Journal of Biomedical Education http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Proactive Student Engagement with Fitness to Practise Tue, 15 Jul 2014 11:10:07 +0000 http://www.hindawi.com/journals/jbe/2014/578649/ Fitness to practise (FTP) is fundamental to health professional education and health service delivery, impacting on both practitioner and client wellbeing. Literature exploring FTP support policies primarily identifies retrospective student support and management. This study describes student perceptions of an innovative FTP policy which supports students and staff to proactively identify FTP management strategies prior to entering the clinical environment. Forty-nine final year physiotherapy students were surveyed regarding their perceptions of self-declaring FTP. Ordinal data from Likert scales were reported using descriptive statistics. Thematic analysis was undertaken for open text responses. The response rate was 88%. Forty-two percent of students stated that they had experienced FTP concerns during the course. Concerns included physical and mental impairment and clinical competence issues. The majority of students (80%) indicated that they were “comfortable” or “very comfortable” in self-declaring FTP issues. Confidentiality, positive relationships with staff and a supportive environment enhanced likelihood of declaration. Eight students (19%) met with university staff to develop management strategies and all rated these meetings as “helpful” or “very helpful.” Students had positive perceptions of self-declaring their FTP to enable early development of management strategies. This strategy successfully navigates sensitive ethicolegal issues, empowering students to take responsibility for their own FTP. Kristin Lo, Stephen Maloney, Margaret Bearman, and Prue Morgan Copyright © 2014 Kristin Lo et al. All rights reserved. Integrating Contemplative Tools into Biomedical Science Education and Research Training Programs Wed, 02 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/jbe/2014/239348/ Academic preparation of science researchers and/or human or veterinary medicine clinicians through the science, technology, engineering, and mathematics (STEM) curriculum has usually focused on the students (1) acquiring increased disciplinary expertise, (2) learning needed methodologies and protocols, and (3) expanding their capacity for intense, persistent focus. Such educational training is effective until roadblocks or problems arise via this highly-learned approach. Then, the health science trainee may have few tools available for effective problem solving. Training to achieve flexibility, adaptability, and broadened perspectives using contemplative practices has been rare among biomedical education programs. To address this gap, a Cornell University-based program involving formal biomedical science coursework, and health science workshops has been developed to offer science students, researchers and health professionals a broader array of personal, contemplation-based, problem-solving tools. This STEM educational initiative includes first-person exercises designed to broaden perceptional awareness, decrease emotional drama, and mobilize whole-body strategies for creative problem solving. Self-calibration and journaling are used for students to evaluate the personal utility of each exercise. The educational goals are to increase student self-awareness and self-regulation and to provide trainees with value-added tools for career-long problem solving. Basic elements of this educational initiative are discussed using the framework of the Tree of Contemplative Practices. Rodney R. Dietert Copyright © 2014 Rodney R. Dietert. All rights reserved. Mobile Learning in a Rural Medical School: Feasibility and Educational Benefits in Campus and Clinical Settings Sun, 29 Jun 2014 11:04:02 +0000 http://www.hindawi.com/journals/jbe/2014/412786/ Students in a new medical school were provided with laptops. This study explored the feasibility and educational benefits of mobile learning for two cohorts of students learning in two settings—university campus (first-year students) and rural clinical placements (second-year students). Evaluation involved questionnaires, focus groups (faculty and students), and document analysis. Descriptive statistics were computed. Focus groups were audio-recorded, transcribed, and analysed thematically. Response rates for questionnaires exceeded 84%. Compared with second-year students, significantly more first-year students (60%) took their laptops to campus daily () and used their laptops for more hours each day (). All students used laptops most frequently to access the internet (85% and 97%) and applications (Microsoft Word (80% and 61%) and Microsoft PowerPoint (80% and 63%)). Focus groups with students revealed appreciation for the laptops but frustration with the initial software image. Focus groups with faculty identified enthusiasm for mobile learning but acknowledged its limitations. Physical infrastructure and information technology support influenced mobile learning. Document analysis revealed significant costs and issues with maintenance. If adequately resourced, mobile learning through university-issued laptops would be feasible and have educational benefits, including equitable access to learning resources, when and where they are needed. However, barriers remain for full implementation. Debra Nestel, Katherine Gray, Andre Ng, Matthew McGrail, George Kotsanas, and Elmer Villanueva Copyright © 2014 Debra Nestel et al. All rights reserved. Faculty Development Effectiveness: Insights from a Program Evaluation Mon, 23 Jun 2014 07:57:54 +0000 http://www.hindawi.com/journals/jbe/2014/286081/ Background. Faculty development programs are often time and resource intensive. In order to accommodate time constrained clinicians a limited time commitment faculty development program was developed and was shown to be effective in improving participant’s scholarly productivity. Objectives. The objective of this study was to assess participants’ perceptions of why the faculty development program was effective in promoting scholarship in education. Methods. In-depth semistructured interviews of course participants were conducted a year after completing a faculty development program. The interviews were audiotaped and transcribed verbatim. The transcriptions were coded independently by the investigators for dominant themes. The investigators held coding meetings to further refine the themes and discrepancies were handled by referring to the transcripts and reaching consensus. Results. The participants’ satisfaction with the course as described in the interviews correlated with the early satisfaction surveys. Reasons offered for this impact fell into four broad categories: course content, course format, social networking during the course, and the course facilitation coaching strategies to achieve goals. Conclusions. Course focusing on the process, experiential learning, and situating the course facilitator in the role of a functional mentor or coach to complete projects can be effective in facilitating behaviour change after faculty development programs. Anupma Wadhwa, Lopamudra Das, and Savithiri Ratnapalan Copyright © 2014 Anupma Wadhwa et al. All rights reserved. A Continuing Medical Education Campaign to Improve Use of Antibiotics in Primary Care Sun, 25 May 2014 12:36:32 +0000 http://www.hindawi.com/journals/jbe/2014/537681/ Because inappropriate use of antibiotics is common, it is an important area for continuing medical education. At an annual review, we conducted a two-year campaign to achieve appropriate use. Our methods included two surveys, directed course content, programmatic evaluation, and a sample practice audit. Ninety percent of learners perceived inappropriate antibiotic use as a “very big” or “big” problem in the United States, but only 44% perceived this about their practice (). Top perceived barriers to appropriate antibiotic use were patient expectations, breaking old habits, and fear that patients would go elsewhere. Top strategies to overcome these barriers were patient educational materials, having guidelines accessible, and developing practice policies. In a hypothetical patient with acute bronchitis, 98% would likely prescribe an antibiotic in certain clinical scenarios even though The Centers for Disease Control and Prevention does not recommend empiric antibiotic treatment. The most common scenarios leading to likely antibiotic prescription were symptoms over 15 days (84%), age over 80 years (70%), and fever (48%). Practitioners are under multiple pressures to prescribe antibiotics even in situations where antibiotics are not recommended (such as acute bronchitis). To achieve complex practice changes such as avoiding inappropriate antibiotic use, no one strategy predominated. Ronald S. Gibbs, Carolyn Wieber, Leslie Myers, and Timothy Jenkins Copyright © 2014 Ronald S. Gibbs et al. All rights reserved. Understanding Student Experiences in a Near-Peer Resident Shadowing Program Sun, 18 May 2014 00:00:00 +0000 http://www.hindawi.com/journals/jbe/2014/318598/ Introduction. The preparation of medical students for clerkship has been criticized, both in terms of students’ ability to understand their new role as clinical trainees and in their ability to carry out that role. To begin to address this gap, this paper reports the experiences of students in a shadowing program aimed at enhancing the preparedness of medical students for clinical training. The study examined a novel program, the Resident-Medical Student Shadowing Program, in which first-year medical students at the University of Alberta shadowed a first-year resident during clinical duties over the course of eight months. Methods. A study was conducted to assess the experiences of 83 first-year medical student participants who shadowed a first-year resident intermittently for one year. Student and resident participants’ experiences were explored using semistructured interviews. Results. Students and residents experiences indicate that participation increased students’ understanding of the clinical environment and their role within it and introduced them to skills and knowledge needed to perform that role. Students reported that a close relationship with their resident enhanced their learning experience. Conclusion. This study demonstrates that a low-cost program in which first-year students shadow residents may be a useful tool for helping prepare students for clerkship. Simon R. Turner, Jonathan White, Cheryl Poth, and W. Todd Rogers Copyright © 2014 Simon R. Turner et al. All rights reserved. Changing Morning Report: An Educational Intervention to Address Curricular Needs Wed, 05 Mar 2014 15:48:36 +0000 http://www.hindawi.com/journals/jbe/2014/830701/ Morning report is a case-based teaching session common to many residency programs with varying purposes and focuses. At our institution, physicians and residents felt our Internal Medicine morning report had lost its educational focus. The purpose of this project was to improve morning report using a well-known curriculum development framework for medical education. We conducted a focus group of residents to develop and implement changes to morning report. Themes from our focus group led us to split morning report with the first 30 minutes for postgraduate year 3 (PGY-3) residents to give handover, to receive feedback on diagnosis and management, and to either discuss an interesting case or receive teaching aimed at their final certification examination. The second 30 minutes involved PGY-3 residents leading PGY-1 residents in case-based discussions with an attending physician providing feedback on the content and process of teaching. We measured success based on a follow-up survey and comments from resident evaluations before and after the change. Overall, the changes were well received by both faculty and residents; however comments revealed that the success of morning report is preceptor dependent. In summary, we have successfully implemented a split morning report model to enhance resident education with positive feedback. Vijay John Daniels and Cheryl Eleanor Goldstein Copyright © 2014 Vijay John Daniels and Cheryl Eleanor Goldstein. All rights reserved. TelePresence in Rural Medical Education: A Mixed Methods Evaluation Mon, 10 Feb 2014 08:56:39 +0000 http://www.hindawi.com/journals/jbe/2014/823639/ In response to rural health workforce shortages, universities and training providers offer rural and remote clinical placements. This has led to development of educational methods to counter the barriers of distance. In this emerging field, recent improvements in technology have provided solutions including the use of sophisticated videoconferencing systems such as the Cisco TelePresence model CTS-500. This paper evaluates the use of TelePresence in diverse medical education activities using a mixed methods design—questionnaires , individual interviews , and observed practice of activities . TelePresence was found to be beneficial to learning and teaching and superior to other systems participants had used. In particular, the audiovisual quality, resulting intimacy, convenience, and ease of use facilitated teaching and learning, while the fixed camera and poorly arranged physical environment were found to be limitations. The system is best suited for small group activities. Clinical skills-based activities are viable. It is recommended that technical support be available during setup and use and a picture-in-picture mode be included and improved integration of office suite software to provide a joint workspace for display of presentations, images, editing or annotation of documents, and file sharing. Katherine Gray, Kristian Krogh, David Newsome, Victoria Smith, Donald Lancaster, and Debra Nestel Copyright © 2014 Katherine Gray et al. All rights reserved. Research Equity: A Capacity Building Workshop of Research Methodology for Medical Health Professionals Sun, 22 Dec 2013 14:12:48 +0000 http://www.hindawi.com/journals/jbe/2013/261643/ Research is a cornerstone for knowledge generation, which in turns requires capacity building for its tools and techniques. Despite having a vast infrastructure in India the research in medical science has been carried out in limited and focused institutions. In order to build the capacity in carrying out research activities a five-day planning workshop was conducted at state run medical college. Total 22 medical faculty members participated in the workshop with average public health experience of 12 years (range: 5–25 years). The knowledge was assessed objectively by multiple-choice questionnaire. The mean score increased from 6.7 to 7.9 from pre- to posttest. About seventy-percent participants showed improvement, whereas 21.0% showed deterioration in the knowledge and the rest showed the same score. Apart from knowledge skills also showed improvement as total 12 research projects were generated and eight were approved for funding by the Indian Council of Medical Research (ICMR), New Delhi. It can be concluded that a supportive environment for research can be built with the technical assistance. Ashok Kumar Bhardwaj, Ashoo Grover, Sunil Kumar Raina, Dinesh Kumar, Vishav Chander, Shailja Sharma Sood, and Sushant Sharma Copyright © 2013 Ashok Kumar Bhardwaj et al. All rights reserved. Identifying Training Requirements in Perioperative Care for Anaesthetists Tue, 10 Dec 2013 08:06:12 +0000 http://www.hindawi.com/journals/jbe/2013/534245/ Education and training in anaesthesia have traditionally focused on the preparation and delivery of intraoperative anaesthesia but are evolving to incorporate aspects of perioperative medical care. The expansion of continued professional development and postgraduate courses in this field has gathered pace, with the aim of teaching anaesthetists and allied professionals to improve patients' surgical care. We surveyed a population of UK-based anaesthetists to establish their views on professional development within perioperative medicine, their role as perioperative medical experts of the future, and the training and educational needs of this cohort. The majority of anaesthetists acknowledged their evolving role in perioperative patient care and recognised a need to train for the task. Only 50% of the senior anaesthetists surveyed believed they had sufficient knowledge and skills to undertake perioperative care with the majority believing the current training curriculum must advance to support professional development. In line with other international healthcare systems, UK-based anaesthetic practice is adopting a responsibility for perioperative medical practice, and this survey has demonstrated willingness amongst anaesthetists of all grades to embrace change, recognise training needs, and improve the outcome for surgical patients. Gautam Kumar, Beverly Wong, and David Walker Copyright © 2013 Gautam Kumar et al. All rights reserved. Bedside Teaching in Australian Clinical Schools: A National Study Sun, 08 Dec 2013 09:21:35 +0000 http://www.hindawi.com/journals/jbe/2013/948651/ Purpose. Bedside teaching (BST) of medical students has become less common in recent years; however, there have been strong recommendations made in the literature to continue this teaching modality for the valued benefits it provides. The purpose of the present study is to explore the perceptions and opinions of bedside teaching among senior Australian medical students. Methods. Medical students at Australian universities were surveyed by means of an electronic questionnaire. The results were collected and analysed. Results. A total of 517 responses were received from students at 15 universities and 94 different clinical sites. The percentage of students who identified BST as very important ranged from 62.5% in psychiatry to 90.4% in internal medicine. The optimal class size was nominated as 3-4 students, and students favoured a style where one individual performs a complete examination, with the remainder allowed to elicit the key sign afterwards. Students felt 3-4 hours of BST per week to be ideal. Advantages identified to BST included provision of feedback and elicitation of clinical signs. Disadvantages included time constraints and excessive class sizes. Conclusions. The unique benefits of BST result in its high demand by students, regardless of the discipline being taught. Praveen L. Indraratna, Louise C. Greenup, and Timothy X. Yang Copyright © 2013 Praveen L. Indraratna et al. All rights reserved. Perceived Quality Improvements Using Daily Allocation of Surgical Residents to the Operating Room and Outpatient Clinics Thu, 24 Oct 2013 16:27:25 +0000 http://www.hindawi.com/journals/jbe/2013/164746/ Introduction. Balancing efficiency and quality in resident education and clinical care is challenging, particularly in a large tertiary center with resident work hour restrictions. This study investigates the use of daily allocation of surgical residents to operative cases and clinics with the goal of improving patient care, resident education, and coverage. Methods. Surgical residents were allocated to cases and clinic activities a day ahead, with a central email generated and sent to all surgical staff the day prior to the procedures and duties. A ten-item questionnaire was administered to the staff on the surgery service before and after this intervention, evaluating perceptions of educational experience, patient care, and coverage of operative cases, clinic, and floor duty. Results. A total of 28 staff members participated. No significant difference was found in the perception of stress at work, coverage of OR cases, or clinic attendance after the intervention. However, a statistically significant increase () was noted in the perception of resident’s educational experience in the clinic (39% vs. 94%), appropriate case distribution (54% vs. 94%), and quality of patient care (50% vs. 100%). Conclusions. Daily allocation of surgical residents to operative cases and clinic activities improves perceptions of resident educational experience and quality of patient care in a busy clinical setting. Keith Wirth, Patricia Leung, Prasanth Patcha, and Aliu Sanni Copyright © 2013 Keith Wirth et al. All rights reserved. Mismatch of Cultural Dimensions in an Urban Medical Educational Environment Mon, 21 Oct 2013 09:48:32 +0000 http://www.hindawi.com/journals/jbe/2013/617674/ Objective. To identify cultural dimensions and their potential mismatches between attending physicians and their residents and medical students. Methods. We surveyed faculty and students, both undergraduates and postgraduate resident physicians, at the SUNY Downstate College of Medicine, using Hofstede’s VSM-08 questionnaire, and calculated cultural dimensions, including the Power-Distance Index (PDI), Individualism (IDV), Masculinity (MAS), Uncertainty Avoidance Index (UAI), and Long-term Outlook (LTO). Correlations between faculty and student demographic data and cultural dimensions were calculated (SPSS). Results. There were 237 student and resident respondents and 96 faculty respondents. Comparing all faculty and student respondents, significant differences were found in four of five cultural dimensions, with faculty scoring higher in MAS, and lower in PDI, IDV, UAI, and LTO. Conclusions. These differences may be important in the design and implementation of a medical educational curriculum, and, particularly, in the measurement and evaluation of educational outcomes. Bethany Malone, Stephania Hasan, Aliu Sanni, and James Reilly Copyright © 2013 Bethany Malone et al. All rights reserved. The Role of Empathy and Wisdom in Medical Practice and Pedagogy: Confronting the Hidden Curriculum Tue, 24 Sep 2013 11:20:46 +0000 http://www.hindawi.com/journals/jbe/2013/923810/ The role of the virtues of empathy and wisdom in clinical practice is used to address two crises facing modern medicine—quality of care and professionalism. To that end, these virtues are initially explored individually and then collectively in terms of a synergistic relationship between them. Next, how empathy and wisdom guide and empower clinical practice, especially in terms of their synergistic relationship, is discussed vis-à-vis the two crises. The “Grand Rounds” scene from “W;t”—Margaret Edson’s 1999 Pulitzer prize-winning play—is used to illustrate how these virtues function with respect to providing quality care in a professional manner. The paper concludes with a discussion of the challenges facing the pedagogy of equipping medical students, residents, and even practicing clinicians with virtues like empathy and wisdom. James A. Marcum Copyright © 2013 James A. Marcum. All rights reserved. TraumaTutor: Perceptions of a Smartphone Application as a Learning Resource for Trauma Management Wed, 10 Jul 2013 08:47:30 +0000 http://www.hindawi.com/journals/jbe/2013/149162/ Aim. We investigated perceptions of a new smartphone application (app) as a learning resource. Methods. We developed TraumaTutor, an iPhone app consisting of 150 questions and explanatory answers on trauma management. This was used by 20 hospital staff that either had a special interest in managing trauma or who were studying for relevant exams, such as ATLS. A subsequent questionnaire assessed users’ experience of smartphone applications and their perceptions of TraumaTutor. Results. Of those surveyed, 85% had a device capable of running app software, and 94% of them had used apps for medical education. Specific to TraumaTutor, 85% agreed that it was pitched at the right level, 95% felt that the explanations improved understanding of trauma management, and 100% found the app easy to use. In fact, on open questioning, the clear user interface and the quality of the educational material were seen as the major advantages of TraumaTutor, and 85% agreed that the app would be a useful learning resource. Conclusions. Smartphone applications are considered a valuable educational adjunct and are commonly used by our target audience. TraumaTutor shows overwhelming promise as a learning supplement due to its immediacy, accessibility, and relevance to those preparing for courses and managing trauma. James Wigley and Saran Shantikumar Copyright © 2013 James Wigley and Saran Shantikumar. All rights reserved. Continuing Medical Education for Primary Care Physicians in Israel: A Cross-Sectional Study Sat, 08 Jun 2013 12:35:54 +0000 http://www.hindawi.com/journals/jbe/2013/843691/ Acquiring a medical degree is only the beginning of a prolonged learning process. At some point, formal studies end, and continuing medical education (CME) may be left to personal initiative. To assess lifetime learning (LL) and CME among primary care physicians in Israel, a self-administered questionnaire, based on the Jefferson Scale of Physician Lifelong Learning (JSPLL), was mailed to 4,104 primary care physicians. A total of 979 completed the study, 53.4% males with a mean age of 51.8 ± 8.3 (range 31–79). A logistic regression model showed that male gender (OR = 1.5, ), teaching (OR = 4.5, ), and not working in a rural clinic (OR = 0.6, ), increased the LL score. The results of the study demonstrate a need to address special subgroups that have a lower tendency to engage in LL activities. Policymakers should develop strategies to increase these physicians' interest in LL activities and the accessibility of these activities to them, including the availability of LL resources at home so physicians can get updates at their convenience. Primary care physicians should also be encouraged to become involved in teaching of any type, as this is a facilitating factor for LL activities. Pesach Shvartzman, Howard Tandeter, Daniel Vardy, Eran Matz, Anthony Heymann, and Roni Peleg Copyright © 2013 Pesach Shvartzman et al. All rights reserved. Are We Learning Enough Pathology in Medical School to Prepare Us for Postgraduate Training and Examinations? Wed, 27 Feb 2013 16:06:35 +0000 http://www.hindawi.com/journals/jbe/2013/165691/ Medical schools responded to the first publication of Tomorrow’s Doctors with an abbreviated syllabus and a reduction in didactic teaching hours. Prescribing errors, however, have increased, and there is a perception amongst clinicians that junior doctors know less about the pathological basis of disease. We asked junior doctors how useful they thought their undergraduate teaching in pathology had been in their postgraduate training. We had 70 questionnaire responses from junior doctors within a single deanery and found that although almost every doctor, (96%), thought that pathology formed a major component of their postgraduate exams, most, (67%), thought that their undergraduate teaching left them unprepared for their postgraduate careers, and they had to learn basic principles, as they revised for postgraduate exams. Few used a pathology text for learning, most doctors, (91%), relying on question and answer revision resources for exam preparation. Perhaps, as revision materials are used so widely, they might be adapted for long-term deep learning, alongside clinical work. This presents an opportunity for pathologists, deaneries, royal colleges, and publishing houses to work together in the preparation of quality written and online material readily accessible to junior doctors in their workplace. Emma Marsdin and Seema Biswas Copyright © 2013 Emma Marsdin and Seema Biswas. All rights reserved. Effectiveness of a Formal Mentorship Program in Family Medicine Residency: The Residents’ Perspective Thu, 21 Feb 2013 08:46:57 +0000 http://www.hindawi.com/journals/jbe/2013/520109/ Introduction. Mentoring is a recognized form of teaching learning strategy in postgraduate medical education. This paper describes the effectiveness of a formal mentorship program from the residents’ perspective after a year of implementation. Methods. The Aga Khan University Family Medicine Residency Program is the first program in Pakistan to our knowledge to implement formal mentorship for all four years of residency. A mentorship program was developed, implemented, and evaluated a year later using a rating scale. The 10-point Likert scale consisted of questions on academics, clinical work, research, administrative issues, and personal/social issues. Results. The response rate was 95% (). Eighty percent () were women. Satisfaction level in seeking help was the highest for academics (75%). Residents scored mentorship as low in helping to tackle their personal problems (20%). Barriers reported in rapport building with mentor were time constraints and gender difference. The most useful attributes of the mentor which helped rapport building were accessibility, active listening, support for emotional needs, and trustworthiness. Conclusion. Mentoring has a role in trainees’ personal and professional growth especially when their needs are addressed. The effectiveness of the mentorship program in residency can improve if the residents are allowed to choose their own mentors. Marie Andrades, Seema Bhanji, Mariam Valliani, Foaud Majeed, and Sheilla Kumari Pinjani Copyright © 2013 Marie Andrades et al. All rights reserved. How and Why Do Junior Doctors Study? What Materials Do They Use? Wed, 06 Feb 2013 15:28:29 +0000 http://www.hindawi.com/journals/jbe/2013/840812/ Context. Junior doctors studying for exams need reliable information close at hand. Objectives. We set out to understand the resources junior doctors use to study and revise. Methods. A questionnaire was circulated to junior hospital doctors within a single UK deanery sitting membership examinations, asking what motivates them to study, what resources they use to learn and revise, and what qualities they look for in the ideal learning and revision resource. Findings. We received a 70% response to the questionnaire (140 out of 200 doctors) and found that nearly all doctors are motivated to study by examinations (95%, ) and by patients they look after on the wards (73%, ). Their ideal learning resources comprise case-based learning (64%, ). They use textbooks at least as much as online resources and learn directly from their seniors. Discussion and Conclusion. To tailor learning and revision resources for junior doctors we need nationwide research on how they learn and revise. This study supports the development of reliable case-based learning material in print and, and the collaboration of educators and junior doctors who have clear ideas about the resources they want to use. Natasha Wiggins, Sananda Haldar, and Seema Biswas Copyright © 2013 Natasha Wiggins et al. All rights reserved.