Project description:IntroductionThis collection of cases in medical genetics focuses on ethical dimensions of genetic testing. Given the recent and continuing revolution in genetic testing technologies, understanding the nuances of genetic tests and the implications of their outcomes for patients is a critical learning goal for medical students.MethodsThis case collection was developed for first-year medical students. The cases fall into two types: discussion cases that lend themselves to both small-group and lecture settings and brief audience-response clicker cases to be used in larger lecture settings. The cases span topics such as direct-to-consumer genetic testing, patient privacy, economic and legal issues of genetic testing, and secondary findings in whole exome/genome sequencing. The clicker cases can be used to punctuate class sessions on the related science, while the discussion cases can be deployed as a single 2-hour session focusing on ethics. The associated materials include teaching notes on the scientific and ethical dimensions of the cases, a slide presentation of the cases, and implementation advice.ResultsStudents found that engaging with these cases was very stimulating and eye-opening. Student comments indicated that they appreciated the opportunity to grapple with the ethical dimensions of the genetic testing technologies and that the challenges brought to light highlighted the complexity of medical practice in the genomic era.DiscussionAlthough these cases were originally developed for use with medical students, they could easily be adapted for use in postgraduate and CME settings to explore complex ethical scenarios on which even the experts disagree.
Project description:Interns are expected to teach medical students, yet there is little formal training in medical school to prepare them for this role. To enhance the teaching skills of our graduating students we initiated a 4-hour "teaching to teach" course as part of the end of the fourth-year curriculum. Course evaluations demonstrate that students strongly support this program (overall ratings 2000 to 2005: mean=4.4 [scale 1 to 5], n=224). When 2004 course participants were surveyed during the last month of their internship, 84%"agree" or "strongly agree" with the statement: "The teaching to teach course helped prepare me for my role as a teacher during internship" (2005: mean 4.2 [scale 1 to 5], n=45, response rate 60%). A course preparing fourth-year students to teach during internship is both feasible and reproducible, with a minimal commitment of faculty and resident time. Participants identify it as an important addition to their education and as useful during internship.
Project description:The transition from medical student to junior doctor is a challenge; the UK General Medical Council has issued guidance emphasizing the importance of adequate preparation of medical students for clinical practice. This study aimed to determine whether a junior doctor-led simulation-based course is an effective way of preparing final year medical students for practice as a junior doctor.We piloted a new 'preparation for practice' course for final year medical students prior to beginning as Foundation Year 1 (first year of practice) doctors. The course ran over three days and consisted of four simulated stations: ward round, prescribing, handover, and lessons learnt. Quantitative and qualitative feedback was obtained.A total of 120 students attended (40 on each day) and feedback was collected from 95 of them. Using a scale of 1 (lowest) to 5 (highest), feedback was positive, with 99% and 96% rating 4 or 5 for the overall quality of the program and the relevance of the program content, respectively. A score of 5 was awarded by 67% of students for the ward round station; 58% for the handover station; 71% for the prescribing station, and 35% for the lessons learnt station. Following the prescribing station, students reported increased confidence in their prescribing.Preparation for practice courses and simulation are an effective and enjoyable way of easing the transition from medical student to junior doctor. Together with 'on-the-job' shadowing time, such programs can be used to improve students' confidence, competence, and ultimately patient safety and quality of care.
Project description:Introduction:Leadership is an area of education and training that is critical to the development of medical providers as health care professionals, yet few medical school curricula offer formal training in this area. Methods:We designed and implemented a course to develop and enhance the leadership and teamwork skills of first-year medical students to better prepare them for medical practice. Following a systematic literature review to identify leadership core competencies, the Leadership in Medicine Optional Enrichment Elective (OEE) was developed in accordance with the University of Massachusetts Medical School's course guidelines. The elective included six interactive sessions to advance skills in the areas of recognizing and utilizing effective leadership styles, communication within the health care team, giving and receiving feedback, delegating responsibilities, and direction setting. We designed a robust, evidence-based, scholarly evaluation plan for the OEE that was integral to ongoing quality improvement of the course. Results:Outcomes were assessed in alignment with the Kirkpatrick method of standardized evaluation. A total of 26 participants completed the course. At completion, participants demonstrated learning and advancement of skills in all five leadership domains. Furthermore, participants found meaning in the course and planned to utilize their skills in future medical practice. Discussion:The development, implementation, and evaluation of this program can serve as a model for future course development, and the program can be adapted and implemented by other institutions in an effort to address the learning gap regarding leadership education.
Project description:Background:Determining whether a professional development program can be enacted with integrity in different settings and by different facilitators is critical to understanding efficacy. In this paper, we describe the two-stage preparation process of a facilitator as she prepared to use and adapt the highly specified Learning and Teaching Geometry video-based professional development materials with fidelity. The latter stage of the preparation process involved a rehearsal, during which the research team used two instruments to measure fidelity. Methods:Two existing instruments were used to explore fidelity through different lenses, including timing and modification of activities and learning goals. Results:Results from both fidelity instruments indicate that the facilitator used the materials as intended by the developers. However, these instruments did not capture important information regarding modifications the facilitator made, including timing and content-focused adaptations. Conclusions:Suggestions are made with respect to measuring fidelity, preparing facilitators, and supporting productive adaptations.
Project description:BackgroundStudents may be the first to recognise and respond to psychological distress in other students. Peer support could overcome medical student reluctance to seek help despite their high rates of mental ill-health. Yet, despite the adoption of peer support programs, there is little evidence of impact on students. Peer support programs may assume that medical students accept and view peer support positively. We explored these assumptions by asking students about their experiences and views on peer support.MethodsQualitative semi-structured interviews exploring peer support experiences and views on peer support were conducted with ten medical students at two contrasting medical schools. Informed by a constructivist stance, interview transcripts underwent thematic analysis.ResultsThree groups of themes were identified: participants' experiences of peer support encounters, concerns about providing support, and views on students' roles in peer support. Participants readily recalled signs of peer distress. Encounters were ad hoc, informal, and occurred within relationships based on friendship or by being co-located in the same classes or placements. Concerns about initiating and offering support included lack of expertise, maintaining confidentiality, stigma from a mental health diagnosis, and unclear role boundaries, with implications for acceptance of student roles in peer support.ConclusionsOur study emphasised the centrality of social relationships in enabling or discouraging peer support. Relationships developed during medical studies may anticipate the collegial relationships between medical professionals. Nevertheless, only some students are willing to undertake peer support roles. We suggest different strategies for promoting informal peer support that can be offered by any student, to those promoting formal support roles for selected students. Future research focusing on the impact for both the students who receive, and on the students who provide peer support is called for.
Project description:Despite the importance of effective communication skills in pediatrics, clinical placements may inadequately prepare undergraduate students to communicate with children. The integration of non-clinical interactions with healthy children within a pediatric curriculum has the potential to enhance learning. We designed and implemented a novel course involving experiential learning, including video-recorded consultations with simulated parents (SPs), team-based scenarios with a pediatric mannequin, interactions with healthy children through a pre-school visit and medical student led health workshops for primary school children. Medical students at the RCSI University of Medicine and Health Sciences took part in the course. We used a mixed methods approach to assess the impact of the course. We investigated medical students' perspectives through a pre- and post-intervention questionnaire and post-intervention focus group discussions (FGDs). We assessed participating children's health literacy at the start of the course. 144/279 (51.6%) of the fourth year medical student cohort on their pediatric rotation, consented to participate in the study. All 144 (100%) of consenting students completed the pre-intervention questionnaire. 59/144 (40.1%) of consenting students completed the post-intervention questionnaire. Results showed a statistically significant improvement in ratings (p < 0.05) for items related to managing a confrontational situation involving family members, completing a psychosocial assessment with an adolescent and effectiveness using evidence-based medicine (EBM) when motivating patients. There was a statistically significant decrease in how students rated their comfort at using EBM when motivating patients. Four themes relating to how students experienced the intervention were identified from eight FGDs (n = 35 students): Shaping Student Learning; Supporting Student Learning; Developing New Skills and Feeling More Prepared. 39/49 (79.6%) children completed a health literacy assessment. All questions had a high percentage of positive responses. Question 7, understanding your doctor, had the highest proportion of negative responses (27%). Ours is one of the first studies to design an educational intervention to enhance pediatrics teaching by combining interactions with healthy children outside of a clinical setting with more traditional simulation-based approaches. We conclude that this type of intervention supports students' learning of pediatric communication skills and enhances students' perceived preparation for clinical placement.
Project description:IntroductionSince the advent of medical education systems, managing high-stakes exams has been a top priority and challenge for all policymakers. However, considering machine learning (ML) techniques as a replacement for medical licensing examinations, particularly during crises such as the COVID-19 outbreak, could be an effective solution. This study uses ML models to develop a framework for predicting medical students' performance on high-stakes exams, such as the Comprehensive Medical Basic Sciences Examination (CMBSE).Material and methodsPrediction of students' status and score on high-stakes examinations faces several challenges, including an imbalanced number of failing and passing students, a large number of heterogeneous and complex features, and the need to identify at-risk and top-performing students. In this study, two major categories of ML approaches are compared: first, classic models (logistic regression (LR), support vector machine (SVM), and k-nearest neighbors (KNN)), and second, ensemble models (voting, bagging (BG), random forests (RF), adaptive boosting (ADA), extreme gradient boosting (XGB), and stacking).ResultsTo evaluate the models' discrimination ability, they are assessed using a real dataset containing information on medical students over a five-year period (n = 1005). The findings indicate that ensemble ML models demonstrate optimal performance in predicting CMBSE status (RF and stacking). Similarly, among the classic regressors, LR exhibited the highest root-mean-square deviation (RMSD) (0.134) and coefficient of determination (R2) (0.62), whereas the RF model had the highest RMSD (0.077) and R2 (0.80) overall. Furthermore, Anatomical Sciences, Biochemistry, Parasitology, and Entomology grade point average (GPA) and grades demonstrated the strongest positive correlation with the outcomes.ConclusionComparing classic and ensemble ML models revealed that ensemble models are superior to classic models. Therefore, the presented framework could be considered a suitable alternative for the CMBSE and other comparable medical licensing examinations.
Project description:We provide an overview of the issue of specific consent for pelvic examinations under anesthesia performed by medical students. Arguments that have historically been made against requiring consent for such examinations are reviewed and refuted. The implications of requiring consent for examinations under anesthesia are discussed as they relate to patient autonomy, medical student education, and society at large. Finally, we outline a solution and offer sample language that balances the interests of patients, learners, and society.