Abstract

Introduction: Gender equity in academic medicine is a global concern. Women physicians lag behind men in salary, research productivity, and reaching top academic rank and leadership positions.

Methods: In this Global Perspective, we provide suggestions for overcoming gender bias, drawn from a multidisciplinary literature and personal experiences working as clinician educators in the international academic arena. These suggestions are not exhaustive but inform a tool kit for institutions and individuals to support the advancement of women in academic medicine.

Results: Barriers include limited access to same gender role models and mentors, fewer networking opportunities, fewer nominations for awards and speakership opportunities, as well as implicit gender bias. Institutional interventions can address disparities along the career continuum focusing on scholarship, promotion and leadership opportunities. Women faculty can also seek out professional development programmes and mentorship to support their own advancement. Informal and formal networking opportunities, using a variety of platforms, including social media, can help build relationships to enhance career development and success, and provide social, emotional and professional support to women at all stages of their career. The National University Health System’s Women in Science and Healthcare project is an example of a successful group formed to empower women and foster personal and professional development.

Conclusion: Successful incentives and policies need to consider local institutional and cultural contexts, as well as approaches to mitigate implicit bias. Achieving gender parity in academic medicine will promote a personally and professionally fulfilled global healthcare workforce to improve patient care and clinical outcomes worldwide.

Abstract

Introduction: E-learning resulted in a revolution in dental education with continuous educational experiences. General objective of this study was to assess the perspective of undergraduate dental students on effectiveness of e-learning in the Bachelor of Dental Surgery (BDS) programme. Specific objectives were to identify students’ opinion on the factors that promote e-learning, awareness on the effectiveness of using different platforms and social media, barriers imposed and suggestions for the improvement of e-learning in the BDS programme.

Methods: This was a cross sectional descriptive study among undergraduate dental students of the Faculty of Dental Sciences, University of Peradeniya, Sri Lanka using a self-administered pre-tested questionnaire administered via a web-based survey form. Frequencies and percentages were obtained for categorical data and Chi-square test was used to determine the association between variables.

Results: The majority received the e-learning experience well. Fifty-four percent of the participants felt it was better compared to traditional face-to-face learning and the difference between the semesters (p=0.000) and genders was statistically significant (p=0.000). Difference in overall satisfaction on e-learning material across the different semesters was statistically significant. Students felt that e-learning should be used as a supplementary tool mainly by means of procedural videos during delivery of the skill component. Fifty percent participants felt that conducting assessments online is fair for all the students.

Conclusion: A positive learning experience was achieved through the e-learning modalities in comparison to traditional face-to-face learning though in terms of skills training, e-learning modalities should only be considered as a supplementary tool.

Keywords:           E-Learning, Perspective, Dental Undergraduates, Dental Education

Abstract

Introduction: Disease outbreaks (DO) result in unprecedented changes to the healthcare industry with far-reaching implications for medical education. The need to adapt to the fluidity during DO requires the delivery of the clinical medical curriculum to be flexible and effective. There is a lack of well-established guidelines on how medical education should be delivered during DO. This study aimed to explore the efficacy of teleconferencing-based platforms (TBP) as a teaching modality to overcome the challenges of clinical year medical education amidst a global pandemic and possibility of its use when there are no disease outbreaks (NDO).

Methods: A cross-sectional survey amongst 144 undergraduate clinical year students from a medical school in Singapore was conducted from May to June 2020, to explore their perspectives on TBP compared to physical venue-based platforms (PVBP). The survey consisted 5-point Likert scale and open-ended questions. Statistical and thematic analyses were performed.

Results: TBP provides greater convenience in travelling, note-taking and ability to overcome administrative challenges. Students strongly recommended its use in DO and NDO. However, students faced increased distractibility, decreased engagement and ease of raising questions, with a lower efficacy in content delivery. The above is dependent on the type of lessons delivered – clinical skills-based or didactic sessions.

Conclusion: TBP is a promising teaching modality for DO with promising possibility of extending its use to NDO. We propose a tri-faceted approach to target improvement in content delivery on TBP, mainly with measures to target propensity for decreased engagement and increased distractibility and to address the technology-related concerns.

Keywords:           Medical Education, Teleconferencing, Teaching Modalities, Medical Students, COVID-19, Disease Outbreaks, Pandemics

Abstract

Introduction: Sleep deprivation impacts clinical performance. However, literature is conflicting, with insufficient focus on patient outcomes. The aim of this study was to assess if patient satisfaction and prescription errors in outpatient clinics were adversely affected when consulting post-call versus non-post-call registrars.

Methods: This prospective, quantitative study was set in a large teaching hospital in Singapore. Between November 2015 and February 2016, patients from clinics run by a registrar after 24-hour shift were recruited to post-call group. Patients from non-post-call clinics run by the same registrar were controls. Outcome measures were patient satisfaction, using 5-item 4-point Likert scale questionnaire, and prescribing error rate, defined as number of errors over number of orders. Differences were analysed using chi-squared test.

Results: 103 of 106 (97%) patients in 9 post-call clinics and 93 of 105 (90%) patients in 9 non-post-call clinics were recruited. Questionnaire completion rate was 99%. 536 and 526 prescriptions were ordered in post-call and non-post-call groups, respectively. Percentage of top-box responses (greatest satisfaction) was higher in post-call group overall (79.3% versus 62.4%, p<0.001), and for each questionnaire item. There was no significant difference in prescribing errors (1.31% versus 2.28%, p=0.23).

Conclusion: Patient satisfaction and prescribing error rates in outpatient clinics were not detrimentally affected. This provides some objective evidence that patients may safely consult post-call registrars. True impacts of sleep deprivation remain poorly understood, and larger, longer term, multicentre studies would inform generalisability. Qualitative studies of fatigue may shed light on complex interactions of emotions that compensate for tiredness.

Keywords:           Medical Education, Sleep Deprivation, Physician Training, Outpatient Clinics, Patient Satisfaction, Patient Safety

Abstract

Introduction: The paediatric team handover process is a crucial workplace practice and comprises the transfer of patient information from one shift to another involving medical professionals and students.  A qualitative study was performed to analyse the feasibility, functionality, benefits and limitations of the dramaturgical approach when applied to examining a handover session. 

Methods: Data relating to one handover were collected and analysed from video and audio recordings, notes created by two independent observers and a de-identified copy of the handover sheet. 

Results: The dramaturgical constructs and subsequent findings allowed us to make informed inferences about the dynamics of the handover procedure. The directors/lead actors consisted of a consultant and a registrar.  One consultant was transitory and the remaining 12 attendees were either major support, support or bit actors.  The students (bit actors/audience) were included when a learning point was emphasised.  The script was informal and improvised as the discussion emphasised certain facets of patient care or accentuated learning points.  The staging involved the seating arrangement, a whiteboard, computer screen and ongoing data presentation.  The performance suggested a handover of two halves: one emphasising learning and the other allocation of patient care responsibility. 

Conclusion: We concluded that the real-life drama occurring within a handover was feasibly analysed, with its functionality demonstrated, using the dramaturgical investigative system.  The multifaceted recordings enabled researchers to review the ‘authentic’ handover system without censorship. These findings have implications for educational and organisational research.

Keywords:           Dramaturgical, Handover, Paediatric, Methodology

Abstract

Introduction: Previous studies indicate that professional identity formation (PIF), the formation of a self-identity with the internalised values and norms of professionalism, may influence self-regulated learning (SRL). However, it remains unclear whether a PIF-oriented intervention can improve SRL in clinical education. The aim of this study was to explore whether a PIF-oriented mentoring platform improves SRL in a clinical clerkship.

Methods: A mixed-methods study was conducted. Forty-one students in a community-based clinical clerkship (CBCC) used a PIF-oriented mentoring platform. They articulated the values and norms of professionalism in a professional identity essay, elaborated on future professional self-image, and reflected on their current compared to future selves. They made a study plan while referring to PIF-based self-reflection and completed it. The control group of 41 students completed CBCC without the PIF-oriented mentoring platform. Changes in SRL between the two groups were quantitatively compared using the Motivated Strategies for Learning Questionnaire. We explore how PIF elements in the platform affected SRL by qualitative analysis of questionnaire and interview data.

Results: A moderate improvement in intrinsic goal orientation (p = 0.005, ε² = 0.096) and a mild improvement in critical thinking (p = 0.041, ε² = 0.051) were observed in the PIF-oriented platform group. Qualitative analysis revealed that the PIF-oriented platform fostered professional responsibility as a key to expanding learning goals. Gaining authentic knowledge professionally fostered critical thinking, and students began to elaborate knowledge in line with professional task processes.

Conclusion: A PIF-oriented mentoring platform helped students improve SRL during a clinical clerkship.

Keywords:           Self-Regulated Learning, Professional Identity Formation, Clinical Clerkship

Abstract

Introduction: Reflection is a critical component of learning and improvement. It remains unclear as to how it can be effectively developed. We studied the impact of reflective writing in promoting deep reflection in the context of learning Accreditation Council for Graduate Medical Education (ACGME) competencies among residents in an Internal Medicine Residency programme.

Methods: We used a convergent parallel mixed-methods design for this study in 2018. We analysed reflective writings for categories and frequencies of ACGME competencies covered and graded them for levels of reflection. We collected recently graduated residents’ perceptions of the value of reflective writings via individual semi-structured interviews.

Results: We interviewed nine (out of 27) (33%) participants and analysed 35 reflective writings. 30 (86%) of the writings showed a deep level (grade A or B) of reflection. Participants reflected on all six ACGME competencies, especially ‘patient care’. Participants were reluctant to write but found benefits of increased understanding, self-awareness and ability to deal with similar future situations, facilitation of self-evaluation and emotional regulation. Supervisors’ guidance and feedback were lacking.

Conclusion: We found that a reflective writing programme within an Internal Medicine Residency programme promoted deep reflection. Participants especially used self-reflection to enhance their skills in patient care. We recognised the important role of mentor guidance and feedback in enhancing reflective learning.

Keywords:           Reflective Writing, ACGME Competencies, Internal Medicine, Residency

Abstract

Introduction: There are certain factors in exam preparedness that are not well studied in the postgraduate medical education context. Non-academic predictors have been extensively researched but usually in isolation.

Methods: The study involved a sequential explanatory mixed methods research design. The study was conducted among anaesthesia postgraduates appearing for high-stake nation-wide primary examination. Data obtained by a questionnaire assessing pre-examination attributes were compared with the students’ reflections through focus group discussions (FGD) after the formal declaration of results. The examination had an overall pass rate of 42.9% (18 out of 42).

Results: The study showed that pre-examination questionnaire could identify attributes and study behaviours in the postgraduates who passed. Passers procrastinated three times lesser, pursuing a timetable-based study (conscientiousness); had higher metacognitive self-regulation (p value<0.05) applying concentrated self-directed learning & effective group study and higher self-efficacy compared to those who failed. The focus group discussions affirmed of these attributes in candidates who ‘breeze through exams’. Postgraduate success required better ‘work-study’ balance, self & cross regulation and peer and faculty support.        

Conclusion: Implementing a composite tool to assess ‘exam preparedness’, we propose, would help the learners and teachers to skim for non-academic factors (metacognitive self-regulation, self-efficacy, conscientiousness) that influence the chances of success. Understanding & predicting this would help educators to identify the ‘candidates with difficulty’ and delegate personalised faculty attention. This could guide the exam candidates to have a ‘reality check’ to plan and pace their effort with peer learning, consolidated study and goal orientation.

Keywords:           Postgraduate Exam Success, Non-Academic Predictors, Self-Regulation

Abstract

Introduction: E-portfolio may facilitate the entrustment process from supervisors to residents in postgraduate medical education. The present study was aimed at identifying necessary features of an e-portfolio application and to conduct pilot study in a teaching hospital.

Methods: Six programs participated. Eight interviews with education directors and six focus group discussions with residents and supervisors were completed for the needs analysis stage. The application was developed based on the thematic analysis of the needs analysis stage. The mobile-app e-portfolio pilot was conducted for four weeks and a modified version of the System Usability Scale (SUS) was distributed to participants following the pilot program.

Results: Key features of the e-portfolio were identified. A total of 45 supervisors and 66 residents participated in the pilot study. The residents utilised the application according to the clinical activities and supervision level, and the information was fed to the supervisors as per the application design. Challenges during the pilot study in terms of feedback provision and residents’ workload which influence the e-portfolio use for entrustment decisions are discussed.

Conclusion: Current e-portfolio features were created for supervision and are potential to facilitate the entrustment process in Entrustable Professional Activities (EPA) implementation. The pilot study highlighted challenges of the implementation which should be considered for future improvement.

Keywords:           Postgraduate Medical Education, E-Portfolio, Entrustable Professional Activities, Supervision, Needs Analysis, Pilot Study

Abstract

Introduction: Use of complementary and alternative medicine (CAM) is popular in the general population and medical practitioners may not be fully equipped in their knowledge of CAM to advise patients appropriately. The aim of this paper was to perform a scoping review of current literature describing undergraduate medical student use, attitudes, and knowledge of CAM as a means of better understanding the educational needs of these students.

Methods: A systematic search of Medline, PubMed and the Education Resources Information Center (ERIC) databases with keywords related to “complementary and alternative medicine” and “undergraduate medical students” for relevant articles published until August 2020.  

Results: Of 131 papers identified, 38 underwent full review. It was found 13-80% of medical students use CAM, and overall have a positive attitude towards CAM therapies.  Female medical students and those with religiosity had more positive attitudes towards CAM than their male colleagues and those without a religion. Knowledge of CAM is lacking with approximately only half of students feeling they were knowledgeable about CAM therapies. Popular information resources are the Internet and social media, but students expressed they want more teaching of CAM in the undergraduate medical curriculum.

Conclusion: Evidence suggests high usage of CAM amongst undergraduate medical students, and positive attitudes towards CAM therapies; however, knowledge of CAM is poor, and students want more CAM teaching to upskill them in counselling patients interested in CAM therapies. Further areas for research include a better understanding of resources medical students use for their knowledge and how gender and religiosity influence attitudes towards CAM.  

Keywords:           Undergraduate Medical Student, Complementary and Alternative Medicine, CAM, Attitude, Knowledge, Use

Abstract

Introduction: In the Philippines, telerehabilitation has been at the forefront of integrating telemedicine into the medical curriculum. However, the course evaluation tool used for traditional classroom-based courses is not appropriate in evaluating the unique teaching-learning tool that is telerehabilitation. This study aimed to develop a questionnaire that will aid in addressing this gap.

Method: A mixed methods study was devised to gather information from medical students exposed to telerehabilitation from the College of Medicine, University of the Philippines Manila as well as the residents from the Department of Rehabilitation Medicine, Philippine General Hospital from October to November 2019. The investigators obtained informed consent from all participants as well as their demographics before undergoing interviews. Themes were identified to create questions under the previously identified constructs, along with items derived from other course evaluation tools and opinions gathered from experts in telerehabilitation.

Results: In total, 26 individuals participated in the study. Most of the respondents had experience or ownership of various communication technologies and were well-versed in communication strategies through these technologies. There were 52 questions formulated from the interviews and review of previous tools.

Conclusion: This study is the first step in providing more research in the student evaluation of telerehabilitation and telemedicine. To match the needs of changing times evaluation of new standards and methods should follow. More research must be done to standardise teaching evaluation tools to validate the data gathered, and allow courses, such as telerehabilitation, an opportunity to adapt and promote further learning.

Keywords:           Assessment, Educational, Education, Medical, Telemedicine, Medical Informatics, Physical and Rehabilitation Medicine

Abstract

Introduction: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the COVID-19 pandemic which started in 2020. This resulted in a disruption to educational activities across the globe. Dental education, in particular, was affected because of its vocational nature where learners come into close contact with patients when performing dental procedures.

Methods: This is a narrative review with no research data analysis involved.

Results: Social distancing measures introduced to curb the spread of the infection revolutionised the advancement of online education as the virtual environment is a safer place to conduct teaching compared to face-to-face teaching. In this article, we share our experience at the National Dental Centre Singapore (NDCS) in ensuring the safety of our faculty and learners when conducting didactic and clinical education during the pandemic. Didactic lectures were conducted in the virtual environment via synchronous and non-synchronous teaching. Essential clinical education was conducted in small groups with safe management measures in place. In addition, we provide guidelines to highlight the importance of meticulous planning, thorough preparation, and seamless delivery in conducting effective synchronous teaching.

Conclusion: Safe management measures put in place to ensure the well-being of our faculty and learners can ensure dental education continuity during the pandemic.

Keywords:            Dental Education, Education Continuity, COVID-19

Abstract

Introduction: The COVID-19 pandemic accelerated use of technology like videoconferencing (VC) in healthcare settings to maintain clinical teaching and continuous professional development (CPD) activities. Sociomaterial theory highlights the relationship of humans with sociomaterial forces, including technology. We used sociomaterial framing to review effect on CPD learning outcomes of morbidity and mortality meetings (M&M) when changed from face-to-face (FTF) to VC.

Methods: All surgical department staff were invited to participate in a survey about their experience of VC M&M compared to FTF M&M. Survey questions focused on technological impact of the learning environment and CPD outcomes. Respondents used 5-point Likert scale and free text for qualitative responses. De-identified data was analysed using Chi-squared comparative analysis with p<0.05 significance, and qualitative responses categorised.

Results: Of 42 invited, 30 (71.4%) responded. There was no significant difference in self-reported perception of CPD learning outcomes between FTF and VC M&M. Participants reported that VC offered more convenient meeting access, improved ease of presentation and viewing but reduced engagement. VC technology allowed alternative communication channels that improved understanding and increased junior participation. Participants requested more technological support, better connectivity and guidance on VC etiquette.

Conclusion: VC technology had predictable effects of improved access, learning curve problems and reduced interpersonal connection. Sociomaterial perspective revealed additional unexpected VC behaviours of chat box use that augmented CPD learning. Recognising the sociocultural and emotional impact of technology improves planning and learner support when converting FTF to VC M&M.

Keywords:            Teleconferencing, Morbidity and Mortality Meeting, Continuous Professional Development, Sociomaterial Theory

Abstract

Introduction: Multiple factors influence doctor-patient communication. A good consultation starts with an introduction of him or herself by the doctor to the patient. The next step is to address patients in a manner they prefer. There is a paucity of data about how best to address patients in an Asian country. This study investigates how patients prefer to be addressed by doctors.

Methods: This is a cross-sectional study conducted from July 1^st to August 31^st, 2020 at a single Centre: Colombo South Teaching Hospital in Sri Lanka.

Results: Of 1200 patients, 63.25% reported that doctors never introduced themselves and 97.91% of patients reported, doctors never inquired how to address them. 49.9% preferred to be addressed informally (as mother, father, sister) than by the name (first name, last name, title). The older female patients, married patients, patients of lower education, and lower monthly income preferred to be addressed informally.

Conclusion: Most doctors did not introduce themselves to patients during medical consultations and did not inquire how patients wish to be addressed.

Keywords:            Doctor-Patient Relationship, Medical Consultation, Professionalism, Introduction, Doctor’s Name Badge, South Asian, Sri Lanka

Continuing professional development (CPD) is a professional obligation of clinicians aiming to ‘improve the safety and quality of care provided for patients and the public’ and ‘covers the development of your knowledge, skills, attitudes and behaviours across all areas of your professional practice’ (General Medical Council UK, 2020). The professional practice of clinicians is highly variable and may include clinical practice, management, education, academia and research, media and public engagement, advisory to charities and pharmaceutical companies, politics, and working for the government. Despite the varied role of clinicians, literature suggested that clinicians undertake the majority of their CPD in their specialist areas, although many clinicians are also interested in undertaking CPD in areas outside their specialty (Maher et al., 2017).

The year of 2020 was a challenging and sobering year for clinicians across the world with redeployment of clinicians from many specialities to undertake activities they were less familiar with (Seah, 2020). The phrase ‘CPD’ took on a new personal meaning through the change of my role as a consultant dermatologist during the COVID-19 pandemic and an unsuccessful application for a National Institute for Health Research (UK) advanced research fellowship so that I can establish myself as an independent researcher.

Dear Editor,

Engaging medical students in frontline efforts during the COVID-19 pandemic has varied greatly worldwide (Kachra & Brown, 2020). This paper illustrates policy challenges in student volunteerism, focusing on Singapore. Although Asia often seeks policy guidance from the West, it possesses a unique culture, political climate, regional solidarity, evolution of the disease, and learnings from prior pandemic responses to SARS and MERS, which warrants distinctive guidelines.