Journal of Advances in Medical Education & Professionalism
Volume:7 Issue: 2, Apr 2019

Increased faculty and resident responsibilities have led to the decreased time available for teaching clinical skills to medical students. Numerous advances in education and simulation have attempted to obviate this problem; however, documented success is lacking. Our objective was to describe a novel fresh cadaver-based, student-driven procedural skills lab and to compare the educational effectiveness of student instructors to the senior instructor (SI). This was a prospective study performed at an academic medical center. A pilot program, “Students Teaching Students,” was introduced where four trained first-year medical students (TMS) instructed 41 other untrained first-year medical students in technical procedures. This study compared the teaching evaluations of the SI with the TMS teaching equivalent procedures. Paired t-test was used to determine statistically significant changes in procedural confidence between pre- and post-training. Utilizing a post-training questionnaire, average post-training confidence improvement values and objective post-training test scores of the participants were compared between TMS and SI, using a 2 sample t-test. Statistical significance was considered as a p<0.05. All statistical analyses were conducted in Stata 11 (StataCorp LP, College Station, TX, USA). Twenty-nine out of 39 (74%) students completed the questionnaire. Both groups demonstrated a statistically significant improvement in subjective confidence level in performing each procedure when pre- and post-training scores were compared, while there was no statistically significant difference found in cognitive knowledge between the groups (p=0.73). There was no statistically significant difference in the mean confidence improvement between the SI and TMS groups for chest tube insertion (2.06 versus 1.92 respectively, p=0.587), femoral line placement (2.00 versus 1.94 respectively, p=0.734) or student test score (88% versus 85% respectively). Our results demonstrate that first-year medical students well-trained in technical skills, such as our TMS, may be a valuable additional teaching resource. The Students Teaching Students procedure lab employed in this study was effective at immediately increasing first-year medical students’ confidence and technical skill. First-year medical students well-trained in technical skills, such as our TMS, may be a valuable additional teaching resource.

Directly observed procedural skills (DOPS) is aunique method for assessment since it tests the trainee’s abilityto apply his knowledge and skills in performing a particularprocedure and provides an assessment of the practical workperformed by the trainee on a ‘real’ patient under supervisionof an experienced faculty. The study aims to make use of DOPSrating for assessment and further improvement in proceduralskills in interns in Ophthalmology rotational posting. A prospective study was planned and 15 interns on 2weeks’ rotational posting in the department of Ophthalmologywere included by purposive sampling over a duration of 2months. Four clinical procedural skills were identified and in thesecond week of posting, the interns were assessed by three DOPSencounters at an interval of 2 days for each clinical skill. TheDOPS ratings were analyzed quantitatively using R-statisticalsoftware by repeated measure ANOVA and Banfuroni test. A total of 180 DOPS were undertaken for 15 internsin 4 core areas of ophthalmic examination. The mean overallDOPS rating for DOPS-1 was 3.70±0.82, DOPS-2, 3.83±1.82and DOPS-3, 4.93±1.65; the difference in DOPS rating betweenthe first and second encounter was not statistically significant(p=0.497), between the second and the third and between the firstand the third were statistically significant (p=0.000 in both cases)using Banfuroni test. The overall difference was also statisticallysignificant (p=0.000) using repeated measure ANOVA. Both theassessor and intern satisfaction increased significantly from thefirst to the third DOPS, but not statistically significant between thefirst and the second and between the second and the third DOPS. We found significant improvement in interns’clinical skills through repeated DOPS and the method waswell accepted by both the students and the faculty. Internshipperiod can be well utilized for improving clinical skills andnovel performance assessment methods like DOPS might proveto be highly beneficial in ensuring adequacy of learning duringinternship and also to assess their readiness for acceptingprofessional responsibilities in future.Keywords: Assessment, Ophthalmology, Internship

The use of clinical rounds, as an integral part ofclinical teaching to help medical students acquire essential skillsof practicing medicine, is critically important. An understandingof medical teachers’ perceptions concerning the challenges ofclinical rounds can help identify the key areas of focus to betterfoster professional development of medical students. This studyexplored the opinions of medical teachers of Kerman Universityof Medical Sciences about the challenges embedded in clinicalrounds. There is a paucity of studies regarding the topic underinvestigation in our context. This qualitative study was conducted using aconventional content analysis method. We held a focus groupdiscussion with eight skilled bedside teachers, chosen usingpurposive sampling, from Kerman University of Medical Sciencesin February 2018. The focus group lasted for approximately2 hours. The session was audio-taped. We analyzed data byconsidering the verbatim transcribed document of the audiorecordeddiscussions using conventional content analysis methodfor theme development. Informed consent was obtained from theparticipants. Medical teachers described many primary challenges toclinical rounds. Some of them were multiple students on roundingpractices, time constraints, priority of research and patient care toteaching, and lack of participation and enthusiasm. We categorizedthese varied challenges into 5 specific areas related to (1) system;(2) teachers; (3) learners; (4) patients; and (5) evaluation issues.Focus group participants expressed some suggestions to mitigatebarriers such as having fewer students on the rounds, addressingtime constraints through planning and flexibility, and the provisionof medical education award. Clinical round practices are valuable but repletewith a spectrum of problems. Many challenges affect the qualityof teaching in clinical rounds that should be taken into accountby bedside teachers in order to improve the quality of roundingpractices. The identified challenges can be used in redressingbedside teaching to have more efficient rounding practices.Keywords: Clinical, Focus group, Medical teachers

Identifying the learners’ problems early enoughand providing advice from the beginning is definitely an importantinvestment in the training and progress of future practitioners. Thecurrent review aimed at examining factors related to academicfailure of the preclinical medical students. The study was carried out as a systematic search ofpublications in the following databases published from January1987 to January 2018: PubMed, Web of Knowledge, EducationalResources, Information Center and Scopus. No language limitationwas set for searching the resources. As a comprehensive search, thefollowing keywords were used for the abstract, title and keywordsections: academic performance, academic failure, academicachievement, drop out, academic engagement, learning disorder,medical student, struggle student and problem learner. A valid tool(STROBE) was used to determine the quality of the articles. Most articles discussed personal causes, 7 discussedlearning style, 7 discussed personality traits, 6 discussedmotivational strategies and self-efficacy, 4 discussed quality ofsleep, 4 discussed the effect of stress, 9 discussed demographicfactors, 3 discussed physical activity, 1 discussed copingstrategies, 2 discussed class attendance and 4 discussed studystrategy. Twenty-five articles described instructional designcause, 3 described teaching strategies, 2 described courseassessments, 1 described the course structure, 3 described criticalthinking, 3 described blended learning, 13 described predictivecourses, 14 described admission tests, 1 described the learningenvironment, 2 described curriculum planning and 3 describedthe pre-matriculation program. Medical teachers often do not know which studentsare problem learners or what causes academic failure. The goalof this systematic review was to determine the origin of problemsin learning to identify problem learners. The results indicatesthat managers, policymakers, instructors and counselors canmonitor student academic achievement by careful planning ofinstructional design, attention to an educational environment, useof active teaching methods, continuous assessment of studentsand consideration of personal factors.Keywords: Academic failure, Medical student, Medical Education

Virtual social networks are increasingly beingused by academics and students in health sciences. It is necessaryto examine opportunities and challenges of these networks basedon the views of faculty and students to describe the existingsituation and planning for proper use. The purpose of this studywas to explore the experiences of students and faculty membersabout opportunities and challenges of using virtual socialnetworks in education. In this qualitative content analysis study, twentytwosemi-structured interviews were conducted with 8 facultymembers and 14 students at Jahrom Universities of MedicalSciences. Participants were selected by purposive sampling.To analyze the data, an inductive content analysis method wasused. The rigor of qualitative data was checked, using Guba andLincoln’s criteria. Five main categories were extracted from the dataas opportunities for using virtual networks in educationincluding improving communication skills; promoting learning;strengthening and facilitating learning of clinical procedures;creating research questions; and educating patients. Four maincategories were also derived as challenges of using virtualnetworks in education including accuracy and validity ofinformation; security and privacy; proper contextualization andculture-building; and control and monitor on virtual networks. According to the results, unique opportunities andchallenges were explored regarding using virtual networks ineducation. These opportunities and challenges and finding waysto obviate challenges and converting it to the opportunities canlead to effective virtual learning, particularly in students whomainly use this method of education, and consequently increasethe quality of learning.Keywords: Social network, Education, Students, Faculty, Qualitative research

Early education and training are mandatory toraise the knowledge and awareness of the healthcare staff. Iranis a disaster prone area with a high number of emergencies.This study aimed to assess the need for disaster and emergencymanagement education for Iranian medical students. Using two-round Delphi technique in 2017, 15 expertswithin the field of disaster and emergency management wereasked for their opinions concerning the education required forIranian medical students. Highly important educational domainsand their sub-domains selected with an agreement of above 70-80% were prioritized by AHP technique. Of 41 identified and prioritized educational subjects,four main groups were obtained: 1) crisis and disaster primaryconcepts, 2) disease control skills, 3) management skills, and4) medical care skills. The medical care skills had the highestpriority (with a weight of 0.546), compared to other areas afterthe final analysis. Different areas of competency are needed to raiseawareness and preparedness in medical students in combatingcrisis and disasters. We propose a curriculum for Iranian medicalstudents and suggest it to be used for other professionals, who areinvolved in the process of disaster management.Keywords: Disasters, Crisis, Medical students, Education, Interdisciplinary, Awareness

Narcissism, being the critical part of the toxic leadership paradigm,has its own impact in the education sphere. Contrastingly,leader’s narcissism cannot be simply underweighted because suchleaders often tend to be creative strategists who can take riskychallenges to suffice the self-ego and leave behind a legacy aswell. This commentary intends to portray the complex mosaic ofthe positive and negative consequences inbred in a narcissisticleader. The debate over whether these people provide a net gain orloss remains everlasting because it varies based on the organizationalclimate and also other contextual factors.

Dear editor Patients’ satisfaction has long been consideredas an important factor when gauging healthoutcome and quality of care in both developedand developing countries (1) and constitutes asubstantial indicator of the health care quality(2). Researches have shown that satisfiedpatients are more likely to develop a goodrelationship with the health system, leading toimproving compliance, continuity of care andultimately better health outcome (3).Identification of patient’ needs and evaluationof the health services provided are the startingpoints of a patient-centered approach in providinghealth care (4). In recent years, the health systemof Sudan has undergone some reforms and hasestablished an extensive health infrastructure inboth the public and private sectors (5). In Sudan,people of different social classes take treatmentfrom different health providers such as public,private, and military hospitals for differentreasons including economic condition, healthknowledge, and socio-demographic determinants.Cultural practices may influence people to choosethe particular healthcare service providers.We aimed, in this study, at assessing thepatients’ satisfaction with their treating doctors,in the internal medicine program, and identifyingthe areas that need more emphasis in the trainingof the residents. A cross-sectional facility-basedstudy was conducted on Wed Madani, a teachinghospital, 200 kilometre south to Khartoum,Sudan from June to September 2017.The patients were accessed through avalidated self-administered questionnaire. Theselection of the participants within the selectedtraining centers was done by systematic sampling.The sample size was 389 patients.All the respondents (n=389) agreed toparticipate in this study giving a response rateof 100%. The majority of patients under studywere women, two hundred thirty-eight (62.2%),and the greatest number of respondents belongedto the age group 46-52, (47.8%).The overall patients’ satisfaction rate was257 (66.1%), and the dissatisfaction rate was132 (33.9%). The areas for satisfaction werethe residents’ respect for what the patientssaid, 77.4% (n=301), maintaining privacy whenconducting physical examination, 68.4 (n=266),and the explanations that residents providedabout the results of their treatment 78.9%(n=307). The areas behind the dissatisfactionwere: residents did not listen carefully to theirpatients, 73.77% (n=287), residents did not makethe patients understand their instruction to takethe drugs, 85.8% (n=334), residents did not spendenough time on the patients 94.08% (n=366), andresidents did not explain to them the purpose ofthe investigation they requested 76.60% (n=298).This study showed that there was a relationshipbetween the level of education and satisfaction,where the satisfaction was low in highly educatedpatients. Females were less satisfied than males.There was no association between patients’satisfaction and the employment and maritalstatus. Regarding the monthly income, thosewith low income were most satisfied comparedto those with high income. This may be due tothe fact that those with high income took theirtreatment in the private sector, where there wasno crowdedness compared to that in the publichospitals most of the time.There are several factors that lead to patients’satisfaction. The findings are in agreement withanother study which showed that the reasonsbehind the high level of satisfaction wereresidents’ respect for what the patients say, andmaintaining the privacy and confidentialities oftheir patients (6).On the other hand, there are several reasonsthat decrease the level of satisfaction includingthe residents’ lack of spending adequate time forlistening to the patient’s complaints and medicalproblems. This is in accordance with the findingsof a similar study conducted in Pakistan (7).The results of this study could be very usefulin the planning and delivery of training forresidents in Sudan and the region.This study has some limitations, one ofwhich is that we depended on self-reports fromrespondents speaking for themselves or theirparents (for illiterate participants). This may haveintroduced surrogate bias.

The increased number of international studentsin higher education systems is recognizedas beneficial not only economically but also interms of preparation of the workforce for theglobal environment. It is believed that diversityin the student cohort can also be beneficial fordomestic students in terms of increasing culturalawareness and achieving cultural competencygoals. Culturally and linguistically diversestudents (CALD) include students whose firstlanguage andor culture is not of the countrythey study in (1). There are 55,000 internationalstudents in Iran, of whom 26,000 have enrolled inuniversities affiliated to the Ministry of Science,10,000 in different branches of Islamic AzadUniversity, 2,000 in universities affiliated to theMinistry of Health, and 17,000 in AlmustafaInternational University (2). According to thelatest data from the UNESCO, more than 82%of the international students in Iran come fromAfghanistan, 8.7% Iraq, and 6% Syria, Lebanon,and Pakistan combined (3). Meanwhile, theMinistry of Health and Medical Educationfollows a plan for expanding internationalmedical education in eligible Iranian universitiesof medical sciences and, hence, concentrateson mechanisms to align the universities withinternational standards. Although economic,political, and societal factors in both the hostand home countries influence internationalstudents’ decision to select the host country, it isnecessary that the authorities address their needsand problems and then take some measures tosolve them in order to increase the number offoreign applicants in Iranian universities.International students’ difficulties havebeen reported as academically and socially,with cultural and language barriers impactingtheir capacity to integrate with domesticstudents. These students have problemswith language and communication, sufferfrom lack of confidence to speak out and askquestions, and approach the teaching staff.For some international students, adaptationto new environment gets so difficult andfailure to adjust will cause them to experiencepsychological symptoms such as feelings ofinferiority, confusion, homesickness, loneliness,and anxiety (4). Commonly cited key issuesaffecting international students in learningenvironments are communication difficulties,cultural differences, and lack of familiarity withsocial, educational, and professional health careenvironments (5). Most of the literature aboutinternational students comes from Englishspeaking countries, and thus challenges in theAsian and Islamic learning context have notbeen addressed enough in the existing evidence.According to the studies conducted in theinternational learning contexts, there is a greaterpower distance and uncertainty avoidance inthe Asian culture, and these cultural differencesmay create tense interrelationships among thetrainees, staff, and supervisors (6).There is a need to develop understanding,accepting and appreciating the studentsfrom diverse backgrounds in the learningenvironments. For health professional students,the challenges become particularly evident inclinical practice settings. Clinical placement isof vital importance for healthcare disciplinesand covers approximately 50% of the trainingactivities. While clinical learning experiencecan be stressful and anxiety-provoking for anystudent, evidence suggests that this situation issignificantly more complex for CALD students(7, 8). Support from the staff in the clinical areacan be a source of motivation to students andmakes them feel welcome and part of the team,thereby helping them with learning. On thecontrary, failure to provide adequate learningopportunities for these students could resultin graduates who have not met the requiredstandards and competencies of the profession(9). Therefore, the educational problems ofCALD students need to be searched and thereasons should be dealt with to increase theirmotivation for academic success. We suggestthat medical education studies should address theinternational healthcare students’ needs and findstrategies to meet their needs in the classroomand clinical learning situations.