فهرست مطالب
Journal of Advances in Medical Education & Professionalism
Volume:6 Issue: 4, Oct 2018
- تاریخ انتشار: 1397/07/18
- تعداد عناوین: 9
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Pages 147-154IntroductionLittle emphasis on standardization, less stringent
outcome measurement and resource constrains can result in
deteriorating competencies among medical graduates in a
country with rapidly increasing number of medical institutions
like India. A competency-based curriculum is where we carefully
design curricular experiences to achieve pre-identified outcomes.
In this study, we aimed to define the outcome objectives of a
competency-based undergraduate Obstetrics and Gynaecology
curriculum which is comprehensive, and is based on the present
day need of our society. These objectives can serve as the basis for
designing a suitable curriculum with aligned teaching learning
and assessment methods.MethodsThis is an observational study in which a Delphi
technique was used to identify the outcome objectives representing
competencies specific to the subject of obstetrics and gynaecology
at graduate level. The six core competencies identified by
Accreditation Council for Graduate Medical Council formed the
framework to identify these competencies. Then, a cross-sectional
countrywide survey was conducted among purposively sampled
teachers and clinical experts through a postal questionnaire to
know the relative importance of the identified outcome measures
and need for their inclusion in a contemporary outcome-based
curriculum.ResultsNinety four medical teachers and clinical experts,
belonging to institutes across the county, with demonstrable
interest and expertise in the field of medical education identified
38 outcome objectives for the curriculum. There were twenty
one “vital”, fourteen “essential”, two “desirable” and one
“optional” outcome objectives identified. There were eighteen
outcome objectives for “patient care” domain, nine for “medical
knowledge”, four for “Practice based learning and improvement”,
three for “professionalism”, two for “system based practice”, and
two for “interpersonal and communication skills”.ConclusionThe outcome objectives for a competency-based
obstetrics and gynaecology curriculum in an Indian context were
definedKeywords: Outcome, Objectives, Competency, Obstetrics, Gynecology, Curriculum -
Pages 155-161IntroductionIn spite of the fact that microteaching has been
practiced extensively in most universities, its actual efficacy
has not been studied systematically. In this study, there was an
attempt to quantify the efficacy of microteaching in inducing
behavioral change in teachers. We also aimed to determine the
perceived utility and ease of this process in teacher training,
using the feedback received from the participants. This feedback
along with efficacy can collectively predict the effectiveness of
microteaching.MethodsA prospective experimental study was designed using a
convenient sample of 30 faculty volunteers. After the institutional
ethics committee approval, the videos of pre-microteaching and
post-microteaching sessions from the 30 participants undergoing 5
sessions of microteaching were graded with a seven point teaching
competency scale and the participant’s perceived usefulness and
perceived ease of use was studied using a validated questionnaire.
Paired sample t-test was used to determine the efficacy of the study.ResultsMicroteaching showed a statistically significant
improvement among the behavior of the participants after five
sessions of microteaching. All the parameters in the scale showed
a statistically significant improvement. Though the participants
felt that this method was useful, the majority of them felt it is a
very time consuming process requiring resources.ConclusionHence, the overall effectiveness in in-service
teaching process was limited for microteaching in this current
scenario; though microteaching induced positive behaviour
change, it was time consuming and also it was difficult to arrange
a peer group to enroleKeywords: Microteaching, Efficacy, Usefulness, Effectiveness, Teacher training -
Pages 162-167IntroductionOccupational burnout is a prevalent syndrome
among medical students as well as other health professionals. It
may be an important factor contributing to professional conducts.
The aim of this study was to determine the prevalence of burnout
among medical students of Shiraz University of Medical Sciences
at clinical level and its relationship with professionalism.MethodsIn this cross-sectional study, all medical clinical
students who had spent a minimum of six months of the first
year of clinical level and who were in their final year, in 2015-16
were examined (using the census method). Data were gathered
using demographics, educational background, and the dimensions
of professionalism questionnaires and Maslach Job Burnout
Inventory. Data analysis was performed using descriptive
statistics, ANOVA and Pearson correlation test by SPSS, version
14. A p-value of <0.05 was considered statistically significant.ResultsThe total mean score of burnout was 61.37±20.44
(moderate). In this study, 54.3% of the students had low, 35.2%
moderate and 10.4% high job burnout. There was a negative
correlation between job burnout and professional ethics with
Pearson correlation test (p<0.000, r=0.23). There was no
significant relationship between the increase in academic years
and burnout.ConclusionRegarding the high prevalence of burnout and its
adverse effects among medical students, developing a workplace
assistance program and adequate facilities to help them is necessary.
Also, due to the negative correlation between professionalism
and burnout, continuous training of professional ethics should be
taken into consideration by educational authoritiesKeywords: Burnout, Professional ethics, Medical students -
Pages 168-175IntroductionIdentification of the factors that promote academic
performance is of importance in the success rate of medical students.
This study aimed to find the relationship between emotions,
motivation and academic performance of medical students.MethodsThis descriptive-correlative study was conducted
among 370 medical students in Shiraz University of Medical
Sciences using convenience sampling. Academic emotions
questionnaire (AEQ) including 75 items and college student
version of work preference inventory including 30 items were used
to collect the data. The Cronbach’s alpha for the eight types of
academic emotions ranged from 0.73 to 0.86, and for the intrinsic
and extrinsic motivation it was 0.81 and 0.87, respectively. The
data were analyzed using Pearson correlation, multiple regression,
independent t-test and one-way ANOVA through SPSS, 14.ResultsResults indicated a positive and significant correlation
between positive emotions (enjoyment, hope, pride) and students’
academic performance (r=0.37, r=0.27 and r=0.39, respectively,
with p<0.01). A negative and significant correlation was found
between negative emotions (anger, anxiety, hopelessness, shame
and boredom) with students’ academic performance (r=-0.15, r=-
0.24, r=-0.23, r=-0.215 and r=-0.21, respectively, with p<0.01).
There was a positive and significant correlation between intrinsic
and extrinsic motivation and academic performance (r=0.63, r=0.14,
with p<0.01, p<0.05, respectively). Emotions related to enjoyment,
hope, pride, hopelessness, boredom and intrinsic motivation were
shown as the key predictors of students’ academic performance.ConclusionThe results of this study showed the key role of
motivation and positive emotions in increasing medical students’
academic performanceKeywords: Academic emotions, Motivation, Academic performance, Medicalstudents -
Pages 176-180IntroductionA multiple-mini interview (MMI) is a type of
structured interview, which may assess many non-cognitive
domains in residency applicants. There are few studies on MMI
during the emergency medicine (EM) residency admissions
process in the United States. We sought to determine the strengths,
weaknesses, and acceptability of a pilot MMI for EM residency
admissions.MethodsWe piloted a five-station MMI with nine residency
applicants. Following the MMI, we surveyed all participants,
using 15 open- and closed-ended questions. Using grounded
theory analysis, we coded the responses to the post-intervention
survey to uncover the strengths and weaknesses of the MMI for
EM residency admissions.ResultsAll nine students completed the survey. A positive
theme that emerged from the survey was that the MMI was
a positive, unexpected experience (all respondents, n=9).
Candidates felt they were able to showcase unique talents,
which would not be observed during a traditional interview
(n=3). A negative theme that emerged from the survey was that
the experience was intimidating (n=3). Candidates felt that the
MMI left out important aspects of a typical interview day (n=3),
such as time for the candidate to become more familiar with
the program.ConclusionAn MMI may be a positive experience for candidates,
but may also induce more anxiety. The MMI may omit an
important piece of the interview day: an opportunity for the
applicants to familiarize themselves with the residency program.Keywords: Internship, Residency, Interview, Medical students -
Pages 181-185IntroductionPharmacology is perceived as a volatile subject as
it’s difficult to recall and recite the core of the subject. Enriching
the learning environment through incorporation of a variety of
teaching and learning strategies and methods yields enhanced
learning. Crossword puzzles provide expansion of vocabulary,
stimulate thinking capacity, boost confidence, and fasten up the
learning capacity; hence, the present study was conducted to
investigate the usefulness of crossword puzzle as an innovative
self-learning tool in pharmacology.MethodsThis prospective study was conducted among 5th
semester students of the second professional MBBS course. A total
of 139 students participated in this study and were evaluated with
formative examination and feedback questionnaire. Permission
was taken from Institutional Ethics Committee for the study.
A crossword puzzle consisting of 32 questions on endocrine
pharmacology was prepared and divided into two sections: the
across section had 17 questions and the down section contained
15 questions. The data were analyzed, using Graph Pad Software
and presented as percentage of the responses.ResultsOn average, out of 32 questions, one mark each, the
students scored 52.69% and all students responded correctly on
questions on the topic of hormonal contraceptives. 75.5% of the
students had an enjoyable experience and the majority of them
agreed that it helped them enhance their knowledge of drugs,
remember diseases and drug names, and overall learning about the
topic. They were also of the opinion that this should be inculcated
in pharmacology curriculum.ConclusionIncorporation of crossword puzzles, as an adjunct
tool, was useful as majority of the students reported that this
improved their attitude of learning, thereby improving their
performanceKeywords: Endocrine system, Pharmacology, Self-learning, Lectures, Feedback -
Pages 186-187Dear Editor With increasing emphasis on publications for
faculty recruitment, career advancement
and obtaining research grants, the issues related
to author kinship and academic nepotism have
grown significantly and these probably reflect
the inflationary growth rather than the optimal
growth warranted due to increasing research
complexity. Allesina S (1) measured the full
magnitude of nepotism in the Italian academia
and found that this pervasive problem was a
blemish that undercuts the quality of advanced
education over there. According to her, this
process of showing favouritism towards close
relatives incentivize illegal hiring practices and
guarantees their career advancement regardless
of their merit. Even though the analysis of
shared last names cannot be considered a valid
tool for measuring the diffusion of nepotism in
any organization (2), we cannot deny its sheer
existence.
An analysis of 12,772 papers published in PLOS
ONE showed that 48% of the listed co-authors did
not fulfil the criteria for authorship, as their role
was meagre or absent in drafting the manuscript
(3). If we extrapolate these data to any settings,
we could enunciate that a substantial amount of
papers hoist the name of an expert (preferably
the kin of primary investigator) belonging to an
entirely different specialty or giving an authorship
instead of mere acknowledgement. Prosperi M et
al. (4) analyzed more than 21 million MEDLINE/
PubMed-indexed papers and documented that kin
authorship is a big menace for India, Italy and
Poland. Measuring nepotism is highly unlikely
in India, owing to the facts that Indian women in
academia prefer to maintain their maiden names
and wide usage of surnames. Number of cases
involving their spouses, lovers and domestic
partners would largely go underestimated,
thereby causing the statistical models to fail.
In the past, the recruitment and promotion
mechanisms were tacit, which had measured the
educational and research qualities in an informal
manner. This, on one hand gave rise to negative
connotations regarding nepotism and, on the
other hand, led to the formation of “academic
dynasties” in Indian medical academia. Since
the evolution of “publish or perish” culture,
the hiring/promotion process was replaced by
a formal, explicit and individually measurable
index. The existing scenario can be crosssectioned
by a participant’s comment in the study
conducted by Anderson et al. (5), “You can fail
to do everything else as long as you have lots and
lots of papers.” In the process of conferring the
aggregate output or research productivity, which
is a mere ‘pseudo-halo’, accomplished researchers
or clinicians sometimes promulgate their spouses
or get involved in reciprocal co-authorship, which
is yet another version of academic nepotism. In
a latest paper, Rivera H (6) proposes a 3 step
scheme for validating the genuine collaboration
and calls for a focused evaluation of research productivity.
In summary, I wish to address the least
signified and unintended consequence of the
present day evaluation/appraisal mechanism
whereby a scholar is potentially assessed by the
number of publications he/she has. Considering
the fact that history of research in global arena
had witnessed conjoint efforts from egalitarian
couples, blanket recommendations are difficult to
be made. Nevertheless, we should not forget the
fact that academic nepotism often depresses the
health care professionals and adversely affects
their morale. I wish to conclude that academic
nepotism is yet another ethical dilemma,
which every administrator/selection committee
member needs to face and at times of making
crucial decisions (like hiring for a job) it is the
responsibility of them to uphold the legitimate
interests of the organization, more than personal
affiliationsKeywords: kin authorship, publication, nepotism -
Pages 188-189
Dear Editor, The traditional approach to medical education
has been dichotomous, with a lack of
integration between basic sciences and clinical
medicine (1). Recent reforms have called for
individualizing the learning process, integrating
knowledge with practice, and cultivating a spirit
of lifelong learning (2). Vertical integration
breaks the traditional division between clinical
and pre-clinical sciences, resulting in better
understanding and application of concepts (3).
We did an exercise to integrate basic sciences
and clinical medicine in the teaching of medical
students. After obtaining informed consent
and ethical clearance, a group of final year
undergraduate students underwent vertically
integrated, small group, problem-based training
on tuberculosis. We studied the effect of the
integration on the students’ understanding of the
subject and acceptance of this method. Students
were divided into intervention and control arms
of 10 students each, based on the medical units
in which they were posted. The control arm
underwent standard clinical teaching (lectures
and practical sessions), as per the institutional
education policy. The intervention group was
given three case scenarios which highlighted
the various presentations of tuberculosis, with
relevant questions regarding the pathogenesis,
clinical course, and management. These were
discussed in a multidisciplinary interactive
session, with input from the faculty taken from
the departments of Pathology, Microbiology and
Internal medicine. Triangulation of data from
pre- and post-test scores, focus groupdiscussionand feedback scores was done.
When compared to the mean pre-test score,
the mean post-test score in the intervention
group significantly improved (6.7 vs. 12.44, mean
difference: 5.74; 95% CI 2.71-8.95; p=0.003).
There was a significant difference in the mean
post-test scores between the intervention and
control groups (12.44 vs 7.55, mean difference:4.89; 95% CI 3.89-5.84; p<0.001). On qualitative
assessment by focus group discussion, the students
stressed on the usefulness of the session and felt
that vertical integration facilitated “integration
and application of knowledge”. They were able to
“recognize how diverse processes are inter-related”.
The problem-based approach motivated them to do
self-directed learning and facilitated formulation
of research ideas. In their own words, “The onus
of the learning was in our hands, so we learnt
better”, “I had never heard of Quantiferon gold,
but because of the session, I read that in detail”,
and “I searched Pub Med to look for articles from
India which might be more relevant”. The session
stimulated “team building” with their peers. The
small group teaching was well accepted and found
to be more useful than lectures. Overall, there was a
favorable perception regarding vertical integration.
On discussion with the faculty, aspects of greater commitment in terms of time and resources,
and cooperation among faculty members were
highlighted. The faculty was motivated to read
in greater detail to clarify the students’ queries.
Feedback scores from the students were positive,
confirming the themes which emerged from the
focus group discussion. Tuberculosis is a major
public health problem in India and it is important
for students to have a deep understanding of the
topic (4). Case-based teaching on a disease of high
prevalence has been shown to improve application
of knowledge (5). Our study has highlighted that
such sessions help the students to form cross-links
and connections, resulting in a smoother transition
into clinical practice. -
Pages 190-191Dear Editor, In pharmacy, professionalism must contain
the skills necessary to be a capable pharmacy
practitioner. It seems that pharmacy students
do not become professionals after graduation
from the pharmacy school. To be a professional
pharmacist, students should have a lifelong
commitment to the society and patients.
Evolving professional knowledge, attitudes
and behaviors is a critical step in providing
high quality patient care (1). In the last previous
years, pharmacy practice has changed from drug
prescription to patient-centered communication
and more stress on pharmacists’ accountability
for the best treatment outcomes. Thus,
pharmacists are accountable for providing good
health care facilities. In this regard, pharmacists
should cooperate well with other health care
professionals and patients (2).
An important component of professionalism
in pharmacy is ethics education (3). The necessity
of ethics education in pharmacy highlights
the significance of ethical considerations
by pharmacists (2). The significant service
delivered by pharmacists in Iran is responding
the patients’ questions. Therefore, pharmacists
must be up to date with ethical issues and apply
the best ethical responses to different patients’
problems (2). In Shiraz University of Medical
Sciences, the medical ethics department is
responsible for ethics education for all medical
and paramedical students including pharmacy
students. This education consists of one week
workshop including important issues in pharmacy
ethics. This is a part of core pharmacy education
curriculum and all of the students should
participate in this course.
In order to measure the students’ knowledge
about ethics in pharmacy education, we
conducted a survey with an 18 item valid and
reliable questionnaire containing three major
domains: truthfulness, professional commitment,
respect for patients’ rights and confidentiality of
patients’ information). 162 pharmacy students
in 7 to 12 semesters in Shiraz pharmacy school
were selected through simple random sampling
method. All of the students filled out the
questionnaire based on a 5 point Likert scale.
The results showed that 14 (8.6%) students had
a moderate level of knowledge, 68 (42%) had a
good level of knowledge, and 80 (49.4%) had
a very good level of knowledge. There was no
significant relationship between gender and
level of knowledge. There was a significant relationship between the level of knowledge and
educational semester. Senior students had higher
knowledge. The best results were in the domain
of respect for patients’ right and confidentiality of
patients’ information. These results showed that
students had an acceptable level of knowledge,
especially in the field that is necessary for their
future profession (patients’ right and patients’
confidentiality). Pharmacy students should
establish good relationships with each other,
patients, and other health care professionals.
Therefore, a professional behavior should be
encouraged more than focusing on knowledge. In
this study, it was not possible to follow the students
in future years to measure their professional
behavior, but it is recommended for future
studies. However, it seems that this knowledge
will not necessarily change to improvement in
practice in pharmacist because pharmacy is not a
science of pure knowledge. The closer integration
of knowledge and practice named “practice-based
knowledge” is an important area that is essential
to be considered by pharmacists (4).
Pharmacy students must remain up to date
with changes in their profession, which may
contain new practice guidelines, new pharmacy
and therapeutic products, and new technologies.
In order to improve the students’ professional
behavior, they should participate in community
services, volunteering programs, (serving and
helping others), health education services and
local health care organizations. After graduation,
participation in Continuing Professional
Development instead of Continuing Pharmacy
Education is necessary to maintain the knowledge
and behavior in this field. In Continuing
Professional Development, learning occurs
in lifetime and continues after the classroom
in everyday practice (5). Excellence should
be considered not only in the undergraduate
pharmacy education, but also after graduation
training, and during practice. Finally, it should be
mentioned that pharmacy students must remain
knowledgeable and pursue guidance to achieve
the goal of excellence in professional ethics.