Background: Medical errors are among the most prevalent and serious adverse events in health care. Lack of situation awareness (SA) is an important factor leading to such errors. SA can be understood using Endsley's three-tier model: level 1 is perception, level 2 is comprehension, and level 3 is projection. While there is extensive literature on the theory of SA, it is difficult to measure and quantify. The purpose of this pilot study was to measure, identify, and characterize SA in some medical objective structured clinical examination (OSCE) guides, including a 1^st year National University of Ireland, Galway (NUIG) OSCE. Methods: Two independent observers analyzed two online OSCE guides and a 1^st year OSCE examination using a self-developed tool. This tool was an inferential measure of SA. The guides were first qualitatively analyzed using NVivo and then quantitatively analyzed using Excel. Results: The results indicated strong internal validity and moderate inter-rater reliability. There was limited statistically significant variance between the observers. The NUIG OSCE had relatively the fewest relative observations of SA and the Geeky Medics OSCE Guide had relatively the most observations of SA. In all guides, Level 1 SA was observed more frequently than Level 2 or 3 SA. Discussion: SA is an important factor in clinical decision-making and patient safety. The challenging aspect is how to best teach and assess SA in medical education. Simulations, such as informative and/or summative OSCEs, are considered a valuable and safe way to do so. Inter-rater reliability can be improved using tool training sessions.

Background: Several medical schools around the world are moving away from isolated, locally developed in-house assessments to the introduction of external examinations into their curriculum. Although the objective varies, it is typically done to evaluate, audit, and compare students' performance to international standards. Similarly, the International Foundations of Medicine-Clinical Sciences Examination (IFOM-CSE) was introduced in the College of Medicine at the University of Sharjah as an external assessment criterion in addition to the existing in-house assessments. The aim of this study was to compare the student performance in this newly introduced IFOM-CSE examination and the existing in-house final examination in the college. Methods: The scores of three consecutive final-year undergraduate medical student batches (2013-2015) who took both the IFOM-CSE and the existing in-house final examination were analyzed. Pearson correlation and one-way analysis of variance test were conducted using SPSS 22. Results: The students' scores in the IFOM-CSE and in the final examination prepared locally were highly correlated with Pearson correlation coefficients of 0.787 for batch 2013, 0.827 for batch 2014, and 0.830 for batch 2015 (P < 0.0005). Interestingly, while the mean scores of the IFOM-CSE among the three batches in the years 2013, 2014, and 2015 (475, 492, and 513, respectively) showed improvement with borderline significance (F[2226] = 2.73, P = 0.067), local examination scores showed a significant improvement during the study period (F[2277] = 52.87, P < 0.0005). Discussion: The findings of this study showed that students' scores in the local examination were consistently correlated with their scores in the IFOM-CSE over all the three batches. Thus, introduction of external examination can be an important evaluation tool to a comprehensive internal assessment system providing evidence of external validity.

Background: There is a growing demand by medical trainees for meaningful, short-term global emergency medicine (EM) experiences. EM programs in high-income countries (HICs) have forged opportunities for their trainees to access this experience in low-and middle-income countries (LMICs). However, few programs in LMICs have created and managed such courses. As more LMICs establish EM programs, these settings are ideal for developing courses beneficial for all participants. We describe our experience of creating and implementing a short-term global EM course in Rwanda. Objectives: The objectives of this study were to (1) provide EM trainees from HICs with an opportunity to observe global clinical practice and to learn from local experts, (2) provide EM trainees from an LMIC with an opportunity to share their expert knowledge and skills with HIC trainees, (3) create a sustainable model for a short-term global EM course in an LMIC context. Methods: A global EM curriculum and course were developed in Rwanda, entitled EM in the Tropics Emergency Medicine in the Tropics (EMIT). The following topics were covered: EM systems development, public health, trauma/triage, pediatrics, disaster management, and tropical EM. A one-and two-week course program was created and implemented. Results: EMIT participants rotated through pediatric and adult EDs, Intensive Care Unit, trauma surgery, internal medicine, emergency medical services, and ultrasound training. Activities included bedside teaching, case presentations, ultrasound practice, group lectures, simulation and skills workshops, and a rotation to a district hospital. A total of 11 participants attended: six for both weeks and five for 1 week. The course raised $5000 USD, which was dedicated in full to sponsoring local EM residents to attend international conferences. Discussion: The EMIT course in Rwanda achieved its objectives of teaching and learning between all participants. Benefits of this in-person experience for both visiting and local participants are clear in clinical, intercultural, and professional ways. Conclusion: Our experience of developing and implementing EMIT in Rwanda demonstrates that EM programs in LMICs can provide short-term global EM courses that are not only beneficial to all participants, but also logistically and financially sustainable.

Background: In this study, we examined the impact of personality traits, assessed with the psychopathic personality inventory revised version (PPI-R), on medical students' likelihood of selecting a surgical specialty. Methods: This is a cross-sectional questionnaire-based study of 360 4^th-year medical students at a single university. We used the PPI-R previously developed to evaluate “adaptive” traits within nonclinical (student) populations. Students were asked to express their specialty of choice. Medical specialties were categorized as surgical and nonsurgical. Logistic regression was used to identify predictors and appropriate adjustments were made for demographic factors. Results: The survey was completed by 335 out of 360 students. The prevalence of students aspiring to a surgical career was 23.6%. They exhibited higher PPI-R total score, self-centered impulsivity (SCI) factor score, Machiavellian egocentricity, social influence, and fearlessness content scale scores. Logistic regression showed that SCI score was a significant predictor for the likelihood of expressing interest toward a surgical career. Discussion: Our findings expand previous research on the usefulness of the nonclinical use of psychopathic personality traits to investigate career choice.

Background: The situational judgment test (SJT) was introduced for all graduating United Kingdom medical students in 2013. Students have anxiety over time pressures and heavy weighting of a single examination. Aims: This study aimed to examine formal SJT preparation available, perceptions of a near peer-delivered course, and to measure improvement in students' confidence. Innovation: Foundation doctors ( first 2 years of postgraduate training) produced a “Situational Judgment Test Preparation Course” in November 2015. Methods: Feedback was collected via Likert scores rating teaching, a mock examination, and pre- and post-course confidence along with free-text responses. Delayed feedback was collected via an online survey. Results: Forty-four students completed the feedback. Seventy percent reported <2 h of university SJT preparation. There were significant post-course improvements in familiarity with structure, scoring system, knowledge and content, and overall SJT confidence (P < 0.05). Delayed feedback showed sustained improvement in familiarity with knowledge and content (P < 0.05). Qualitative analysis revealed themes of improved confidence, approachable tutors, and identifying question strategies. Discussion: Students perceived a lack of formal SJT preparation which was reflected in low pre-course confidence. Improvements in confidence may reflect a unique insight into how to approach the examination from those having recently undertaken it.

Background: Adequate ophthalmic diagnostic and clinical skills are essential for practitioners in primary care settings as well as specialty care physicians. The objectives of this study were to assess the adequacy of ophthalmology teaching in undergraduate medical education and to evaluate the comfort of medical students in diagnosing common eye problems and performing ophthalmic skills. Methods: A questionnaire based, cross-sectional survey was conducted among third-year undergraduate students from a medical college in South India at the end of ophthalmology training from February 2014 to December 2014. The main outcome measures were hours of classroom-based instruction and clinical exposure to ophthalmology received by the students and their comfort level in diagnosing common eye problems and performing ophthalmic skills. Results: 134 students participated in the study. They had received an average of 96.2 ± 5.9 and 112.5 ± 11.3 hours of classroom and clinic-based instruction, respectively. The participants' comfort in diagnosing eye problems was satisfactory for cataract and eyelid disorders but not for ophthalmic emergencies. Only 45.5% had satisfactory knowledge in community ophthalmology. Respondents were more proficient in visual acuity testing (93.3%) and assessment of pupillary reaction (80.6%) than direct ophthalmoscopy (41%). Discussion: Undergraduate medical students from India received a greater amount of ophthalmology instruction compared to the International Council of Ophthalmology task force recommendations. Gaps in community ophthalmology and knowledge-skills discrepancies were noted. Review of curriculum, appropriate training resources, and effective teaching methods tailored towards primary care may be useful to improve the training.

Background: Communication skills can be difficult to teach and assess in busy outpatient settings. These skills are important for effective counseling such as in cases of influenza vaccine hesitancy. It is critical to consider novel educational methods to supplement current strategies aimed at teaching relational skills. Methods: An immersive virtual reality (VR) curriculum on addressing influenza vaccine hesitancy was developed using Kern's six-step approach to curriculum design. The curriculum was meant to teach best-practice communication skills in cases of influenza vaccine hesitancy. Eligible participants included postgraduate level (PL) 2 and PL-3 pediatric residents (n = 24). Immediately following the curriculum, a survey was administered to assess residents' attitudes toward the VR curriculum and perceptions regarding the effectiveness of VR in comparison to other educational modalities. A survey was administered 1 month following the VR curriculum to assess trainee-perceived impact of the curriculum on clinical practice. Results: All eligible residents (n = 24) completed the curriculum. Ninety-two percent (n = 22) agreed or strongly agreed that VR simulations were like real-life patient encounters. Seventy-five percent (n = 18) felt that VR was equally effective to standardized patient (SP) encounters and less effective than bedside teaching (P < 0.001). At 1-month follow-up, 67% of residents (n = 16) agreed or strongly agreed that the VR experience improved how they counseled families in cases of influenza vaccine hesitancy. Discussion: An immersive VR curriculum at our institution was well-received by learners, and residents rated VR as equally effective as SP encounters. As such, immersive VR may be a promising modality for communication training.

Background: Key elements in the clinical practice of prevention, health and wellness are best cultivated in medical professionals during undergraduate medical training. This study explores students' self-assessed stress relative to gender, academic expectations, and level of medical training to guide development of targeted wellness interventions. Methods: In early 2012, undergraduate (M1–M4) students in four Southeastern U.S. allopathic medical schools were surveyed about health-related attitudes and behaviors. Results: A total of 575 students returned completed questionnaires. Students in the preclinical years (M1–M2), especially females, reported significantly higher stress levels. Academic expectations and satisfaction were also significantly implicated. Discussion: These findings highlight the general areas of potential concern regarding stressors associated with medical training. Future research should guide programmatic efforts to enhance students' overall health and wellness vis-à -vis curriculum, skills training, and support services.

Background: As the burden of noncommunicable diseases (NCDs) has been rising globally, various educational programs have introduced chronic disease epidemiology teaching, which is now a component of most of the Master of Public Health (MPH) programs. However, the process of curriculum development for these courses has not been adequately documented for use by educators planning such courses. Methods: A detailed process of curriculum development based on David Kern's six-step approach was undertaken for a 2-week course on NCDs, as part of the MPH program of a tertiary institution in South India. The processes were documented so that the method of curriculum development for such a course could be made available for educators across this field. Results: The course on NCDs was carried out over 73 learning hours (2 weeks) for a group of MPH students including medical, dental, allied health, and nursing graduates. Evaluation of the revised curriculum at the end of the 2 weeks revealed that mean scores for knowledge and confidence in skills increased by 50% (11.1–16.6, t-test, P < 0.001) and 79% (3.3–5.9, t-test, P = 0.002), respectively, from baseline scores. Discussion: The revised curriculum was effective in improving knowledge and confidence in epidemiological skills. The documented process of curricular development using standard methods if made publicly available can be of use to those involved in planning similar educational programs for students of public health.

Background: Christian Medical College (CMC), Vellore, India, a tertiary care hospital, designed a year-long Fellowship in Secondary Hospital Medicine (FSHM) for CMC graduates, with the aim to support them during rural service and be motivated to consider practicing in these hospitals. The FSHM was a blend of 15 paper-based distance learning modules, 3 contact sessions, community project work, and networking. This paper reports on the evaluation of the FSHM program. Methods: The curriculum development process for the FSHM reflected the six-step approach including problem identification, needs assessment, formulating objectives, selecting educational strategies, implementation, and evaluation. Telephone interviews with students were conducted to determine if the program motivated them to consider working in smaller hospitals. Results: Qualitative data analysis showed that the program motivated the FSHM students to consider practicing in secondary hospitals by creating awareness of challenging opportunities and instilling confidence to provide good quality clinical care with limited resources. Discussion: We propose rural service for MBBS graduates, supported by a blend of on-site and distance education as a model for medical education.

An important aspect of academic medicine is publication in peer-reviewed journals and other media. Early scholarly productivity in medical school may jump-start a successful academic career. Topic choice, search methodology, writing strategies, mentorship, and collaboration are all fundamental to successful academic productivity. The authors reviewed the importance of instituting the germinal stages of scholarly productivity during medical training and created 12 steps for facilitating productive academic writing by students.

Background: Women account for 16% of deans of American medical schools. To investigate this gender gap, female deans were interviewed about the barriers facing women advancing toward deanships. Methods: The author conducted semi-structured interviews with eight women deans. Interviews were analyzed using provisional coding and sub coding techniques. Results: Four main themes emerged during the interviews: (1) the role of relationships in personal and career development, (2) leadership challenges, (3) barriers between women and leadership advancement, and (4) recommendations for improvement. Recommendations included allocating resources, mentorship, career flexibility, faculty development, updating the criteria for deanships, and restructuring search committees. Discussion: The barriers identified by the deans are similar to those found in previous studies on female faculty and department chairs, suggesting limited improvement in gender equity progress.