In our January 2020 Editorial, we drew the attention of our readers to “Grit in Healthcare Education and Practice”. In particular, we focused on developing the “Grit” of students and trainees; medical students who are well-equipped with the ‘Power of Grit’ will display a “passion for patient well-being and perseverance in the pursuit of that goal [which] become social norms at the individual, team and institutional levels” (Lee & Duckworth, 2018). However, never could we imagine then that such an attribute (i.e. ‘Grit’) would become contextual so soon, as exemplified by the passion and perseverance of healthcare practitioners in patient care in their response to the serious disruptions in individual health (including fatalities) caused by the Covid-19 pandemic!

Abstract

Introduction: Whilst the importance of effective communications in facilitating good clinical decision-making and ensuring effective patient and family-centred outcomes in Intensive Care Units (ICU)s has been underscored amidst the global COVID-19 pandemic, training and assessment of communication skills for healthcare professionals (HCPs) in ICUs remain unstructured

Methods: To enhance the transparency and reproducibility, Krishna’s Systematic Evidenced Based Approach (SEBA) guided Systematic Scoping Review (SSR), is employed to scrutinise what is known about teaching and evaluating communication training programmes for HCPs in the ICU setting. SEBA sees use of a structured search strategy involving eight bibliographic databases, the employ of a team of researchers to tabulate and summarise the included articles and two other teams to carry out content and thematic analysis the included articles and comparison of these independent findings and construction of a framework for the discussion that is overseen by the independent expert team.

Results: 9532 abstracts were identified, 239 articles were reviewed, and 63 articles were included and analysed. Four similar themes and categories were identified. These were strategies employed to teach communication, factors affecting communication training, strategies employed to evaluate communication and outcomes of communication training.  

Conclusion: This SEBA guided SSR suggests that ICU communications training must involve a structured, multimodal approach to training. This must be accompanied by robust methods of assessment and personalised timely feedback and support for the trainees. Such an approach will equip HCPs with greater confidence and prepare them for a variety of settings, including that of the evolving COVID-19 pandemic.

Keywords:           Communication, Intensive Care Unit, Assessment, Skills Training, Evaluation, COVID-19, Medical Education

Abstract

Introduction: A good understanding of basic child-and-adolescent psychiatry (CAP) is important for general medical practice. The undergraduate psychiatry teaching programme included various adult and CAP topics within a six-week time frame. A team of psychiatry tutors developed two new teaching formats for CAP and obtained feedback from the students about these teaching activities.

Methods: Medical students were introduced to CAP via small group teaching in two different modes. One mode was the “Clinical Vignettes Tutorial” (CVT) and the other mode “Observed Clinical Interview Tutorial” (OCIT). In CVT, tutors would discuss clinical vignettes of real patients with the students, followed by explanations about theoretical concepts and management strategies. OCIT involved simulated-patients (SPs) who assisted by acting as patients presenting with problems related to CAP, or as parents for such patients. At each session, students were given the opportunity to interview “patients” and “parents”. Feedback was given following these interviews. The students then completed surveys about the teaching methods.

Results: Students rated very-positive feedback for the teaching of CAP in small groups. Almost all found these small groups enjoyable and that it helped them apply what they had learnt. Majority agreed that the OCIT sessions increased their level of confidence in speaking with adolescents and parents. Some students agreed that these sessions had stimulated their interest to know more about CAP.

Conclusion: Small group teaching in an interactive manner enhanced teaching effectiveness. Participants reported a greater degree of interest towards CAP, and enhanced confidence in treating youths with mental health issues as well as engaging their parents.

Keywords:           Child Adolescent Psychiatry, Medical Education, Small Group, Teaching

Abstract

Introduction: Almost all published literature on effective clinical teachers were from western countries and only two compared medical students with residents. Hence, this study aims to explore the perceived characteristics of effective clinical teachers among medical students compared to residents graduating from an Asian medical school, and specifically whether there are differences between cognitive and non-cognitive domain skills, to inform faculty development.

Methods: This qualitative study was conducted at the National University Health System (NUHS), Singapore involving six final year medical students at the National University of Singapore, and six residents from the NUHS Residency programme. Analysis of the semi-structured one-on-one interviews was done using a 3-step approach based on principles of Grounded Theory.

Results: There are differences in the perceptions of effective clinical teachers between medical students and residents. Medical students valued a more didactic spoon-feeding type of teacher in their earlier clinical years. However final year medical students and residents valued feedback and role-modelling at clinical practice. The top two characteristics of approachability and passion for teaching are in the non-cognitive domains. These seem foundational and lead to the acquisition of effective teaching skills such as the ability to simplify complex concepts and creating a conducive learning environment. Being exam-oriented is a new characteristic not identified before in “Western-dominated” publications.

Conclusion: The results of this study will help to inform educators of the differences in a learner’s needs at different stages of their clinical development and to potentially adapt their teaching styles.

Keywords:           Clinical Teachers, Medical Students, Residents, Cognitive/Non-Cognitive, Asian Healthcare, Faculty Development

Abstract

Introduction: Professionalism is a context-specific entity, and should be defined in relation to a country’s socio-cultural backdrop. This study aimed to develop a framework of medical professionalism relevant to the Sri Lankan context.

Methods: An online Delphi study was conducted with local stakeholders of healthcare, to achieve consensus on the essential attributes of professionalism for a doctor in Sri Lanka. These were built into a framework of professionalism using qualitative and quantitative methods.

Results: Forty-six attributes of professionalism were identified as essential, based on Content Validity Index supplemented by Kappa ratings. ‘Possessing adequate knowledge and skills’, ‘displaying a sense of responsibility’ and ‘being compassionate and caring’ emerged as the highest rated items. The proposed framework has three domains: professionalism as an individual, professionalism in interactions with patients and co-workers and professionalism in fulfilling expectations of the profession and society, and displays certain characteristics unique to the local context.

Conclusion: This study enabled the development of a culturally relevant, conceptual framework of professionalism as grounded in the views of multiple stakeholders of healthcare in Sri Lanka, and prioritisation of the most essential attributes.

Keywords:           Professionalism, Culture, Consensus

Abstract

Introduction: In 2017, the School of Medicine of the University of Notre Dame Australia implemented a data-informed mentoring program as part of a more substantial shift towards programmatic assessment. Data-informed mentoring, in an educational context, can be challenging with boundaries between mentor, coach and assessor roles sometimes blurred. Mentors may be required to concurrently develop trust relationships, guide learning and development, and assess student performance. The place of data-informed mentoring within an overall assessment design can also be ambiguous. This paper is a preliminary evaluation study of the implementation of data informed mentoring at a medical school, focusing specifically on how students and staff reacted and responded to the initiative.

Methods: Action research framed and guided the conduct of the research. Mixed methods, involving qualitative and quantitative tools, were used with data collected from students through questionnaires and mentors through focus groups.

Results: Both students and mentors appreciated data-informed mentoring and indications are that it is an effective augmentation to the School’s educational program, serving as a useful step towards the implementation of programmatic assessment.

Conclusion: Although data-informed mentoring is valued by students and mentors, more work is required to: better integrate it with assessment policies and practices; stimulate students’ intrinsic motivation; improve task design and feedback processes; develop consistent learner-centred approaches to mentoring; and support data-informed mentoring with appropriate information and communications technologies. The initiative is described using an ecological model that may be useful to organisations considering data-informed mentoring.

Keywords:           Data-Informed Mentoring, Mentoring, Programmatic Assessment, E-Portfolio

Abstract

Introduction: Performance assessment of residents should be achieved with evaluation procedures, informed by measured and current educational standards. The present study aimed to develop, test, and evaluate a psychometric instrument for evaluating clinical practice performance among Dermatology and Venereology (DV) residents.

Methods: This is a qualitative and quantitative study conducted from 2014 to 2016. A pilot instrument was developed by 10 expert examiners from five universities to rate four video-recorded clinical performance, previously evaluated as good and bad performance. The next step was the application of the instrument to evaluate the residents which was carried out by the faculty of DV at two Universities.

Results: The instrument comprised 11 components. There was a statistically significant difference (p < 0.001) between good and bad performance. Cronbach’s alpha documented high overall reliability (a = 0.96) and good internal consistency (a = 0.90) for each component. The new instrument correctly evaluated 95.0% of poor performance. The implementation study showed that inter-rater reliability between evaluators range from low to high (correlation coefficient r =0.79, p < 0.001).

Conclusion: The instrument is a reliable and valid instrument for assessing clinical practice performance of DV residents. More studies are required to evaluate the instrument in different situation.

Keywords:            Instrument, Clinical Assessment, Performance, Resident, Dermatology-Venereology, Workplace-Based Assessment

Abstract

Introduction: Physician empathy is declining due to an unproportionate focus on technical knowledge and skills. The medical humanities can counter this by allowing connection with our patients. This is a pilot study that aims to investigate the acceptability, efficacy, and feasibility of a humanities educational intervention to develop physician empathy.

Methods: Junior doctors at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore between July 2018 and June 2019 attended two small-group sessions facilitated by psychologists to learn about empathy using literature and other arts-based materials. Feasibility was defined as a completion rate of at least 80% while acceptability was assessed by a 5-question Likert-scale questionnaire. Empathy was measured pre- and post-intervention using Jefferson’s Scale of Physician Empathy (JSPE) and the modified-CARE (Consultation and Relational Empathy) measure.

Results: Seventeen participants consented, and all completed the programme. Acceptability scores ranged from 18 to 50 out of 50 (mean 38, median 38). There was an increase in JSPE scores (pre-test mean 103.6, SD=11.0 and post-test mean 108.9, SD=9.9; t (17) =2.49, P=.02). The modified-CARE score increased between pre-test mean of 22.9(SD=5.8) and a post-test mean of 28.5(SD=5.9); t (17) = 5.22, P<0.001.

Conclusion: Results indicate that the programme was acceptable, effective, and feasible. The results are limited by the lack of longitudinal follow-up. Future studies that investigate the programme’s effect over time and qualitative analysis can better assess its efficacy and elicit the participants’ experiences for future implementation and refinement.

Keywords:            Empathy, Humanities, Literature, Palliative Medicine

Abstract

Introduction: During resuscitations, healthcare professionals (HCPs) find balancing the need for timely resuscitation and adherence to infection prevention (IP) measures difficult. This study explored the effects of an innovative teaching method, using in-situ simulation and inter-professional education to enhance compliance to IP through better inter-professional collaboration. 

Methods: The study was conducted in the Surgical Intensive Care Unit (SICU) in a 1200-beds teaching hospital. HCPs working in the SICU were conveniently allocated to the intervention or control group based on their work roster. The intervention group attended an in-situ simulated scenario on managing cardiac arrest in an infectious patient. The control group completed the standard institution-wide infection control eLearning module. Outcomes measured were: (a) attitudes towards inter-professional teamwork [TeamSTEPPS Teamwork Attitudes Questionnaire (TAQ)], (b) infection prevention knowledge test, (c) self-evaluated confidence in dealing with infectious patients and (d) intensive care unit (ICU) audits on infection prevention compliance during actual resuscitations.

Results: 40 HCPs were recruited. 29 responded (71%) to the pre- and post-workshop questionnaires. There were no significant differences in the TeamSTEPPS TAQ and infection prevention knowledge score between the groups. However, ICU audits demonstrated a 60% improvement in IP compliance for endotracheal tube insertion and 50% improvement in parenteral medication administration. This may be attributed to the debriefing session where IP staff shared useful tips on compliance to IP measures during resuscitation and identified threats that could deter IP compliance in SICU.

Conclusion: Learning infection prevention through simulated inter-professional education (IPE) workshops may lead to increased IP compliance in clinical settings.

Keywords:            Inter-Professional Education, Simulation Infection Control, Resuscitation, Inter-Professional Teamwork

Abstract

Introduction: Simulation-based training has become a popular tool for chest tube training, but existing training modalities face inherent limitations. Cadaveric and animal models are limited by access and cost, while commercial models are often too costly for widespread use. Hence, medical educators seek a new modality for simulation-based instruction. 3D printing has seen growing applications in medicine, owing to its advantages in recreating anatomical detail using readily available medical images.

Methods: Anonymised computer tomography data of a patient’s thorax was processed using modelling software to create a printable model. Compared to a previous study, 3D printing was applied extensively to this task trainer. A mixture of fused deposition modelling and material jetting technology allowed us to introduce superior haptics while keeping costs low. Given material limitations, the chest wall thickness was reduced to preserve the ease of incision and dissection.

Results: The complete thoracostomy task trainer costs approximately SGD$130 (or USD$97), which is significantly cheaper compared to the average commercial task trainer. It requires approximately 118 hours of print time. The complete task trainer simulates the consistencies of ribs, intercostal muscles and skin.

Conclusion: By utilising multiple 3D printing technologies, this paper aims to outline an improved methodology to produce a 3D printed chest tube simulator. An accurate evaluation can only be carried out after we improve on the anatomical fidelity of this prototype. A 3D printed task trainer has great potential to provide sustainable simulation-based education in the future.

Keywords:            Medical Education, Chest Tube, Thoracostomy, Simulation, 3D Printing

Abstract

Introduction: This study aimed to examine the perception of faculty on the relevance, feasibility and comprehensiveness of the Professionalism Mini Evaluation Exercise (P-MEX) in the assessment of medical professionalism in residency programmes in an Asian postgraduate training centre.

Methods: Cross-sectional survey data was collected from faculty in 33 residency programmes. Items were deemed to be relevant to assessment of medical professionalism when at least 80% of the faculty gave a rating of ≥8 on a 0-10 numerical rating scale (0 representing not relevant, 10 representing very relevant). Feedback regarding the feasibility and comprehensiveness of the P-MEX assessment was also collected from the faculty through open-ended questions.

Results: In total, 555 faculty from 33 residency programmes participated in the survey. Of the 21 items in the P-MEX, 17 items were deemed to be relevant. For the remaining four items ‘maintained appropriate appearance’, ‘extended his/herself to meet patient needs’, ‘solicited feedback’, and ‘advocated on behalf of a patient’, the percentage of faculty who gave a rating of ≥8 was 78%, 75%, 74%, and 69% respectively. Of the 333 respondents to the open-ended question on feasibility, 34% (n=113) felt that there were too many questions in the P-MEX. Faculty also reported that assessments about ‘collegiality’ and ‘communication with empathy’ were missing in the current P-MEX.

Conclusion: The P-MEX is relevant and feasible for assessment of medical professionalism. There may be a need for greater emphasis on the assessment of collegiality and empathetic communication in the P-MEX.

Keywords:            Professionalism, Singapore, Survey, Assessment

I. INTRODUCTION

“To have striven, to have made the effort, to have been true to certain ideals – this alone is worth the struggle.”

William Osler

The word “values” is heard frequently in healthcare. From the moment we step into medical school, we are challenged to reflect what our intrinsic values are, or how we can “add value” to a department during the residency application.

With time, and in going through the system, our definitions of the word “values” may change. To me, values are those things which are right and wrong, and which are important in life. In other words, values include not only what is important to my profession and to being a good doctor, but also to what is important to being a good person.

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.

I. INTRODUCTION

Family medicine training encompasses the need to develop a diverse skillset and the ability to practice in different settings. During three years of training, family medicine residents from National University Health System (NUHS) rapidly transit through many hospital rotations with varying specialty-specific competency requirements. Throughout this period, each resident is rostered to run a half-day primary care clinic on the same day each week and is assigned a dedicated faculty member to supervise him during the session. Each faculty member is assigned up to four to six residents for the half-day sessions every week.  There is a need to contextualise what is learnt in hospital to primary care, and to effectively integrate knowledge across disciplines. We describe here a tool that the NUHS family medicine residency has used to bring together faculty and residents of varying seniorities and locations for discussion, reflection, and growth.

I. FACTORS INFLUENCING MOTIVATION TO PURSUE GRADUATE-ENTRY MEDICINE

The decision to pursue medicine is a significant step for individuals, particularly those for whom this involves a career change. While medicine in the UK has traditionally been an undergraduate course, graduate-entry medicine (GEM) programmes were introduced in 2000 and offer an accelerated course for suitably qualified candidates with a Bachelor’s degree. Students have a variety of motivations for undertaking a GEM programme (Carter & Peile, 2007), and we herein explore the factors that influence this range of motivations.