Abstract

Introduction: There is a global call for transforming medical education to meet evolving healthcare needs. However, navigating the challenges of educational change in resource-limited contexts requires key stakeholders, from leaders to educators and students, to adopt innovative approaches. This paper presents practical examples of such innovations from the University of Health Sciences (UHS) in Cambodia’s experiences, followed by discussions on enabled and hindered factors of their initiation, implementation, and sustainability. This paper also aims to inspire future medical education innovations.

Methods: This paper relied on internal document reviews, including strategic plans, project proposals & planning, course syllabi, and evaluation reports, and the collective working experiences of co-authors in initiating, implementing, and leading these innovations.

Results: Three innovative projects at UHS illustrated how creative ideas are put into practice, including (1) The elective International Programme (IP) with a dual objective of training local trainers while preparing students for international mobility, (2) The Master of Health Professions Education (MHPE), a cost-effective faculty development programme delivered in-person at UHS campus by faculty of a university partner, and (3) Peer-assisted Learning (PAL), a student-led initiative to promote learning skills.

Conclusion: Medical education innovations are needed in resource-limited contexts. The success of these initiatives resulted from multi-factors, notably long-term strategic planning, supportive leadership, active partnerships, policy commitment, local champions, resourcefulness, and student engagement. The late adoption of technology-enhanced learning, the necessity for robust faculty development programmes, and early investment in student leaders, coupled with post-graduate retention planning, represent challenges that present strategic opportunities.

Abstract

Introduction: Case write-ups and reflective journals have been used as assessment tools of learning in clinical rotations in Yong Loo Lin school of medicine. It is timely to review the current process of conducting these assessments and effectiveness as an assessment tool. This study aims to understand faculty outlook towards these assessments.

Methods: This is a study that involves a survey-based questionnaire with both closed and open-ended questions, sent out to faculty marking the students’ assignments. This survey was anonymous & voluntary and was disseminated by administrative assistants. The purpose of this survey was to collect the feedback from faculty about current process with intentions of improving the effectiveness of these assessments. The suggestions for improvement were incorporated in the survey and faculty was invited to comment over these suggestions and provide further suggestions if any.

Results: Fifty-two responses from faculty were collected and analysed. Ninety percent of respondents thinks that this is an effective tool to assess and promote self-directed learning. Qualitative feedback was received about need of improvement in a) alignment of the submissions timings with rotation postings b) marking rubric to incorporate factors such as case complexity and weightage to different components of case write-ups, c) timely feedback to students, and d) follow up on action plans.

Conclusion: Case write-ups and reflective journals are still effective learning and assessment tools. They promote self-directed learning and clinical analysis in students. Feedback and action plans are the backbone of these assessments and optimal utilisation of these is recommended.

Keywords:           Undergraduate Medical Education, Case Write-ups, Medical Assessments, Reflective Journals

Abstract

Introduction: Oral health education is essential for adolescents, yet traditional methods face challenges in engaging this demographic. This study evaluates the effectiveness of a multimedia-based dental education program among high school students. This study was carried out to assess the impact of a comprehensive multimedia-based dental education program on oral health knowledge and practices among high school students.

Methods: A total of 228 students were recruited and randomly assigned to experimental (n=114) and control (n=114) groups. The experimental group received a four-week multimedia program, while the control group followed the standard curriculum. Outcome measures included oral health knowledge scores, brushing frequency, flossing habits, dietary choices, and observational assessments. Statistical analysis employed descriptive statistics, paired t-tests, and analysis of covariance (ANCOVA).

Results: The multimedia-based program led to a significant increase in oral health knowledge scores in the experimental group compared to the control group (Mean Change: 14.6, p < 0.001). Moreover, the experimental group demonstrated higher brushing frequency (p < 0.001), increased flossing habits (p < 0.001), and improved dietary choices (p < 0.05). Observational assessments showed higher adherence to oral hygiene practices in the experimental group (p < 0.001).

Conclusion: The multimedia-based dental education program effectively improved oral health knowledge and practices among high school students. This approach holds promise for scalable and engaging oral health education strategies.

Keywords:           Multimedia-based Education, Oral Health, Adolescents, Dental Education, Health Promotion, Preventive Dentistry

Abstract

Introduction: Mentoring is an essential component of post-graduate medical training programs worldwide, with potential benefits for both mentors and mentees. While factors associated with mentorship success have been described, studies have focused on intrapersonal characteristics and are largely based in Western academic programs. Mentorship occurs in a broader environmental milieu, and in an Asian context, cultural factors such as respect for authority, hierarchy and collectivism are likely to affect mentoring relationships. We aim to explore the lived experience of mentors within an Asian postgraduate medical training program, and thus identify challenges and develop best practices for effective mentoring.

Methods: 14 faculty mentors from a post-graduate paediatric residency program were interviewed between October 2021 to September 2022. Data was collected through semi-structured one-on-one interviews, with participants chosen via purposeful sampling. Qualitative analysis was done via a systematic process for phenomenological inquiry, with interviews thematically coded separately by 2 independent reviewers and checked for consistency.

Results: 4 main thematic concepts were identified: “professional, but also personal”, “respect and hierarchy”, “harmony and avoidance of open conflict” and the “importance of trust and establishing a familial relationship”. Mentors also highlighted the value of structure in Asian mentoring relationships.

Conclusion: Cultural factors, which are deeply rooted in social norms and values, play an important role in shaping mentoring relationships in an Asian context. Mentoring programs should be tailored to leverage on the unique cultural norms and values of the region in order to promote career growth and personal development of trainees and mentors.

Keywords:           Medical Education, Graduate Medical Education, Professional Development

Abstract

Introduction: Many societal changes threaten the sustainability of health systems. Entrepreneurs play a significant role in creating sustainable innovations necessary for development and structural change. This study aimed to evaluate how university students studying health sciences perceive individual entrepreneurship during the COVID-19 pandemic and to explore the impact of COVID-19-related hopelessness on their perception of entrepreneurship.

Methods: Six hundred eighty-one undergraduate students from the faculty of health sciences in Türkiye, participated in the study. The Individual Entrepreneurship Perception Scale and Beck Hopelessness Scale were used to collect data.

Results: The results revealed that the students’ perception of individual entrepreneurship was high, while their hopelessness levels were moderate. In addition, a moderate negative relationship was found between the students’ hopelessness levels and their perception of individual entrepreneurship. The regression analysis showed that the students’ hopelessness levels and sub-dimensions (hope, loss of motivation, and future expectation) accounted for 26.3% of the total variance in individual entrepreneurship perception. Increased hopelessness regarding the sub-dimensions of hope, loss of motivation, and expectations for the future decreased their individual entrepreneurship perceptions.

Conclusions: These findings suggest that individual entrepreneurship perception among health sciences students could be negatively impacted during extraordinary periods related to health crises like pandemics. Developing hope, motivation, and expectations for the future is crucial to enhancing individual entrepreneurship perception among health sciences students.

Keywords: Individual Entrepreneurship Perception, Hopelessness, Health Sciences, University Students, COVID-19 Pandemic

Introduction: Globally, persons with disabilities (PWD) face structural and social barriers to inclusive healthcare. Medical schools, as crucibles of medical professional identity formation, have the responsibility to foster person-centredness toward all patients, including PWD, among her graduates. We co-designed with PWD a “Communications with Persons with Disabilities” workshop and evaluated its impact.

Methods: The workshop enlisted PWD as patient educators, occurred within the third-year undergraduate Family Medicine posting, and was designed to positively impact communications skills and attitudes toward PWD. Students (n=135) were surveyed pre- and post- workshop following a mixed-methods approach (demographic data, Attitude Towards Disabled Persons (ATDP)-O scale, feedback questions, and post-workshop free reflections). Descriptive analysis was used for demographic and feedback questions, and thematic analysis for reflections. Paired t-test was used to evaluate change in ATDP-O scores.

Results: There were 69 survey respondents (51.11%). Most students agreed that communications training with PWD could be strengthened in medical school, and that the workshop was relevant to their future medical career (n=68, 98.55%). Attitudes towards PWD significantly improved after the workshop (ATDP-O change: +9.29 points (12.7%), p <0.001). Student reflections included attitudes, such as the importance of seeing the person beyond the disability, and a call for action towards inclusivity and accessibility of care for PWD.

Conclusion: Students’ attitudes were positively affected by involving PWD in the curriculum. Further research is needed for assessing the impact of how a longitudinal PWD curriculum could affect medical trainees and improve social inclusiveness in healthcare practice.

Keywords:           Medical Education, Communication, Persons with Disabilities, Disability, Social Inclusiveness, Student Attitudes, Person Centred Care, Active Learning

Abstract

Introduction: A valid, longitudinal approach is critical for service planning in healthcare and to understand career choice in medical graduates.

Methods: We quantitatively analysed self-reported influences underlying career choice in a national cohort of medical graduates over the first five years of their careers. Participants rated career influences on importance across 26 items using a 5-point Likert scale (1=not at all, 5=a great deal).

Results: We included 659 New Zealand medical graduates (mean 25.4 years old, 376 F, 283 M) from the University of Auckland and the University of Otago, graduating in 2012 and 2013 (85% response rate). Responses were linked longitudinally over their post-graduate years 1, 3 and 5, and underwent principal component analyses. At graduation the factor rated as the most important in career choice had a mean (SD) item score of 3.9 (0.7) and comprised: Medical School Experiences; Specialty Experience; Mentors; and Self-Appraisal – consistent with graduates securing initial employment. Factors which explained the most variance in career choice over the five years after graduation indicated that the costs of medical school and further training were consistently rated as the least important in career choices, while flexibility in working hours were consistently rated as the most important. Factors remained relatively stable over time, showing variation in scores of only a median of 0.5 Likert points, indicating further opportunities for career choice research.

Conclusion: Our results regarding costs of medical training are reassuring, and suggest that greater flexibility in working hours may attract graduates to underserved specialties.

Keywords:           Medical Education, Career Choice, Career Influences, Cost, Debt, Measurement, Medical Graduates, National Longitudinal Study, Working Hours, Work Culture

Abstract

Introduction: Clinical practice education is an important curriculum in developing physiotherapy students to professionals. This curriculum is largely dependent on clinical educators. Although traits of effective clinical educators had been studied in Western population, it was unclear if the Asian population would yield similar traits. Hence, we studied perspectives of students and academic educators to identify top five core traits of an effective clinical educator. The findings will then help guide policy development for clinical educator training and development.

Methods: A survey was circulated to physiotherapy students and academic educators through convenience sampling. We studied 16 traits – enthusiasm, availability, clarity, clinical competence / knowledge, feedback skills, organisational skills, professionalism, well prepared, scholarly activity, non-judgemental, respect students’ autonomy / independence, sincerity, listening skills, evidence-based practice, role model, and awareness of students’ learning needs.

Results: The top five traits identified by students and academic educators were similar in four traits – clinical competency / knowledge, clarity, feedback skills, and enthusiasm, and differed in the choice of “non-judgemental” by students and “awareness of students’ learning needs” by academic educators. Interestingly, when the top six traits were considered instead of five, students and academic educators identified the same traits but in different ranked orders.

Conclusion: The study found six common core traits of an effective clinical educator from the perspectives of students and academic educators. Continuing education development for clinical educators should focus on these six traits prior to other 10 sub-traits.

Keywords:           Training, Development, Education, Allied Health, Entrustable Professional Activities, Mentoring

Abstract

Introduction: This study compares online and in-person delivery of a weekly clinical reasoning seminar for fourth-year medical students at a Malaysian medical school. During the easing of COVID-19 pandemic restrictions, the initial eight seminars took place online, followed by eleven in-person seminars. This study looks at student preference for online or in-person delivery and how these reasons differ due to gender.

Methods: An online questionnaire was sent to fourth-year medical students after returning to in-person seminars. The response rate was 60/128 (46.88%) and the data was analysed using SPSS software.

Results: 65% of students preferred in-person seminars and a larger proportion of female students (71.43%) preferred in-person sessions compared to male students (50.00%), although this was not statistically significant (p=0.11). A significantly larger proportion of female students preferred in-person seminars for the following reasons compared to male students: enjoyment (p=0.041), developing history-taking skills (55.56%) and for formulating differential diagnoses (p=0.046). Students were asked whether online or in-person seminars were most appropriate for eighteen reasons, they felt in-person seminars were most appropriate for 16/18 of these reasons.

Conclusions: More students preferred in-person clinical reasoning seminars and a higher proportion of these students were female. A significantly larger proportion of female students felt in-person seminars were better for; enjoyment and for developing history-taking skills and formulating differential diagnoses, compared to male students. The students preferred online seminars for home comforts and ease of travel, but they preferred in-person seminars for the other 16/18 reasons listed including all reasons linked to learning skills and interreacting with others.

Keywords:            Online Teaching, In-person Teaching, Gender, Clinical Reasoning, Medical Students

I. INTRODUCTION

“Teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction”- Hippocratic Oath

Since time memorial, the very act of teaching has been intertwined with that of being a physician. In so far that this tradition is found inscribed in the Hippocratic Corpus dating to the 5^th century BC. Beyond a calling and a duty, the sharing of experience and expertise is also a rewarding aspect of our roles of doctors. In a climate of ever-increasing demands of knowledge and clinical load, it is imperative we hold on to this aspect closely, and simultaneously look to and embrace new mediums to assist medical educators to meet the current challenges. In this article, we share our experience on how we can incorporate X, formerly known as Twitter, as an extra tool to facilitate teaching on the go during ward rounds and promote self-reflection after.

I. ON PROFESSIONAL IDENTITY FORMATION

Professionalism in medicine can be considered as attributes, behaviours, and identity of the professionals who put the needs of their patients and the community they serve above their individual needs. The concept of professionalism is dynamic and might be perceived differently over time, in different contexts, and by different fields, although some ground values like excellence, competence, and altruism might persist. 

Identity formation is an inseparable part of professionalism as it underlines the importance of “being” in addition to the essence of “behaving”. Professional identity formation (PIF) in medical education is both an active psychological process conducted by individuals in internalising their values and others’ expectations. It is also a dynamic socialisation process allowing an individual to be part of the professional community with increasing roles and recognitions. This applies for both medical students who grow to become medical professionals and for medical teachers who probably juggle their different identities as clinicians/researchers to be able to enact their roles as teachers (Cruess et al., 2014).

There is no “one-size-fits-all” rule as to how their PIF should be navigated, as PIF is a journey unique to each individual. The students need to be supported to form their identity from the stage where they just follow the rules to become individuals who can internalise values and expectations from their professional community as an integral part of themselves. The medical teachers, on the other hand, still have to develop their professional identities as teachers and educators in addition to their other identities.

I. INTRODUCTION

Concept maps serve as teaching and learning tools that appear to assist medical students in cultivating critical thinking skills. This is attributed to the adaptability of the tool, acting as a facilitator for knowledge integration and a method for both learning and teaching. The extensive array of contexts, purposes, and approaches in utilising Concept maps and tools to evaluate critical thinking enhances our confidence in the consistent positive effects (Fonseca et al., 2023).

In the realm of medical education, employing concept maps as a learning strategy can prove to be beneficial (Torre et al., 2023). Concept maps, visual representations of learners’ understanding of a set of concepts, have proven to be valuable tools in medical education (Novak & Cañas, 2008). The integration of concept maps as a teaching strategy allows for the depiction and exploration of the relationships among various medical concepts (Ruiz-Primo & Shavelson, 1996). In our instructional approach, instructors employ concept maps during lectures (Appendix 1), emphasising the interconnectedness of key concepts. Students actively participate in creating their own concept maps, facilitating collaborative learning. This flexible approach accommodates diverse learning styles, with students using both concept map notes and textbooks. The final evaluation includes an assessment of students based on their application of concepts outlined in the concept maps, contributing to a well-rounded and adaptable learning experience in medical education.

In this study, we aimed to assess the impact of utilising the concept map teaching technique in conjunction with concept map notes on the academic performance of students.

I. INTRODUCTION

Residents are vital to the medical workforce, especially for overnight call duties. Transitioning from junior roles to handling overnight calls as senior residents (SRs) can be anxiety-inducing, leading to decline in cognitive performance and fatigue (Weiss et al., 2016). These pose concerns for patient safety and quality of supervision, as SRs often serve as the most senior staff on-site overnight. However, calls offer valuable training opportunities, fostering autonomy, decision-making skills, and preparation for future consultant roles. The challenge is to ensure that overnight calls are safe for both patients and physicians while being conducive to learning.

During the COVID-19 pandemic, the health system’s reallocation of manpower substantially increased the workload. While there remains conflicting evidence on the optimal on-call arrangement, the Accreditation Council for Graduate Medical Education stipulates a maximum of 24 consecutive hours of direct patient care to safeguard against negative effects of chronic sleep deprivation (Nasca et al., 2010). In our tertiary hospital, two medical SRs performed stay-in overnight calls ranging from 15 to 21 hours (1700-0800h on weekdays and 1100-0800h on weekends). Before each call, SRs started work at 0700h. One SR was in-charge of the intensive care unit (ICU) and the other was on the general medicine floor. During each call, the ICU SR was responsible for supervising 2 stay-in junior residents, 2-5 new patient admissions and 20 existing ICU patients; the general medicine SR was responsible for supervising a team of four stay-in junior residents, 30-50 new patient admissions, and 100-150 existing inpatients. After each call, SRs would continue with the morning ward rounds before ending work. SRs could seek help by calling the duty consultant, who stayed out of hospital.

With limited data on SRs’ call experiences during the pandemic, understanding their perceptions and attitudes would be essential for system improvement and preparation for future challenges. Therefore, we aimed to explore the perceptions, attitudes, and practices of SRs with regards to overnight stay-in calls during the COVID-19 pandemic, as well as avenues for improvements in the call system.

I. INTRODUCTION

Portfolios, as structured collections of documentation, not only showcase a student’s learning progress and achievements but also foster a self-directed approach to assessing their own performance and setting future goal (Birgin & Adnan, 2007). Existing literature predominantly addresses the broader usage of portfolios across various disciplines, underscoring their role in enhancing reflective practice and competency-based assessments (David et al., 2001). Although portfolios in paediatrics department provide advantages, their implementation encounters substantial obstacles. These include the substantial time and effort required to maintain them, the need for clear guidelines from faculty, and a varying degree of acceptance among students and faculty, who may prefer traditional assessment methods. This study specifically aims to address these challenges by exploring the perceptions of postgraduate students on the use of portfolios in the paediatrics department at the Defence Services Medical Academy.

I. INTRODUCTION

Recommended strategies for the development of eLearning resources have largely focused on teachers rather than students. Co-creating eLearning resources with students has received increasing attention driven by learner-centric design and dialogical learning models (Gros & López, 2016). Engaging students as co-creators is beneficial, leading to better engagement and academic performance as students take ownership of the learning experience (McDonald et al., 2021). However, challenges to engaging students as creators include the lack of clear processes, the lack of content expertise among students, students feeling threatened or uncomfortable with an unfamiliar role, power relations between learners and teachers, and teachers feeling insecure about giving up control of curricular elements.

Hackathons began as computer programming competitions which aimed to solve problems through intensive collaboration over a short time. In healthcare, they have been used to spur innovation in mHealth and surgery. In this paper, we report an innovative approach to engaging students as co-creators in eLearning resource development by using a virtual hackathon as well as the evaluation outcomes of this approach.

Dear Editor,

Advance care planning (ACP) enables individuals to define their goals and preferences for future treatment and care, discuss them with their families and healthcare providers, and record and review their preferences if appropriate (Rietjens, et al., 2017). In Japan, guidelines for ACP were developed in 2007, and the Ministry of Health, Labour and Welfare (MHLW) promoted it. However, whether the COVID-19 pandemic, which infected many people and led to the deaths of many, affected ACP practices needs to be explored.