual stations it was 60% vs 65-70% and for the overall score it was 60% vs 70%. The percentage of students failing the exam is 13.7% based on arbitrary scores and is 29.4% when Hofstee cut score is applied.
Conclusions: The two methods lead to different cut scores and students’ failure rates. Overall, Hofstee method is more appropriate for assessing competencies in an OSCE exam in medical schools as it leads to calculation of cut scores based on the difficulty level of the station/exam and the examiners expected level of performance by the students.
Keywords: Objective Structured Clinical Examination, Standard Setting, Hofstee Method, Arbitrary Method
Jia Le Ivan Tan1 & Sashikumar Ganapathy2
1School of Biological Sciences, Nanyang Technological University, Singapore; 2Department of Emergency Medicine, KK Hospital, Singapore
Abstract
Introduction: Maintenance of procedural skills is crucial for paediatric emergency medicine (PEM) physicians to provide high-quality care. A study by Lin-Martore et al. (2021) in the US identified key themes in conceptualising procedural skill maintenance (PSM), its motivations, and barriers to maintenance. However, the difference in culture brings into question the validity of their findings in other contexts. To determine its applicability specifically in an Asian context, this study aims to replicate the study at KK’s Women and Children Hospital (KKH), focusing on PEM physicians. While the findings are limited to a single hospital, they provide valuable insights into challenges encountered by PEM physicians.
Methods: A general qualitative approach was used through semi-structured interviews. Participants were recruited through email. Interviews were conducted via Zoom and subsequently de-identified and transcribed. The data was coded manually through thematic analysis, identifying key themes.
Results: Fifteen PEM physicians were interviewed. Participants conceptualised PSM through technical aspects and measured competence through objective and subjective measures. General motivation themes found the (1) desire to provide optimal patient care, (2) procedural competence as part of the identity of a PEM physician who teaches and performs procedures, and (3) desire for choice when alternatives are present. Barriers included limited time, support, and opportunities.
Conclusion: The study found that the themes from the original study are applicable in KKH, featuring SDT concepts prominently. Practical recommendations for KKH were proposed. Future research can focus on the challenges and gaps in maintaining procedural skills and develop strategies to improve PSM in PEM physicians.
Keywords: Procedural Skill Maintenance, Singapore, Emergency Medicine, Qualitative, Paediatric Medicine
Michiko Goto1, Ryota Sakamoto2, Hideki Wakabayashi3 & Yousuke Takemura4
1Department of General Medicine, Mie University School of Medicine, Japan; 2Department of Medical Informatics, Mie University Hospital, Japan; 3Department of Community Medicine, Mie University School of Medicine, Japan; 4Department of General Medicine, Tokyo Women’s Medical University, Japan
Abstract
Introduction: From the late 1960s to the present, physicians’ dress codes have been actively studied in Western countries. Until the early 21st century, patients tended to prefer a conservative dress style, such as “shirt and tie or skirt” with white coats for physicians. However, as attitudes toward dress codes have changed, knowledge regarding this issue needs to be updated. A variety of colours of scrubs are currently commonly used by medical professionals, but it is not known whether all colours are acceptable to patients. The current study sought to investigate the acceptability of various dress codes for physicians from the patients’ perspective, to inform medical education.
Methods: Outpatients and their family members at a university hospital and a small-to-medium-sized hospital were surveyed. We inquired about which of the different styles of white coats and different colours of scrubs were most desirable for male and female physicians. We used Scheffe’s paired comparison method to determine rankings.
Results: Patients and their family members expected their physicians to wear white coats rather than scrubs. Furthermore, a more traditional and formal dress code was preferred. The least preferred colour of scrubs was yellow.
Conclusion: The current results indicated that patients’ preference for a traditional, conservative appearance has not changed over time. This finding does not match current perspectives on infection prevention. Both patient preferences and infection prevention are important for informing education and gaining patient trust.
Keywords: White Coat, Scrub Colour, Physicians’ Appearance, Medical Education, Doctor-Patient Communication
Rosy Swee Cheng Tay1, Debby Regina Wegner2, Li Siong Lim3, Joshua Ting4 & Shu Ting Ong5
1University of Glasgow Singapore, Singapore; 2Singapore Institute of Technology, Singapore; 3Singapore Institute of Technology, Singapore; 4Alexandra Health, Singapore; 5Gleaneagles Hospital, Singapore
Abstract
Introduction: The Singapore Institute of Technology-University of Glasgow (SIT-UofG) Nursing Programme has traditionally taken a didactic teaching approach in the delivery of the Evidence-Based Practice (EBP) module. A hybrid approach was introduced using Game-Based Learning (GBL) to encourage active learning through gameplay.
Methods: A Randomised Controlled Trial (RCT) was undertaken encompassing a cohort of 100 Nursing students taking the EBP module in their first year at the Singapore Institute of Technology (SIT) in the 2021/22 academic year. The experimental group (n=27) worked through the online GBL intervention and the EBP module, while the control group (n=27) took the EBP module alone. The GBL included five Learning Quests and three case studies.
Results: High levels of satisfaction were reported by both the experimental group (n=22) and the control group (n=15) on the traditional content and delivery of the EBP module. High levels of engagement were reported by the experimental group on the GBL intervention; a one-sample statistics analysis confirming a significant level of engagement (p<0.001). A Mann-Whitney U Test, however, found no significant difference in the Continuous Assessment (CA) scores of the two groups (p=0.507 and 0.461).
Conclusion: The introduction of GBL designed to deliver educational content directly associated with the learning outcomes increased the nursing student engagement in the EBP module. These findings and discoveries can be utilised to improve the GBL intervention to the EBP module to have a more positive impact the student CA scores and therefore on student learning.
Keywords: Evidence-Based Teaching, Evidence-Based Practice (EBP), Nursing Education, Game-Based Learning (GBL), Teaching and Learning EBP, Nursing Students, Gamification
Chuu Ling Chan1, Russell Lee2, Lih Ing Goh1, Nathanael Hao Kai Chong1, Li Neng Lee2 & Jun-Hong Ch’ng1
1Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 2Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
Abstract
Introduction: We frequently associate microbes with infection, rarely expounding on their usefulness and importance to healthy development. For humanity to leverage these microbial “super powers”, learners from all backgrounds need to appreciate their utility and consider how microbes could help solve some of the most critical problems we face. However, learners are frequently uninterested or intimidated by microbiology. The card game “No Guts No Glory” was created to engage students by piquing curiosity and encouraging informal learning to change perceptions and advocate the value of microbes to good health.
Methods: Undergraduates from various faculties in the National University of Singapore were invited to play and give feedback on accessibility, engagement and self-reported learning gains.
Results: The game was well-received across disciplinary backgrounds with positive feedback (5-point scale) on game mechanics being fun (4.17±0.63), attractive artwork (3.83±1.00) and scientific snippets (3.79±1.04), positive re-playability (3.46±0.84), player engagement for those without foundational knowledge in microbiology (3.63±1.04), and usefulness of knowledge taught (3.54±1.10). Areas for improvement evidenced from feedback included unclear instructions (2.74±0.98), limited content taught (2.76±0.93), not generating interest to attend formal microbiome classes (2.88±1.17) and not prompting lifestyle changes (1.98±1.11).
Conclusion: This pilot study provided valuable insights from the target demographic, with concrete ideas on how to improve the educational potential of “No Guts No Glory”. Findings further lay the groundwork for the design of future instruments to objectively quantify learning gains from gameplay.
Keywords: Game-based Learning, Microbiome, Microbiology, Card Game, No Guts No Glory
Sean B Maurice
Northern Medical Program, Division of Medical Sciences, University of Northern British Columbia, Prince George, Canada; Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
I. INTRODUCTION
Risk management is a skillset that is embedded within clinical practice. Clinicians use protective equipment to safeguard themselves from pathogens carried by patients, learn de-escalation techniques to manage violent patients, and learn to ask for help. Patients of course are also at risk, because they present with illness or injury that may get worse despite our best efforts, and because there’s always a chance of iatrogenic injury or disease. Healthcare providers dedicate themselves to healing injury and illness, and to not causing further harm. In contrast, risk management is rarely considered with regards to teaching and learning, as they are not commonly understood to involve risk. When a teaching or learning experience feels risky, but we don’t think it should, then we don’t talk about it, and this can create cognitive dissonance and discourage us from engaging in teaching and learning.
Kosala N. Marambe1, Deepthi H. Edussuriya2 & Dharshana Jayawickrama1
1Medical Education Unit, Faculty of Medicine, University of Peradeniya, Sri Lanka; Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
Abstract
Introduction: Feedback reinforces good practice, identifies deficiencies and directs the learner to narrow the gap between actual and desired performance thus, playing a crucial role in the development of competence in medical training. However, feedback if not carefully handled can result in de-motivation and deterioration in performance.
It is believed that culture plays an important role in the way behaviours are valued and tolerated in educational settings.
Aim: To explore perceptions of Sri Lankan medical graduands on feedback received from teachers during clinical training.
Method: The study was conducted on a single intake of medical graduates after release of final MBBS results, ensured maximum variation sampling by including students from high, average and low performance categories. Participation was voluntary. Interviews were conducted using a short interview guide, transcribed and themes identified.
Results: 21 interviews were conducted. There were eight, six and seven volunteers from the high performing, average and poorly performing groups respectively. 63% were male.
Positive experiences encompassed; trainer taking a balanced approach to feedback by acknowledging good practices while indicating negative aspects, providing an emotionally supportive environment, clear articulation, offering focused learner support and motivating the learners through encouraging words and support to realize their potential. Negative experiences encompassed fault finding, biased nature and indiscreet behaviour of the trainers.
Conclusion: Sri Lankan medical graduands have experienced desirable and undesirable teacher behaviours during feedback episodes. Accurate conceptualization of ‘feedback process’ among clinical teachers and proactive measures to enhance the skills of teachers on giving feedback is needed.
Keywords: Undergraduate Clinical Training, Student Perceptions, Feedback
Tari Stowers1, Mataroria P. Lyndon2,3, Marcus A. Henning2, Andrew G. Hill3,4& Melinda Webber5
1Faculty of Education, The University of Auckland, New Zealand; 2Centre for Medical and Health Sciences Education, The University of Auckland, New Zealand; 3Counties Manukau District Health Board, New Zealand; 4South Auckland Clinical Campus, The University of Auckland, New Zealand; 5Te Puna Wānanga/School of Māori and Indigenous Education, The University of Auckland, New Zealand
Abstract
Introduction: This study explored motivation among a cohort of New Zealand medical students from The University of Auckland. The research questions were: 1) What motivates students to attend medical school? 2) What are the values, beliefs or cultural practices that influence students’ decisions to go to medical school? 3) How do students’ families influence their decisions to go to medical school?
Methods: Twenty medical students from The University of Auckland in Years Two and Five of a Bachelor of Medicine and Bachelor of Surgery (MBChB) degree participated in semi-structured focus group interviews. Two cohorts of medical students were involved, Māori and Pacific Admission Scheme students (MAPAS), and non-MAPAS students. An interpretive methodology was used, and data analysed using thematic analysis.
Findings: This study found both MAPAS and non-MAPAS students have intrinsic and extrinsic motivation to attend and continue medical school. However, the non-MAPAS students had more individualised motivations to study medicine whereas the MAPAS students were more motivated by collectivism. Family and cultural customs influenced MAPAS students’ motivation to study medicine. Non-MAPAS students were influenced by positive school experiences.
Common to both cohorts was the significant influence of family. Non-MAPAS students specified family members’ professions and educational support as influencing factors. In contrast, MAPAS students identified being motivated to study medicine to improve the financial and health situations of their families.
Conclusion: All students have different motivations for attending medical school which is influenced by their culture and environment. Culture encompasses the individual and their family, inclusive of ethnicity, beliefs, values and behaviours. Family plays a crucial role in motivating and influencing students to pursue medicine.
Keywords: Motivation, Medical Students, Culture, Indigenous, Ethnic Minority
Nathalie Khoueiry Zgheib1, Ahmed Ali2 & Ramzi Sabra1
1Department of Pharmacology and Toxicology, American University of Beirut Faculty of Medicine, Beirut, Lebanon; 2Medical Education Unit, American University of Beirut Faculty of Medicine, Beirut, Lebanon
Abstract
Introduction: The forced transition to online learning due to the COVID-19 pandemic has impacted medical education significantly.
Methods: In this paper, the authors compare the performance of Year 1 and 2 classes of medical students who took the same courses either online (2019-2020) or face-to-face (2018-2019), and compare their evaluation of these courses. The authors also present results of three survey questions delivered to current Year 1 medical students on the perceived advantages and disadvantages of online learning and suggestions for improvement.
Results: Performance and evaluation scores of Year 1 and 2 classes was similar irrespective of the mode of delivery of the course in question. 30 current (2019-2020) Year 1 students responded to the survey questions with a response rate of 25.4%. Some of the cited disadvantages had to do with technical, infrastructural and faculty know-how and support. But the more challenging limitations had to do with the process of learning and what facilitates it, the students’ ability to self-regulate and to motivate themselves, the negative impact of isolation, loss of socialisation and interaction with peers and faculty, and the almost total lack of hands-on experiences.
Conclusion: Rapid transition to online learning did not affect student knowledge acquisition negatively. As such, the sudden shift to online education might not be a totally negative development and can be harnessed to drive a more progressive medical education agenda. These results are particularly important considering the several disadvantages that the students cited in relation to the online delivery of the courses.
Keywords: Online Learning, COVID-19 Pandemic, Medical Students
Claude Jeffrey Renaud1, Zhi Xiong Chen2,6, Heng-Wai Yuen3, Lay Ling Tan4, Terry Ling Te Pan5 & Dujeepa D. Samarasekera6
1Department of Medicine, Khoo Teck Puat Hospital, Singapore; 2Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 3Department of Otorhinolaryngology-Head & Neck Surgery, Changi General Hospital, Singapore; 4Department of Psychological Medicine, Changi General Hospital, Singapore; 5Department of Anaesthesiology, National University Health System, Singapore; 6Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Abstract
Introduction: The Coronavirus-19 pandemic has had profound effects on health professions education (HPE) posing serious challenges to the continued provision and implementation of undergraduate, postgraduate and continuing medical education (CME). Across these HPE domains, the major disruptions included the exclusion of undergraduate learners from clinical learning environments, restricted intra-, inter-institutional and overseas movement of medical professionals, termination of face-to-face learner-educator interactions, deployment of postgraduate learners into non-scope service settings, and CME postponement.
Methods: In this review we report on how in Singapore various adaptive measures were instituted across the 3 HPE domains at institutional and national level to maintain adequate resources at the frontline to meet service exigencies, promote healthcare professionals’ wellbeing and safety as well as mitigate the spread of the pandemic.
Results: We identified several strategies and contingencies developed to address these challenges. These involved the use of online learning platforms, distributed and asynchronous learning, an undergraduate Pathway Programme, and use of innovative hands-on technology like simulation. Robust, well pre-planned pandemic preparedness, effective communication, as well as provision of psychological support resources ensured maintenance of service and academic continuity, trust and resilience within HPE. However, several challenges remain, namely the timing and manner of conducting formative and summative assessments, cybersecurity, and the indispensable hands-on, in-person experiential learning for surgical training.
Conclusion: Strong leadership with vision and planning, good communication, prioritising learners’ and educators’ wellbeing and safety, and harnessing existing and emerging online learning technologies are crucial elements for effective contingencies for HPE disruption during pandemics.
Keywords: Pandemic Preparedness, COVID-19, Curriculum Development, Online Learning and Assessment, Learner Wellbeing and Safety, Health Profession Education
Lawrence T. Sherman1 & Kathy B. Chappell2
1Academy for Global Interprofessional Learning and Education, Switzerland; 2American Nurses Credentialing Centre, United States of America
Abstract
Healthcare professionals worldwide participate in continuing professional development (CPD) to remain competent in practice, and to ensure they provide high-quality care to patients. Globally, CPD systems have evolved at different rates resulting in significant variation in structure, requirements, and oversight. In some countries, CPD has moved from single profession educational designs and formal didactic methods of delivery to educational models that are innovative, dynamic, and learner-centric. In other countries, CPD is a neglected part of the healthcare education continuum. This article provides a global perspective on the evolution of CPD over the past 20 years, and identifies opportunities for the future.
Julie Yun Chen1,2, Weng-Yee Chin1, Agnes Tiwari3, Janet Wong3, Ian C K Wong4, Alan Worsley4, Yibin Feng5, Mai Har Sham6, Joyce Pui Yan Tsang1,2 & Chak Sing Lau7
1Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 2Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 3School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 4Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 5School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 6School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 7Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong, Hong Kong
Abstract
Introduction: The demanding nature of medical and health sciences studies can cause stress among students in these disciplines affecting their wellbeing and academic performance. The Perceived Stress Scale (PSS-10) is a widely used measure of perceived stress among medical students and healthcare professionals that has not yet been validated among medical and health sciences students in Hong Kong. The aim of this study is to establish the construct validity and reliability of the PSS-10 in this context.
Methods: 267 final year medical and health sciences students were surveyed using the PSS-10. The data were analysed using exploratory factor analysis for construct validity and Cronbach’s alpha coefficient and corrected item-total correlations for reliability.
Results: Exploratory factor analysis revealed a two-factor structure for PSS-10, with Cronbach’s alpha of 0.865 and 0.796, indicating good internal consistency. Corrected item-total correlations showed satisfactory correlation ranged from 0.539 to 0.748 for all items and their respective subscale. Both tests supported PSS-10 as a two-factor scale.
Conclusion: The PSS-10 is a valid measure for assessing perceived stress in Hong Kong medical and health sciences students.
Keywords: Undergraduate Students, Medicine, Nursing, Pharmacy, Health Sciences, Validation, Perceived Stress
Seow Chong Lee & Foong May Yeong
Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
I. INTRODUCTION
One of the biggest challenges at engaging undergraduates effectively in Biology modules is large class size (Wood, 2009). Typically, the class size of an undergraduate Cell Biology module in our institution ranges from 200 to 300 students. Instructors of large class modules traditionally teach didactically by simply disseminating facts, which become outdated quickly in this growing field of science. Furthermore, using didactic instruction, it is difficult to help students develop skills such as critical-thinking expected of our university graduates.
Sethuraman K. Raman
Faculty of Medicine, Sri Balaji Vidyapeeth, Indi
I. INTRODUCTION
A. Why this is an issue of global relevance
India is the world’s largest exporter of doctors and healthcare workforce to other nations. More than 70,000 medical graduates from India (nearly 10% of the qualified doctors in India) are in the USA, UK, Europe, and the other nations. Therefore, the quality of medical education and the competence level of medical professionals from India acquire global relevance. Over the years, several critiques have been published on Indian Medical Education (Solanki & Kashyap, 2014).
Thilanka Seneviratne1, Kosala Somaratne2, Deelaka Bandara1, Vindya Alahakoon1, Dilan Bandara1, Randima Munasinghe1, Nabil Ilyas3, Thilini Subasingha4& P. V. R. Kumarasiri5
1Department of Pharmacology, Faculty of Medicine, University of Peradeniya, Sri Lanka; 2Base Hospital, Rikillagaskada, Sri Lanka; 3Teaching Hospital, Peradeniya, Sri Lanka; 4Lady Ridgeway Hospital, Colombo, Sri Lanka; 5Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
Abstract
Introduction: English is the medium of instruction in the medical faculties in Sri Lanka, although the majority of the students who admit to the medical faculties completed their secondary school education with Sinhala as their first language. This disparity presents a potential barrier to their assimilation of knowledge in medical education.
Objective: To assess the medical students’ perception of the medium of instruction in medical education.
Method: The medical students of the Faculty of Medicine, University of Peradeniya, Sri Lanka, enrolled from 2013 to 2017, whose first language is Sinhala were included in the study. Perceptions about the medium of instruction in medical education were assessed through an anonymous self-administered questionnaire, which used a five-point Likert scale for responses.
Results: From the total of 837 medical students, 665 (79.5%) participants had studied the General Certificate of Education – Ordinary Level (GCE O/L) in Sinhala and 172 (20.5%) in English. Eighty-eight percent (87.8%) had obtained an “A” grade for English Language in the GCE O/L examination. Over half (53.4%) of students responded that if medical textbooks were available in Sinhala, it would have increased their understanding of medical concepts. Nearly two-thirds (61%) responded that they perceived their performance in clinical examinations would have improved if those were carried out in Sinhala.
Conclusion: The findings reveal the positive perception of students towards using their first language in medical education. Specifically, students feel that concepts of medicine would be better understood if medical textbooks were available in Sinhala and that they could have performed better if examinations were done in Sinhala, their first language.
Keywords: Mother Tongue, Native Language, First Language, Sinhala, English, Medical Education
Julie Drendall & John J. Norcini
Foundation for Advancement of International Medical Education and Research, United States
I. INTRODUCTION
The Foundation for Advancement of International Medical Education and Research (FAIMER®) is a non-profit foundation committed to improving the health of communities by enhancing the quality of health professions education. This article highlights several of FAIMER’s international efforts, with particular emphasis on the fellowship programs developed in partnership with institutions in the Asia-Pacific region.
Thamudi D Sundarapperuma1, Eranthi Weeratunga1, Prabhavi Wijesiriwardhana2, Eranga Silva2, Shanika Karunanayaka3, & Kithmini Yasarathne3
1Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka; 2Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka; 3Department of Pharmacy, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka
Abstract
Introduction: Several nations around the world had to close schools, colleges, universities, and other educational institutions as they were badly affected by the spread of COVID-19. The purpose of this study was to measure the effectiveness of online vs physical teaching during the COVID-19 pandemic, at the Faculty of Allied Health Sciences (FAHS), University of Ruhuna (UoR) Sri Lanka.
Method: A cross-sectional study was conducted among 200 undergraduates. The data were collected through displayed/approved results sheets of the students of selected batches in the Department of Nursing, Department of Pharmacy, and Medical Laboratory Science (MLS). Paired sample T-test was used to compare the results of undergraduates.
Results: The examination results of 47-54 undergraduates in nursing, 28 in pharmacy, and 22 in MLS were analysed. Significant differences in Psychiatry in Nursing and Nursing Clinical Attachment were identified in the Department of Nursing (p=0.001). In the Department of Pharmacy, only Pharmaceutical Chemistry I (p=0.012) reported a significant difference. The undergraduates of MLS who underwent online theory sessions had scored more in Microbiology and Immunology (p=0.022) and Basic Genetics and Molecular Biology (p=0.000) whereas in Research Methodology and Epidemiology, the undergraduates who participated in physical lectures had scored more marks (p=0.001).
Conclusion: Practical/interactive session-based course units and clinical appointments had a higher impact on the mode of teaching than many theoretical course units. The results might serve as a primer for the creation of an action plan to support the academics and clinical/practical components of undergraduates.
Keywords: Undergraduates, Online Teaching, Physical Teaching, Examination Results, COVID-19
Diane Kenwright, Wei Dai, Emma Osborne, Tehmina Gladman, Peter Gallagher & Rebecca Grainger
University of Otago Wellington, New Zealand
Abstract
Although the flipped classroom approach has been theorised to encourage active learning, recorded lectures were used as flipped learning activities in the majority of the flipped learning studies, which many still consider to be passive knowledge input. To further promote active learning, the first four modules in a pathology course at University of Otago Wellington were flipped and delivered to fourth year medical students with redesigned active learning activities based on constructive theory of learning. The innovative active learning tasks were delivered via “kuraCloud” (an online-learning platform) and included short video clips, labeling exercises, written questions with immediate feedback, multiple-choice questions with explanatory text and links provided for further information. Students were required to complete all the activities prior to a face-to-face tutorial. A mixed methods design was used in which student engagement was assessed using both survey instruments and focus groups. Results showed that students did not engage with the new flipped learning activities designed to improve active learning, they preferred the passive learning approach with exam- or clinical practice- based core knowledge summarized and delivered to them directly. Three themes emerged: 1. Students considered the time invested in the active learning activities was inefficient. 2. The flipped course challenged students’ sense of predictability. 3. The knowledge construction process was valued as application rather than learning. This might be attributed to time-poor medical students judging the value of the learning task based on the relevance to their immediate learning goal: pass the exam, the new flipped learning activities imposing a heavy cognitive load that impairs the knowledge construction process and the less predictable structure of the flipped learning environment compared to the familiar traditional lectures.
Keywords: Passive Learning; Active Learning; the Flipped Classroom; Course Structure; Cognitive Load
Rita Mustika1,2, Hiroshi Nishigori3, Sjamsuhidajat Ronokusumo1 & Albert Scherpbier4
1Medical Education Department, Faculty of Medicine, Universitas Indonesia, Indonesia; 2The Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Indonesia; 3Center of Medical Education, Graduate School of Medicine, Kyoto University, Japan; 4Faculty of Health, Medicine, and Life Sciences, Maastricht University, Netherland
Abstract
Medical education in Indonesia has undergone a long journey. It began with the establishment of medical training for native youth in a military hospital in Jakarta during the Dutch colonial period in 1849. Since then, the number of medical schools has increased according to socio-political needs. Currently, there are 83 medical schools, public and private, which generate approximately 8000 graduates per year. The explosion in the number of medical schools challenged quality of medical education. Indeed, several curriculum changes and improvements applied to elevate the quality. Undergraduate program was initially implementing Dutch curriculum, but was then changed into American curriculum. The improvement continued by implementing the first and the second national curriculum. Since 2005 a national level competency-based curriculum (CBC) was carried out for undergraduate programs, while for postgraduate clinical training the CBC began later on. Moreover, Medical Internship Program and the National Competency-based Examination were introduced following the CBC. Nevertheless, some problems with advancement of medical schools were identified, including lack of staff and facilities, existing learning cultures and limitation of experts. Accordingly, many efforts have been made, including enactment of law on medical education and national accreditation. In the future, support from international organizations in terms of financial, consultation, faculty development and accreditation should be optimized. In addition, collaboration with medical education community elsewhere would be beneficial to overcome the challenges and promote the quality of medical education.
Keywords: Medical Schools, Curriculum Changes, Medical Education, Indonesia
Roger Strasser
Northern Ontario School of Medicine, Lakehead and Laurentian Universities, Canada
Abstract
Background: The Northern Ontario School of Medicine (NOSM) opened in 2005 with a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario. NOSM recruits students from Northern Ontario or similar backgrounds and provides Distributed Community Engaged Learning in over 90 clinical and community settings located in the region, a vast underserved rural part of Canada. This paper presents outcomes for graduates of NOSM’s undergraduate and postgraduate medical education programs with emphasis on NOSM’s social accountability mandate.
Methods: NOSM and the Centre for Rural and Northern Health Research (CRaNHR) used mixed methods that include administrative data from NOSM and external sources, as well as surveys and interviews of students, graduates and other informants.
Results: 92% of all NOSM students come from Northern Ontario with substantial inclusion of Aboriginal (7%) and Francophone (22%) students. 62% of NOSM graduates have chosen family practice (predominantly rural) training. 94% of the doctors who completed undergraduate and postgraduate education with NOSM are practising in Northern Ontario. The socio-economic impact of NOSM included: new economic activity, more than double the School’s budget; enhanced retention and recruitment for the universities and hospitals/health services; and a sense of empowerment among community participants attributable in large part to NOSM.
Discussion: There are signs that NOSM is successful in graduating doctors who have the skills and the commitment to practice in rural/remote communities and that NOSM is having a largely positive socio-economic impact on Northern Ontario.
Keywords: Social Accountability; Community Engagement; Distributed Medical Education
Lawrence T. Sherman1 & Kathy B. Chappell2
1Academy for Global Interprofessional Learning and Education, Switzerland; 2American Nurses Credentialing Centre, United States of America
Abstract
Healthcare professionals worldwide participate in continuing professional development (CPD) to remain competent in practice, and to ensure they provide high-quality care to patients. Globally, CPD systems have evolved at different rates resulting in significant variation in structure, requirements, and oversight. In some countries, CPD has moved from single profession educational designs and formal didactic methods of delivery to educational models that are innovative, dynamic, and learner-centric. In other countries, CPD is a neglected part of the healthcare education continuum. This article provides a global perspective on the evolution of CPD over the past 20 years, and identifies opportunities for the future.
Seow Chong Lee & Foong May Yeong
Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
I. INTRODUCTION
One of the biggest challenges at engaging undergraduates effectively in Biology modules is large class size (Wood, 2009). Typically, the class size of an undergraduate Cell Biology module in our institution ranges from 200 to 300 students. Instructors of large class modules traditionally teach didactically by simply disseminating facts, which become outdated quickly in this growing field of science. Furthermore, using didactic instruction, it is difficult to help students develop skills such as critical-thinking expected of our university graduates.
Julie Yun Chen1,2, Weng-Yee Chin1, Agnes Tiwari3, Janet Wong3, Ian C K Wong4, Alan Worsley4, Yibin Feng5, Mai Har Sham6, Joyce Pui Yan Tsang1,2 & Chak Sing Lau7
1Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 2Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 3School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 4Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 5School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 6School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; 7Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong, Hong Kong
Abstract
Introduction: The demanding nature of medical and health sciences studies can cause stress among students in these disciplines affecting their wellbeing and academic performance. The Perceived Stress Scale (PSS-10) is a widely used measure of perceived stress among medical students and healthcare professionals that has not yet been validated among medical and health sciences students in Hong Kong. The aim of this study is to establish the construct validity and reliability of the PSS-10 in this context.
Methods: 267 final year medical and health sciences students were surveyed using the PSS-10. The data were analysed using exploratory factor analysis for construct validity and Cronbach’s alpha coefficient and corrected item-total correlations for reliability.
Results: Exploratory factor analysis revealed a two-factor structure for PSS-10, with Cronbach’s alpha of 0.865 and 0.796, indicating good internal consistency. Corrected item-total correlations showed satisfactory correlation ranged from 0.539 to 0.748 for all items and their respective subscale. Both tests supported PSS-10 as a two-factor scale.
Conclusion: The PSS-10 is a valid measure for assessing perceived stress in Hong Kong medical and health sciences students.
Keywords: Undergraduate Students, Medicine, Nursing, Pharmacy, Health Sciences, Validation, Perceived Stress
Hirohisa Fujikawa1, Daisuke Son1,2 & Masato Eto1
1Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Japan; 2Department of Community-based Family Medicine, School of Medicine, Tottori University Faculty of Medicine, Japan
I. INTRODUCTION
Many countries enforce limits on the number of hours that medical residents work. For example, in the United States, regulations about duty hours were instituted by the Accreditation Council of Graduate Medical Education as early as in 2003, reinforcing those limits in 2011 and again in 2017 (Accreditation Council for Graduate Medical Education, 2017). These reforms triggered discussion in medical education literature about their wide-ranging effects on resident education, resident wellness, and patient care (Bolster & Rourke, 2015).
In Japan, restrictions on working hours will be implemented for physicians in April 2024 (Shibuya & Unno, 2019). Because of its rapidly shifting demographics to being a super-aged society with a low birth rate, Japan is now facing issues with residents’ learning and working that other countries will need to confront in the near future as their populations shift as well (as of late 2020). Here we report on the history and current situation of postgraduate medical education in Japan, which are highly relevant to re-evaluating postgraduate training in other countries.
1Judy McKimm & 2Hiroshi Nishigori
1Strategic Educational Development, Swansea University Medical School, Swansea University, United Kingdom; 2Center for Medical Education, Nagoya University Graduate School of Medicine, Japan
Abstract
It has been a pleasure for us to act as guest editors for this themed issue on the Implications of Culture in the Education and Practice of Healthcare Professionals. We thank the TAPS Editorial team, our reviewers, and authors for all their hard work and patience and we hope you enjoy this varied issue with articles from around the region, and the world.
Pairoj Boonluksiri
Hatyai Medical Education Centre, Hatyai Hospital, Songkhla, Thailand
Abstract
Background: Smartphones are used worldwide. Consequently, it does seem to be having an impact on health-related problems if overused. However, it is uncertain whether it is associated with sleep problems or poor learning.
Objective: To determine the association between smartphone overuse and sleep problems in medical students as primary outcome and poor learning as secondary outcome.
Methods: A cross-sectional study was conducted in 89 students having their own smartphones, at Hatyai Medical Education Centre, Thailand. The habits of using smartphone were obtained. Smartphone overuse during bedtime was defined as using longer than 1 hour according to Smartphone Addiction Scale (SAS). The primary outcome was napping in a classroom that was defined as a problem if it happened more than 20% of the time attending class. Sleep problems using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were obtained by self-assessment. Learning outcome measured by grade point average was the secondary outcome. Multivariable analysis was performed for the association between smartphone overuse and sleep problems.
Results: Of all students, 77.5% had sleep problems and 43.6% had napped in the classroom No personal characteristics, daily life behaviours, and physical environments were associated with sleep problems. 70.8% of all students found to over use smartphones during bedtime. The Facebook website was the most popular. Smartphone overuse was significantly associated with poor sleep quality (odds ratio= 3.46) and napping in the classroom (odds ratio=4.09) but not grade point average.
Conclusion: Smartphone overuse during bedtime in medical students is associated with sleep problems but not learning achievement.
Keywords: Napping in Classroom, Sleep Problems, Smartphone Overuse
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