Journal of Advances in Medical Education & Professionalism
Volume:7 Issue: 1, Jan 2019

Providing feedback to students is an essential component in medical education and has been shown to improve the students’ learning. The purpose of this study is to evaluate the effect of computer-based immediate feedback on the medical students’ learning in a pharmacology course. In this prospective intervention study some feedback modules in pharmacology (FMP) were prepared in two topics:the cardiovascular system (CVS) and chemotherapy, using blank templates on “Hot Potatoes” software. The FMP included MCbased questions and two versions were developed: one withfeedback (FMP-1) and the other without feedback (FMP-2). The FMP-1 module provided immediate feedback for each option the student chose. The students (n=48) were randomized by computer generated random number table to two groups A and B to receive the module in CVS, i.e., FMP-1 and FMP-2, respectively. A crossover design was adopted to expose all students to immediate feedback modules. The test scores were compared and feedback was obtained from students and faculty using a validated questionnaire. A focus group discussion was conducted to clarify the issues raised by the students. The module with immediate feedback was much better appreciated by the students than the module without feedback. The students spent more time on FMP-1 (42±7.00 minutes vs 27±12.36 minutes; p<0.001 in chemotherapy and 40±12.11 minutes vs 24±6.01 minutes; p<0.001 in CVS). However, there was no statistically significant difference in mean test scores. The qualitative data collected provided important information on the value of immediate feedback. The students believed that immediate feedback was an excellent way for self-assessment and improved their deeper understanding of content areas. They also felt that it supplemented their traditional learning habits and stimulated them to read more. The students enjoyed its nonthreatening nature. Immediate feedback improved the deeper understanding of pharmacology and its relevance to medicine for the two topics although immediate feedback did not improve test scores. Overall, immediate feedback had a positive impact on the students’ self-directed learning.

Clinical reasoning skill is the core of medical competence. Commonly used assessment methods for medical competence have limited ability to evaluate critical thinking and reasoning skills. Script Concordance Test (SCT) and Extended Matching Questions (EMQs) are the evolving tests which are considered to be valid and reliable tools for assessing clinical reasoning and judgment. We performed this pilot study to determine whether SCT and EMQs can differentiate clinical reasoning ability among urology residents, interns and medical students. This was a cross-sectional study in which an examination with 48 SCT-based items on eleven clinical scenarios and four themed EMQs with 21 items were administered to a total of 27 learners at three differing levels of experience i.e. 9 urology residents, 6 interns and 12 fifth year medical students. A non-probability convenience sampling was done. The SCTs and EMQs were developed from clinical situations representative of urological practice by 5 content experts (urologists) and assessed by a medical education expert. Learners’ responses were scored using the standard and the graduated key. A one way analysis of variance (ANOVA) was conducted to compare the mean scores across the level of experience. A p-value of <0.05 was considered statistically significant. Test reliability was estimated by Cronbach α. A focused group discussion with candidates was done to assess their perception of test. Both SCT and EMQs successfully differentiated residents from interns and students. Statistically significant difference in mean score was found for both SCT and EMQs among the 3 groups using both the standard and the graduated key. The mean scores were higher for all groups as measured by the graduated key compared to the standard key. The internal consistency (Cronbach’s α) was 0.53 and 0.6 for EMQs and SCT, respectively. Majority of the participants were satisfied with regard to time, environment, instructions provided and the content covered and nearly all felt that the test helped them in thinking process particularly clinical reasoning. Our data suggest that both SCT and EMQs are capable of discriminating between learners according to their clinical experience in urology. As there is a wide acceptability by all candidates, these tests could be used to assess and enhance clinical reasoning skills. More research is needed to prove validity of these tests.

Postgraduate medical education involves the use of online-learning tools. However, there is a paucity of data on the use of online-learning among doctors who are in their 1st and 2nd years of professional work after graduating from medical school (also known as Foundation doctors). Our aim was to explore the use of online-learning among Foundation doctors. A cross-sectional study was carried out, using convenience sampling. During one month, 66 Foundation doctors from across 2 district hospitals and 1 teaching hospital in Southeast England filled out a specially designed questionnaire. Data were collected and analyzed using Microsoft Excel™, and reported in numbers and percentages. The majority of Foundation doctors (86.4% (n=57)) reported using online-learning packages. These are the tools which consist of key information on a particular topic, and may be interactive and broken down into several smaller modules. Less than half embarked on online-learning in their 1st month of employment, with a decline in the numbers who started in the later months. Of those who reported completing online-learning packages, 57.9% (n=33) reported completing non-compulsory modules, 66.7% (n=38) reported completing a range of 0-15 modules per week, and 75.4% (n=43) completed the modules without skipping components. More Foundation doctors reported using online-learning for lifelong learning (63.6% (n=42)) and filling knowledge gaps (51.5% (n=34)) than improving their practice following a mistake (24.2% (n=16)). Additionally, onlinelearning was used less frequently than medical websites or search engines, for the aforementioned purposes. Most Foundation doctors use online-learning, but this needs to be incorporated into their postgraduate learning activities earlier in their career and directed more towards improving their clinical practice.

Lack of a clear policy for the development of health human resources has created inconsistencies. These imbalances are threats to the health system to achieve its goals. Therefore, the development of human resources through proper performance of higher education health system is an important part of the policy development process of the health sector. The present paper to introduce the methods applied for the compilation of evolution and innovation program of medical sciences training as well as the most important directions for evolution and innovation. In this study, we evaluated the methodology for designing packages of Iran’s higher education health system evolution and innovation. For this purpose, the evaluation of the policy process was conducted based on Michelle and Scott’s policy process models. This policy evaluation model starts by problem identification and definition and continue by agenda setting, policy formation, legitimation, implementation, evaluation, and policy modification, using the proper feedback. Qualitative content analysis method was used as a research method for subjective interpretation of the content of the text data. Twelve policies, 68 strategies and their translation in the health system were adopted in a comprehensive plan for higher health education. Eleven practical packages were also developed in order to implement these policies as packages for reform and innovation in medical education. These packages were organized based on the IPOCC pattern. The lack of a comprehensive look at each project or program could bring about irreparableness consequences. However, the MoHME of Iran, relying on the integration of health higher education with health care system and comprehensive method used for transformation and innovation plan in the field of health higher education could take an important step towards improving the nation’s health.

Virtual education is among the important factors improving the learning of medical students. This study aimed to explain the perceptions of faculty members towards the challenges of virtual education. The present study was carried out with a qualitative approach and using a conventional content analysis method. The participants included 28 faculty members working in Medical universities in Iran who were purposefully recruited and interviewed face to face practicing semi-structured interviews. All interviews were conducted and reviewed; then, the results were extracted. For this purpose, semantic similarities were first measured and subcategories identified. Subsequently, going through the re-review, we grouped the associated subcategories into wider categories. From the analysis of the participants’ narratives, two wide categories including organizational barriers and legalethical challenges were obtained. The organizational barriers included two subcategories of defective organizational culture and disproportionate infrastructure. The legal-ethical challenges also included subcategories of neglecting intellectual property rights and ignoring ethical actual instances in the field of virtual education. Understanding the challenges to which virtual education implementation is faced leads to their elimination which, in turn, develops the application of e-learning in the field of medical sciences. These challenges can be addressed through putting the emphasis on promoting the organizational culture of medical universities, improving the infrastructures of virtual education, and considering the legal and ethical concepts specific to virtual education.

Clinical empathy ascertains the quality of doctorpatient relationship and entails beneficial outcomes for both parties. Role-modeling is a major factor in promoting clinical empathy skills of medical students. The present study attempted to explain the importance of role-modeling in clinical empathy of medical interns. It was also intended to obtain a better and more profound understanding of the subject based on the experiences of medical interns. In this qualitative conventional content analysis, semistructured individual interviews were conducted with 14 medical interns and 6 clinical professors. The participants were selected by purposive sampling. All interviews were recorded, transcribed, and analyzed. Trustworthiness, credibility, and confirmability of the data were confirmed. Data analysis led to the emergence of a theme called rolemodeling, and two subcategories: “advertent role-modeling” and “inadvertent role-modeling”. Advertent role-modeling included “influenced by the charismatic personality of professors”, “critique of faculty members’ communicative behaviors with patients”, and “observation of the faculty members’ performance”. Inadvertent role-modeling included “crystallization of human values in communication behaviors” and “compliance with hierarchical behavior”. Role-modeling was the main theme of the present study. To improve clinical empathy skills, particular attention should be paid to role-modeling. Informing clinical professors and medical students on role-modeling, strengthening students’ empathetic behaviors by role model professors, and recruitment of professors with strong communication skills are among the recommended strategies of this study.

Medical education requires participation of various stakeholders and this contributes to power dynamics operating at multiple levels. Personality traits of an individual can affect the smooth execution of the educational programmes and eventually the professionalism of the environment. With the increased focus on leadership traits in medical education and collaboration in health care settings, I, through this commentary, would like to explore the Machiavellian power dynamics involved and how it can influence the harmony prevailing in an organization. The author has tried to review the several aspects of Machiavellianism in health care settings and describe day-to-day experiences at four levels; micro (individual), meso (departmental), macro (institutional) and mega (discipline). Introspecting on the unaddressed issues in a different light would help to gain a deeper understanding regarding work place ethics and professionalism. The reflection of day-to-day experiences in a different perspective would provide an insight regarding various issues to health professionals and help in developing ethical leadership abilities in them, which eventually promulgates professionalism. To my best knowledge, this is the first commentary to deal with the implications of Machiavellianism in different issues related to health care settings. With the increased emphasis on the leadership traits related to medical education, analysing organizational issues in various dimensions is of paramount importance.