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   2017| May-August  | Volume 30 | Issue 2  
    Online since September 19, 2017

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A first step in addressing medical education Curriculum gaps in lesbian-, gay-, bisexual-, and transgender-related content: The University of Louisville Lesbian, Gay, Bisexual, and Transgender Health Certificate Program
Susan Sawning, Stacie Steinbock, Rachel Croley, Ryan Combs, Ann Shaw, Toni Ganzel
May-August 2017, 30(2):108-114
DOI:10.4103/efh.EfH_78_16  PMID:28928340
Background: Individuals who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming, and/or born with differences of sex development have specific health needs and significant health disparities exacerbated by a lack of training among health professionals. The University of Louisville LGBT Health Certificate Program used an interdisciplinary approach to increase training, potentially enabling future physicians to provide quality healthcare to LGBT patients. Methods: A pretest-post-test design was used to investigate medical students' (n = 39) attitude and knowledge outcomes after program participation. Attitudinal items with Likert-type responses were analyzed using the Wilcoxon signed-rank test. Baseline frequency and percentage of correct responses were tabulated for knowledge questions. At both pre- and post-test, the 11 knowledge items were summed to establish a total knowledge score, creating two total scores. The paired sample t-test was used to evaluate the pre- and post-change, and Cohen's D was used to assess effect size. All P values were two-tailed. Statistical significance was set by convention at P < 0.05. Results: Students correctly answered 69% or less of the knowledge questions at baseline. Total correct knowledge scores significantly increased post intervention with the effect size being large (Cohen's D = 0.90, P < 0.001). Attitudes significantly increased post intervention on two items (P = 0.019 and P = 0.037). Some attitude items decreased post intervention: students felt it is more challenging to conduct a patient history with a LGB patient (pre-mean agreement = 2.44; post-mean agreement = 2.97, P = 0.018). Conclusions: Medical educators can play a critical role in decreasing LGBT healthcare disparities. The University of Louisville LGBT Health Certificate Program played an important first step in increasing medical students' knowledge and improving certain attitudes about LGBT patients.
  5,401 1,089 16
Using Maslow's hierarchy to highlight power imbalances between visiting health professional student volunteers and the host community: An applied qualitative study
Tracey Evans, Orezioghene Akporuno, Katrina M Owens, Brittany Lickers, Jazmin Marlinga, Henry C Lin, Lawrence C Loh
May-August 2017, 30(2):133-139
DOI:10.4103/efh.EfH_175_16  PMID:28928343
Background: Health professional students from high-income countries increasingly participate in short-term experiences in global health (STEGH) conducted abroad. One common criticism of STEGH is the inherent power differential that exists between visiting learners and the local community. To highlight this power differential, this paper explores perceived benefits as described by volunteer and community respondents and applies Maslow's hierarchy of needs to commonly identified themes in each respondent group. Methods: A semistructured survey was used to collect qualitative responses from both volunteers and community members located in a Dominican Republic community, that is, a hotspot for traditionally conducted STEGH. Thematic analysis identified themes of perceived benefits from both respondent groups; each group's common themes were then classified and compared within Maslow's hierarchy of needs. Results: Each respondent group identified resource provision as a perceived benefit of STEGH, but volunteer respondents primarily focused on the provision of highly-skilled, complex resources while community respondents focused on basic necessities (food, water, etc.) Volunteer respondents were also the only group to also mention spiritual/religious/life experiences, personal skills development, and relationships as perceived benefits. Applying Maslow's hierarchy thus demonstrates a difference in needs: community respondents focused on benefits that address deficiency needs at the bottom of the hierarchy while volunteers focused on benefits addressing self-transcendence/actualization needs at the top of the hierarchy. Conclusions: The perceived difference in needs met by STEGH between volunteers and the host community within Maslow's hierarchy may drive an inherent power differential. Refocusing STEGH on the relationship level of the hierarchy (i.e., focusing on partnerships) might help mitigate this imbalance and empower host communities.
  3,921 392 3
Influence of pharmacy students on the attitudes of medical students following an interprofessional course
Fatemeh Dabaghzadeh, Bahare Zihayat, Farhad Sarafzadeh
May-August 2017, 30(2):103-107
DOI:10.4103/efh.EfH_185_16  PMID:28928339
Background: Clinical interprofessional education (IPE) can promote mutual understanding of other health professions and respectful behaviors among health-care professionals. The aims of this study were to evaluate the effects of IPE on the attitudes of medical and pharmacy students in an inpatient hospital setting and, in particular, the influence of pharmacy students on the attitudes of medical students. Methods: The 6th year doctor of pharmacy students and medical students were enrolled in a prospective cohort study. They were paired and each pair was responsible for three beds and all the patients occupying these mentioned beds over the 2-week course. The Readiness for Interprofessional Learning Scale (RIPLS) questionnaire was used to assess the students' attitudes before and after the course. Results: The attitudes of the medical students changed positively after the IPE course based on RIPLS teamwork and collaboration and professional identity subscales. Changes in the attitudes of the pharmacy students were not statistically significant based on the mentioned scale and subscales. Discussion: IPE could improve the attitudes of the medical students regarding interprofessional teamwork, communication, and sharing learning experience. Based on the current investigation, IPE did not have an effect on pharmacy students.
  3,085 850 3
Reforming pathology teaching in medical college by peer-assisted learning and student-oriented interest building activities: A pilot study
Sumit Grover, Neena Sood, Anurag Chaudhary
May-August 2017, 30(2):126-132
DOI:10.4103/efh.EfH_267_16  PMID:28928342
Background: Peer-assisted learning (PAL) is a teaching–learning method in which students act as peer teachers and help other students to learn while also themselves learning by teaching. PAL through modified interest building activities (MIBAs) is seldom tried in teaching pathology in medical colleges. This study aimed to evaluate the usefulness of peer teaching using MIBA, obtain feedback from students, and compare different activities with each other and with traditional teaching–learning methods. Methods: An interventional pilot study was conducted in 2 months on the 2nd MBBS undergraduates learning pathology at a medical college in North India. Students acted as peer teachers and performed different MIBAs including role plays, demonstration of pathogenesis through props, student-led seminars such as PowerPoint teaching, blackboard teaching, multiple choice question seminars, case-based learning (CBL) exercises, and quizzes before teaching sessions. Feedback was obtained through structured questionnaires on a 5-point Likert scale. Paired t-test was used to compare traditional teaching with MIBAs, and Friedman test was used to compare among different MIBAs. Results: Students found ease of understanding and the interaction and involvement of students as the most important benefits of PAL. MIBAs increased voluntary participation, coordination, teamwork, shared responsibility, and group dynamics among students. Quiz sessions followed by PowerPoint seminars and prop demonstrations received highest mean scores from students on most of the parameters. Quizzes, blackboard teaching, prop activities, and CBL helped students understand topics better and generated interest. Learners advocated for making MIBAs and PAL compulsory for future students. Discussion: PAL complemented by MIBAs may be adopted to make teaching–learning more interesting and effective through the active involvement and participation of students.
  3,184 561 1
The pursuit of healthier communities through a community health medical education program
Francisco Lamus-Lemus, Camilo Correal-Muñoz, Erwin Hernandez-Rincon, Natalia Serrano-Espinosa, Clara Jaimes-deTriviño, Diana Diaz-Quijano, Juan Gabriel García-Manrique
May-August 2017, 30(2):116-125
DOI:10.4103/efh.EfH_283_14  PMID:28928341
Background: Distinct periods in the community health undergraduate medical program at the University of La Sabana (Colombia) were identified in its evolution from 1999 to 2013. We describe each period and explain the succesion of changes toward improvement. Methods: An ordered review of the community health program was constructed based on the retrospective recollection, classification, and analysis of information from document archives and interviews with participants. The review of the experience reconstructs periods of the program, organizing the evolution of its learned lessons and identified changes across the development of community health projects (CHPs) and the phases followed in their implementation. Results: Two principal stages were identified, the first when students' CHPs involved only schools, and the second when students worked in a broader array of community settings. Identified phases of the community health cycle leading to identifying changes across the program timeline were focus of the community–campus partnership; development of relationships among participants; health and health determinants' assessment; defining project goals and objectives; devising a project activity plan; implementing and gathering results; disseminating project achievements; and building sustainability of program activities. Periods were bounded by important new characteristics introduced in the pursuit of healthier communities. Discussion: Understanding the evolution of the program revealed the key concepts and practices in setting community health apprenticeship scenarios for the various participants. Overall, trust and commitment from stakeholders requires competent facilitators able to build meaningful and sustainable collaborations that can translate the purpose of community health practice into an effective teaching–learning experience. Institutional capacity building and collaborative practice contribute to improvements in the community health program and its ability to be flexible to adapt to different contexts. Periods reflecting improvement in this school's programs over time can help others identify key elements that need to be integrated into a community health medical education program.
  2,904 427 3
Medical students' perceived educational needs to prevent and treat childhood obesity
Natalie K Cooke, Sarah L Ash, L Suzanne Goodell
May-August 2017, 30(2):156-162
DOI:10.4103/efh.EfH_57_16  PMID:28928346
Background: Medical schools are challenged to incorporate more prevention-based education into curricula, offering an opportunity to revisit approaches to nutrition education. The objective of this study was to explore United States (US) medical students' understanding of childhood obesity, specifically barriers to childhood obesity prevention and treatment and students' perceived educational deficits. Methods: The research team conducted phone interviews with 78 3rd- and 4th-year medical students, representing 25 different medical schools across the US. Using a semi-structured interview guide, researchers asked students to describe the etiology of childhood obesity and reflect on where they acquired knowledge of the etiology and what additional resources they would need to treat obese children. Using a phenomenological approach to analysis, researchers identified five dominant emergent themes. Results: Student-perceived barriers to childhood obesity prevention and treatment in clinical care included student-centered (e.g., lack of knowledge), patient-centered (e.g., lack of access), and healthcare system-centered barriers (e.g., limited time). Students requested more applicable nutrition information and counseling skills relevant to preventing and treating childhood obesity; however, they tended to identify others (e.g., parents, schools), rather than themselves, when asked to describe how childhood obesity should be prevented or treated. Discussion: To provide students with an understanding of their role in preventing and treating childhood obesity, US medical schools need to provide students with childhood obesity-specific and general nutrition education. To build their self-efficacy in nutrition counseling, schools can use a combination of observation and practice led by skilled physicians and other healthcare providers. Increasing students' self-efficacy through training may help them overcome perceived barriers to childhood obesity prevention and treatment.
  2,787 353 3
Knowledge of scientific misconduct in publication among medical students
Syed Muhammad Mubeen, Qurrat-ul-Ain , Rabia Ghayas, Syed Hasan Adil Rizvi, Sohaib Ahmed Khan
May-August 2017, 30(2):140-145
DOI:10.4103/efh.EfH_221_16  PMID:28928344
Background: Publication is a central element in research dissemination and scientific misconduct in publication is relatively ignored in biomedical research. This study is to assess the knowledge of scientific misconduct in publication among private and public sector medical students. Methods: A questionnaire-based cross-sectional study was carried in four (two public and two private) medical colleges of Karachi in 2015. After ethical approval, data were collected through convenient sampling and analyzed in SPSS 16.0. Descriptive statistics was used to summarize the data and Chi-square test was used for cross tabulation with sex, type of medical colleges, and knowledge of scientific misconduct in publication. Results: A total of 592 medical students participated with mean age of 22.2 ± 1.47 years. The majority (491, 79%) of medical students had heard about the word “publication ethics,” higher among public sector students than from private sector (P < 0.001). Only 78 (13.2%) reported to had published original articles, and 64 (10.8%) and 53 (9%) medical students had heard of “ICMJE authorship criteria” and “COPE,” respectively. Knowledge about fabrication of data and scientific misconduct in publication was found to be statistically significant (P < 0.05) among males than female students. Statistically significant differences were also observed between public and private medical students for knowledge regarding salami slicing, ghost author, fabrication, and photomanipulation (P < 0.001) and for plagiarism (P < 0.005). Participants from public sector colleges scored significantly better in all above variables than private medical colleges except knowledge about salami slicing in which participants from latter performed significantly better than public sector students. Discussion: The study demonstrates deficiencies in knowledge regarding several aspects of publication ethics among medical students of both public and private medical colleges in Karachi. There is a need to increase the awareness of research and publication ethics among students during their academic years.
  2,596 504 1
Improving breastfeeding medicine in undergraduate medical education: A student survey and extensive curriculum review with suggestions for improvement
Anna J Gary, Erin E Birmingham, Laurie B Jones
May-August 2017, 30(2):163-168
DOI:10.4103/efh.EfH_180_15  PMID:28928347
Background: Breastfeeding education should be incorporated routinely into medical school curricula. Despite strong evidence supporting exclusive breastfeeding of infants, lack of physician education has continued to undermine the practice of breastfeeding. Protecting and supporting breastfeeding should be a public health priority as it has the potential to save billions of dollars in health care and also provide the most benefit to the newborn infant. The purpose of this article was to evaluate how the United States undergraduate medical institution incorporates breastfeeding medicine into its curriculum and to suggest modifications that will improve breastfeeding education at all undergraduate medical institutions. Methods: The authors performed an in-depth review of the undergraduate medical curriculum at the United States medical institution. Course requirements and lectures were compared with the 12 knowledge-based and 12 skill-based competencies that the authors suggest all medical students should possess. In addition, the authors sent out an electronic survey to 600 medical students at the same institution to assess current students understanding and comfort with basic breastfeeding topics. Results: Students in the preclinical years are only learning 3 of the 12 knowledge-based competencies and 1 of the 12 skill-based competencies. Students in the clinical years are learning 5 of the 12 knowledge-based competencies and 9 of the 12 skill-based competencies. Survey results showed that the majorities of medical students were not comfortable with basic breastfeeding medicine and guidance. Discussion: The authors recommend several curriculum changes to advance breastfeeding education. A more targeted breastfeeding curriculum in medical education will help to improve physician knowledge, practice patterns, and confidence in breastfeeding management.
  2,637 444 6
Co-editor notes 30:2
Danette Mckinley, Maaike Flinkenfögel, Michael Glasser
May-August 2017, 30(2):101-102
DOI:10.4103/efh.EfH_236_17  PMID:28928338
  2,412 548 -
Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis
Ryan William Raymond Guilbault, Joseph Alexander Vinson
May-August 2017, 30(2):146-155
DOI:10.4103/efh.EfH_226_16  PMID:28928345
Background: Undergraduate medical students are enrolled in clinical education programs in rural and underserved urban areas to increase the likelihood that they will eventually practice in those areas and train in a primary care specialty to best serve those patient populations. Methods: MEDLINE and Cochrane Library online databases were searched to identify articles that provide a detailed description of the exposure and outcome of interest. A qualitative review of articles reporting outcome data without comparison or control groups was completed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis of articles reporting outcome data with comparison or control groups was completed with statistical and graphical summary estimates. Results: Seven hundred and nine articles were retrieved from the initial search and reviewed based on inclusion and exclusion criteria. Of those, ten articles were identified for qualitative analysis and five articles included control groups and thus were included in the quantitative analysis. Results indicated that medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about four times as likely to practice primary care in underserved areas than students who do not train in those locations (RR = 4.35; 95% CI: 1.56, 12.10). Discussion: These estimates may help guide medical school administrators and policymakers to expand underserved clinical training programs to help relieve some of the problems associated with access to medical care among underserved populations.
  2,413 419 8
An interprofessional education program's impact on attitudes toward and desire to work with older adults
Kaitlyn McManus, Katherine Shannon, Darson L Rhodes, Julia D Edgar, Carolyn Cox
May-August 2017, 30(2):172-175
DOI:10.4103/efh.EfH_2_15  PMID:28928349
Background: Insufficient numbers of health professions students aspire to work with the increasing numbers of the elderly. Although programs exist to promote interest in serving this population, inadequate numbers of health professionals remain an issue. Methods: This study sample consisted of medical (n = 75) and health profession students (n = 210) enrolled in a semester-long interprofessional clinical education program designed to enhance interprofessional teamwork and provide positive exposure to elderly in the community. Each team of three visited an assigned elder three times during the semester. Students were acquainted with their elder and also administered a comprehensive geriatric physical and socioemotional battery of assessments. After each visit, the teams met and held a debriefing with faculty. Attitudes toward older adults and the desire to work with older adults were assessed using the Carolina Opinion of Care of Older Adults. The survey was administered twice: before initiating the semester-long program and immediately after program completion. Results: Total score and subscale scores were compared pre- and post-experience. Scores on the subscale “Early Interest in Geriatrics” were significantly higher postexperience compared to pre-experience. Scores on the remaining subscales and the total score remained unchanged. Discussion: Results indicate that exposure to elderly adults may increase the interest in working with this population and does not diminish attitudes toward the elderly. Longer exposure may be needed to invoke attitudinal changes across additional subtests.
  1,743 291 3
Cross-cultural adaptation of Jefferson scale of empathy-health professions students version: An experience with developing the Tamil translation
Kathiresan Jeyashree, Soundappan Kathirvel, Muthu K Prathibha
May-August 2017, 30(2):169-171
DOI:10.4103/efh.EfH_312_16  PMID:28928348
Background: Empathy is a key cognitive attribute among healthcare professionals that fosters better patient– healthcare provider relationships. The Jefferson scale of empathy (JSE) measures self-rated empathy among various groups of healthcare professionals–health professionals, medical students and health professions students (HPS). The authors present the experience in translating the JSE-HPS version into an Indian regional language with insights into the issues faced in every step. Methods: With official permission from the Thomas Jefferson University, the authors embarked on the translation proceeding through forward translation (three rounds of modification), back translation (two independent translates), and synthesis of a final translated version. While targeting literary accuracy, the simplicity and comprehensibility of the instrument by the study population were also ensured. Variations in regional dialects and accents across the population were considered. Results: The back-translated version was evaluated for semantic, content, cultural, and technical equivalence. It was then pretested on ten students followed by a group discussion with them to ensure the comprehensibility of the tool and the differences between written and spoken language were addressed through necessary modifications. Discussion: The Tamil translation of the HPS version of JSE is now approved by and officially available with the Thomas Jefferson University.
  1,761 256 -
Does the early adopter catch the worm or choke on it? A reflective journey of the challenges of technology adoption in a health sciences education institution
Chrisna Botha-Ravyse, Seugnet Blignaut
May-August 2017, 30(2):176-181
DOI:10.4103/efh.EfH_219_16  PMID:28928350
Background: Early adoption of technology is a struggle well known to early adopters and now to me. Since the demand to use and implement technology in health professions' education has increased, I have been led to adopt various technologies, leading to many headaches. Methods: This paper addresses my experiences in developing and implementing technology in health science classrooms in a setting not adequately equipped to do so. Results: After reflecting on my experiences, I conclude that it is crucial that systems help innovators and early adopters as they work to develop and implement teaching and learning technology. Technical decisions should address the needs of the higher education educator. Discussion: In addition, once an institution chooses a specific technological approach, such as using e-guides, there should be resources in place to support the forerunners of these initiatives.
  1,768 213 -
Application of Spreitzer's and Kanter's theories for empowerment education
Janet Neal, Sandra Shortt
May-August 2017, 30(2):183-184
DOI:10.4103/efh.EfH_320_16  PMID:28928352
  1,616 343 -
E-learning module on interpersonal dynamics: An evaluation
David Reiss, Joanna Dow, Gabriel Kirtchuk
May-August 2017, 30(2):186-187
DOI:10.4103/efh.EfH_140_15  PMID:28928354
  1,410 183 -
Graduate medical research in India: Where are we today?
Rohan Shad, Naveen Sharma
May-August 2017, 30(2):182-182
DOI:10.4103/efh.EfH_60_16  PMID:28928351
  1,316 160 -
Incorporating single best answer questions into revision lectures results in increased student satisfaction with lecture-based teaching
Sophie Fitzsimmons, Aliya Bryce, Sean Main
May-August 2017, 30(2):185-185
DOI:10.4103/efh.EfH_273_16  PMID:28928353
  1,204 153 -