The practice of medicine and provision of healthcare is evolving rapidly, driven not just by advancements in new treatment modalities but also by the integration of modern technologies in providing precision care to our patients. It is important to understand and embrace, where appropriate, innovative technologies to respond effectively to the evolving needs of a modern society. What will be seen in this transformative wave is how Artificial Intelligence (AI) has the potential to revolutionise various sectors in medicine and healthcare (Yu et al., 2018).

Focusing on health professions education, AI emerges as a pivotal force in training the future healthcare practitioners and preparing them for the multifaceted challenges of the modern medical landscape (Paranjape et al., 2019). There are 3 distinct uses of AI in education which was reported by Baker et al. (2019): Learner-oriented AI, Instructor-oriented AI and Institution-oriented AI. Let’s focus on some of these areas:

Abstract

Introduction: The mini-Clinical Evaluation Exercise (CEX) is meant to provide on the spot feedback to trainees. We hypothesised that an ultra-short assessment tool with just one global entrustment scale (micro-CEX) would encourage faculty to provide better feedback compared to the traditional multiple domain mini-CEX.

Methods: 59 pairs of faculty and trainees from internal medicine completed both the 7-item mini-CEX and a micro-CEX and were surveyed regarding their perceptions of the 2 forms. Wordcount and specificity of the feedback was assessed. Participants were subsequently interviewed to elicit their views on factors affecting the utility of the CEX.

Results: Quantity and quality of feedback increased with the micro-CEX compared to the mini-CEX. Wordcount increased from 9.5 to 17.5 words, and specificity increased from 1.6 to 2.3 on a 4-point scale, p < 0.05 in both cases. Faculty and residents both felt the micro-CEX provided better assessment and feedback. The micro-CEX, but not the mini-CEX, was able to discriminate between residents in different years of training. The mini-CEX showed a strong halo effect between different domains of scoring. In interviews, ease of administration, immediacy of assessment, clarity of purpose, structuring of desired feedback, assessor-trainee pairing and alignment with trainee learning goals were identified as important features to optimize utility of the (mini or micro or both) CEX.

Conclusions: Simplifying the assessment component of the CEX frees faculty to concentrate on feedback and this improves both quantity and quality of feedback. How the form is administered on the ground impacts its practical utility.

Keywords:           Workplace Based Assessment, Mini-CEX, Micro-CEX, Feedback, Assessment

Abstract

Introduction: The level of BLS achievement at the end of basic education is not clear, so to develop a BLS training program using QCPR Learner^Ⓡ and to verify its effectiveness.

Methods: A quantitative descriptive study design was used. The developed BLS program was implemented for 81 fourth-year students at the school of nursing. The program consisted of 2 minutes of training per student and real-time feedback by QCPR Learner^Ⓡ as well as feedback among students and from faculty members and was conducted twice for each student. Evaluation was conducted from three aspects: learner response and program evaluation both using questionnaires, learning achievement of QCPR score.

Results: The mean values of learners’ responses before and after the program were: attention, 4.32 before and 4.59 after; relevance, 4.48 before and 4.75 after; confidence, 2.32 before and 3.78 after; and satisfaction, 2.12 before and 3.41 after, which increased significantly after the program. The QCPR Learner^Ⓡ scores increased significantly from 74.08 for the first time to 86.76 for the second time. In the free response, some respondents stated that “visualisation of the procedure by the application improved my skills.”

Conclusion: The results of the evaluation from three aspects showed that this program was effective in improving students’ motivation to learn and skills.

Keywords:           Basic Life Support, Real-Time Feedback, Basic Nursing Education, Simulation Training, QCPR Learner

Abstract

Introduction: This study was undertaken to investigate students’ perceptions of innovation-integrated learning, adopted as an alternative approach for special care dentistry (SCD) training.

Methods: Ninety final-year dental students from the 2021 cohort were divided into eight groups to complete an innovation project dedicated to eight categories of patients with special health care needs. Discussion and final presentations, involving related experts were conducted remotely via an online platform. Then, students were invited to answer a validated online feedback survey on their perceptions of the learning approach.

Results: The response rate for the feedback survey was 91.1% (n=82). Most students agreed that the activity was interesting, improved their knowledge and understanding of SCD, allowed engagement between peers, supported sharing of ideas and experiences, encouraged student–lecturer interactions, and enhanced knowledge integration and application. Students also expressed that the activity enhanced creativity and innovation, instilled an interest and positive attitude toward learning SCD, and encouraged teamwork. However, a few students noted facing some limitations in completing their projects (i.e., technological challenges and reduced physical access to purchase materials). Around half felt neutral about having an increased workload from this activity. Moreover, perceptions differed regarding time and financial commitments, as well as supervisors’ and patients’ involvement during the project development process.

Conclusion: Students perceived that the innovation-oriented learning activity, was beneficial in multiple aspects of SCD training.

Keywords:           Innovation, Learning, Dental Students, Perception

Abstract

Introduction: The night float (NF) system has been instituted in some hospitals in Singapore to improve the working hours and wellbeing of junior doctors. There have been concerns of compromised learning and patient safety with NF. The objective of this study is to compare clinical competency outcomes, based on existing assessment framework, between post-graduate year 1 (PGY1) doctors working on NF versus traditional call (TC) systems. The secondary aim was to explore patient safety outcomes between these groups of PGY1s.

Methods: Data on the formal assessments of PGY1s using the Entrustable Professional Activities (EPAs) and medical errors were prospectively collected between May 2021 and April 2022 from two hospitals that employed different on-call systems. Data was analysed descriptively. Categorical data was analysed using the Chi-square test or Fisher’s exact test where appropriate.

Results: One hundred and ninety-three PGY1s consented to the study. There was no statistically significant difference in the clinical competency of PGY1s in both groups. The number of PGY1s who had ‘needs improvement’ scores in a detailed EPA was not significantly different (9.0% in the NF group versus vs 3.7% in the TC group (p = 0.14)). They nonetheless passed the overall core EPA and no PGY1 failed their postings. No serious reportable medical errors occurred in either group.

Conclusion: PGY1s who worked on NF are equally competent compared to those who worked on TC based on the EPA assessment matrix. Patient safety is not compromised by PGY1s working on NF.

Keywords:           Clinical competence, Float, Junior doctor, Patient safety, Wellbeing

Abstract

Introduction: Singapore Institute of Technology’s undergraduate (UG) occupational therapy (OT) and physiotherapy (PT) programs are one of the first implementors of Entrustable Professional Activities (EPAs) in the respective allied health professions training. The aim of the paper is to report the outcomes of the first year of EPAs implementation in clinical practice education (CPE) and share next steps refining implementation.

Methods: A quality improvement (QI) study using the Plan-Do-Check-Act (PDCA) cycle was conducted. UG OT Year 2 and Year 3 students, UG PT Year 3 students and their clinical educators (CEs) who experienced the use of EPAs for the first time were surveyed at the end of the clinical block.

Results: There was generally high agreement (>70% agreed or strongly agreed) among all groups in using EPAs to better understand the learning objectives of CPE and practice expectations as future entry-level practitioners at conditional-registration. More than 70% of OT respondents but less than 50% PT respondents found the EPA assessment forms easy to use. Less than 60% of both program CEs did not include colleagues for EPA assessments. 55% of both OT and PT CEs found the EPA training and resources adequate. Overall, PT respondents showed lower agreement than OT respondents in five survey items.

Conclusion: The first implementation cycle of EPA in the undergraduate OT and PT CPE had mixed acceptability to the EPA assessment tools. Three strategic changes were made for the second implementation cycle., i.e., redesign of EPA-based assessment forms, training focus and ‘just-in-time’ training with streamlined resources.

Keywords:           Clinical Training, Entrustable Professional Activities, Occupational Therapy, Physiotherapy, Undergraduate, Workplace-based Assessment

Abstract

Introduction: Several nations around the world had to close schools, colleges, universities, and other educational institutions as they were badly affected by the spread of COVID-19. The purpose of this study was to measure the effectiveness of online vs physical teaching during the COVID-19 pandemic, at the Faculty of Allied Health Sciences (FAHS), University of Ruhuna (UoR) Sri Lanka.

Method: A cross-sectional study was conducted among 200 undergraduates. The data were collected through displayed/approved results sheets of the students of selected batches in the Department of Nursing, Department of Pharmacy, and Medical Laboratory Science (MLS). Paired sample T-test was used to compare the results of undergraduates.

Results: The examination results of 47-54 undergraduates in nursing, 28 in pharmacy, and 22 in MLS were analysed. Significant differences in Psychiatry in Nursing and Nursing Clinical Attachment were identified in the Department of Nursing (p=0.001). In the Department of Pharmacy, only Pharmaceutical Chemistry I (p=0.012) reported a significant difference. The undergraduates of MLS who underwent online theory sessions had scored more in Microbiology and Immunology (p=0.022) and Basic Genetics and Molecular Biology (p=0.000) whereas in Research Methodology and Epidemiology, the undergraduates who participated in physical lectures had scored more marks (p=0.001).

Conclusion: Practical/interactive session-based course units and clinical appointments had a higher impact on the mode of teaching than many theoretical course units. The results might serve as a primer for the creation of an action plan to support the academics and clinical/practical components of undergraduates.

Keywords:           Undergraduates, Online Teaching, Physical Teaching, Examination Results, COVID-19

Abstract

Introduction: The purpose of this study is to carry out a comparative analysis of the job satisfaction of nurses working in India based on the different types of the hospital they are working with. The study tests the null hypothesis that the job satisfaction of nurses from India across different types of hospitals is the same.

Methods: Four hundred nurses divided into 100 each for four popular types of hospitals – (1) Educational; (2) Government; (3) Charitable Trust; and (4) Private, from all over India were surveyed. Two ANOVA tests were performed. The first one was performed, taking overall job satisfaction as the dependent variable. The second ANOVA was performed by taking the monetary and compensation factors, work environment and management support, and job-related factors as the dependent variables.

Results: The overall mean of job satisfaction was -0.73 (SD 0.60). Overall, 65 percent of the variability of the dependent variable, job satisfaction, is explained by the type of hospital and is statistically significant (p<0.0001).

Conclusion: Monetary and compensation factors, work environment and management support, and job-related factors impact nurses’ job satisfaction. These factors vary with the type of hospital, and hence it can be concluded that due to variation in these factors depending on the type of hospital, the job satisfaction of nurses varies. Implications of our study are for the educational, government, and charitable trust hospitals to improve their work culture, management, and work environment so that nurses will have higher job satisfaction.

Keywords:           Nurses, Job Satisfaction, India, Hospitals, Government, Private, Charitable Trust, Educational 

I. GLOBALISATION IN EAST ASIA

Globalisation, a complex and multifaceted phenomenon, encompasses not merely an increasing people’s mobility and economical trades, but sometimes, their political and ideological struggles, and cultural identity formation issues, too. While North American and European countries have had a long history of accepting a large number of immigrants, while Asia experienced 74% growth of hosting international migrants from 2000 to 2020, which was most remarkable (McAuliffe & Triandafyllidou, 2021). For example, Japan’s proportion of immigrant population increased from 1.3% in 2000 to 2.2% in 2021, with Chinese migrants constituting the largest group, followed by Vietnamese, Koreans, Filipinos, and Brazilians. Similarly, in 2021, immigrants accounted for 3.4% of Korea’s total population in 2021, compared to 0.5% in 2000. These immigrants came from China, Vietnam, Thailand, Uzbekistan and other countries (McAuliffe & Triandafyllidou, 2021).

I. INTRODUCTION

Antimicrobial resistance has been considered a “silent” global pandemic of magnitudes similar to climate change. However, just as climate change, awareness and understanding of the public on this needs to be increased. Recent work from Sri Lanka indicates the same (Gunasekera et al., 2022). World Health Organisation (WHO) also recommends that awareness should be increased among those involved in antibiotic prescription as well as consumers and that this should be made part of the core curriculum in professional training (World Health Organisation, 2023). Those studying in health-science related streams and other biology related streams tend to take knowledge on concepts like “microorganisms”, “infectious diseases” and “antibiotics” as granted. As they are taught these concepts, or they revise what they learnt in school once again in the university, they assume that the others may also have an acceptable level of understanding on these key concepts. This leads to a communication gap between the two groups of people, the ones who have formal education on concepts like “microorganisms”, “infectious diseases” and “antibiotics” and the ones who do not have such education. Therefore, we find that health education materials are not targeted to the level of simplicity that is required by the general public.

Artificial intelligence (AI) in education has raised several ethical questions regarding academic integrity, privacy, and bias in language algorithms (Master, 2023). These concerns have yielded to distrust to the point that several institutions banned chatbots at Campus locations. Still, the discussion should not be about whether we should use them but how fast we can leverage the data-crunching possibilities to address the biggest challenges of medical education. To do so, educators have the task of transforming the generic use of generative AI to a specific task, such as designing an educational case, a grading rubric, or an exam. However, the quality of the designs depends heavily on the clarity of the educational intent and the technological savviness of the user to provide clear instructions for the algorithm to process.