Int. Med. Educ., Volume 3, Issue 3 (September 2024) – 12 articles

(1) The purpose of this project was to create and collect validity evidence for a lifestyle medicine objective structured clinical examination (OSCE) station to assess medical students’ performance related to lifestyle medicine competencies. (2) We developed a lifestyle medicine case/station with an associated observation checklist and rubric. We piloted the checklist and rubric in one lifestyle medicine OSCE station, securing triplicate scores of each student’s performance. For analysis, generalizability (G) theory was utilized for observation checklist data and interclass correlation coefficients (ICC) for patient encounter notes (PENs). (3) One hundred and fifteen third-year medical students completed the lifestyle medicine OSCE station in the Internal and Family Medicine Clerkship. The generalizability coefficient and Phi-coefficient based on the number of encounters (P = 115), facet 1 (nfacet1 = 10 assessment tool checklist items), and facet 2 (nfacet2 = two performance ratings in the live examination) were 0.71 and 0.69, respectively. The average interclass correlation coefficient (ICC) measure for PEN was 0.79 (CI = 0.69–0.85). (4) For this OSCE station, the G-coefficient provides positive indicators for the validity of the observation checklist items. Similarly, the ICC result provides validity evidence for the usefulness of the PEN rubric for capturing lifestyle medicine knowledge reflected in students’ PEN notes. Full article

Student-centered active learning (SCAL) shifts the focus from the teacher to the student. Implementing SCAL requires the development of new forms of assessment beyond memorization and comprehension. This paper aims to demonstrate the effectiveness of SCAL by analyzing student performance at different cognitive levels. In flipped classrooms, students completed tasks with varying cognitive demands. The tests measured knowledge (level 1), comprehension (level 2), application (level 3) and analysis (level 4). This approach to assessment assesses not only the acquisition of content, but also skills that are critical to a health science student’s future career. The results of expository learning were compared with student-centered collaborative learning in the Anatomy and Embryology I course over three academic years. Student opinions were collected through 326 anonymous Wooclap^® (Version: 2019101500) surveys. No differences in performance were found for low-cognitive-level questions. However, SCAL significantly improved performance on higher-cognitive-level questions that required problem solving and application of knowledge. Despite the benefits of SCAL, it requires more effort from both teachers and students. The current assessment system at Universidad Complutense, which measures teaching quality primarily in terms of student satisfaction, tends to penalize efforts to innovate. Many students are attracted to passive learning techniques because they provide a clear and structured path to success. This approach, which focuses on memorizing information for exams, provides a sense of security. Teachers need to have a strong belief in the effectiveness of SCAL methods to persist in their implementation. Full article

Clinical academics experience dual workplaces, namely the clinical and the research environment. However, working in two workplaces leads to difficulties in forming an integrated identity, affecting a person’s work environment and well-being. The aim was to explore how clinical academics experience the psychosocial work environment and their suggestions for improving and changing work well-being. A multicenter qualitative approach with group interviews inspired by participatory action design was used. A purposeful criterion sampling strategy was used, selecting researchers affiliated with the university’s research network (n = 12). Data were analyzed by thematic analysis and the consolidated criteria for reporting qualitative research was applied. The main finding, ‘lack of integration of research in clinical practice’, revealed how clinical academics balanced between the two practices, how their need for belonging in both work environments was established by fellowship, and how motivational factors and role models could be enhanced through a joint commitment of responsibility in research units and clinical practice. This study provides a contemporary understanding of the challenges that mainly Ph.D. students encounter and what solutions they would offer. This study adds to knowledge on well-being in psychological work and provides solutions on how clinical academic Ph.D. students can achieve the integration of research in clinical practice. Full article

Introduction: In this narrative review, we identified concepts related to the process of transforming a psychiatry curriculum for New Zealand medical students. Method: A literature search was performed on four databases (Embase, Medline, PsycInfo, and Scopus) for articles related to curriculum development in psychiatry, including relevant aspects of culture and technology. Results: Ninety-three articles met the inclusion criteria. Three main themes were identified: the needs of learners; curriculum frameworks that optimise learning; and the role of technology. The key features of an effective psychiatry curriculum are the extent to which it integrates with other disciplines, develops key competencies, supports authentic learning, and promotes cultural safety. Conclusions: Transforming curricula is an iterative process that prioritises learners’ needs, establishes psychiatry within the teaching context, integrates learning evidence, and responds to the changing demands of society. The findings from this review apply to medical curricula more generally: a well-integrated specialist curriculum, in this case psychiatry, enables medical students to build essential competencies and depends upon effective collaboration with stakeholders, attention to cultural safety, and incorporating technology into the teaching context. Full article

Background: Clinical reasoning (CR) is fundamental in medical education. However, the Italian curriculum has not incorporated a structured CR format yet. Therefore, we introduced the Clinical Case Discussions (CCD), to medical students attending the University of Bologna as a tool for developing CR abilities. CCDs are a case-based peer-teaching format, simulating the diagnostic process using published patient cases. Methods: Students of all clinical years of the University of Bologna Medical School were invited to voluntarily participate in a two-day CCD training program. They completed pre- and post-training questionnaires assessing their expectations before and impressions after the training and comparing learning outcomes to their usual classes. Results: Twenty-one students participated in this pilot program. Before the training, more than half of the participants expressed either interest or a strong interest in all proposed learning objectives. Afterward, 84.6% of the students stated that the training much exceeded (63.5%) or exceeded (23.1%) their expectations considering its utility for their future medical activities. A total of 92.3% strongly agreed (84.6%) or agreed (7.7%) to have improved their CR. Conclusions: Although this pilot program had some intrinsic limitations, the students’ positive feedback on this CCD format (combining the benefits of case-based learning and peer teaching) encourages further research on its potential role in the Italian curriculum. Full article

Over the last decade, initiatives like the Choosing Wisely campaign have promoted the practice of evidence-based, cost-conscious care. However, education surrounding value in medicine has been largely restricted to graduate-level medical education or post-clerkship undergraduate medical education. Here, we present a mixed-methods study evaluating pre-clerkship medical student engagement with and response to new value-based curricular initiatives to assess whether high-value care (HVC) can be introduced successfully earlier in training. Initiatives were introduced into the pre-clerkship clinical curriculum without major alterations to the established curricular structure. These comprised an annual event devoted to self-reflecting on HVC observed in prior and current clinical experiences and subsequent small-group facilitated discussion. Engagement with and response to these initiatives were analyzed for two whole-class cohorts using an abductive, progressive focusing approach complementing quantitative survey data. Baseline familiarity with HVC and post-event response to the annual event was higher and more positive, respectively, among responders from the Class of 2025 compared with those from the Class of 2024. Analysis of reflection essays revealed the emergence of five primary themes differentiating the two class years: (1) understanding HVC, (2) addressing barriers to HVC, (3) medical waste and underserved communities, (4) patient–physician relationship and value, and (5) self-reflection. Evaluation of thematic patterns in light of survey response data suggests that early clinical exposure combined with intentional self-reflection could promote engagement with HVC topics in a way that shapes students’ foundational understanding of the practice of medicine. Full article

Immunology is an important component of the medical curriculum. It provides a foundation for understanding the cellular and molecular processes by which the body protects itself from external substances and the immunological responses that contribute to the development of many illnesses. The inclusion of immunology in an osteopathic medical curriculum is essential to understanding the body’s defense systems as well as the alignment of osteopathic concepts with immunology. By encompassing innate and adaptive immunity, immunology reflects the interconnectedness of the body’s systems and the foundation for self-regulation inherent in osteopathy. A problem facing medical educators is determining how to facilitate students’ learning of immunological concepts in a way that will help them retain and apply the material throughout their clinical years and beyond. This paper aims to provide an immunology education framework designed to effectively integrate immunology topics across the preclinical courses of an osteopathic medical curriculum. Drawing insights from an extensive review of the literature and current medical curricula, we propose an integrative curriculum model that broadly incorporates fundamental concepts of immunology across multiple disciplines and systems-based courses horizontally as well as vertically over the preclinical years using clinical presentations and laboratory findings and further connecting them to osteopathic principles. This integrative curriculum will augment medical students’ understanding of immunology, making them better able to connect core concepts with clinical applications and enhance their application of immunological concepts in osteopathic patient care in alignment with the NBOME guidelines. Using the proposed integrative medical curriculum may better prepare medical students for providing holistic medical care and guidance to their future patients. Full article

Child abuse affects millions of children globally. Comprehensive training is essential to promote its recognition and trigger appropriate responses to prevent missed opportunities for intervention. We describe a child abuse and child protection training programme for University of Ghana Medical School students and the cross-sectional survey of student assessment at the end. The programme comprised a lectures, dissertations, community surveys, case reports, public health advocacy topics, and poster designs. These were carried out as part of regular coursework in community health, using individual and group—methods. It culminated in a one-day whole-class seminar after their final examinations with completion and analyses of self-administered student assessment questionnaires. The seminar comprised nineteen 10-min oral presentations, twelve poster presentations on community surveys and dissertations, nine educative posters, three leaflets and a question-and-answer session. The training involved 208 students, and 126 completed the questionnaires. The majority of the students had good knowledge (80–100%). They correctly identified the types (91%), risk factors (87%), and gained clarity in selected areas. Added benefits were awards, a book of abstracts and summaries, policy brief and continuous professional development points for doctors. This training programme exemplifies the establishment of medical education in the context of the needs of the population to—be served. Full article

Entrustable Professional Activities-based (EPAs-based) assessments gained much interest among clinical educators, especially after the AAMC publication in 2014. In 2016, a standardized tool, the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM), was developed at a national conference. Since 2018, the modified NCAT-EM has been used at Central Michigan University School of Medicine at shift ends, midway through clerkships, and upon completion of the clerkship. This empirical study analyzed student performance progression in order to enhance school assessment practices and inform future action plans. Descriptive and inferential statistics were calculated. During the 2021–2022 academic year, 89 faculty and residents assessed 97 students on 238 submission days. The students generally received multiple sets of daily shift feedback. Two domains, note writing and practice-based learning, showed significant differences between the mid-clerkship formative and summative scoring. Professionalism issues were evident with this cohort of students. The study provides some validity evidence regarding student performance and progression within the context. The NCAT-EM provides values and benefits as evidenced by the substantial volume of assessor feedback during its fourth year of implementation. This study provides directions for future action plans for faculty training, promising continuous improvement in emergency medicine assessment practices. Full article

Motivation is essential in education, with highly motivated learners engaging more deeply with content and more ably transferring knowledge to new contexts. However, the validity of scales to measure motivation has been underexplored in pre-clerkship medical education. This study evaluates the validity of the Situational Motivation Scale (SIMS) for measuring motivation among pre-clerkship medical students in post-situational and short-term contexts. Using a sample of n = 156 students from the Frank H. Netter MD School of Medicine at Quinnipiac University, SIMS was tested to construct validity, with attention paid to content, response process, internal structure, relationships to other variables, and consequences of use evidence. Small modifications from present to past tense in English were made for clarity following focus-group feedback, and content validity was ensured via expert consultation. The SIMS demonstrated strong internal consistency, with a satisfactory Cronbach’s alpha for all subscales and anticipated patterns of correlations. The factor analysis confirmed appropriate factor loadings, with a stronger model fit for the short-term context, and no observed adverse effects on student engagement. These findings support the robustness of the SIMS in capturing intrinsic, extrinsic, and amotivation in pre-clerkship medical students, highlighting its applicability for short-term and situational motivational assessment. Full article

In recognition of the critical role of residency programs in narrowing healthcare inequalities, Global Health scholarships were introduced at Mbarara University of Science and Technology (MUST) in 2011. Since then, at least 154 postgraduate students in priority programs have benefited. We conducted an online cross-sectional survey to examine how the scholarships and beneficiaries have impacted MUST and the community. Fifty (50) beneficiaries, representing 32.5%, responded, of whom 36 (72%) were alumni. Most respondents were males (n = 30; 60%) pursing Master of Medicine (n = 29; 58%) or Master of Nursing Science (n = 20; 40%) programs. The scholarship schemes included First Mile (n = 29; 58%), Kayanja (n = 12; 24%), Paiko (n = 5; 10%) and Seed (n = 4; 8%). The majority of the scholarships supported both tuition and research fees (n = 41; 82%), the rest being partial. Career advancement was undertaken by eight (16%) of the scholars in the form of fellowships (n = 3; 6%), other masters (n = 3; 6%) and PhDs (n = 3; 6%), with some students having attained a combination of these. All scholars belonged to at least one health professional association. Over 88% (n = 32) of the alumni and 28% (n = 4) of the students were employed. The majority of those employed were in the public sector (n = 24; 66.7%), mainly the health sector (n = 18; 50%), academia (n = 14; 38.9) or both (n = 4; 11.1%). There was a high impact on health care provision, undergraduate training and research carried out by the scholars both during training and post-graduation. High levels of career satisfaction, scholarship impact and academic program relevance were reported. The findings provide insights on how low-fund specialty scholarships can have a far-reaching impact on local training, health care and research in low- and middle-income countries. Full article

Three-dimensional (3D)-printed models with high anatomic fidelity are an increasingly viable tool in simulation-based medical education. One advantage of 3D models is they provide enhanced tactile and spatial understanding of complex anatomy to develop technical skills used in minimally invasive procedures. We propose that 3D anatomical models can improve the development of interventional radiology vascular access skills—first described in the 1950s as the Seldinger technique—for pre-clerkship medical students. The early adoption of 3D-printed technology in pre-clinical medical education can lead to improved student engagement and satisfaction when learning procedural techniques. This study involved creating a 3D model of the upper limb vasculature from an anonymized Computed tomography (CT) angiogram, using it as a medical education tool for 31 pre-clinical medical students practicing the Seldinger Technique on a prefabricated venipuncture upper limb, and assessing student satisfaction with this form of learning. Overall, attendees responded positively to the incorporation of the 3D model in medical education to improve their anatomic understanding and application of the Seldinger technique. These results indicate that the use of 3D models in simulation-based medical education can provide benefits in acquiring technical skills and the potential to decrease training costs without harming a patient. Full article