The practice of medicine has been rooted strongly in traditions. Discipline-based academies, colleges, societies, and associations regularly practice “rituals” based on context-specific traditional norms and cultural practices. Medical education and training are no different. Being part of a larger, higher education institution and preparing graduates for a future profession, they too have deeply embedded rituals such as the whitecoat ceremony, the silent mentor appreciations, oath taking, and the commencement. These practices have a strong influence of the institutions in which the programs are conducted giving each of these practices not only the professional but the context and institution specific angle and colours.

Abstract

Introduction: This article summarises a report published in July 2021 by Medical Deans Australia and New Zealand (Medical Deans), the peak body representing the 23 medical programs in Australia and New Zealand. It explores how medical schools responded to the early impacts of COVID-19 in 2020, and how they might build on some of the changes to achieve fundamental improvements in medical education in Australia and New Zealand.

Methods: The Medical Deans report was based on: Responses to a survey midway through 2020 of its member schools about their experiences during the initial lockdowns; the contributions of presenters at the Medical Deans 2020 Annual Conference; subsequent discussions among communities of practice.

Results: Innovations introduced in response to the pandemic, included greater equity of learning opportunities across geographical locations; health services taking more responsibility for clinical placements; greater emphasis on competencies and less on clinical rotations in specific disciplines; strong collaboration between medical schools, and with providers in the medical training and research pipeline. Challenges include balancing the benefits of online learning with the need for human connection and a chronic lack of clinical training opportunities in community-based care.

Conclusion: While the impact of the pandemic on medical education and training was costly for all involved – both financially and personally – the scale of disruption provided a unique opportunity for step change. To fully realise this potential moving forward, medical schools will need to work in partnership with all those involved: students, health services, prevocational training, specialist colleges, regulators and governments.

Abstract

Introduction: Tri-Generational HomeCare (TriGen) is a student-initiated home visit programme for patients with a key focus on undergraduate interprofessional education (IPE). We sought to validate the Readiness for Interprofessional Learning Scale (RIPLS) and evaluate TriGen’s efficacy by investigating healthcare undergraduates’ attitude towards IPE.

Methods: Teams of healthcare undergraduates performed home visits for patients fortnightly over six months, trained by professionals from a regional hospital and a social service organisation. The RIPLS was validated using exploratory factor analysis. Evaluation of TriGen’s efficacy was performed via the administration of the RIPLS pre- and post-intervention, analysis of qualitative survey results and thematic analysis of written feedback.

Results: 79.6% of 226 undergraduate participants from 2015-2018 were enrolled. Exploratory factor analysis revealed four factors accounting for 64.9% of total variance. One item loaded poorly and was removed. There was no difference in pre- and post-intervention RIPLS total and subscale scores. 91.6% of respondents agreed they better appreciated the importance of interprofessional collaboration (IPC) in patient care, and 72.8% said MDMs were important for their learning. Thematic analysis revealed takeaways including learning from and teaching one another, understanding one’s own and other healthcare professionals’ role, teamwork, and meeting undergraduates from different faculties.

Conclusion: We validated the RIPLS in Singapore and demonstrated the feasibility of an interprofessional, student-initiated home visit programme. While there was no change in RIPLS scores, the qualitative feedback suggests that there are participant-perceived benefits for IPE after undergoing this programme, even with the perceived barriers to IPE. Future programmes can work on addressing these barriers to IPE.

Keywords:           Interprofessional Education, Student-Initiated Home Visit Programme, RIPLS, Validation

Abstract

Introduction: The COVID-19 pandemic has caused significant disruption to undergraduate medical education globally, with worldwide implementation of social distancing and lock-down measures. This systematic review aims to identify challenges in undergraduate medical education during the pandemic and report creative approaches that have been employed to ensure continuity of education.

Methods: A MEDLINE (PubMed) search was performed for articles published between 1 February 2020 and 1 September 2020, corresponding to the pandemic’s global upsurge. Studies, commentaries, perspectives, and correspondence reporting challenges, adaptations and innovations in undergraduate medical education were screened. Data was grouped in accordance with the research questions it sought to address and analysed qualitatively.

Results: 43 studies were included. The COVID-19 pandemic has resulted in lost opportunities for clinical exposure, reduced motivation, and heightened anxiety among medical students. Traditional teaching and assessment methods have transitioned to virtual platforms, harnessing video conferencing, social media, and virtual or augmented reality technologies. The long-term effectiveness of these solutions is uncertain, but immediate benefits conferred include increased access, improved time management, and cultivation of self-directed learning. The lack of authentic clinical experiences and patient interaction remains a major concern. Technical challenges and digital fatigue were also highlighted as pertinent challenges.

Conclusions: The COVID-19 pandemic has provided unexpected, yet invaluable opportunities to explore new pedagogies that may be instrumental in shaping medical education in the new norm. As future members of the healthcare workforce, medical students should be integrated into current healthcare systems to equip them with knowledge and skills to manage future pandemics.

Keywords:           COVID-19, Education, Medical, Undergraduate, Medical Student, Telemedicine

Abstract

Introduction: The International University of Health and Welfare (IUHW) School of Medicine was founded in 2017 with the intention of providing medical content in English a historical first in Japan. Twenty international medical students have been accepted annually, with the majority possessing less than beginner level Japanese language proficiency at the time of enrolment. However, proficiency in Japanese, especially in the context of medicine is required for academic success and program completion. To address this, the IUHW School of Medicine has developed a course in medical Japanese with the objective of facilitating international students’ acquisition of medical Japanese and reinforcing such acquisition through various listening, speaking, reading, and writing activities. This study aims to describe the Japanese language education program for international students at the IUHW School of Medicine, with particular focus on the development of the curriculum and course content.

Methods: The course is designed based on the following educational strategies and their applications: (a) Synchronisation of both medical and Japanese contents; (b) Collaborative learning; (c) Japanese output of medical content learned in English; (d) Practical output through making/giving a presentation and discussion with medical experts; (e) Detailed language feedback from language experts; (f) Reinforcing the vocabulary knowledge by writing; and (g) Building up vocabulary and expressions with relevant contents.

Results: Our observations suggest that our international students have been able to continue their medical education in Japanese smoothly.

Conclusion: The content-based instructional design that includes second language acquisition strategies may also be applicable to other Asian languages such as Korean and Chinese.

Abstract

Introduction: The COVID-19 pandemic forced medical schools worldwide to transition online. While there are ample reports about medical education adaptations to this crisis, there are limited studies evaluating the impact.

Methods: This study includes a case study of how Taiwanese medical school deans maintained in-person education during the COVID-19 pandemic. Additionally, it demonstrates how SWOT analyses can help medical educators reflect on adaptations during the COVID-19 pandemic and future crises.  This study employed two online surveys and a semi-structured interview regarding curricular adaptations. Eligible participants were deans or associate deans of all medical schools in Taiwan.

Results: Through a SWOT analysis, this study identified Strengths as strong leadership, prior experience with SARS, and ability to promptly adapt curriculum; Weaknesses as lack of faculty confidence in online education, limited numbers of administrative staff, and inability to rapidly add new topics; Opportunities as centralised anti-epidemic policies, inter-institutional collaborations, and educational innovations; and Threats as concerns from parents, patients, and teaching hospitals. It is reported that the quality of education was maintained as students’ evaluations of courses, performances in written exams, clerkship supervisors’ assessments, national OSCE, and national board exams remained comparable to pre-COVID times. Strengths and Opportunities such as strong leadership and centralised anti-epidemic policies can overcome Weaknesses and Threats, such as lack of confidence in online education and familial pressure to suspend hospital-based education.

Conclusion: This study recommends that medical school leaders conduct SWOT analyses as early as possible to plan strategies to continue safe and quality medical education during COVID-19 and future crises.

Abstract

Introduction: The direct ophthalmoscope is a standard tool for fundus examination but is underutilised in practice due to technical difficulties. Although the smartphone ophthalmoscope has been demonstrated to improve fundus abnormality detection, there are limited studies assessing its utility as a teaching tool for fundus examination in Southeast Asian medical schools. This study explored the perception of medical students’ toward using a smartphone ophthalmoscope for fundus examination and compared their abilities to diagnose common fundal abnormalities using smartphone ophthalmoscope against direct ophthalmoscope. 

Methods: Sixty-nine Year-4 undergraduate medical students participated in the study. Their competencies in using direct ophthalmoscope and smartphone ophthalmoscope for fundus examination on manikins with ocular abnormalities were formatively assessed. The scores were analysed using the SPSS statistical software. Their perceptions on the use of smartphone ophthalmoscopes for fundus examination were obtained using a questionnaire.

Results: The students’ competency assessment scores using the smartphone ophthalmoscope were significantly higher than those using the direct ophthalmoscope. A significantly higher percentage of them correctly diagnosed fundus abnormalities using the smartphone ophthalmoscope. They were confident in detecting fundus abnormalities using the smartphone ophthalmoscope and appreciated the comfortable working distance, ease of use and collaborative learning. More than 90% of them were of the view that smartphone ophthalmoscopes should be included in the undergraduate medical curriculum.

Conclusion: Undergraduate medical students performed better in fundus examination on manikins with ocular abnormalities using smartphone ophthalmoscope compared to direct ophthalmoscope. Their positive perceptions toward smartphone ophthalmoscope support its use as a supplementary teaching tool in undergraduate medical curriculum.

Keywords:           Medical Students, Smartphone, Ophthalmoscope, Teaching Tool

Abstract

Introduction: As young healthcare professionals (HCPs) enter the workforce, they find challenges adapting as academic training and workplace settings often do not mirror each other. Mentorship is a possible solution to help bridge this transition. The aim of this study was to gather information from HCPs with regards to their views towards mentorship as a strategy to help in the transition of newly qualified HCPs from study to work.

Methods: Two 3-hour interactive workshops entitled “Bridging the Study-Work Chasm” were organised, and participants were invited to complete a survey voluntarily after the workshop. The survey comprised questions regarding the benefits of mentorship, qualification of mentors, time commitment for mentoring, elements of an effective mentorship programme, and barriers to its effectiveness. The anonymised responses were analysed descriptively.

Results: Fifty-two out of 62 participants from various healthcare backgrounds completed the survey. 96.2% of respondents felt a study-work chasm exists in the healthcare workplace with 90.4% indicating that a mentorship programme would help to bridge the chasm. More than 70% of participants agreed or strongly agreed that mentoring would boost confidence, reduce anxiety, and aid in study-work transition. It was identified that to produce a more effective mentorship programme, time commitment, training, and proper organisation of the programme would be necessary.

Conclusion: It was perceived that a mentorship programme can help to bridge the study-work chasm in the healthcare landscape in Singapore, and will best serve mentors and mentees by committing the proper time and training to ensure its effectiveness.

Keywords:           Training-Work Transition, Graduate, Healthcare Professionals, Mentorship

Abstract

Introduction:  With the evolution of healthcare needs for the community and the changing trends in medical education in the 21^st century, medical educators need to be prepared for their tasks in the coming decades. Medical educator training is crucial but other factors can also affect the development of their competency. This study aims to measure the impact of the medical educators’ training course and find out the key challenges encountered by the medical educators in Myanmar.

Methods: A retrospective quantitative design was conducted on 45 respondents by four levels of Kirkpatrick’s model assessment consisting of 39 statements and 9 items of key challenges, using five-point Likert scale. The item scores were analysed as mean and standard deviation, ‘t’ test and ANOVA were used for relationship between impact of training and demographic background.

Results: There was significant association between the impact of training and the educational background (p=0.03), job position (p=0.02), and academic year attended (p=0.03). The respondents distinctly agreed that the training increased their knowledge and attitudes and that they could apply the learnt lessons practically in their workplace (minimum 3.75±0.60 and maximum 4.28±0.50). Regarding the key challenges, respondents viewed that their institution needed to support more scholarship opportunities and academic recognition; encourage networking and strengthen ICT-based medical education system (minimum 2.55±0.84 – maximum 4.17±0.71).

Conclusion: This study indicates that enhancing the competency of medical educators with medical educator training programs is effective and useful; but inadequacy of institutional support for faculty development and internet facilities posed challenges in the overall faculty development.

Keywords:           Medical Education, Faculty Development, Impact of Medical Educator’s Training, Kirkpatrick’s Model, Key Challenges

Abstract

Introduction: Humanistic values lie at the heart of medicine. In the wake of professional breaches among health care professionals, the place of humanistic values in medical training has been the subject of much debate and development in the literature. This scoping review aims to map the current understanding of how humanism in the Asian socio-cultural context may be understood and applied, and how the strengthening of humanistic values may be further integrated into medical schools in Asia.

Methods: Arksey and O’Malley’s approach to scoping reviews was used to guide the study protocol. Databases PubMed, ERIC, EMBASE, Scopus, CINAHL, and Web of Science were searched for articles on humanism and medical education in Asia. Data charting and thematic analysis were performed on the final articles selected.

Results: Three hundred and six abstracts were retrieved, 93 full-text articles were analysed, and 48 articles were selected. Thematic analysis revealed four themes on the need to strengthen humanistic values, the challenge of finding a common framework and definition, opportunities in medical school for curriculum design and training, and the need for validated tools in program evaluation in Asia.

Conclusion: Themes highlighted in this review show an increasing recognition amongst Asian medical educators of the importance of inculcating humanistic values into medical training. Further research and ongoing discussion are needed to develop culturally relevant, effective, and integrative curricula in order to promote humanistic attitudes and behaviours among medical students and physicians in Asia.

Keywords:           Humanism, Asia, Medical Education, Medical Students, Admission, Curriculum, Mentorship, Assessment, Medical Humanities, Humanistic Values

Abstract

Introduction: Personal protection in aerosol-generating procedures is an important skill to safely deliver care to patients in the COVID-19 pandemic. This aim of this study was to evaluate the impact of “just-in-time” simulation training for airway management in a suspected COVID-19 patient.

Methods: This was a prospective mixed-method cohort study in a tertiary paediatric department. A mandatory “just-in-time” simulation training session for intubation of a suspected COVID-19 patient was conducted. Pre- and post-simulation questionnaires were administered. Participants were invited to attend focus group interviews to further delineate their experience. Quantitative and qualitative methods were employed to analyse the data.

Results: Thirty-three participants, including doctors, nurses and respiratory therapists attended the training. Self-confidence in intubation, managing and leading a resuscitation team and dealing with problems with intubation significantly improved. Simulation was valued for the experiential learning as well as for increasing confidence and awareness. Process improvement suggestions from both participants and trainers were raised.  There was a small signal of skill translation to real life scenarios.

Conclusion: Simulation-based training is a useful tool for infectious disease outbreak preparedness. Further research will need to be done to determine the impact on actual clinical practice in pandemics.

Keywords:           Simulation, COVID-19, Pandemic Preparedness, Training, Intubation

Abstract

Introduction: In-class engagement enhances learning and can be measured using observational tools. As the COVID-19 pandemic shifted teaching online, we modified a tool to measure the engagement of instructors and students, comparing in-person with online teaching and different class types.

Methods: Video recordings of in-person and online teachings of six identical topics each were evaluated using our ‘In-class Engagement Measure’ (IEM). There were three topics each of case-based learning (CBL) and lecture-based instruction (LLC). Student IEM scores were: (1) no response, (2) answers when directly questioned, (3) answers spontaneously, (4) questions spontaneously, (5) initiates group discussions. Instructor IEM scores were: (1) addressing passive listeners, (2) asking ≥1 students, (3) initiates discussions, (4) monitors small group discussion, (5) monitoring whole class discussions.

Results: Twelve video recorded sessions were analysed. For instructors, there were no significant differences in percentage time of no engagement or IEM scores when comparing in-person with online teaching. For students, there was a significantly higher percentage time of no engagement for the online teaching of two topics. For class type, there was overall less percentage time of no engagement and higher IEM scores for CBL than LLC.

Conclusion: Our modified IEM tool demonstrated that instructors’ engagement remained similar, but students’ engagement reduced with online teaching. Additionally, more in-class engagement was observed in CBL. “Presenteeism”, where learners were online but disengaged was common. More effort is needed to engage students during online teaching.

Keywords:           Engagement, Observational Tool, Online Learning, E-learning, COVID-19, Medical Education, Research

Abstract

Introduction: In paediatric practice, healthcare professionals are required to connect with the child and interact at his/her level. However, it can be very difficult for medical students to put themselves in the shoes of the young child, to empathize and understand how a child actually feels while being treated. The Teddy Bear Hospital (TBH) can serve as a platform for medical students to learn how to communicate and empathise with children. Additionally, virtual reality (VR) can be used to portray a child’s viewpoint. This study aims to assess how TBH and VR can improve learning outcomes for medical students.

Methods: A cohort study was conducted on 20 first-year medical students taking part in TBH sessions. The medical students did a Pre-, Post- and 1-year Post-intervention Jefferson Scale of Empathy to assess their empathy levels. They also completed a 1-year Post-intervention quantitative and qualitative survey on their experience.

Results: There was a significant increase in Jefferson score compared to Pre-intervention (116.95 ± 8.19) for both Post-intervention (121.65 ± 11.03) and 1-year Post-intervention (123.31 ± 8.86). More than 80% believed that participating in TBH improved their confidence and ability to interact with children, while 50% felt that VR scenarios helped prepare them for the TBH. Thematic analysis of qualitative responses described (1) Personal development, (2) Insights into interacting with children, and (3) Structure and curriculum.

Conclusion: TBH improved empathy and communication with children among pre-clinical medical students and the use of VR can be used to augment sessions.

Keywords:           Education, Medical Student, Simulation Training, Teddy Bear Hospital, Virtual Reality

Abstract

Introduction: As healthcare educators undergo a career transition from providing care to providing education, their professional identity can also transition accompanied by significant threat.  Given their qualifications are usually clinical in nature, healthcare educators’ knowledge and skills in education and other relevant theories are often minimal, making them vulnerable to feeling fraudulent in the healthcare educator role. This threat and vulnerability is described as the impostor phenomenon. The aim of this study was to examine and map the concepts of professional identity and the influence of impostor phenomenon in healthcare educators. 

Methods: The authors conducted a scoping review of health professions literature.  Six databases were searched, identifying 121 relevant articles, eight meeting our inclusion criteria.  Two researchers independently extracted data, collating and summarising the results.

Results: Clinicians who become healthcare educators experience identity ambiguity. Gaps exist in the incidence and influence of impostor phenomenon in healthcare educators. Creating communities of practice, where opportunities exist for formal and informal interactions with both peers and experts, has a positive impact on professional identity construction.  Faculty development activities that incorporate the beliefs, values and attributes of the professional role of a healthcare educator can be effective in establishing a new professional identity.

Conclusion: This review describes the professional identity ambiguity experienced by clinicians as they take on the role of healthcare educator and solutions to ensure a sustainable healthcare education workforce.

Keywords:           Professional Identity, Impostor Phenomenon, Healthcare Educators, Health Professions Education, Scoping Review

Abstract

Introduction: Practicals are core components of an undergraduate health sciences curriculum to promote experiential learning and motivation in students. With restrictions on traditional forms of face-to-face practicals during the COVID-19 pandemic, we designed and investigated the efficacy of remote practicals as a viable learning strategy in exercise physiology teaching.

Methods: Student volunteers were instructed to perform a graded exercise test in a remote setting and provide their collected data for subsequent discussion in an online lecture. The effectiveness of this remote practical in promoting students’ motivation and learning outcomes achievement was assessed via an anonymous questionnaire containing 29 closed-ended and 2 open-ended items. Continual Assessment (CA) results were also investigated. Unpaired student’s t-tests were performed for comparisons between interventions with significance level set at P<0.05.

Results: Sixty-one (out of 81; 75%) students responded to the questionnaires and 49 (60%) consented to the use of their CA results for this study. Results revealed that students were moderately motivated and attained strong achievement of learning outcomes. When compared to students who did not volunteer for the hands-on component of the remote practical, students who participated in the hands-on component reported significantly higher self-efficacy (P<0.05) in explaining the practical procedures to their peers. Qualitative analysis further revealed that experiential learning and real-life data analysis were the central reasons supporting the effectiveness of the remote practical. Students were generally satisfied and would recommend the remote practical to future students.

Conclusion: Our study highlights the potential of remote practicals as viable alternatives to traditional practicals.

Keywords:           Remote Practical, Experiential Learning, Student Motivation, Learning Outcomes

Abstract

Introduction: The Scholarly Project provides medical students with an opportunity to conduct research on a health and health care topic of interest with faculty mentors. Despite the proven benefits of the Scholarly Project there has only been a gradual change to undergraduate medical education in Vietnam. In the academic year of 2020-2021, the University of Medicine and Pharmacy (UMP) at Ho Chi Minh City launched the Scholarly Project as part of an innovative educational program. This study investigated the impact of the Scholarly Project on the research skills perception of participating undergraduate medical students.

Methods: A questionnaire evaluating the perception of fourteen research skills was given to participants in the first week, at midterm, and after finishing the Scholarly Project; students assessed their level on each skill using a 5-point Likert scale from 1 (lowest score) to 5 (highest score).

Results: There were statistically significant increases in scores for 11 skills after participation in the Scholarly Project. Of the remaining three skills, ‘Understanding the importance of “controls”’ and ‘Interpreting data’ skills showed a trend towards improvement while the ‘Statistically analyse data’ skill showed a downward trend.

Conclusion: The Scholarly Project had a positive impact on each student’s perception of most research skills and should be integrated into the revamped undergraduate medical education program at UMP, with detailed instruction on targeted skills for choosing the optimal study design and follow-up assessment.

Keywords:           Study Skills, Scholarly Project, Undergraduate, Medical Education, Self-Assessment

Abstract

Introduction: Nurturing preventive-minded dental students has been a fundamental goal of dental education. However, students still struggle to regularly implement preventive concepts such as caries risk assessment into their clinical practice. The objective of this study was to identify areas in the cariology curriculum that could be revised to help address this.

Methods: A total of 10 individuals participated and were divided into two focus group discussions. Thematic analysis was conducted, and key themes were identified based on their frequency of being cited before the final report was produced.

Results: Three major themes emerged: (1) Greater need for integration between the pre-clinical and clinical components of cariology; (2) Limited time and low priority that the clinical phase allows for practising caries prevention; and (3) Differing personal beliefs about the value and effectiveness of caries risk assessment and prevention. Participants cited that while didactics were helpful in providing a foundation, they found it difficult to link the concepts taught to their clinical practice. Furthermore, participants felt that they lacked support from their clinical supervisors, and patients were not always interested in taking action to prevent caries. There was also heterogeneity amongst students with regards to their overall opinion of the effectiveness of preventive concepts.

Conclusion: Nurturing preventive-mindedness amongst dental students may be limited by the current curriculum schedule, the prioritisation of procedural competencies, the lack of buy-in from clinical supervisors, and a perceived lack of relevance of the caries risk assessment protocol and should be addressed through curriculum reviews.

Keywords:           Dental Education, Caries Risk Assessment, Cariology, Preventive Dentistry, Qualitative Study, Clinical Teaching, Cariogram

Abstract

Introduction: Medical schools universally responded by migrating teaching and learning to virtual learning environments (VLE) due to the impact of the COVID-19 pandemic. The use of virtual problem-based learning (PBL) in lieu of face-to-face sessions seems to be an appropriate response, but its effectiveness was understudied. The study compared the learning experiences of pre-clinical medical students at the beginning and completion of the virtual PBL.

Methods: The study was conducted at the University of Malaya, a public-funded university in Malaysia. A 12-item questionnaire was developed and validated to assess the learning experiences of students conducting virtual PBL sessions. Principal component analysis and test for internal consistency suggested that the questionnaire is valid and reliable. The questionnaire was administered to pre-clinical students (Year 1 and Year 2) twice: at the beginning and the end of the virtual PBL implementation. Their responses were compared for the domains “learning”, “confidence” and “concern”.

Results: Three hundred and forty-four pre-clinical students were recruited but only 275 students (80%) responded to both the initial and final questionnaires. Based on the responses, the learning experiences of students generally improved by the completion of the virtual PBL implementation. Students were most convinced that they obtained and understood the information given during the virtual PBL. However, they continued to be worried about passing the clinical examination and content acquisition.

Conclusion: The study supports the feasibility of virtual PBL as an acceptable alternative to replace face-to-face PBL during the COVID-19 pandemic.

Keywords:           Problem-based Learning, COVID-19, Undergraduate Medical Education, Virtual Learning Environment

Abstract

Introduction: Magnetic Resonance (MR) safety is critically important in any Radiology Department, and MR-related accidents are preventable. Serious games provide opportunities for learners to build MR safety awareness through play in an immersive learning environment by using simulated scenarios such as screening virtual patients and managing an MR-related accident.

Methods: We developed a serious game, in partnership with a game developer, introducing MR safety concepts to learners as they navigate through a virtual 3D Radiology department. Drag-and-drop minigames are incorporated to aid the learner to identify hazards in and around the MR environment. Virtual patients are placed in waiting areas to provide realism, and learners are tasked to screen them as part of MR Safety Screening checks. A simulation of an MR-related accident prompts learners to make decisions or take actions to ensure safety and mitigate further risks during the accident. The learner also role-plays as a Risk Officer to identify the multiple key incidents that led to the accident. These formative assessments, with instantaneous feedback, assesses the learners’ knowledge of MR safety.

Results: Pilot feedback of this serious game revealed that it is realistic, engaging and relatable. The instructions within the game were clear and aided learning. The game has also been scaled up and customised for the radiology departments of 3 other healthcare institutions.

Conclusion: Serious games provide a training solution to raise MR safety awareness by simulating real-life scenarios in an immersive learning environment. It supplements face-to-face training and is scalable to other healthcare institutions.

Keywords:           Medical Education, Technology-Enhanced Learning, Gamification, MR Safety, Workplace Safety, Simulation

Abstract

Introduction: Emotional Intelligence (EI) is especially important for medical undergraduates due to the long undergraduate period and relatively high demands of the medical course. Determining associates of EI would not only enable identification of those who are most suited for the discipline of medicine but would also help in designing training strategies to target specific groups. However, there is diversity of opinion regarding the associates of EI in medical students. Aim of the study was to determine associates of EI in medical students.

Methods: The databases MEDLINE, CENTRAL, Scopus, EbscoHost, LILAC, IMSEAR and three others were searched. It was followed by hand-searching, cited/citing references and searching through PQDT. All studies on the phenomenon of EI and/or its associates with medical students as participants were retrieved. Studies from all continents of the world, published in English were selected. They were assessed for quality using Q-SSP checklist followed by narrative synthesis on selected studies.

Results: Seven hundred and ninety-two articles were identified of which 29 met inclusion criteria. One article was excluded as its full text was not available. Seven articles found an association between ‘EI and academic performance’, 11 identified an association between ‘EI and mental health’, 11 found an association between ‘EI and Gender’, 6 identified an association between ‘EI and Empathy’ while two have found an association with the learning environment.

Conclusion: Higher EI is associated with better academic performance, better mental health, happiness, learning environment, good sleep quality and less fatigue, female gender and greater empathy.

Keywords:           Emotional Intelligence, Associates of Emotional Intelligence, Medical Students, Mental Wellbeing, Empathy

Abstract

Introduction: We aimed to find out how medical students coped with online learning at home during the COVID 19 pandemic ‘lockdown’.

Methods: A cross-sectional study was carried out from July to December 2020, using an online SurveyMonkey Questionnaire®, with four sections: biodata; learning environment; study habits; open comments; sent to 1359 students of the International Medical University, Malaysia. Responses of strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree and strongly agree for the closed-ended questions on the learning environment and study habits, were scored on a 5-point Likert scale. Percentages of responses were obtained for the closed ended questions.

Results: There were 323 (23.8%) responses. This included 207 (64%) students from the preclinical semesters 1 – 5 and 116 (36%) students from clinical semesters 6 – 10. Of the respondents, more than 90% had the necessary equipment, 75% had their own personal rooms to study, and 60% had satisfactory internet connections. Several demotivating factors (especially, monotony in studying) and factors that disturbed their studies (especially, tendency to watch television) were also reported.

Conclusion: Although more than 90% of those who responded had the necessary equipment for online learning, about 40% had inadequate facilities for online learning at home and only 75% had personal rooms to study. In addition, there were factors that disturbed and demotivated their online studies.

Keywords:            Online Learning, Self-directed Learning, Self-regulated Learning, Learning Environment, Malaysian Medical Students

Abstract

Introduction: Simulation-based learning (SBL) is a practical and efficient learning method that involves the replacement of a portion of clinical education with quality simulation experiences. It has been utilised in various countries, such as the United States, Canada, and South Korea. However, based on current regulations in Japan, clinical education cannot be replaced with simulation experience. For future curriculum integration, it is necessary to clarify the current use of SBL and tackle systematic educational strategies of SBL. Therefore, this national survey aimed to clarify the prevalence and practices of SBL in undergraduate nursing education programs in Japan.

Methods: This article presents the results of our national survey in Japan. It presents the questionnaire based on the International Nursing Association for Clinical Simulation and Learning Standards of Best Practice and demonstrates the use of simulation-based learning in Japanese undergraduate nursing programs.

Results: Overall, the schools using simulation-based education (SBE) comprised 346 schools (82.4%) of the sample. Those equipped with high-fidelity simulators were 146 schools (27.6%); the rest owned medium-fidelity simulators. Almost all undergraduate nursing education systems were equipped with simulators, however, the frequency of use was low. SBL was incorporated into the curriculum at many undergraduate nursing education institutions, and awareness of the INACSL Standard of Best Practice: Simulation^SM was extremely low.

Conclusion: This study shows that SBL is not properly utilised in undergraduate nursing programs, even though many schools are equipped with simulators. Thus, further study on barriers to simulator use is needed.

Keywords:           Simulation-based Learning, Curriculum, International Nursing Association for Clinical Simulation and Learning Standard of Best Practice: Simulation^SM, Japan, Undergraduate Nursing Education

Abstract

Introduction: Advanced Cardiac Life Support (ACLS) course is one of the mandatory certifications for the majority of medical as well as some nursing professionals. There are, however, multiple variations in its instruction model worldwide.  We aim to evaluate the efficacy of traditional ACLS course versus a hybrid ACLS course utilised during the COVID-19 pandemic.

Methods: This retrospective study was carried out at SingHealth Duke-NUS Institute of Medical Simulation using course results of participants in the centre’s ACLS course between May to October 2019 for the traditional course were compared with participants attending the hybrid course from February to June 2021.

Results: A total of 925 participants were recruited during the study period. Of these, 626 participants were from the traditional group and 299 participants were from the hybrid learning group. There is no statistically significant difference between the two group (χ²=1.02 p = 0.313) in terms of first pass attempts; first pass attempt at MCQ (p=0.805) and first pass attempt at practical stations (p=0.408). However, there was statistically significant difference between the mean difference in results of traditional vs hybrid MCQ score, -0.29 (95% CI: -0.57 to -0.01, p=0.0409). Finally, senior doctors were also found to perform better than junior doctors in both traditional (p=0.0235) and hybrid courses (p=0.0309) at the first pass attempt of ACLS certification.

Conclusion: Participants in the hybrid ACLS course demonstrated at least equal overall proficiency in certification of ACLS as compared to the traditional instruction.

Keywords:           Advanced Cardiac Life Support, Teaching Model, COVID-19, Hybrid Learning

I. INTRODUCTION

Healthcare systems and medicines operate in a complex landscape and constantly interact with individuals, the environment, and society. In such a complex healthcare delivery system, nonlinearity always exists, and treatments, different healthcare services, and medicines cannot be delivered without factoring in the uncertainty brought about by human, behavioural, system, and societal factors.

Abstract

Introduction: During the first wave of the COVID-19 pandemic in Singapore, clinical attachments for medical and nursing students were temporarily suspended and replaced with online learning. It is unclear how the lack of clinical exposure and the switch to online learning has affected them. This study aims to explore their perceptions of online learning and their preparedness to COVID-19 as clinical postings resumed.

Methods: A cross-sectional study was conducted among undergraduate and graduate medical and nursing students from three local universities, using an online self-administered survey evaluating the following: (1) demographics; (2) attitudes towards online learning; (3) anxieties; (4) coping strategies; (5) perceived pandemic preparedness; and (6) knowledge about COVID-19.

Results: A total of 316 responses were analysed. 81% agreed with the transition to online learning, most citing the need to finish academic requirements and the perceived safety of studying at home. More nursing students than medical students (75.2% vs 67.5% p=0.019) perceived they had received sufficient infection control training. Both groups had good knowledge and coping mechanisms towards COVID-19.

Conclusions: This study demonstrated that medical and nursing students were generally receptive to this unprecedented shift to online learning. They appear pandemic ready and can be trained to play an active part in future outbreaks.

Keywords:           Medical Students, Nursing Students, COVID-19, Pandemic, Online Learning, Survey

Abstract

Introduction: This study investigates psychological distress and quality of life (QoL) amongst first year premedical and health science students. The primary aim of this study was to investigate potential differences in QoL and psychological distress between students who sought entry into a medicine programme when compared to those opting for a non-medicine career. 

Methods: We examined participant responses to measures of QoL, psychological distress, and course preference (medicine or other). A structural equation model was conducted to consider the interrelationships among future course preference, gender, QoL, depression, anxiety and stress.

Results: Three hundred and sixty-five students completed the online survey. An a priori conceptual model was developed and then evaluated using a structural equation model. The values obtained for RMSEA (0.027), CFI (0.999), and SRMR (0.016) indicated an excellent model fit. The overall model fit statistic, chi-square (χ2 = 7.626, df=6, p= .267), confirmed a good model fit. Students aiming to enrol in medicine generated higher psychological health and environmental QoL scores compared to their non-medicine oriented peers. In addition, physical QoL and psychological health QoL scores significantly predicted psychological distress measures.

Conclusion: The study raises a potential debate regarding placing students with mixed career intentions into the same course and the potential implications this may have on teaching in interprofessional and large student groups in relation to wellbeing, pedagogy, equity, and expenditure. The findings clearly indicated that medical students are not as adversely impacted upon in terms of QoL and psychological distress compared with their non-medical peers.

Keywords:           Medical and Health Science Students, Quality of Life, Psychological Distress, Course Preference

Abstract

Introduction: Medical students (MS) may lack the knowledge and experience in performing basic surgical skills (BSS) when they first commence their postgraduate surgical training. We conducted a pilot BSS workshop with specific learning outcomes for MS.

Methods: Our BSS workshop program consisted of reading the pre-workshop online modules, watching the instructional videos of skills demonstration, and completing the pre-workshop multiple-choice questions (MCQ). MS attended the onsite workshop a week later, which consisted of a basic surgical theory lecture, live demonstration of the skills by the teaching faculty and, supervised skills training coupled with feedback. Surgical skills taught were knot tying, suturing techniques, laparoscopic peg transfer, precision cutting, application of endoloop ties. A standardised surgical skills rubric was used to assess the competency and safety of BSS. A post-workshop MCQ was administered to assess the knowledge learned. The criteria for successful completion of BSS were a satisfactory grade in the surgical skills assessment and a pass score in the MCQ.

Results: All the participating MS achieved a satisfactory grade in the surgical skills assessment and passed the MCQ. Several pedagogical methods were used to enhance knowledge learning and practical skills competency including a flipped classroom in blended learning, technology-enhanced learning, kinesthetic learning, and providing effective feedback.

Conclusion: MS taught in BSS workshop can achieve competency in knowledge, skills, safe attitude and prepare them for future postgraduate surgical training. In the current COVID-19 pandemic, our challenge is to develop similar BSS in a safe environment using technology-enhanced tools such as online instructional videos and online feedback.

Keywords:           Assessment, Basic Surgical Skills, Competency, Feedback, Medical Students, Outcome-based Education

I. INTRODUCTION

Educational strategies that are effective in one culture may not elicit the expected response when transferred across cultures. For instance, discussion-based learning methods such as problem-based learning, which were developed in Western contexts to foster self-directed lifelong learning (Franbach et al., 2019), are not easy for Asian students to adapt to. The quietness of Asian students, noted in multi-national contexts, is not always due to linguistic or cultural literacy barriers (Remedios et al., 2008) and requires contextual deconstruction to enable effective solution generation. In a Japanese context, we have observed how quietness manifests through insufficient question generation and a lack of spontaneous opinion expression in class. Such attitudes may be interpreted by western standards as lacking initiative and critical thinking (Tavakol & Dennick, 2010) but are in line with Japanese social norms and traditional views of learning. Because effective learning through discussion requires cognitive conflict to facilitate conceptual transformation (De Grave et al., 1996), it is necessary to ease the psychological burden experienced by our students when deviating from inherited cultural habits so that they can comfortably express opinions to embrace such conflicts. In this case study we share how we created a supportive environment to enable Japanese medical students to embrace this behavioural change.

From exams based on short answer questions and multiple-choice questions with a definite answer keys, to project-based, independent, and problem-oriented studies offered in university, the rapid dive transitioning from pedagogical learning into the world of andragogy within the university, truly is one of the highlights of a scholar’s long journey. A 6 year-long habit of having information spoon-fed into our mind, meticulously studying every Cambridge GCE A-Levels past marking scheme and question papers available on the internet had led me to believe that there always had to be the correct, if not perfect, way of finishing an assignment.

Abstract

Introduction: Development of expertise and counselling skills in psychiatry can be mastered only with effective supervision and mentoring. The conceptualisations of educational supervision amongst supervisors and residents were explored in this study to understand how supervisory roles may have been affected by the adoption of competency-based psychiatry residency training.

Methods: A qualitative research approach with thematic analysis was adopted. Individual in-depth interviews using a semi-structured interview guide with a purposive sample of six supervisors and six newly graduated residents were conducted. Transcripts of the interview were analysed and coded using the Atlas Ti software.     

Results: Four major themes emerged from analysis of the transcripts: (1) Meaning and definition of supervision; (2) Expectations and responsibilities of the educational supervisor; (3) Elusiveness of mentoring elements in educational supervision and (4) Personal and professional development of residents in supervision. Supervisors and residents perceived educational supervision narrowly to be transactional with acquisition of knowledge and skills, but residents yearned for more relational interactions.

Conclusion: This study showed that the roles and functions of supervisors in educational supervision were unclear. It also highlighted the lack of a mentoring orientation in supervision in the psychiatry residency training program. An emphasis on assessment of competencies might have contributed to tension in the supervisory relationship and lack of a mentoring role, with concerns on residents’ personal and professional identity development in their psychiatry training. 

Keywords:           Psychiatry, Mentoring, Educational Supervision, Competency-Based Medical Education, Professional Identity Development

Abstract

Introduction: Personal statements are important documents in the admission and programme application processes, including international elective programmes, in medical education. However, writing these is challenging for international applicants not only because of their unfamiliarity with this genre but also their English academic writing skills. This study aims to explore the organisation and elaboration of text in personal statements written by Japanese medical students for international elective programme application.

Methods: Drawing on genre analysis, the first draft of personal statements written by eight fifth-year medical students at a Japanese university were analysed. The text data were deductively classified into moves and steps, using Chiu’s framework of the personal statement genre.

Results: In the introduction, Japanese medical students commonly described the context and issues of healthcare in Japan and the future goals for physicians. In the move of the relevant background, it was notable that six out of eight personal statements showed personality. Although a range of moves was covered when writing about the reasons for applying, only two students described their understanding of programmes and institutional attributes. In the move of conclusion, they focused more on writing their goals of future success and contribution to the course. Furthermore, no applicant expressed self-promotion and praise for academics, programmes, and institutions.

Conclusion: The findings of this study can provide a springboard for the development of support for Japanese students’ academic writing in English in medical education across cultures.

Keywords:           Medical Education, International Electives, Personal Statement, Genre Analysis, Discourse, Rhetorical Patterns, Written Communication

I. INTRODUCTION

Twenty first century learning requires analytical thinking and problem solving; hence, medical educators must design suitable model to prepare learners for challenges in future. Medical teaching and learning are moving towards this direction and use of technology in education is embedded in the process. The role of laboratory testing in patients care is recognised as a critical component of modern medical care (Smith et al., 2010). Ability of practicing physicians to appropriately order and interpret laboratory tests is declining and little attention was given to appropriate medical student education in pathology (Smith et al., 2010).

I. INTRODUCTION

The AO foundation aims to improve patient outcomes in the surgical treatment of trauma and musculoskeletal disorders and promote education and research. Yearly, approximately 30,000 Orthopaedics surgeons worldwide attend AO foundation courses. To ensure that the planned curriculum is delivered, the AO foundation requires its surgeon-faculty to attend the Faculty Education Program (FEP) before teaching at regional and international courses.

I. INTRODUCTION

After the “To err is human” report in 1999, health care systems have become aware of the serious consequences of failures in health care and have sought to reduce them by enhancing patient safety education. The current medical educators consider that errors are inevitable in clinical practice and think of learning from these errors to improve the quality of the practice and maintain the safety of health care services. This effort on quality improvement and patient safety is now regarded as part of patient safety education. One example is the Morbidity and Mortality conference, a continuous professional development opportunity that had sprung from the efforts of learners to improve practice through the examination of medical errors and unfavourable outcomes. Openness to discussion and study of errors, with a realisation that “errors must not be accepted as a person’s fault”, is central to their message.

Abstract

Introduction: As significant autonomy is given in a Massive Open Online Course (MOOC), online self-regulated learning (SRL) ability is crucial in such courses. We aim to measure the online SRL abilities of early-career medical doctors enrolled in a MOOC.

Methods: We performed a cross-sectional study using the Self-Regulated Online Learning Questionnaire-revised version (SOL-Qr). We conducted a three-stage cross-cultural validation of the SOL-Qr, followed by Confirmatory Factor Analysis (CFA). The online SRL ability of 5,432 medical doctors enrolled in a MOOC was measured using the validated SOL-Qr.

Results: The CFA of the cross-translated SOL-Qr confirmed its comparability to the original version, with excellent validity & reliability. Participants showed high levels of online SRL during their early careers. Despite high online SRL scores, MOOC completion rate was low. Male participants showed slightly better time management ability than female participants. Participants working in the primary epicentrum for COVID-19 in the country showed lower online SRL scores, while participants who graduated from higher accreditation levels showed better time management ability.

Conclusion: The SOL-Qr and its subscales are suitable and valid for measuring the online SRL abilities of medical doctors in a MOOC during their early-career period. Time management ability was associated with previous experience during the medical education period, while other online SRL subscales were mostly associated with workload. However, as the scores did not correlate with the time spent for learning in MOOC, the corresponding learning effort or time spent may be beyond just the commitment to the described MOOC.

Keywords:           Self-Regulated Learning, MOOC, Online Learning

Abstract

Introduction: The transition from medical student to houseman is well recognised as a stressful period for newly qualified doctors. This stress is likely to be heightened when the transition occurs during a pandemic. We aimed to evaluate the perceived stress levels of housemen as they begin housemanship and explore their sentiments and preparedness in starting work amidst the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Housemen starting work at a tertiary institution in Singapore in May 2020 completed the following: (1) Perceived Stress Scale, (2) open-ended questions on perceived challenges and concerns and (3) questionnaire on preparedness and confidence in starting work. Descriptive statistics were used to analyse quantitative data and modified thematic analysis performed for qualitative data.

Results: Sixty-one housemen participated. Thirty-five (57.4%) reported high perceived stress. The themes for perceived challenges in this transition included coping with constant change, lack of reliable information from authorities, dealing with disappointment, physical fatigue, and loss of autonomy. The themes for concerns in beginning housemanship elicited relate to clinical competence, transitioning into new responsibilities, risk of infection with COVID-19, senior expectations, physical fatigue and training-related concerns. Despite these challenges and concerns, housemen were prepared to begin work during this pandemic.

Conclusion: Housemen transitioning during this pandemic experienced additional stressors and unique challenges pertaining to working in a pandemic. Encouragingly, they remain prepared to start work. Institutions and departments should be mindful of the specific concerns and challenges so that appropriate support can be put in place to support these junior doctors.

Keywords:            COVID-19, Junior Doctor, Intern, Pandemic, Challenges, Preparedness

Dear Editor,

We are delighted to report that the Japanese translated version of R2C2 (relationship, reaction, content, coaching) was published in the Journal of Medical Education in Japan, under kind permission of the author and Journal of Academic Medicine. The R2C2 model, developed by Sargeant et al. (2015), promotes behavior change through reflection and feedback, while incorporating coaching. The effectiveness and influencing factors have been demonstrated in supervisor–resident pairs in various residency programs (family medicine, psychiatry, internal medicine, surgery, and anesthesiology) in the U.S., Canada, and the Netherlands. The R2C2 model is fascinating since it emphasises the relationship and dialogue between the resident and the supervisor, and provides insights into the residents’ in-depth learning.

I read with great interest the article titled ‘Humanism in Asian medical education – A scoping review’ (Zhu et al., 2021). The article provides an overview of the teaching of humanism in medical schools in Asia. Teaching humanistic values is still not common among Asian medical schools and the published literature is predominantly from a few countries.

Abstract

Introduction: Pelvic examination of patients in the department of obstetrics and gynaecology (Ob–Gyn) is an important skill for medical students. Because it involves a physical assessment of the patients’ genitalia, patients may refuse medical students to participate in the examination, affecting the medical students’ clinical skills.

Methods: This cross–sectional study was conducted at Naresuan University Hospital to determine the factors that influence the acceptance of medical student participation in the pelvic examinations. A total of 198 out–patients from the Ob–Gyn department were included. A Likert scale questionnaire was designed which featured topics on patients’ attitudes and circumstances related to medical student involvement in gynaecological procedures.

Results: The majority of outpatients (71.7%) accepted the participation of medical students in pelvic examinations. Patients with prior experiences in physical and pelvic examination by medical students had a significant impact on the patients’ acceptance (P–value<0.001). The patients’ impressions had an influence on the decision to accept students in pelvic exam participation. Approximately 40% of patients were concerned about the breach of confidentiality. However, most patients strongly agreed that allowing medical students to perform pelvic examination would benefit their medical education.

Conclusion: Most of the participants permitted medical students to participate in pelvic examinations and preferred that the medical instructor be the one to request permission. The patients’ impressions of medical students were crucial factors that significantly influence their decision whether to allow or deny them to participate in the procedure. Disclosure of confidentiality was found to be matters of concern to most patients.

Keywords:           Pelvic Examination, Medical Students, Acceptance, Performance, Clinical Teaching

Although there have been many calls for dental education to move to comprehensive training, many have remained in rhetoric. However, recently the strategic analysis of the American Dental Association of Education recommended a curriculum transformation to engage students in life-long learning and nurturing an educational community with well-qualified teachers to mentor students and model the values of the profession (Formicola et al., 2018).

Abstract

Introduction: Team-based learning (TBL) pedagogy is a structured, flipped classroom approach to promote active learning. In April 2019, we designed a TBL workshop to introduce the New Classification of Periodontal Diseases 2017 to a group of general dental practitioners (GDPs). We aimed to investigate GDPs feedback on learning this new classification using TBL pedagogy.

Methods: Two articles related to the 2017 classification were sent to 22 GDPs 2 weeks prior to a 3-hour workshop. During the face-to-face session, they were randomly assigned to five groups. They participated in individual and group readiness assurance tests. Subsequently, the GDPs had inter- and intragroup facilitated discussions on three simulated clinical cases. They then provided feedback using a pen-to-paper survey. Based on a 5-point Likert scale (1-strongly disagree to 5-strongly agree), they indicated their level of agreement on items related to the workshop and their learning experience. 

Results: Majority (94.7%, 18 out of 19 GDPs) agreed the session improved their understanding of the new classification and they preferred this TBL pedagogy compared to a conventional lecture. All learners agreed they can apply the knowledge to their work and there was a high degree of participation and involvement during the session. They found the group discussion and the simulated clinical cases useful.

Conclusion: A TBL workshop is suitable for clinical teaching of the New Classification of Periodontal Diseases 2017 for GDPs. Its structure promotes interaction among learners with the opportunity to provide feedback and reflection during the group discussions. This model might be a good pedagogy for continuing dental education.

Keywords:            Team-based Learning, General Dental Practitioners, New Classification of Periodontal Diseases

Abstract

Introduction: The switch to online off-campus teaching for universities worldwide due to COVID-19 will transform into more sustainable and predictable delivery models where virtual and local student contact will continue to be combined. Institutions must do more to replace the full student experience and benefits of learners and educators being together.

Methods: Our centre has been delivering distance blended and online learning for more than 40 years and has over 4000 alumni across five continents. Our students and alumni come from varied healthcare disciplines and are at different stages of their career as educators and practitioners. Whilst studying on the programme students work together flexibly in randomly arranged peer groups designed to allow the establishment of Communities of Practice (CoP) through the use of online Discussion Boards.

Results: We found Discussion Boards encouraged reflection on learning, sharing of ideas with peers and tutors, reduce anxiety, support progression, and enable benchmarking. This led to a highly effective student sense of belonging to each other, our educators, and the wider University, with many highlighting an excellent student experience and maintaining a thriving CoP within the alumni body.

Conclusion: Despite being based on one large postgraduate programme in medical education, our CoP approach is relevant to any undergraduate programme, particularly those that lead to professional qualification. With our mix of nationalities, we can ‘model the way’ for enabling strong CoP’s to share ideas about best practice with a strong student and alumni network which can be shared across the international healthcare community.

Keywords:           Communities of Practice, Sense of Belonging, Student Experience

Medical Professional Identity Formation (PIF) has been suggested as a fundamental outcome in medical education (Cruess et al., 2014). Medical professional identity is development of both personal and professional identity as a physician. PIF achieved in stages over time during which the characteristics, values, and norms of the medical profession are internalised, resulting in individual thinking, acting, and feeling like a physician (Cruess et al., 2014).  It is basically not a process of learning to demonstrate professional behaviour but of change into a “professional being” or professional physician. Throughout the journey of PIF, moments of dissonance between personal values and professional values are likely to occur. So logically, there will be phases of learning and unlearning. Learning is generally well-defined, but unlearning has been conceptualised through different lenses both on the process of unlearning and the unlearnt content, leading to conflicting views.

I. INTRODUCTION

Single case designs (SCDs) comprise repeated measurements (time series) of the same variables of interest (Van de Schoot & Miocevic, 2020) to understand changes in knowledge, skill, attitude or other constructs in a defined time period that includes one or more events or developments that may affect that change. Possible units of analysis include individuals (e.g., individual skill development), teams (e.g., team dynamics), or settings (e.g., situational-contextual change). Whether the outcome variables are quantitative (e.g., time-on-task), qualitative (e.g., changes in habits or preferences), or some combination of the two (e.g., test scores and transitions in practice strategy), a range of parametric and nonparametric statistical models are available for analysis at the level of N = 1, and the outcomes of multiple N = 1 analyses can be combined using multilevel and meta-analytic models (for reviews and examples, see: Leppink, 2020; Van de Schoot & Miocevic, 2020). This makes SCDs useful for any sample size and, contrary to traditional randomised controlled experiments and other group comparison studies, can help health professions education (HPE) researchers and practitioners to (1) Respect the dynamic nature of learning, (2) Use no more resources than needed, (3) Bridge the research-practice gap, and (4) Appreciate diversity and approach challenges in the sector accordingly. Each of these advantages is explained in the following.

I. BACKGROUND

The coronavirus disease 2019 (COVID-19) has been declared as a pandemic. On 7 February 2020, the Ministry of Health (MOH), announced the suspension of all clinical postings. All healthcare students were ordered to withdraw from hospitals within hours after the announcement. Graduating year nursing students from the National University of Singapore (NUS) were into their final phases of clinical postings. The suspension of clinical postings greatly disrupted the students’ preparations in developing clinical competencies critical to their future nursing professions.

Dear Editor,

Khoo Teck Puat Hospital held its first LOTTE (Learning Oriented Teaching in Transdisciplinary Education) elective program for Yong Loo Lin School of Medicine students in April 2021. The four-week program focuses on undergraduate medical education in an inter-professional collaborative setting through observation and presentation of complex clinical cases. Its teaching-learning activities are underpinned by the Learning Oriented Teaching (LOT) theory (ten Cate et al., 2004) to improve learning at the cognitive, affective and metacognitive levels with shared guidance between students and faculty.