Search Results (36)

Introduction: The escalating scarcity of skilled healthcare professionals is particularly pronounced within surgical specialties, where the prospect of attracting prospective medical practitioners poses formidable challenges. Throughout their academic journey, students exhibit diminishing enthusiasm and motivation to pursue careers in surgery, including trauma surgery. It is postulated that the caliber of teaching plays a pivotal role in influencing students’ subsequent specialization choices. Methods: This prospective observational study was conducted among a cohort of third-year medical students at the German University Medicine Greifswald. The methodology encompassed the utilization of a self-administered questionnaire to procure data. Results: The study encompassed 177 participants, of whom 34.7% expressed an inclination toward a career in surgery (22.7% in trauma surgery). Participants who reported a favorable impact from the examination course displayed a significantly heightened interest in clinical clerkships within trauma surgery (p < 0.001), and even expressed a contemplation of specializing in orthopedics and trauma surgery (p = 0.001). Logistic regression analysis highlighted that the convergence of practical training and positive role modeling emerged as the most influential factors augmenting the allure of trauma surgery. Conclusions: Evidently, students who gleaned substantial benefits from high-quality practical instruction in trauma surgery exhibited a significantly heightened likelihood of pursuing this domain in their future endeavors. Surgical academic institutions stand to leverage this insight in their strategic planning for attracting and retaining potential residents. Cultivating a positive affinity for trauma surgery should be instilled early in the curriculum, subsequently sustained through ongoing immersive engagement that encompasses professional as well as interpersonal dimensions. Full article

Background: Nasogastric tube (NGT) intubation is a critical skill, but it comes with the blind nature of the procedure and its high failure rates. Resources restrict access to traditional training methods, such as simulations based on manikins. We developed a mobile-based application, the Mobile-based Hands-on Learning System for Nasogastric Tube Intubation (MoHoNGT), to enhance undergraduate medical students’ training in this essential procedure. Methods: This open-label, randomized controlled trial was conducted in a medical center between August and October 2020, with medical students expected to enter their clerkships. The MoHoNGT and control group were exposed to the traditional training course and a self-learning period. The MoHoNGT group received additional access to MoHoNGT. Training effectiveness was evaluated by measuring knowledge, self-confidence, and performance on an objective structured clinical examination (OSCE). Statistical analyses included descriptive statistics, chi-square tests, and t-tests. Results: Seventy-three medical students were recruited. Thirty-two were allocated to the MoHoNGT group. No between-group differences were observed regarding demographic data. Post-intervention results indicated that the MoHoNGT group revealed more pronounced improvements in both NGT intubation knowledge (38.75 vs. 21.46, p < 0.001) and the confidence scale (8.50 vs. 5.17, p = 0.04). Post-study scores for NGT intubation knowledge were also higher in the MoHoNGT group (69.06 vs. 49.02, p < 0.001). Additionally, participants in the MoHoNGT group demonstrated superior performance on the OSCE (98.81 vs. 91.18, p = 0.003). Conclusions: Employing MoHoNGT with traditional training methods significantly enhanced the knowledge, self-confidence, and skills in NGT intubation among undergraduate medical students. This approach addresses various limitations of conventional techniques, suggesting that mobile-based learning could be a potential strategy for medical education. Full article

(1) Background: Exposure to blood carries the risk of transmission of many infectious diseases. Healthcare workers (HCWs), including hospital-based medical students, face high and often under-reported rates of exposure to needlestick and sharps injuries. Previous studies have shown that students’ knowledge of infection control varies, highlighting the importance of pre-placement training. This study aims to assess knowledge, attitudes and practices regarding these risks in a population of medical students from Albania. (2) Methods: A validated questionnaire was administered to 134 medical students in an Italian hospital in May 2023. It assessed HBV vaccination status, adherence to infection control practices, knowledge of pathogen transmission, exposure incidents and attitudes towards infected patients. Three additional questions addressed air-borne transmission of tuberculosis and vaccination recommendations for healthcare workers. (3) Results: Most students (64%) reported being aware of occupational exposure risks. While 93% and 87%, respectively, recognised HIV and HBV as blood-borne pathogens, fewer recognised Treponema pallidum (44%). Awareness of post-exposure prophylaxis for HIV was high (85%), but although 75% reported having received training, only 45% felt it was adequate. Statistical analysis revealed an association between knowledge of infection control, awareness of pathogen transmission and understanding of the importance of vaccination. (4) Conclusions: Our study highlights gaps in medical students’ knowledge of occupational infections and highlights the need for improved pre-clerkship education. Improved education could reduce anxiety, ethical issues and misconceptions and promote safer healthcare practices. Full article

Transitioning from being a student to becoming a professional is challenging even though medical education provides periods of clinical practice and clerkships to support the transfer between university and the future work as a doctor. Using an ethnographic approach, we investigated how medical students navigated their clerkship in psychiatry. We applied the concepts from situated learning in the analysis of students’ navigation of discrepancies between course requirements and clerkship routines. The analysis shows different ways of navigating the clerkship, which all beget a parallel practice embedded in the clinical setting, where students choose to engage in tasks that directly prepare them for the university exam. The parallel practice is counterproductive for the student’s development of a professional identity, which is an important element of transitioning from being a student to becoming a medical doctor. Therefore, it is imperative to consider, if this undermines the university’s ambition of delivering doctors prepared for clinical practice. Full article

(1) Background: Medical graduates who have undertaken longitudinal rural training have consistently been found to be more likely to become rural doctors and work in primary care settings. A limitation of such findings is the heterogeneous nature of rural medical education and contested views of what constitutes ‘rurality’, especially as it is often reported as a binary concept (rural compared to metropolitan). To address the identified gaps in workforce outcomes for rural medical training and to demonstrate accountability to the communities we serve, we investigated whether Longitudinal Integrated Clerkship (LIC) graduates are practicing in communities with similar rural classification to those where they trained. Within an LIC, students learn the curriculum in an integrated, simultaneous manner. (2) Material and Methods: A retrospective cohort study analysing variables associated with working in smaller rural communities. (3) Results: LIC graduates who undertook an additional year of rural training were five times more likely to work in communities of similar rurality to the program’s training footprint. (4) Conclusions: The duration of rural training alone did not lead to optimal rural workforce outcomes. However, graduates who had trained in a combination of rural settings, an LIC, and block rotation were the most likely to practice in communities of similar rurality to the clerkship’s training footprint. This highlights the impact of both the training duration and setting inclusive of an LIC on fostering positive rural workforce outcomes and the need to develop innovative solutions to expand these models of training in smaller rural communities. Full article

Small-group learning is a mainstay of medical education, and group functioning can have a major influence on these learning experiences. Our objective was to explore verbal exchange patterns within small-group learning sessions and examine how different patterns related to tutor involvement, tutor expertise, and participants’ perceptions. A non-participant observer collected group interactivity data using a real-time mobile device-based system. Verbal interaction patterns were visualized and analyzed using social network analysis and correlated with participant survey data and aggregate course grades. There were 46 observations across 30 separate groups. Group interactions clustered into four patterns defined by (1) tutor involvement (high vs. low) and (2) interactivity (high vs. low). Interaction patterns were largely stable for a given group and groups with content expert facilitators were generally less interactive. Students reported objectively fewer interactive groups as more interactive and enjoyable. There were no significant intergroup differences in aggregate course grades. Paradoxically, student perceptions were not aligned with observed interactivity data, and tutor content expertise influenced group interactivity. These findings suggest the need to better manage learner expectations of small-group learning, and to explicitly reflect on and develop skills for effective collaborative learning with both faculty and students. Full article

(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

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

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

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

Suboptimal knowledge of clinical pharmacology, therapeutics, and toxicology (CPT) and poor-quality prescribing are threats to patient safety. Our previous national survey of medical faculty identified limited confidence in medical student graduates’ ability to safely prescribe, as well as an interest in a national prescribing competence assessment. Given the in-person challenges posed by the restrictions related to the COVID-19 pandemic, we aimed to re-evaluate opinions and gauge the interest in e-learning resources and assessments. Using public sources, a sampling frame of medical school leaders from all 17 Canadian medical schools, including deans, vice-deans, and program directors for clerkship, residency, and e-learning, were invited to participate in a cross-sectional survey. Survey questions were finalized after several rounds of testing, and analyses were descriptive. Of 1448 invitations, 411 (28.4%) individuals reviewed the survey, and, among them, 278 (67.6%) completed at least one survey question, with representation from all schools. While more than 90% of respondents agreed that medical students should meet a minimum standard of prescribing competence, only 17 (7.9%) could vouch for their school meeting objectives in CPT, and many had significant concerns about their own or other schools’ recent graduate prescribing abilities. Given the lack of local CPT e-curricula resources, there was strong interest in a national online course and assessment in CPT. Our national survey results suggest an ongoing inadequacy of medical trainees’ prescribing competence, and also provide a strong endorsement for both a national online CPT course and assessment during medical school. Full article

Traditional approaches to marking short-answer questions face limitations in timeliness, scalability, inter-rater reliability, and faculty time costs. Harnessing generative artificial intelligence (AI) to address some of these shortcomings is attractive. This study aims to validate the use of ChatGPT for evaluating short-answer assessments in an undergraduate medical program. Ten questions from the pre-clerkship medical curriculum were randomly chosen, and for each, six previously marked student answers were collected. These sixty answers were evaluated by ChatGPT in July 2023 under four conditions: with both a rubric and standard, with only a standard, with only a rubric, and with neither. ChatGPT displayed good Spearman correlations with a single human assessor (r = 0.6–0.7, p < 0.001) across all conditions, with the absence of a standard or rubric yielding the best correlation. Scoring differences were common (65–80%), but score adjustments of more than one point were less frequent (20–38%). Notably, the absence of a rubric resulted in systematically higher scores (p < 0.001, partial η² = 0.33). Our findings demonstrate that ChatGPT is a viable, though imperfect, assistant to human assessment, performing comparably to a single expert assessor. This study serves as a foundation for future research on AI-based assessment techniques with potential for further optimization and increased reliability. Full article

Impostor syndrome is a psychological condition that inhibits individuals’ ability to recognize their achievements such that they fear being exposed as forgers. It is common in medical students, particularly in the early stages of clerkship training while transitioning from preclinical to clinical training. This cross-sectional study assessed the prevalence and associated factors of the imposter phenomenon among medical clinical students using the Clance Impostor Phenomenon Scale (CIPS), focusing on sociodemographic characteristics, mental health status, and occurrence of the impostor phenomenon. Out of 228 undergraduate clinical-year medical students, 108 (47.4%) reported experiencing the impostor phenomenon. The results from the multivariable analysis showed that high levels of stress (adjusted odds ratio = 2.315; 95% confidence interval = 1.105–4.853), anxiety (6.462; 1.374–30.392), and depression (4.219; 1.448–12.290) were significantly associated with an increased risk of experiencing the impostor phenomenon. We found no difference between participants in the early or later years of clerkship training. The study highlights the prevalence of impostor syndrome among medical students and its link to mental health issues. Addressing this issue through education, mentorship, systemic problem solving, normalizing failure, and monitoring and treating mental health issues could help students reach and realize their full educational and professional potential. Full article

From the beginning of their clinical training, medical students demonstrate difficulties when incorporating patient perspectives. This study aimed to assess if students, after an instructional programme, increased their sensitivity towards patients’ needs and carried out bidirectional conversations. An observational study involving 109 medical students prior to their clerkships was designed. They attended a five-step training programme designed to encourage the use of communication skills (CSs) to obtain patients’ perspectives. The course developed experiential and reflective educational strategies. The students improved their use of CSs throughout three sessions, and the overall score for these patient consultations went up in the opinions of both the external observer (EO) (5; 6.6; 7.5) and the simulated patients SPs (5.3; 6.6; 7.8). Most of the students (83.9%) considered that the CSs addressed were useful for clinical practice, particularly the interviews and the feedback received by the SP and the lecturer. The programme seems to help the students use CSs that facilitate a more bidirectional conversation in a simulated learning environment. It is feasible to integrate these skills into a broader training programme. More research is needed to assess whether the results are applicable to students in real settings and whether they influence additional outcomes. Full article