Journal of Advances in Medical Education & Professionalism
Volume:5 Issue: 4, Oct 2017

Lifelong learning is an integral part of health professionals’ maintenance of competence. Several studies have examined the orientation toward lifelong learning at various stages of the education and career continuum; however, none has looked at changes throughout training and practice. The objective of the present study was to determine if there are differences between groups defined by their places on the education and career continuum.
The authors performed a group-level meta-analysis on studies that used the 14-item Jefferson Scale of Physician Lifelong Learning or its variants. Eleven published articles, which reported on studies with post-secondary health professions students, residents, and practicing health professionals met the inclusion criteria. In total, there were 12 independent data sets, with four data sets per group.
In total, over seven thousand students, residents, and practicing health professionals responded to the Jefferson Scale (N=7.269). Individual study means tendency to be high, suggesting a high orientation toward lifelong learning among the trainees (students and residents) and practicing health professionals. Metaanalysis results indicated that the orientation toward lifelong learning tended to increase gradually along the education and career continuum. Significant differences in the group means were found between the trainees and practicing health professionals.
In the reviewed studies, the orientation toward lifelong learning among students, residents, and practicing professionals was high. Nonetheless, although based on separate cohorts, it appears that the orientation toward lifelong learning continues to develop even after the completion of formal training.

The learner-centred approach in medical and health sciences education makes the study of learning preferences relevant and important. This study aimed to investigate the interdisciplinary, interinstitutional, gender and racial differences in the preferred learning styles among Malaysian medical and health sciences students in three Malaysian universities, namely SEGi University (SEGi), University of Malaya (UM) and Universiti Tunku Abdul Rahman (UTAR). It also investigated the differences in the preferred learning styles of these students between high achievers and non-high achievers.
This cross-sectional study was carried out on medical and health sciences students from three Malaysian universities following the approval of the Research and Ethics Committee, SEGi University. Purposive sampling was used and the preferred learning styles were assessed using the VARK questionnaire. The questionnaire was validated prior to its use. Three disciplines (medicine, pharmacy and dentistry) were chosen based on their entry criteria and some similarities in their course structure. The three participating universities were Malaysian universities with a home-grown undergraduate entry medical program and students from a diverse cultural and socioeconomic background. The data were analysed using the Statistical Package for the Social Sciences (SPSS) software, version 22. VARK subscale scores were expressed as mean±standard deviation. Comparisons of the means were carried out using t-test or ANOVA. A p value of Both statistically significant interdisciplinary and inter-institutional differences in learning preferences were observed. Out of the 337 students, a majority of the participants were unimodal learners (n=263, 78.04%). The most common type of learners was the reading/writing type (n=92, 27.30%) while the kinesthetic subscale (M=6.98, SD=2.85) had the highest mean score. Female students (M=6.86, SD=2.86) scored significantly higher than male students (M=6.08, SD=2.41; t(249), p=0.014) in the auditory subscale, whereas Chinese students (M=5.87, SD=2.65) scored significantly higher than Malay students (M=4.70, SD=2.87; p=0.04) in the visual subscale. However, the mean VARK subscale scores did not differ significantly between high achievers and non-high achievers (p>0.05).
This study gives an insight into the learner characteristics of more than one medical school in Malaysia. Such multi-institutional studies are lacking in the published literature and this study gives a better representation of the current situation in the learning preferences among medical students in Malaysia.

Teaching renal physiology for undergraduate medical students in an understandable way using methods which improve their deep learning has always been a problem. In this study, Early Clinical Exposure (ECE) was used in teaching renal physiology for the second year medical students in Shiraz Medical School. This article aims to introduce and develop this program and also measure the attitude of medical students toward ECE in learning renal physiology.
This is a mixed method study conducted on 120 second year undergraduate students. After performing the course, both qualitative and quantitative methods were used for measuring the viewpoints of the students. In the qualitative part, 10 high rank medical students were selected. These students participated in brain storming sessions to express their opinion about the program based on the strengths and weaknesses. For trustworthiness of the qualitative part, member check and peer check were done. In the quantitative part, a researcher-made questionnaire was used based on the objectives of the program in a 4 point Likert scale. The validity of questionnaire was determined by medical education experts and reliability was determined after a pilot study.
Based on the results of the quantitative part of the study, 98 percent of the students stated that the ECE program was generally a useful program. In the qualitative part, the students’ comments were obtained. The benefits of the program were summarized in 4 main themes. These themes are “understanding of renal physiology”, “Integration of basic and clinical knowledge”, “Improvement of attitude toward importance of physiology”, and “encouragement to study”. In response to the questions about negetive aspects of this program in qualitative part, the two main themes were insufficient time and large grup size.
Students reported that ECE was useful, but they stated that they needed to have more encounter with patients and more hospital teaching. The results also reveal that this ECE program is an excellent approach to strengthen learning in a difficult subject like renal physiology. This approach is adjustable to other basic science topics and subjects as well.

Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings
A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized
Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning.
A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.

Educators need to be aware of different learning styles to effectively tailor instructional strategies and methods to cater to the students’ learning needs and support a conductive learning environment. The VARK [an acronym for visual (V), aural (A), read/write (R) and kinesthetic (K)] instrument is a useful model to assess learning styles. The aim of this study was to use the VARK questionnaire to determine the learning styles of pre-clinical medical students in order to compare the perceived and assessed learning style preferences, assess gender differences in learning style preferences, and determine whether any relationships exists between awareness of learning styles and academic grades, age, gender and learning modality.
The VARK questionnaire was administered to preclinical students taking a variety of courses in the first three years of the undergraduate MB BS degree programme at the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados in 2014.
The majority of the students were multimodal learners with no differences observed between males (59.5%) and females (60.0%), with tetramodal being the most common. Read/write (33.8%) followed by kinesthetic (32.5%) were the most common learning style preferences. The sensory modality preference for females was read/write (34.2%) and for males it was kinesthetic (40.5%). Significant differences were observed between the perceived and assessed learning style preferences with a majority of visual and read/write learners correctly matching their perceived to their actual learning styles. Awareness of learning styles was associated with learning modality but not with academic performance, age or gender. Overall, 60.7% of high achievers used multimodal learning compared to 56.9% low achievers.
The findings from this study indicated that the VARK tool was useful in gathering information about different learning styles, and might assist educators in designing blended teaching strategies to cater to the students’ needs as well as help the students in becoming aware of their learning style preferences to enhance learning.

Several factors play a role in academic achievement, individual’s excellence and capability to do actions and tasks that the learner is in charge of in learning areas. The main goal of this study was to present academic achievement causal model based on the dimensions of goal orientation and learning approaches among the students of Medical Science and Dentistry courses in Guilan University of Medical Sciences in 2013.
This study is based on a cross-sectional model. The participants included 175 first and second year students of the Medical and Dentistry schools in Guilan University of Medical Sciences selected by random cluster sampling [121 persons (69%) Medical Basic Science students and 54 (30.9%) Dentistry students]. The measurement tool included the Goal Orientation Scale of Bouffard and Study Process Questionnaire of Biggs and the students’ Grade Point Average. The study data were analyzed using Pearson correlation coefficient and structural equations modeling. SPSS 14 and Amos were used to analyze the data.
The results indicated a significant relationship between goal orientation and learning strategies (P Results showed that the students’ academic achievement model fits with experimental data, so it can be used in learning principles which lead to students’ achievement in learning.

Evidence based practice (EBP) education is essential in promoting of clinical care, but an effective educational strategy for teaching EBP in nursing faculties is not available. The aim of this study was to explore the experiences of nursing students of EBP Education according to Rogers’ Diffusion of Innovation Model.
This qualitative study was carried out using a directed content analysis method and purposeful sampling. Data were collected until saturation by fourteen semi-structured face-toface individual interviews and two focus group discussions with nursing students from two nursing faculties in Tehran, Iran. Rogers’ Model was used in this study.
Data were classified into five themes and 11 categories according to the Rogers’s Model. Themes and main categories were knowledge (educational enrichment, new strategy for education), persuasion (internalization of education, improvement of motivation), decision (acceptance, use in the future), implementation (objectivity, consolidation of learning) and confirmation (learning and teaching, achieving a goal, selfconfidence).
EBP Education, based on the teaching strategy of Rogers’s Model, leads to an improved EBP learning. All the necessary steps for a better education of it are included in this educational approach which can be used to teach any new subject like EBP.

Doctors’ shortage has remained a concern worldwide. The developed countries started aids to recruit international medical graduates (IMG) to cope with the defects that the health care system suffers from; however, this solution may not work in developing countries that have a limited resource and poor budget to spend on the health care system. This study aims to present an alternative way to approach the physicians’ shortage by accelerating undergraduate medical education and reform some post-graduate courses in order to cope with this problem.
The literature in PubMed/Medline and Google scholar were searched using such keywords as undergraduate medical education, physician shortage, health care reform, physicians’ performance, medical curriculum.
The finding revealed that performance during undergraduate medical school does not have a relationship with the physician’s performance post-graduation. Moreover, the overloaded curriculum and the years spent in undergraduate education have a negative impact on the students in terms of burn out, lack of competency, and loss of motivation in medicine. The method of education was found to have a positive effect on preparing good students and ultimately good physicians.
Since performance in undergraduate years does not have an impact on the practice post-graduation, the developing countries may consider the option of changing the context, and abbreviating undergraduate medical education as a solution for physicians’ shortage dilemma. Moreover, modifying some postgraduate majors such as family physician, and general practitioner to allow the physicians enter the practice in areas of need is recommended.

Dear Editor, The relationship between the PhD supervisor and the PhD student is a complex one. When this relationship is neither effective nor efficient, it may yield negative consequences, such as academic failure (1). The intricacy of the supervisor-student relationship may be in part comparable to the one between the physician and his/her patient [see, for example (2)]. Both interactions develop over several years and the players involved in each relationship – PhD supervisor-student on the one side and physician-patient on the other side – may at some point of the journey develop different expectations of one another [see, for example (3, 4)] and experience emotional distress (5). In both relationships, the perceived satisfaction with the interaction will contribute to the success or failure of the treatment in one case, and in the other, the writing of a thesis. To improve the mentioned satisfaction, not only there is a need to invest time (6), as does the physician to his/ her patients, but also both the supervisor and the PhD student must be willing to negotiate a research path to follow that would be practical and achievable. The communication between the physician and patient is of paramount importance for the provision of health care (7), and so is the communication between the supervisor and PhD student which encourages the progression of both the research and the doctoral study (8). As to a smooth transition to the postgraduate life, supervisors should start thinking about providing the same kind of positive reinforcement that every student is used to experience in the undergraduate course. The recognition for a job well done will mean a lot for a PhD student, as it does for a patient. One good example is the increase in medication compliance by patients with high blood pressure who receive positive reinforcement from their physicians (9). Supervisors can organize regular meetings for (and with) PhD students in order to not only discuss their projects but also improve their coping skills, including critical thinking and problem-solving methods (5). The act of sharing knowledge and experiences can motivate the PhD students to persevere in their studies (10). When needed, supervisors should use their power of influence to increase the time that the student has available to devote to research while maintaining a part of their employment activities (health care‑related or not), since many PhD students are also full-time workers. Last but not least, supervisors and faculty members must encourage PhD students to pursue the available funding opportunities. Socioeconomic problems are known to be an issue for PhD students (5). Without the supervisor’s support – by dealing with PhD student’s emotions and personality –, research time, funding, and the student’s proactiviness, the doctoral journey may not attain success.