فهرست مطالب

Journal of Advances in Medical Education & Professionalism
Volume:6 Issue: 4, Oct 2018

  • تاریخ انتشار: 1397/07/18
  • تعداد عناوین: 9
|
  • Ajay Halder, Ankur Joshi, Ragini Mehrotra, Bertha Rathinam, Sushruta Shrivastava Pages 147-154
     
    Introduction
    Little 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.
    Methods
    This 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.
    Results
    Ninety 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”.
    Conclusion
    The outcome objectives for a competency-based
    obstetrics and gynaecology curriculum in an Indian context were
    defined
    Keywords: Outcome, Objectives, Competency, Obstetrics, Gynecology, Curriculum
  • Vijay Kautilya Dayanindhi, Shruti Prabhat Hegde Pages 155-161
    Introduction
    In 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.
    Methods
    A 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.
    Results
    Microteaching 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.
    Conclusion
    Hence, 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 enrole
    Keywords: Microteaching, Efficacy, Usefulness, Effectiveness, Teacher training
  • Sedigheh Ebrahimi, Fatemeh Atazadeh Pages 162-167
    Introduction
    Occupational 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.
    Methods
    In 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.
    Results
    The 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.
    Conclusion
    Regarding 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 authorities
    Keywords: Burnout, Professional ethics, Medical students
  • Ali Asghar Hayat, Asieh Salehi, Javad Kojuri Pages 168-175
    Introduction
    Identification 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.
    Methods
    This 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.
    Results
    Results 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.
    Conclusion
    The results of this study showed the key role of
    motivation and positive emotions in increasing medical students’
    academic performance
    Keywords: Academic emotions, Motivation, Academic performance, Medicalstudents
  • Megan Boysen, Osborn, Alisa Wray, Wirachin Hoonpongsimanont, Bharath Chakravarthy, Jeffrey R. Suchard, Warren Wiechmann, Shannon Toohey Pages 176-180
    Introduction
    A 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.
    Methods
    We 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.
    Results
    All 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.
    Conclusion
    An 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
  • Shilpa Patrick, Kirti Vishwakarma, Vishal P. Giri, Debranjan Datta, Priyanka Kumawat, Preeti Singh, Prithpal S. Matreja Pages 181-185
    Introduction
    Pharmacology 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.
    Methods
    This 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.
    Results
    On 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.
    Conclusion
    Incorporation 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
    performance
    Keywords: Endocrine system, Pharmacology, Self-learning, Lectures, Feedback
  • Dinesh Kumar. V Pages 186-187
    Dear 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
    affiliations
    Keywords: kin authorship, publication, nepotism
  • Maria Koshy, Selvin Sundar Raj Mani, Sudha Jasmine Rajan, Ramya Iyyadurai, Sowmya Sathyendra 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 group
    discussion
    and 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.
  • Hossein Kholghipour, Ali Dehshahri, Hossein Mahmoodian Pages 190-191
    Dear 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.