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  Citation statistics : Table of Contents
   2016| May-August  | Volume 29 | Issue 2  
    Online since August 19, 2016

 
 
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ORIGINAL RESEARCH ARTICLES
Reducing the physician workforce crisis: Career choice and graduate medical education reform in an emerging Arab country
Halah Ibrahim, Satish Chandrasekhar Nair, Sami Shaban, Margaret El-Zubeir
May-August 2016, 29(2):82-88
DOI:10.4103/1357-6283.188716  PMID:27549644
Background: In today's interdependent world, issues of physician shortages, skill imbalances and maldistribution affect all countries. In the United Arab Emirates (UAE), a nation that has historically imported its physician manpower, there is sustained investment in educational infrastructure to meet the population's healthcare needs. However, policy development and workforce planning are often hampered by limited data regarding the career choice of physicians-in-training. The purpose of this study was to determine the specialty career choice of applicants to postgraduate training programs in the UAE and factors that influence their decisions, in an effort to inform educational and health policy reform. To our knowledge, this is the first study of career preferences for UAE residency applicants. Methods: All applicants to residency programs in the UAE in 2013 were given an electronic questionnaire, which collected demographic data, specialty preference, and factors that affected their choice. Differences were calculated using the t-test statistic. Results: Of 512 applicants, 378 participated (74%). The most preferred residency programs included internal medicine, pediatrics, emergency medicine and family medicine. A variety of clinical experience, academic reputation of the hospital, and international accreditation were leading determinants of career choice. Potential future income was not a significant contributing factor. Discussion: Applicants to UAE residency programs predominantly selected primary care careers, with the exception of obstetrics. The results of this study can serve as a springboard for curricular and policy changes throughout the continuum of medical education, with the ultimate goal of training future generations of primary care clinicians who can meet the country's healthcare needs. As 65% of respondents trained in medical schools outside of the UAE, our results may be indicative of medical student career choice in countries throughout the Arab world.
  4 2,847 402
Teaching tobacco cessation to large student cohorts through train-the-trainers and problem based learning strategies
Laura Llambi, Mary Barros, Carolina Parodi, Mariana Cora, Gaston Garces
May-August 2016, 29(2):89-94
DOI:10.4103/1357-6283.188726  PMID:27549645
Background: Smoking is a leading cause of preventable deaths worldwide. Graduates of medical schools receive limited training on tobacco cessation and are ill-equipped to treat tobacco dependence. In this paper, we describe and present evidence from an educational intervention based on a train-the-trainers model and problem-based learning strategy aimed to educate a large number of first-year medical students on tobacco-related issues. Methods: A survey assessing students' knowledge, attitudes and beliefs was conducted before and after educational intervention. Tobacco experts from the faculty staff, who are trained problem-based learning tutors, served as facilitators in the problem-based learning setting with 1000 medical students. Results: Significant changes in knowledge and beliefs were observed. Items such as need for further training in cessation, importance, and effectiveness of brief advice showed significant variations after the educational intervention. Discussion: Educational intervention based on a train-the-trainers and problem-based learning approaches are feasible and effective to educate a large cohort of first-year medical students in tobacco issues. Further research is needed to find out whether this intervention improves overall patient care management.
  3 3,124 438
Factors influencing medical students' self-assessment of examination performance accuracy: A United Arab Emirates study
Sami Shaban, Elhadi H Aburawi, Khalifa Elzubeir, Sambandam Elango, Margaret El-Zubeir
May-August 2016, 29(2):75-81
DOI:10.4103/1357-6283.188688  PMID:27549643
Background: Assessment of one's academic capabilities is essential to being an effective, self-directed, life-long learner. The primary objective of this study was to analyze self-assessment accuracy of medical students attending the College of Medicine and Health Sciences, United Arab Emirates University, by examining their ability to assess their own performance on an MCQ examination. Methods: 1 st and 2 nd year medical students (n = 235) self-assessed pre and post-examination performance were compared with objectively measured scores (actual examination performance). Associations between accuracy of score prediction (pre and post assessment), and students' gender, year of education, perceived preparation, confidence and anxiety were also determined. Results: Expected mark correlated significantly with objectively assessed marks (r = 0.407; P < 0.01) but with low predictability (R 2 = 0.166). The average objectively determined mark was 69% and the average expected mark was equivalent to 83%; indicating that students significantly overestimate their examination performance. Self-assessed pre-examination score range was significantly different between males and females (P < 0.05) with females expecting higher marks. Preparation and confidence correlated significantly with actual examination score (P < 0.05; r = 0.459 and 0.569 respectively). Discussion: Gender, self-reported preparation and confidence are associated with self-assessment accuracy. Findings reinforce existing evidence indicating that medical students are poor self-assessors. There are potentially multiple explanations for misjudgment of this multidimensional construct that require further investigation and change in learning cultures. The study offers clear targets for change aimed at optimizing self-assessment capabilities.
  3 3,215 501
STUDENT CONTRIBUTIONS
Which peer teaching methods do medical students prefer?
Nithish Jayakumar, Danushan Srirathan, Rishita Shah, Agnieszka Jakubowska, Andrew Clarke, David Annan, Dekan Albasha
May-August 2016, 29(2):142-147
DOI:10.4103/1357-6283.188764  PMID:27549654
Background: The beneficial effects of peer teaching in medical education have been well-described in the literature. However, it is unclear whether students prefer to be taught by peers in small or large group settings. This study's aim was to identify differences in medical students' preferences and perceptions of small-group versus large-group peer teaching. Methods: Questionnaires were administered to medical students in Year 3 and Year 4 (first 2 years of clinical training) at one institution in the United Kingdom to identify their experiences and perceptions of small-and large-group peer teaching. For this study, small-group peer teaching was defined as a tutorial, or similar, taught by peer tutor to a group of 5 students or less. Large-group peer teaching was defined as a lecture, or similar, taught by peer tutors to a group of more than 20 students. Results: Seventy-three students (81% response rate) completed the questionnaires (54% males; median age of 23). Nearly 55% of respondents reported prior exposure to small-group peer teaching but a larger proportion of respondents (86%) had previously attended large-group peer teaching. Of all valid responses, 49% did not have a preference of peer teaching method while 47% preferred small-group peer teaching. The majority of Year 3 students preferred small-group peer teaching to no preference (62.5% vs 37.5%, Fisher's exact test; P = 0.035) whereas most Year 4 students did not report a particular preference. Likert-scale responses showed that the majority of students held negative perceptions about large-group peer teaching, in comparison with small-group peer teaching, with respect to (1) interactivity, (2) a comfortable environment to ask questions, and (3) feedback received. Discussion: Most respondents in this study did not report a preference for small-versus large-group settings when taught by peers. More Year 3 respondents were likely to prefer small-group peer teaching as opposed to Year 4 respondents.
  3 2,193 327
BRIEF COMMUNICATIONS
A comparison of medical students', residents' and tutors' attitudes towards communication skills learning
Beatriz Molinuevo, Amor Aradilla-Herrero, Maria Nolla, Xavier Clèries
May-August 2016, 29(2):132-135
DOI:10.4103/1357-6283.188755  PMID:27549652
Background: The consensus about the importance of communication skills in patient-care does not guarantee that students and faculty perceive the usefulness of these skills. This study evaluated and compared medical students', residents' and tutors' attitudes towards learning communication skills, and examined the association with gender and year of residency. Methods: We conducted a cross-sectional survey with 492 participants (282 second-year students, 131 residents and 79 tutors). They completed the Communication Skills Attitude Scale (CSAS) and demographic/educational information. Results: In general, participants showed positive attitudes towards learning communication skills. Medical students, residents and tutors did not differ on the Positive Attitudes Scale (CSAS-PAS). Residents scored higher than medical students on the Negative Attitudes Scale (CSAS-NAS) (P < 0.01). Females showed higher scores on the CSAS-PAS (P < 0.05) and lower scores on the CSAS-NAS (P < 0.01) than males in all subsamples. The effect sizes were medium. There were no significant differences according to year of residency. Discussion: Medical students, residents and tutors consider training in communication skills an essential component for clinical practice and they agree about the need to learn these communication skills. Attention should be paid to measuring attitudes at all three levels of medical education in the design of communication skills courses.
  2 2,090 299
GENERAL ARTICLES
Reflective learning in community-based dental education
Suryakant C Deogade, Dinesh Naitam
May-August 2016, 29(2):119-123
DOI:10.4103/1357-6283.188752  PMID:27549649
Background: Community-based dental education (CBDE) is the implementation of dental education in a specific social context, which shifts a substantial part of dental clinical education from dental teaching institutional clinics to mainly public health settings. Dental students gain additional value from CBDE when they are guided through a reflective process of learning. We propose some key elements to the existing CBDE program that support meaningful personal learning experiences. Methods: Dental rotations of 'externships' in community-based clinical settings (CBCS) are year-long community-based placements and have proven to be strong learning environments where students develop good communication skills and better clinical reasoning and management skills. We look at the characteristics of CBDE and how the social and personal context provided in communities enhances dental education. Results: Meaningfulness is created by the authentic context, which develops over a period of time. Structured reflection assignments and methods are suggested as key elements in the existing CBDE program. Strategies to enrich community-based learning experiences for dental students include: Photographic documentation; written narratives; critical incident reports; and mentored post-experiential small group discussions. A directed process of reflection is suggested as a way to increase the impact of the community learning experiences. Discussion: We suggest key elements to the existing CBDE module so that the context-rich environment of CBDE allows for meaningful relations and experiences for dental students and enhanced learning.
  2 2,328 322
PRACTICAL ADVICE PAPERS
Self-directed learning modules of CT scan images to improve students' perception of gross anatomy
Pananghat Achutha Kumar, Ramakrishnan Jothi, Dharmalingam Mathivanan
May-August 2016, 29(2):152-155
DOI:10.4103/1357-6283.188778  PMID:27549656
Background: A contemporary anatomy curriculum that aims to be clinically relevant requires medical students to be introduced to radiological anatomy in the preclinical years. Ideally, the curriculum should also support self-directed learning, a habit best instilled early. Based on these educational requirements, we designed an interesting and clinically-meaningful program of self-learning modules in radiological anatomy to augment students' learning of gross anatomy. The program is guided by current theories of learning, which emphasize an individualized learning pace for students. Methods: This program uses enlarged computerized tomography (CT) scan images and associated resource materials. Scans are posted on the first day of the week in a public area for students to review on their own time. On the second day penciled outlines of important structures are provided to help students identify structures, and students are encouraged to discuss the images with faculty. On the last day of the week the identity of the structures are revealed to students. Results: An open-ended questionnaire used to evaluate the program revealed that 95.5% of students used the program and a great majority recommended the program should be continued for future students. Discussion: The present program enhances learning of gross anatomical relations through having students use visual clues in logically interpreting unlabeled CT scans in an organized and sequential way. The program promotes self-directed learning. In addition to its use with preclinical students, the modules might also help students in the clinical phase of the curriculum bolster their knowledge of spatial anatomy.
  2 2,224 245
STUDENT CONTRIBUTIONS
How do medical student journals fare? A global survey of journals run by medical students
Yassar Alamri
May-August 2016, 29(2):136-141
DOI:10.4103/1357-6283.188756  PMID:27549653
Medical students have made significant contributions to the medical and scientific fields in the past. Today, medical students still contribute to biomedical research; however, they often face disappointment from journals when trying to publish their findings. This led to the development of medical student journals, which take a more "student-friendly" approach. This article reviews the current medical student journals published in English and sheds light on current trends and challenges.
  2 6,089 324
LETTERS TO THE EDITOR
Understanding culture in higher education in Thailand
Joko Gunawan
May-August 2016, 29(2):160-161
DOI:10.4103/1357-6283.188783  PMID:27549659
  1 2,409 300
ORIGINAL RESEARCH ARTICLES
Developing and pilot testing of a tool for "clinicosocial case study" assessment of community medicine residents
Manisha Gohel, Uday Shankar Singh, Dinesh Bhanderi, Ajay Phatak
May-August 2016, 29(2):68-74
DOI:10.4103/1357-6283.188684  PMID:27549642
Background: Practical and clinical skills teaching should constitute a core part of the postgraduate curriculum of Community Medicine. The clinicosocial case study is a method to enhance learners' skills but there is no generally accepted organized system of formative assessment and structured feedback to guide students. A new tool based on the principles of mini-Clinical Evaluation Exercise (mini CEX) was developed and pilot tested as a 'clinicosocial case study' assessment of community medicine residents with feedback as a core component. Methods: Ten core domains of clinicosocial skills were identified after reviewing the relevant literature and input from local experts in community medicine and medical education. We pilot tested the tool with eight faculty members to assess five residents during clinicosocial case presentations on a variety of topics. Kappa statistic and Bland Altman plots were used to assess agreement between faculty members' average assessment scores. Cronbach's alpha was used to test the internal consistency with faculty members as domains. Results: All 95% confidence limits using the Bland-Altman method were within the predetermined limit of 2 points. The overall Kappa between two faculty members was fair ranging from 0.2 to 0.3. Qualitative feedback revealed that both faculty and residents were enthusiastic about the process but faculty suggested further standardization, while residents suggested streamlining of the process. Discussion: This new assessment tool is available for objective and unbiased assessment of residents through 'clinicosocial case study,' which enriches learning through comprehensive feedback. Further validation in different settings is needed.
  1 3,154 568
Medical students' epistemological beliefs: Implications for curriculum
Dwight Assenheimer, Katherine Knox, Vishna Devi Nadarajah, Craig Zimitat
May-August 2016, 29(2):107-112
DOI:10.4103/1357-6283.188748  PMID:27549647
Background: Epistemological beliefs have a pervasive influence on learning and practice. Understanding these beliefs and how they develop, could play an important role in medical student training and shape later clinical practice. Methods: The epistemological beliefs of first-year medical students from an Australian and Malaysian university were explored using a domain-specific instrument. Results: There were significant differences between the disciplinary epistemological beliefs of Australian and Malaysian medical students across many items, and two specific factors (Certainty of Knowledge and Justification for Knowing). Discussion: These findings have potential implications for teaching in biomedical disciplines and adaptation of Western curriculum innovations in Eastern educational contexts. Further work is needed to confirm and understand any epistemological differences and subsequent implications for learning and teaching in medicine.
  1 2,330 331
PRACTICAL ADVICE PAPERS
Implementing a centralized institutional peer tutoring program
Natalie White Gaughf, Penni Smith Foster
May-August 2016, 29(2):148-151
DOI:10.4103/1357-6283.188773  PMID:27549655
Background: Peer tutoring has been found to be beneficial to both students and peer tutors in health sciences education programs. This article describes the implementation of a centralized, institutional peer tutoring program at the University of Mississippi Medical Center, an academic health science center in the U.S. The Program: This multispecialty peer tutoring program paired students experiencing academic difficulties with peer tutors who showed prior academic success, professionalism and effective communication skills. The program allowed students and peer tutors to coordinate their own tutoring services. Program Evaluation: Evaluations by both students and peer tutors showed satisfaction with the program. Recommendations: Recommendations for developing and implementing an effective peer tutoring program are presented, including utilization of an online system, consistent program policy with high professionalism expectations, funding, program evaluation and data tracking.
  1 2,189 291
BOOK AND MULTI MEDIA REVIEW
Millions saved: New cases of proven success in global health
Karen E Peters
May-August 2016, 29(2):162-163
DOI:10.4103/1357-6283.188784  
  - 2,015 221
BRIEF COMMUNICATIONS
Educating medical students about military health: Perspectives from a multidisciplinary lecture initiative
Christos Theophanous, Mariya Kalashnikova, Claire Sadler, Elizabeth Barreras, Cha-Chi Fung, Madeleine Bruning
May-August 2016, 29(2):128-131
DOI:10.4103/1357-6283.188754  PMID:27549651
Background: Medical student education on military health topics is critical in ensuring optimal future care for military service members and their families. Methods: Keck School of Medicine of the University of Southern California (Keck SOM) students were invited to participate in an anonymous, voluntary, online survey ("Pre") rating their level of interest, awareness, exposure and comfort with military health issues on a 5-point Likert scale. A student-organized program of four voluntary lectures discussing military health-related topics was then implemented. Students were invited to re-take the survey ("Post") and also indicate which, if any, lectures they had attended. Results: 230 students completed the "Pre" survey. A statistically significant deviation in responses was observed in all four questions, showing high interest (mean: 3.19 ± 1.20, P = 0.002), low awareness (mean: 2.52 ± 1.15, P < 0.001), low comfort (mean: 2.66 ± 1.11, P < 0.001), and low exposure (mean: 1.80 ± 0.95, P < 0.001) to military health issues. 132 students completed the "Post" survey, including 37 lecture attendees and 95 non-attendees. A statistically significant difference in the level of interest (P < 0.05) and exposure (P < 0.05) was observed between these groups. Discussion: Medical schools that lack military health curricula may underprepare students to care for military-affiliated patients. Student-led programs can help introduce this topic before formalized curricula are instituted.
  - 1,808 156
EDITORIAL
Co-Editors' Notes 29:2
Donald Pathman, Michael Glasser
May-August 2016, 29(2):65-67
DOI:10.4103/1357-6283.188681  PMID:27549641
  - 2,900 789
GENERAL ARTICLES
A medical school's approach to meeting the challenges of interdisciplinary global health education for resident physicians
Carlough Martha, Becker-Dreps Sylvia, Hawes Samuel, Hodge Bethany, Martin Ian, Clark Denniston
May-August 2016, 29(2):113-118
DOI:10.4103/1357-6283.188750  PMID:27549648
Background: Following a similar trend among United States (US) medical students, US resident physicians are increasingly interested in pursuing global health education. Largely, residency education has lagged behind in addressing this demand. Time and curriculum requirements make meeting this need challenging. The Office of International Activities (OIA) at University of North Carolina-Chapel Hill (UNC-CH) was founded to provide support to students and residents in the area global health. In order to more fully understand resident physicians' attitudes and educational needs, a survey of incoming residents was undertaken. Methods: The OIA administered a survey for incoming first-year residents of all specialties in July 2012. The survey was administered over one month using Qualtrics® and the response rate was 60%. Results: Although 42% of residents had had an international experience during medical school, only 36% reported they felt prepared to address issues of international public health, including travel medicine and immigrant health. Significant barriers to involvement in global health opportunities in residency education were identified, including lack of time, finances and mentorship. Discussion: As has been previously documented for global health education for medical students, this study's residents saw significant barriers to international electives during residency, including lack of elective time, finances and family responsibilities. In response to the survey results, an interdisciplinary educational initiative was developed at our school. This included obtaining buy-in from core residency leadership, establishing a pathway to arrange experiences, competitive scholarships for travel, and initiation of interdisciplinary educational opportunities. Results may serve as a useful model for other academic centers in developed countries.
  - 2,187 266
Lessons learned from the disruption of dental training of Malaysian students studying in Egypt during the Arab spring
Sibu Sajjan Simon, Srinivas Sulugodu Ramachandra, Datuk Dr Fawzia Abdullah, Md Nurul Islam, CG Kalyan
May-August 2016, 29(2):124-127
DOI:10.4103/1357-6283.188753  PMID:27549650
Background: Political crisis and worsening security situation in Egypt in late 2013 resulted in Malaysian students who were pursuing their dental education in Egypt being recalled home to Malaysia. The Ministry of Higher Education in Malaysia took steps to integrate these students into public and private universities in Malaysia. Methods: We used a questionnaire and informal interviews to learn from students returning from Egypt about their experiences transitioning from dental schools in Egypt to Malaysia. Results: We discuss the challenges students faced with regards to credit transfer, pastoral care, the differences in the curriculum between the dental faculties of the two nations, and the financial implications of this disruption of their training. Discussion: We live in a fragile world where similar political situations will surely arise again. The approaches used by the Malaysian government and the lessons learned from these students may help others. The perspectives of these students may help educators reintegrate expatriate students who are displaced by political instability back into the education system of their own countries.
  - 1,925 142
LETTERS TO THE EDITOR
Simulation and lessons learned from the Ebola epidemic
Cameron R Wangsgard, Damian V Baalmann, Virginia R Keaveny, Pritish K Tosh, Deepi G Goyal, Byron I Callies, Torrey A Laack
May-August 2016, 29(2):156-157
DOI:10.4103/1357-6283.188781  PMID:27549657
  - 1,685 182
Community medicine teaching for paramedical courses in India: Does the curriculum for medical laboratory technology course need a revision?
Mahendra M Reddy, Sonali Sarkar, Kalaiselvi Selvaraj, Subitha Lakshminarayanan
May-August 2016, 29(2):158-159
DOI:10.4103/1357-6283.188782  PMID:27549658
  - 2,091 168
ORIGINAL RESEARCH ARTICLES
Using scientific inquiry to increase knowledge of vaccine theory and infectious diseases
Zachary F Walls, John B Bossaer, David Cluck
May-August 2016, 29(2):95-106
DOI:10.4103/1357-6283.188743  PMID:27549646
Background: The aim of this study was to design and evaluate a laboratory activity based on scientific inquiry to educate first-year pharmacy students in the U.S. about vaccination theory and the attributes of common pathogens. Methods: The laboratory activity had two principal sections. The first consisted of an interactive game during which students rolled a die to determine outcomes based on a set of pre-determined criteria. In the second section, students generated and tested hypotheses about vaccine theory using a computer simulation that modeled disease transmission within a large population. In each section students were asked to evaluate epidemiological data and make inferences pertinent to vaccination effectiveness. Results: Mean scores on a knowledge-based assessment given immediately before and immediately after the activity increased from 46% to 71%. Discussion: A laboratory activity designed to stimulate scientific inquiry within pharmacy students enabled them to increase their knowledge of common vaccines and infectious diseases.
  - 2,123 204
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