Journal of Medical Education
Volume:22 Issue: 1, Dec 2023

 Academic burnout, in addition to affecting different aspects of the students' personal lives, can have many negative impacts on their academic and family conditions.

 The present study aimed to investigate the relationships between academic burnout and hope for the future through examining the mediating role of stress in medical students.

 The statistical population of this descriptive-correlational study included all students at Ahvaz University of Medical Sciences in 2022. Multistage cluster sampling was used to select 301 students. The research instruments included the Academic Burnout Questionnaire, the Attitudes towards Education and Career Prospects Scale, and Medical Student Stressor Questionnaire. The proposed model was evaluated using structural equation modeling (SEM).

 The results showed that the direct path from hope for the future to stress was significant (P < 0.001). The indirect path from hope for the future to academic burnout was significant with the mediation of stress (P < 0.001), while the direct path from hope for the future to academic burnout was not significant.

 Stress mediated the relationship between hope for the future and academic burnout. It was also found that the proposed model had a desirable goodness of fit and may have been considered a major step in identifying the factors responsible for academic burnout in medical students. Given that stress was a central factor in academic burnout, it was suggested that policymakers should appreciate the necessity of providing the stressed students with support from family members and instructors.

Context: 

During the COVID-19 pandemic and challenges, medical education with insight toward training competent students with a global vision has highlighted the necessity of a robust approach toward sustainable development (SD) on internationalization. Inevitable transformations in medical education and its internationalization component due to the COVID-19 pandemic have not yet been investigated. Accordingly, the objective of this study was to assess the current situation and propose the operational framework of internationalization for medical education with a global vision toward SD.

Evidence Acquisition:

 A critical review was conducted on English papers extracted from Google Scholar, Scopus, PubMed, and Elsevier databases using the following search terms: Sustainable development, operational approach, educational environment, management strategies, internationalization, and COVID-19. Boolean operators were used to eliminate inappropriate hits with a focus on research goals. Ineligible studies were excluded by screening titles and abstracts. The knowledge management was applied to the related findings of the internationalization of medical education components.

 Evidence presents a new order of internationalization components of internal and external dimensions with an educational paradigm shift to virtual programs. Assessing these dimensions indicated the requirement of implementing SD. The suggested pathway should initiate from the internal institution dimensions (facilities and budget component with generating income), followed by the external institution dimensions (sociocultural element and nation-building).

 The COVID-19 pandemic has forced educational institutions to shift to virtual education. The designed framework highlights educational activities toward virtual education and earning income, empowering faculties, and meeting social needs in medical education to achieve SD.

Context: 

Critical thinking (CT) has been recognized as a key learning outcome in health profession education (HPE). A holistic, well-defined process for initiating CT is essential to promote critical problem-solving in HPE students. Various perceptions of CT have emerged from different paradigms and disciplines. Integration of this variability into the CT process could be beneficial for medical educators to develop CT in learners. This study aimed to outline the CT process in view of the multiple conceptualizations of CT.

Evidence Acquisition: 

In this narrative review, SID, Google Scholar, and PubMed databases were searched. After studying 35 selected articles, the CT process was formulated based on the multiple conceptualizations of CT.

 Multiple perceptions of CT, emerged from disciplines and paradigms, should be incorporated into the CT process to achieve strong CT. In view of this multiplicity, not only the CT skills but also its dispositions are of key importance in the CT process. Furthermore, the essential role of the context in which the CT takes place, one’s own creativity, metacognition over the thinking process, social construction of meaning, caring to others, and seeking problems through challenging the systems should be considered.

 We outlined the CT process, grounded from multiple conceptualizations of CT, and advocated for the use of it by HPE students to promote critical problem-solving in facing complex challenges during their professional careers.

 Many educators have developed an interest in an emerging new concept called entertainment education (edutainment). Edutainment is a kind of tool that, in this age of technology, can be easily incorporated into education.

 This study aimed to use edutainment for teaching orthodontic lateral cephalometric and dental cast analysis as well as to evaluate the dental students’ attitudes towards it.

 In this cross-sectional study, the multimedia-enhanced with edutainment was designed using Articulate Storyline version 3.5. To evaluate the students’ attitudes, 52 ninth-semester dental students doing their second semester in 2019 - 2020 were included in the study. Then they were asked to complete a standard questionnaire with a 7-point Likert scale from strongly disagree to strongly agree and including 26 items in eight domains of perceived self-efficacy, perceived satisfaction, understanding usefulness, behavioral concept, e-learning system quality, interactive learning activities, e-learning effectiveness, and multimedia instructions. Data were analyzed and expressed using independent sample t-test, one-way ANOVA, and descriptive statistics.

 The majority of the students had positive attitudes towards the areas of perceived self-efficacy (83.3%), perceived satisfaction (90.4%), perceived usefulness (96.8%), behavioral intention (91.7%), e-learning system quality (75%), interactive learning activities (73.1%), e-learning effectiveness (88.5%), and multimedia education (85.3%).

 In sum, the students’ attitudes towards learning were positively and significantly influenced by the designed educational multimedia enhanced with edutainments to teach lateral cephalometric analysis in orthodontics. It was found that the application of edutainment as an educational tool together with traditional training may have been an effective method for teaching and, therefore, it was recommended that edutainment should be used as an alternative to traditional methods during crises such as the COVID-19 pandemic.

Context: 

Universities are among the best places to foster innovation and provide services, as they are in close contact with clients. In order to offer the best possible services, they need to be innovative in their respective fields. Service innovation is widely recognized as one of the three strategic research priorities of service institutions. Given the vast number and types of services available, various models are adopted to achieve this goal.

Evidence Acquisition: 

This article aims to provide a critical review of the available service innovation models and propose a comprehensive service innovation model. To achieve this objective, relevant keywords were used to conduct a literature search in databases. Initially, 1504 studies were obtained, and after a screening process, only 10 studies that were most relevant to the study's purpose were selected.

 The model proposed in this study is an integrated form of service innovation models, encompassing the process, dimensions, required infrastructures, capabilities, and the types and outcomes of service innovation, which are discussed separately in other models.

 Service innovation is a complex and resource-intensive activity with potential long-term benefits for firms in both service and manufacturing industries. If a service company aims to establish a more sustainable strategic position based on innovation, it should examine its management process for physical, organizational, and intellectual resources.

 Health professionals should receive lifelong education to maintain competency in medication administration and ensure safe medical practice. Game-based education is one way to enhance and ensure health professionals’ medication competency.

 This study aimed to describe registered nurses’ experiences of the Imagine 3D game and their views of the effectiveness of this game-based education program in improving their medication competency.

 This qualitative interview study included eight registered nurses who completed an education program based on the 3D game Imagine, which aims to strengthen medication administration competency. Data were collected via semi-structured interviews between March and April 2019 and analyzed using content analysis.

 Three themes were extracted from the study with the following concepts: (1) experiences of playing; (2) the usability of the game in verifying nurses’ medication competency; and (3) the game’s effectiveness in fostering registered nurses’ medical competency. On analyzing the nurses’ personal experiences, the game-based education program was valuable in training nurses to enhance their medication administration competency. Participants reported that the game was comfortable to play and useful in repeated medication administration tasks, and it increased their self-reflection and even changed their actions based on learning. The nurses reported that the game was most beneficial to nursing students and recent graduates and was used especially during the introductory period. Moreover, based on the interviews, the game was also useful in continuing education; therefore, it should be applied in all healthcare professionals’ training.

 This study shows that a 3D computer game can be useful for nurses to foster their knowledge and expertise in medication administration tasks.

 Teaching undergraduate medical students clinical skills in a child health setting is a particular challenge for clinical educators. Students spend less time with pediatric patients and have fewer opportunities to practice clinical skills. The coronavirus (COVID-19) pandemic further reduced students’ opportunities to observe and practice skills in the workplace. This has necessitated a greater shift towards teaching skills in a "skills lab" setting, which allows for simulated practice in a safe environment. This study reports the design, implementation, and evaluation of a standardized course that utilizes the "skills lab" to train undergraduate medical students in five clinical skills important to child health.

 This study aimed to implement and evaluate a standardized undergraduate clinical skills course for child health and improve students' confidence in performing child health clinical skills.

 Evaluations were carried out over approximately one academic year, with a total of 174 participants from a single medical school in the United Kingdom. Qualitative and quantitative data were collected, examining students' self-reported confidence (pre- and post-course) along with free-text course evaluations. A paired t-test was used to calculate the mean difference in students' pre- and post-course confidence scores. Qualitative evaluations were analyzed for themes using framework analysis.

 The students had greater confidence in all measured learning outcomes following the course. Qualitative data, examined using framework analysis, suggested that the course was valued by students, who felt it was relevant to their future practice. Numerous written comments suggested particular content and teaching methods that were strengths of the course, including practical elements, small group teaching, and feedback from tutors.

 Implementing a child health clinical skills course in a skills lab setting is feasible and valued by students. The course increased the self-reported confidence of the studied cohort and might therefore support them in practicing these skills with actual patients. Further studies are required to determine whether these effects demonstrate longevity and whether they translate to increased competence in performing the taught skills.

Clinical education is a vital component of physician education, where medical students learn by attending to patients and applying their knowledge and reasoning to solve their problems. However, many medical students struggle to acquire procedural skills, the ultimate goal of clinical education. Procedural skills are expected to be learned by the residents according to their academic year and are essential for providing better health services to children and families.

This study evaluates the status of the training provided and the level of learning the necessary procedural skills in pediatric residents based on standards.

This research was a descriptive cross-sectional method from 1998 to 99. In the first part of the researcher-made questionnaire, the implementation of the educational program on all pediatric residents (115) of Mofid Children's Hospital was evaluated. In the second part, the residents' views on the current state of their learning of essential procedural skills were determined.

All residents from years one to four participated in the study. After assessing the status of skills acquired by residents with a questionnaire and comparing the average of each skill acquisition procedure with the desired standards, the average of all skills in all three methods was under the standards approved by the Ministry of Health, except for independent subcutaneous, intramuscular and intravenous injection skills and the skill of working with a ventilator. Also, according to the Friedman test, the lowest score for gaining skills in performing procedures was related to NG tube placement skills and subcutaneous, intramuscular, and intravenous injection skills. According to the statistical results obtained from the Spearman coefficient in all procedures, the level of subcutaneous, intramuscular, and intravenous injection skills had a significant correlation with independent skills.

According to the specialized assistants of children participating in this study, the current training program of essential procedural skills implemented at Shahid Beheshti University of Medical Sciences was generally useful and effective. But there were also obstacles and limitations. Therefore, it is recommended to review the implementation of the training programs and implement effective measures, including providing more exposure conditions for independent procedures.

The growing interest in artificial intelligence (AI) has spurred an increase in the availability of Large Language Models (LLMs) in surgical education. These LLMs hold the potential to augment medical curricula for future healthcare professionals, facilitating engagement in remote learning experiences, and assisting in personalised student feedback.

To evaluate the ability of LLMs to assist junior doctors in providing advice for common ward-based surgical scenarios with increasing complexity.

Utilising an instrumental case study approach, this study explored the potential of LLMs by comparing the responses of the ChatGPT-4, BingAI and BARD. LLMs were prompted by 3 common ward-based surgical scenarios and tasked with assisting junior doctors in clinical decision-making. The outputs were assessed by a panel of two senior surgeons with extensive experience in AI and education, qualitatively utilising a Likert scale on their accuracy, safety, and effectiveness to determine their viability as a synergistic tool in surgical education. A quantitative assessment of their reliability and readability was conducted using the DISCERN score and a set of reading scores, including the Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Coleman-Liau index.

BARD proved superior in readability, with Flesch Reading Ease Score 50.13 (± 5.00), Flesch-Kincaid Grade Level 9.33 (± 0.76), and Coleman-Liau index 11.67 (± 0.58). ChatGPT-4 outperformed BARD and BingAI, with the highest DISCERN score of 71.7 (± 2.52). Using a Likert scale-based framework, the surgical expert panel further affirmed that the advice provided by the ChatGPT-4 was suitable and safe for first-year interns and residents. A t-test showed statistical significance in reliability among all three AIs (P < 0.05) and readability only between the ChatGPT-4 and BARD. This study underscores the potential for LLM integration in surgical education, particularly ChatGPT, in the provision of reliable and accurate information.

This study highlighted the potential of LLM, specifically ChatGPT-4, as a valuable educational resource for junior doctors. The findings are limited by the potential of non-generalizability of the use of junior doctors' simulated scenarios. Future work should aim to optimise learning experiences and better support surgical trainees. Particular attention should be paid to addressing the longitudinal impact of LLMs, refining AI models, validating AI content, and exploring technological amalgamations for improved outcomes.

 Learning clinical skills on “real patients” not only endangers patient safety but also raises many ethical concerns.

 This is a qualitative study designed and implemented using the content analysis method. The studied population included all midwifery students of Ahvaz Jundishapur University of Medical Sciences who had recently passed the course: “Introduction to the Principles and Techniques of Patient Care at Clinical Skill Centers (CSC)”. Data were analyzed by conventional content analysis method.

 Overall, 156 codes were extracted from the research data, which were organized into 9 categories and 28 subcategories after removing or merging similar codes. The midwifery students’ experience of attending CSC was reflected in the form of three main themes (i.e., self-regulation, mentoring, and support management) and nine sub-themes (reinforcing intrinsic motivation in students, building self-confidence in students, mentor as a model, proper formulation and implementation of rules in CSC, training communication skills, the need to apply modern training methods, revising the structure, practice, and schedule of student groups).

 According to the findings of the present study, it could be concluded that primary education in CSC plays a very important role in reducing the stress of working with patients, professionalism, increasing self-confidence, and teaching clinical skills to students. Of course, achievement of this goal heavily relies on the crucial role of teachers of this course, who act as mentors responsible for planning, organizing, and modeling in addition to teaching.

 The utilization of effective educational methods is crucial for enhancing the clinical skills of health sciences students.

 This study aimed to assess the impact of a blended teaching approach involving videos and demonstrations in clinical skills training on midwifery students’ performance and satisfaction.

 This quasi-experimental study was carried out with 41 midwifery students from Hamadan University of Medical Sciences, Hamadan, Iran, using a census sampling method within 2018 to 2019. The experimental group received training through a combination of video presentations and demonstrations; nevertheless, the control group received training solely through demonstrations. The data were collected using a demographic questionnaire, a satisfaction scale, and the objective structured clinical examination (OSCE). Data analysis was performed using the Mann-Whitney U test and chi-square test with SPSS software (version 16).

 The experimental group exhibited significantly higher mean scores in vital signs assessment, intravenous therapy, injection techniques, urinary catheterization, application and removal of sterile gloves, and prepping and draping for normal delivery (P < 0.001). There were no significant differences in the mean scores for hand washing (P = 0.380) and oxygen therapy (P = 0.604) between the two groups. The combined group achieved notably better scores in the OSCE, with scores of 18.25 (1.58) compared to 16.60 (1.60) in the control group (P = 0.002). Additionally, the combined group expressed higher satisfaction with the training method, scoring 86.10 (9.50) compared to 75.52 (16.07) in the control group (P = 0.027). Moreover, the combined group reported significantly higher levels of satisfaction regarding the facilitation of educational content transfer and overall satisfaction with the training course (P < 0.05).

 Employing instructional videos and demonstrations as a combined teaching method for basic clinical skills training results in improved student performance and satisfaction.

 The identification of the factors influencing the academic progress and performance of students can be a suitable basis for planning and developing educational programs to achieve the best possible results in line with educational development.

 The present study aimed to investigate the mediating role of stress in the relationship of mindfulness and self-construal with the academic performance of medical sciences students.

 This was a descriptive correlational study in which the convenience sampling method was used to select 301 medical students from Jondishapur University of Ahvaz, Iran, in 2022. The participants completed the mindfulness, self-construal, and stress questionnaires. In addition, academic performance was measured based on the grade point average (GPA) in the previous semester. Structural equation modeling (SEM) and bootstrapping were also employed to examine the fit of the proposed model and indirect relationships between the variables, respectively.

 The mean of academic performance, mindfulness, self-construal, and stress were obtained as 16.57, 57.6, 140.53, and 29.72, respectively. The results showed a significant relationship between all research variables (P < 0.05) except for the relationship between mindfulness and academic performance. The results also indicated that stress was a mediator in the indirect relationship of mindfulness and self-construal with academic performance (P < 0.001). The fit indices of the Tucker–Lewis index (TLI), comparative fit index (CFI), relative fit index (RFI), normed fit index (NFI), and Root Mean Square Error of Approximation (RMSEA) in the final model were 0.94, 0.96, 0.92, 0.94, and 0.077, respectively.

 The results confirmed the proposed model’s goodness of fit. Therefore, this model can be used for identifying the factors affecting the academic performance of medical students and developing programs to prevent academic failure and stress among these students.

 The coronavirus disease 2019 (COVID-19) pandemic has negatively influenced several aspects of medical education (ME).

 We aimed to assess the perception of emergency medicine (EM) residents of COVID-19 impacts on the quality of ME and their wellness.

 This descriptive study was conducted in Tehran, Iran. A questionnaire consisting of 33 questions (5 on hospital experience, 5 on clinical experience, 12 on education, and 11 on wellness) and 1 open-ended question were designed based on the elements found in the existing literature. Face and content validity were determined by an expert panel. The baseline and demographic data were recorded, and the viewpoints of EM residents about different items in the questionnaire (ME and wellness) were evaluated.

 The mean age of residents was 36.4 ± 7.3 years, and 64.8% and 71.8% of the participants were female and married, respectively. Most residents (81.7%) had a previous history of COVID-19 infection (mainly mild and outpatient). We observed that 90.1% of the residents had concerns about transmitting the virus to their families. Most residents agreed on the negative impacts of COVID-19 on the EM residency program and routine clinical care in hospitals. COVID-19 led to a decrease in the diversity of other diseases and bedside learning opportunities. They added that virtual learning and online programs were comfortable and flexible despite some unpleasant outcomes. EM residents experienced anxiety and stress due to the change in physical and social activities and sleep habits during the COVID-19 pandemic.

 EM residents declared that despite the positive attitudes developed after the pandemic, COVID-19 had non-negligible and negative effects on ME. They were also exposed to greater anxiety and worriedness during the mentioned period.

Anatomy embraces various fields and is regarded as the foundation of medical sciences due to its broad clinical applications, particularly in surgery. However, teaching this subject, particularly in practical units, poses challenges, and insufficient anatomical knowledge and errors in anatomy-related decisions by physicians can lead to avoidable deaths and medical errors. This study aimed to design and develop an electronic moulage (EM) for teaching upper limb anatomy, specifically focusing on the muscles and brachial plexus (BP).

This was a quasi-experimental study with a pre-test-post-test design. Electronic moulage has been implemented in a manner that allows independent structures within a compartment to be taught without the presence of a teacher or anatomical atlases and enables learners to comprehend the anatomical features and relationships of structures in both combined and isolated modes, even without prior knowledge of anatomical theory specific to that compartment. The EM incorporates a skeletal compartment system and a BP component, utilizing audio and visual systems to deliver a comprehensive educational experience. The effectiveness of the EM was evaluated by experts in anatomy and medical science students, comparing it to other teaching methods. Four groups of undergraduate medical radiology students with no prior instruction in upper limb anatomy participated in the study. Each group was assigned to a different training method, including lecture-based education, digital-based education with a simulator, cadaver-based education, and EM-based education.

After assessing the results using educational and motivational indicators, it was determined that the EM demonstrated innovative potential and could enhance motivation and the quality of anatomy education. Comparing the post-test scores of the EM-based education group to the other groups revealed significantly higher scores in the EM-based group. This finding indicates that the EM has the potential to improve the effectiveness and efficiency of anatomy education, addressing the limitations of other teaching methods.

The developed EM presents a promising solution for enhancing anatomy education, particularly in the context of upper limb anatomy. The innovative features of EM and its ability to improve motivation and learning outcomes make it a valuable tool for teaching this subject matter.

With the rapid development of healthcare, traditional teaching has been unable to meet the learning needs of hospital staff training, which has led to talent development. With the development of Internet technology, blended learning seems to be a new available choice to solve the current predicament. However, the effectiveness of blended learning is still controversial. In addition, most studies have primarily evaluated the teaching effect unilaterally.

The purpose of this study was to apply a meta-synthesis approach to synthesize research on blended learning models for talent development in healthcare settings. By examining a body of evidence from peer-reviewed studies, the authors aimed to identify common elements of effective blended learning models applied to hospital employee training. This synthesis provided a foundation for developing a comprehensive blended learning model tailored to the specific needs of hospital employees.

In this study, the meta-synthesis approach was used to synthesize qualitative evidence in relation to blended learning factors in talent development. A comprehensive search strategy was used to retrieve articles from ScienceDirect, Emerald, PubMed, Web of Science, and Scopus within 1990 to 2023. To find additional studies, the bibliographic search of included studies and review articles and a random search in Google Scholar, Research Gate, and Google were carried out. A total of 751 studies were identified. After reviewing the full text of the articles, 89 studies were selected. This review evaluated studies that explained blended learning and talent development among healthcare employees. Eighty-six studies were selected and included in the meta-synthesis process after critical appraisal using the Critical Appraisal Skills Program.

The findings consisted of the model’s dimensions, components, and indices. The five identified dimensions include specifying learning needs, learning campaign elements, learning proposal, content strategy, and facilitation model consisting of 22 components and 76 indices.

The identification and application of the obtained components will allow the policymakers and managers of the health system field to replace the traditional training of employees with blended learning, culminating in employee talent development.

It is becoming harder and harder to persuade talented medical students to choose carers in any of the medical specialties. According to studies, the majority of medical students make their final career decisions while still in college. Various student and institution-related aspects are crucial to the decision on specialization. Gender, age, marital status, prestige influence, surgical mentors, career potential, intellectual challenge, and clerkship experience are among the variables recognized as having a major impact on the decision to choose surgery as a career.

The data were collected through an online self-administered questionnaire. The study is a questionnaire-based cross-sectional study. The target population of this study included medical students in the fourth year and above from Saudi Arabia.

This study was conducted in Saudi Arabia with 835 participants, of whom 62.4% and 37.6% were female and male, respectively. The majority of respondents (83.2%) fell within the age range of 18 - 25 years. The largest representation of participants came from the western region (29.7%), followed by the southern region (27.4%). Regarding career aspirations, 60.5% were willing to pursue a career in surgery; however, 39.5% expressed a negative inclination. Among medical students, general surgery students showed no significant change in attitudes before and after a surgical clerkship; nevertheless, other specialties remained largely unaffected. Factors influencing the choice of a surgical career included lifestyle concerns, perception of working hours, prestige, manual activity, intellectual challenge, research opportunities, work-life balance, financial considerations, and patient perception.

This study indicated that a significant percentage of participants expressed a positive inclination toward pursuing a career in surgery. However, a surgical clerkship did not significantly influence the attitudes of medical students toward general surgery or other specialties. Factors such as lifestyle concerns, working hours, prestige, intellectual challenge, and financial considerations played crucial roles in shaping career choices among medical students.

The integration of educational games has significantly transformed pedagogical approaches, emphasizing the importance of constantly updating educational programs. High-quality games motivate students and foster engagement, surpassing traditional methods. Addressing this need, this protocol study aimed to provide practical instruction on developing a memory game. Educational memory games have been found to enhance intrinsic motivation in learners and are particularly beneficial for clinical subjects. The design of memory games involves three components: Pedagogical level, design level, and modeling of learning content. Adjusting elements, such as the number and nature of items, time limits, feedback mechanisms, and task difficulty, can fine-tune the effectiveness of a memory game. The memory game consists of 2 main components: Learning and scoring, and it is designed using Articulate Storyline software. The learning phase focuses on mastering correct methods; however, the scoring phase evaluates learning retention and comprehension. Memory games can be adapted to different formats supported by educational websites and learning management systems. They are an effective tool for enhancing cognitive development and memory retention; however, it is important to consider the audience’s age, learning goals, genre, and assessment approaches when determining the ideal content level. Memory games can be used to identify learning challenges, promote active student engagement and collaboration, and improve learning outcomes. Educators must continually evolve their methods to resonate with new generations of learners, and success in implementing memory games depends on considering lesson characteristics, student needs, and instructor expertise.