Journal of Advances in Medical Education & Professionalism
Volume:10 Issue: 1, Jan 2022

We designed and implemented a Programmed Learning Simulation (PLS) exercise depicting obstetric scenarios of hemorrhage to train anesthesiologists, ancillary staff, and surgeons to accurately estimate blood loss visually. We then measured the efficacy of this exercise in a clinical setting. We conducted a prospective study to assess the effect of implementing a PLS exercise on quantification of blood loss in an operative setting. The PLS exercise consisted of 13 simulationstations of varying quantities of simulated blood loss paired with standardized objects of known volume. Eighty-eight individuals participated including attending physicians, residents, medicalstudents, and ancillary staff participated in this study. The PLS was part of regularly scheduled continuing medical education activities; thus, the sampling used was non-randomized convenience method. The percent error was calculated for each of the 13 stations. A subgroup analysis was performed to assess the effect of the years of experience, size of hemorrhage, and occupation on accuracy. Univariate analyses for continuous variables were compared using a one-way ANOVA test. For the comparison of the three groups (years of experience and size of hemorrhage), a p-value of determine the effect of PLS in a clinical setting, the percent error of blood loss estimation for cesarean deliveries during the twomonth period after the PLS exercise was compared to the twomonth period immediately prior to using the student’s t-test with p During Part A, the baseline performance of the participants was evaluated during the PLS activity. The PLS data showed no significant difference in absolute value of mean percent error estimation (standard deviation) across professions: student 63.61% (69.74), ob/gyn 56.91% (47.72), ancillary 62.15% (77.90), general/trauma surgeon 66.70% (65.06), anesthesia 61.51% (63.12). (P=0.681), or levels of experience 0-5: 62.21% (60.06), 6-10 years: 56.22% (52.66), greater than 10 years: 61.89% (71.89) (P=0.831). However, mean percent error of estimation was higher when participants estimated smaller samples 77.7% (104.73) compared to either medium 56.8% (49.06) or large 57.9% (46.19) samples (p <0.001). For Part B, 179 cesarean deliveries occurred during the pre-intervention period and 193 occurred during the postintervention period. Mean error in provider estimation of blood loss significantly improved from 47% (68.51) pre-intervention to 31% (32.70) post-intervention (P=0.009). We believe our described PLS activity was effective in teaching techniques for visual blood loss estimation. This was reflected by improved competency in a clinical setting, demonstrated by more accurate visually estimated blood loss during the period immediately following simulation activity compared to a prior time frame. Further research is needed to assess the impact of simulation activities on patient outcomes, such as utilization of blood products and patient morbidity.

Team-based learning (TBL) is a highly structured, instructive, and student-focused pedagogy used by medical educators to foster the students’ learning. The present study aimed to qualitatively explore the students’ perception of the effectiveness of online synchronous TBL pedagogical strategy in promoting learning outcomes. A cross-over interventional study was conducted on MD4 year medical students, using four modified TBL sessions on common immunological diseases on four different dates. 139 participants were divided into 4 groups [35 each in A, B, C, & 34 in D]. For TBL session 1, Group A and group B were the study and control groups, respectively. For the second session on different topics, the groups were reversed with group B and group A as the study and control groups, respectively. The same was followed for groups C and D. The means and standard deviations of the pre-test and post-test scores were compared after calculating the improvement in scores from pre- to post-tests. Repeated measures ANOVA suitably coded in SPSS for cross-over design was used to find out confounding by sequence of interventions with a p-value of on a 3-point Likert scale. The data were analyzed using SPSS version 22 and expressed as number and percentage. The post-test scores of the students who participated in the TBL session were significantly higher when compared to the self study (SS) arm. The overall improvement in scores was 4.98 (1.4) in TBL group, whereas in the SS arm it was only 2.29 (1.51). The new method was found far superior to the self-study method regardless of being applied before or after the comparison mode of self-study (p <0.0001). The scores of the self-study was marginally better when offered first rather than after a TBL session, indicating the negative effect of cross-over on SS mode (P=0.024). The overall response of our students toward the effectiveness of online TBL pedagogy was overwhelmingly positive in terms of an opinion survey which had a Cronbach’s alpha of 0.932. The majority (>80%) perceived TBL as an enjoyable active session that promoted their active participation and engagement through student-led discussions. Many stated that TBL enhanced their critical thinking, problem-solving ability, communication skills, and knowledge. TBL is an instructive and highly structured teachinglearning strategy, welcomed by the majority of our participants. Online TBL sessions are effective in fostering the students’learning and can be used confidently when needed.

Implementation of competency-based medical education (CBME) offers challenges to the faculty and students. As a part of the new curriculum by the National Medical Council of India, we introduced certain teaching and assessment modifications in anatomy. There are few studies on the actual implementation of CBME. The current study aimed to assess the perceived usefulness of the teaching, learning, and assessment methodology (TLAM) based on written feedback from students. All the 147 first MBBS students of the batch who had undergone the new teaching learning methodology answered the questionnaire on usefulness of the various TLAMs on a 3-point Likert scale which was taken as quantitative data. They were also asked to pen down their opinions and suggestions about the TLAM which was thematically analysed and considered as qualitative data. Face and content validity was assessed prior to administration of the questionnaire. Descriptive statistics were used for quantitative variables. Qualitative data were analysed bythematic analysis. 100% of the students found vertical integration and small group teaching as useful. Seminars and quizzes were reported as useful to extremely useful by 75.5% of the students. Self-directed learning and near-peer teaching was also appreciated well by 78% of students. In Embryology and Neuroanatomy, these active learning methods were not found to be useful as these topics were difficult to understand. Overall, the new TLAM introduced as per the new medical curriculum was found useful for the majority of students. This study provides valuable insights on the teaching, learning, and assessment methods as formulated by the competency-based medical curriculum. Though active learning methods are the integral principles of andragogy, the concepts which are difficult to understand need to be taught using the traditional teaching methodology.

The Continuing Medical Education (CME) programs in the medical community aim to improve the knowledge of practitioners and its effect on changing their performance. Previous studies showed that CME causes minimum changes in physicians’ behaviors, so it is important to pay attention to the views of this group. In this regard, this qualitative study aimed to explain the Iranian Ophthalmologists’ perceptions and experiences concerning the CME Programs in Iran. In this qualitative study, 18 participants, including 10 subspecialists and 8 general ophthalmologists, were recruited to participate in in-depth interviews concerning their experienceswith CME. The required data were collected from April 2018 to Feb 2019. Each interview was conducted in medical universities; eye research centers; and the ophthalmology departments, offices, and operating rooms of public and private hospitals. The current study was performed using a content analysis based on the Granheim and Lundman’s methods. The codes, sub- categories,categories, and themes were then explored through an inductive process in which the researchers moved from specific to general. The data obtained from interviews, and filed notes were analyzed and then classified into the following four themes: “growth and development of the ophthalmology’s CME program over time”, “challenges of the ophthalmology’s CME program”, “reasons for the participation of the ophthalmologist in the CME program”, and “strategies for improvement”. Based on the qualitative study’s results, in spite of growth and development of the design and implementation of the Ophthalmologic CME programs, we are still facing multiplechallenges. Enhancing the interactivity between the providers and participants can also improve the ophthalmology CME programs.

COVID-19 pandemic is the main challenge with which the education systems in the world have ever faced. Furthermore, nursing students and nurse educators have faced the challenges in the teaching-learning process. This study aimed to explain the experiences of nursing education amid COVID-19 pandemic. This research was conducted in 2020-2021 through qualitative content analysis approach. Participants were selected from nursing schools using purposive sampling. Data were collected using in-depth, unstructured, and face-to-face interviews. The interviews were digitally recorded and transcribed verbatim. The conventional content analysis method was used to analyze the data. 232 codes were generated which were grouped into four main categories, namely mandatory change in nursing education, change of training priorities of nurse educators, insufficient clinical competence, and opportunities during coronavirus outbreak. COVID-19 prevalence caused many unprecedented changes in nursing education. Such changes have brought about opportunities and challenges in nursing education.

Epidemics such as the recent one, COVID-19, have caused a change in education and its methods. Virtual simulation is one of the types of technology used in medical education andrelated sciences. Virtual simulation provides practical and clinical medical education in a safe, cost-effective, reproducible, and flexible learning environment where students can practice over and over in a standard environment. This study was conducted to compare the effect of virtual-based medical education versus lecture-based method in teaching start triage lessons in emergency medical students in educational and medical centers affiliated to Birjand University of Medical Sciences Ferdows, Paramedical School, in 2020. This is a quasi-experimental study. All 44 students of emergency medicine registered for triage course participated in the study. They were divided into two homogenous groups whichwere matched based on their grade point average. The simple triage and rapid transport (START) triage course was taught in the traditional way- lecture based- from the beginning of the semesterto the middle of the semester; then, the other group (simulationbased) was trained in the second half of the same semester using virtual simulation. The students’ rate of learning was measured by their scores at the end of the course exam in both groups. The mean scores of virtual simulation-based education were slightly higher than those of the lecture-based education, but it was not statistically significant (P>0.05). The students were more satisfied with virtual simulation-based education than the lecture-based and the difference between the mean scores of satisfaction was statistically significant (P>0.05). The results of this study suggest that VR can effectively improve knowledge in undergraduate emergency student’s education, but it was not more effective than traditionaleducational methods. More experimental studies with a larger sample size are needed to confirm that virtual simulation-based education can more effectively improve knowledge in teaching practical lessons such as triage.

The Covid-19 global pandemic has suspended thousands of clinical education programs around the world. Also in Italy, as in the rest of the world, frontal teaching activities and internships in the medical field have been suspended. At the university hospital of Udine (North-Eastern Italy) it was decided to strengthen the use of simulation in all training stages to get over the block of training activities. A protocol has been drawn up with the aim of providing training in safety for every student of the degree courses in medicine and health area and for doctors in residency training. In this way it was possible to carry out training sessions with a maximum of 6 students engaged in the simulation activities offered by the Center (3D) virtual cadaver, laparoscopic pelvic trainer stations, ultrasound laboratory, microsurgery, etc.). The key points of the protocol were represented by i) internetbooking of the training activity; ii) respect of safety measures (hand hygiene, safe distance, restricted total number of presences, constant use of the surgical mask) and iii) reorganization of thematerial and cleaning of the rooms. Our educational strategy allowed to resume training activity maintaining adequate levels of safety for students and teachers. Applying our protocol, it was possible to guarantee safe access to our Medical Simulation Center (MSC) to a total of about 1400 students from different course of study during the period between June 2020 and February 2021. Our protocol could represent a practical tool in the management of resuming the activity at a MSC.

Explosion in scientific knowledge of our understanding of diseases, diagnostics, and targeted therapeutics, all possible & advantageously perfected with Clinico-pathological correlation (CPC). A narrative of evolution from the past to the present & the novelty in the future is exciting, with pragmatic presentation of important recent developments & interesting research directions, for ‘evolving excellence’. Analysis of the guidance was produced by leading medical education institutions and an in-depth search on Google Scholar, Medline, and PubMed for CPC. We thoughtfully formulated ways of incorporation of CPC for teaching and training of medical students at different levels. We put available policies, evidence, and personal experience gleaned in proper perspective. The four HPs (i) Historical perspective: Tracing the progress, the important developments extending the physician’s range are clinical correlation with the outgivings of chemical analysis and biological experimentation. (ii) Holistic professionalism: Integrating Basic and Clinical Sciences.Knowledge for practice and knowledge applications in practice are two pillars of medical education. Learning opportunities provisioning should enable linking of theory and practice. (iii) The happening perfect: Clinic-Pathological Conference. Problembased learning is highly effective. A clinical case presentation with deliberation on all aspects is useful for all. The denouement should include research developments and desired research directions. (iv) Heightened professionalism: Progress features promise exciting future. Chemistry of life and disease has been evolving manifold, opening new vistas. Microbiome research results for clinically actionable microbe-host relationships identification are in foresight. Genomic and proteomic approach to human disease is leading to new understanding of pathogenesis for clinical strategies. Systems Biology studies living organisms with their cellular or molecular network components holistically to predict response to perturbations. ‘Systems pathobiology’ is energising avenues for early diagnosis and advancing clinical applications for halting progress for better medical practice. Teaching CPC for all round understanding will lead to all knowledgeable proficient medical practitioners.

Comprehending the cross sectional anatomy of brain is one of the ultimate objective of neuroanatomy teaching. We cannot deny the fact that any physician or radiologist or surgeon who is inclined towards neuroscience should be a master in interpreting the brain cross sections. However, the literature search on this topic hardly yields valuable educational pedagogies whereby neurology residents could learn brain cross sectional anatomy. We, in our institute, have developed an educational pedagogy to fit that purpose and we wish to disseminate the details of pedagogy alongside the cognitive principles involved in it. This pedagogy serves as a valuable bridge between anatomy and neurology. We feel that this topic is much salient in the contemporary era and would enable neurologists to try this in their corresponding institutes.

With great interest, we read the article by Shivananda et al on the differing perspectives of medical students to small group tutorial classes in India,1 and we thank the authors for conducting this study. Allowing reflections with our own experiences as final year Medical Students at the University of Manchester, we compared and contrasted these views, and wanted to share our opinions following this.