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   Table of Contents - Current issue
May-August 2019
Volume 32 | Issue 2
Page Nos. 51-109

Online since Monday, November 18, 2019

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EDITORIAL  

Co-Editors' Notes p. 51
Danette McKinley, Maaike Flinkenflögel, Michael Glasser
DOI:10.4103/1357-6283.271200  
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ORIGINAL RESEARCH ARTICLES Top

The human kindness curriculum: An innovative preclinical initiative to highlight kindness and empathy in medicine Highly accessed article p. 53
Johanna Shapiro, Julie Youm, Aaron Kheriaty, Tiffany Pham, Yanjun Chen, Ralph Clayma
DOI:10.4103/efh.EfH_133_18  
Background: Prior studies have shown a marked drop in empathy among students during their third (clinical) year of medical school. Curricula developed to address this problem have varied greatly in content and have not always been subjected to validated measures of impact. Methods: In 2015, we initiated a Human Kindness (HK) curriculum for the initial 2 years of medical school. This mandatory 12-h curriculum (6 h/year) included an innovative series of lectures and patient interactions with regard to compassion and empathy in the clinical setting. Both quantitative (Jefferson Scale of Empathy [JSE]) and qualitative data were collected prospectively to evaluate the impact of the HK curriculum. Results: In the initial Pilot Year, neither 1st (Group 1) nor 2nd (Group 2) year medical students showed pre-post changes in JSE scores. Substantial changes were made to the curriculum based on faculty and student evaluations. In the following Implementation Year, both the new 1st (Group 3) and the now 2nd year (Group 4) students, who previously experienced the Pilot Year, showed significant improvements in post-course JSE scores; this improvement remained valid across subanalyses of gender, age, and student career focus (e.g., internal medicine, surgery, etc.). Despite the disappointingly flat initial Pilot Year JSE scores, the 3rd year students (Group 2) who experienced only the Pilot Year of the curriculum (i.e., 2nd year students at the time of the Pilot Year) had subsequent JSE scores that did not show the typical decline associated with the clinical years. Students generally evaluated the HK curriculum positively and rated it as being important to their medical education and development as a physician. Discussion: A required preclinical curriculum focused on HK resulted in significant improvements in medical student empathy; this improvement was maintained during the 1st clinical year of training.
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Approaches of anatomy teaching for seriously resource-deprived countries: A literature review p. 62
Ana Yoe-Cheng Chang Chan, Olle ten Cate, Eugène J. F. M. Custers, Maarten S van Leeuwen, Ronald L. A. W. Bleys
DOI:10.4103/efh.EfH_272_17  
Background: Teaching anatomy is an important but expensive part of the medical curriculum, potentially more than many countries can afford. In the search for efficient methods, cost-effectiveness is of utmost importance for such countries. The aim of this contribution is to provide a review of the literature on anatomy teaching methods, evaluating these for feasibility in resource-deprived countries. Methods: A literature review was carried out to identify distinct approaches to anatomy teaching published in the period 2000–2014, using the databases of PubMed, Wiley Online Library, Elsevier, HINARI, Springer, and ERIC. The approaches found were compared against their conceptual, operational, technical, and economic feasibility and Mayer's principles of effective instruction. Results: Our search yielded 432 papers that met the inclusion criteria. We identified 14 methods of teaching anatomy. Based on their conceptual feasibility, dissection and technology enhanced learning approaches appeared to have more benefits than others. Dissection has, besides benefits, many specific drawbacks. Lectures and peer teaching showed better technical and economic feasibility. Educational platforms, radiological imaging, and lectures showed the highest operational feasibility. Dissection and surgery were found to be less feasible with regard to operational, technical, and economic characteristics. Discussion: Based on our findings, the most important recommendations for anatomy teaching in seriously resource-deprived countries include a combination of complementary strategies in 3 different moments, lecturing at the beginning, using virtual learning environment (for self-study), and at the end, using demonstration through prosected specimens and radiological imaging. This provides reasonable insights in anatomy through both dead and living human bodies and their virtual representations.
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BRIEF COMMUNICATIONS Top

Evaluation of the educator's portfolio as a tool for self-reflection: Faculty perceptions p. 75
Saee Deshpande, Suresh Chari, Usha Radke, Tapasya Karemore
DOI:10.4103/efh.EfH_277_17  
Background: Preparing a teaching portfolio to document educational expertise has shown to be useful for both promotion and to stimulate faculty development. This article describes a study of the effectiveness of the Educator's Portfolio (EP) as a stimulus for faculty reflection about educational practice. Methods: A sensitizing session of thirty faculty from medical, dental, and physiotherapy colleges on the same campus was conducted; faculty members were asked to complete and submit their EPs. Out of 30 members, 25 responded (83%). Semi-structured interviews of 25 faculties who prepared EPs were conducted, and a qualitative content analysis of the resulting protocols was completed to determine how the EP development process had promoted their reflection on education. Results: All the 25 faculty members indicated that reflection about education had occurred. Four categories of reflection emerged, namely, (a) lack of understanding regarding how to categorize their work; (b) lack of evidence of the effectiveness of educational activities; (c) reformulating educational practice; and (d) source of motivation and self-regulation. Discussion: The findings indicate that EP preparation serves as a tool for reflection on educational practice, which promotes faculty development.
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Engaging family medicine residents in research training: An innovative research skills program in Israel p. 79
Christina Solbach-Sabbach, Tamar Adar, Mordechai Alperin, Khaled Karkabi, Inbar Levkovich
DOI:10.4103/efh.EfH_36_18  
Background: The importance of medical research in developing academic and clinical excellence is widely acknowledged. Obstacles hindering research in primary care include negative attitudes, lack of dedicated time, funding shortages, and a relative paucity of mentors. Residency is the appropriate stage for developing research skills and encouraging research performance. In this article, we describe an intensive research training program offered at the family medicine (FM) Department, Technion Faculty of Medicine in Haifa, Israel. The program aims to engage residents in FM in constructing a research protocol to provide them with a positive experience, help them to overcome barriers, and enhance their research performance. Methods: Learning is achieved through a course design that includes the following six components: (1) course website: a platform for online collaborative learning; (2) inverted classroom: theory is learned through website video lectures and presentations during resident's own time according to a guided schedule, while weekly classroom sessions are dedicated to step-by-step implementation of theory, group discussion, and individual mentoring; (3) Peer feedback; (4) personal mentoring; (5) presentation of the protocol to peers and senior department staff at the end of the course; and (6) evaluation of protocol presentation and engagement during the research course as well as possibilities for further development. Results: Five teams of residents went on to conduct full research projects. Their studies have been presented at seven national and three international conferences, and one has been published. The outcomes of these studies have been useful in FM practices and have inspired residents to continue scholarly work in our department. Discussion: Innovation in teaching methods enhances engagement in learning research skills among residents and may encourage them to conduct research in primary care.
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Charting a successful course: The academic and clinical success committee's impact on student success p. 84
Chris Diem, Angela Hairrell
DOI:10.4103/efh.EfH_244_17  
Background: The road from prematriculation to graduation looks different for each student at each institution. To successfully complete the curriculum, students must often overcome difficulties, both academic and nonacademic. Up to 15% of 3rd-year medical students in the United States are still struggling on the major components of their clerkships and 11% in their 4th year. While there is an established need for medical school remediation, there is little evidence supporting what specifically works across the board. These deficiencies often do not go away on their own and with the need to educate all students, the guidance provided by multiple stakeholders (i.e., administration, staff, faculty, and clinicians) would be necessary to chart a course of success for these students. Methods: The Academic and Clinical Success Committee (ACSC) at the Texas A and M University College of Medicine provides a venue to review individual students and provide input, resources, and support on a timely basis. This is a necessary ingredient in guiding the students facing academic and clinical challenges toward successful completion of graduation requirements. Results: Since its incorporation, the work of the ACSC has contributed to a decrease in failures on consecutive block examinations, a decreased failure rate on Step 2 clinical skills (CS), and increased capacity to help students at risk of failing Step 1 to not do so. Discussion: In this brief report, we illustrate how we developed the ACSC, the impact and levels of success it has had on students, and challenges we have faced.
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Checking in on check-out: Survey of Learning Priorities in Primary Care Residency Teaching Clinics p. 87
Yvonne N Covin, Shannon Scielzo, Lynne Kirk, Blake Barker
DOI:10.4103/efh.EfH_206_16  
Background: Despite focus on increasing the quality of ambulatory education training, few studies have examined residents' perceptions of learning during case discussions with their preceptors (i.e., “check-out”). The objective of this study was to assess the difference between residents' and preceptors' perceptions of behaviors that should occur during check-out discussions. Methods: We conducted a cross-sectional survey of categorical internal medicine and family medicine residents and preceptors. The survey was distributed electronically and assessed 20 components of the check-out discussion. Results: Of 38 preceptors, 22 (61%) completed the survey. Of 172 residents, 82 (48%) completed the survey. For residents, we identified discrepancies in desired and perceived check-out behaviors. Specifically, utilizing a dependent sample t-test, residents felt that all 20 areas needed additional teaching during check-out (P < 0.05). Preceptors believed that demonstrating physical examination skills in the patient room during check-out was significantly more important than did residents (P = 0.01). Increasing years of preceptor experience did not statistically relate to their valuation of components important to residents. Discussion: Our research highlighted a major deficiency in training in the check-out process, with residents desiring more patient management education in all components. Moreover, faculty and residents do not necessarily agree with what is an important focus in the “teachable moment.” Our results serve as a training needs assessment for future faculty development seminars and highlight the need to consider resident learning needs in general.
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Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study p. 91
Victor Mogre, Fred C. J. Stevens, Paul A Aryee, Anthony Amalba, Albert J. J. A. Scherpbier
DOI:10.4103/efh.EfH_134_17  
Background: Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students' perspectives on health professionals' nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting. Methods: Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process. Results: Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health-care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors' advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient. Discussion: Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients.
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Developing an objective structured clinical examination in comprehensive geriatric assessment – A pilot study p. 95
Michael Vassallo, Joseph Grey, Anthony Hemsley, Liliana Chris, Stuart G Parker
DOI:10.4103/efh.EfH_111_18  
Background: Acquiring medical competencies alone does not necessarily lead to the delivery of quality clinical care. Many UK training programs are soon to be based on the curricula of entrustable professional capabilities (EPCs). These are tasks carried out in practice requiring proficiency in several competencies for quality practice. Assessments to evaluate EPCs for independent practice are needed. Comprehensive geriatric assessment (CGA) is an EPC in geriatric medicine. We describe the development of an assessment of CGA as an example of examining EPCs. Methods: A CGA station was introduced in the Diploma in Geriatric Medicine clinical examination. Candidates rotate through four stations: three single competency-based stations (history, communication/ethics and physical examination) and an EPC-based station in CGA. Results: One hundred and seventy-eight (female: 96 [53.9%]) candidates took it. There was a weak but significantly positive correlation between the score at CGA and the total score in the other stations (r = 0.46; P < 0.001). Most candidates passing the station passed the examination. Correlation with other stations similarly showed weak significant correlations (Station 1: r = 0.38; P < 0.001, Station 3: r = 0.28; P < 0.001, and Station 4: r = 0.37; P < 0.001). There was 61.4% (kappa: 0.61; P = 0.000) agreement between examiners whether a candidate passed or failed. Agreement was higher for the other stations, i.e. Station 1 (kappa: 0.85; P < 0.001), Station 3 (kappa: 0.72; P < 0.001), and Station 4 (kappa: 0.85; P < 0.001). Discussion: Performance on the station correlated positively with overall performance, suggesting that it has discriminatory value in differentiating candidates with varying ability and the more able candidates pass the examination.
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LETTERS TO THE EDITOR Top

A Report from the 2017 Sino-US Medical Education Symposium in Wuhan, China p. 99
Rimas Vincas Lukas, Ivy Jiang, Jonathan Lio, Brian Cooper, Hongmei Dong, Jingyi Fan, Renslow Sherer
DOI:10.4103/efh.EfH_206_17  
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Breast self-examination education for skill and behavior p. 101
Putri Halimu Husna, Marni , Susana Nurtanti, Sri Handayani, Nita Yunianti Ratnasari, Retno Ambarwati, Tantut Susanto
DOI:10.4103/efh.EfH_226_18  
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Trauma care teaching in colombian medical and nursing schools: A training curriculum analysis p. 103
Jorge Hernan Montenegro Munoz, Sandra Lucia Lozano Alvarez, Andres Mariano Rubiano Escobar
DOI:10.4103/efh.EfH_86_15  
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Vitreoretina training in residency: A necessity p. 105
Archana Sunil Nikose
DOI:10.4103/efh.EfH_228_15  
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OBITUARY Top

Obituary: David Sanders and His Struggle for Equitable Care p. 106
Jan De Maeseneer
DOI:10.4103/efh.EfH_244_19  
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Dr. Daniel Blumenthal – Activist p. 108
David Bor, Jose Francisco Gutierrez, Michael Glasser
DOI:10.4103/1357-6283.271201  
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ERRATUM Top

Erratum: A network of networks: 40 years of uniting global agendas toward universal health and equitable care p. 109

DOI:10.4103/1357-6283.271297  
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