International Medical Education

(1) Objective: This study evaluates the effects of simulation education at our institute on cardiac arrest resuscitation regarding knowledge, attitude, and practice (KAP) over a five-year period (2016–2020). (2) Subjects: Staff responded to the annual survey questionnaires followed by monthly training in Basic Life Support/Advanced Cardiovascular Life Support (BLS/ACLS) and Immediate Cardiac Life Support (ICLS) of the Japanese Association for Acute Medicine (JAAM) in 2016, 2017, and 2018. Additionally, in-house training was implemented in 2019 without post-assessment followed by training suspension in 2020 due to the COVID-19 pandemic. The last delivery of the survey questionnaires was in late 2020 for KAP retention measurement. (3) Measurements and Results: The self-efficacy level of BLS/ACLS/ICLS KAP of the survey respondents was analyzed using a five-point Likert scale. The mean self-efficacy level of BLS/ACLS/ICLS KAP increased over time, and that of the trained people was three-fold that of the untrained people. Trainees that had no cardiopulmonary resuscitation (CPR) experience gained the BLS/ACLS/ICLS key-point self-efficacy level, which we call the “Grip 14” in this study, as high as their untrained counterparts who had three-time CPR experience. Training suspension lessened the BLS/ACLS/ICLS KAP in both groups. (4) Conclusions: Continuous training enhances not only the BLS/ACLS/ICLS KAP of trainees but also of their untrained colleagues. The training likely had the same efficacy as the CPR experience. Full article

Effective communication is key for healthcare providers to provide optimal care for patients. Pharmacists’ fluency in a patient’s native language is important for effective communication. Additionally, language concordance improves patients’ trust and ensures health equity. In the United States (US), Hispanics are the largest minority group, but only 36% of the pharmacy schools in the US offer Spanish courses in their curriculum. Conversely, Middle Eastern countries have implemented English as the language of instruction in pharmacy schools, though the native language of the patient population is Arabic. The discrepancy between the language of education and the language used by patients might lead to communication problems, thus limiting a pharmacist’s role in practice. This review aims to describe the efforts of pharmacy schools both in the US and Middle Eastern countries to incorporate a second language (Spanish and Arabic, respectively) in their curriculum. Spanish language content has scarcely been introduced into the pharmacy curriculum in the US, either as didactic elements (elective courses, lab sessions, modules within a course, or co-curricular programs) or as language immersion experiences (rotations and internships, nationally or abroad). In Arabic-speaking countries, an Arabic course was introduced to the pharmacy curriculum to enhance students’ communication skills. This review provides an overview of the steps taken in various pharmacy programs to prepare students for adequate multilingual speaking. The findings reveal the need for additional strategies to assess the impact of language courses on student performance and patient experience, as well as language competence in pharmacists and pharmacy students. Full article

Background: Physician burnout is increasingly recognized as a problem in physician well-being and may negatively affect patient care outcomes. Burnout can begin at any point of training or practice, potentially as early as the first year of medical school. Thus, there is a need to characterize possible burnout in medical students as the first step to optimizing strategies for mitigation. Traditionally, burnout has been studied using survey-based variables; however, identifying novel physiological and molecular biomarkers could allow for the expansion of screening and intervention strategies. Methods: In this pilot prospective cohort study, we followed a group of preclinical 1st and 2nd year medical students (n = 9) at the University of Florida over one academic year of medical school. We collected survey responses (Maslach Burnout Inventory [MBI], Patient Health Questionnaire-9 [PHQ-9], and Perceived Stress Scale [PSS]) and measured a panel of candidate physiological biomarkers of burnout (Inflammatory Cytokine Panel, Heart Rate Variability [HRV], and Leukocyte Telomere Length). Results: In the study participants, MBI composite scores and PHQ-9 scores showed a statistically significant increase over the course of an academic year, indicating higher levels of medical student burnout. Additionally, respondents reported a statistically significant decrease in time devoted to exercise, and we measured a significant increase in body mass index (BMI) during the academic year. PSS scores showed an upward trend which was not statistically significant. Likewise, average leukocyte telomere length trended downward, but the change was not statistically significant. There were no measured changes in the serum concentration of pro-inflammatory cytokines, and time-domain heart rate variability metrics did not differ significantly between timepoints. Conclusions: This pilot study supports the notion that burnout can begin early in medical school and is detectable via survey instruments in first-year and second-year medical students even with a small sample size. Additionally, leukocyte telomere length could potentially be a useful biomarker of burnout with supporting data, but we did not observe any statistically significant changes in inflammatory cytokines or heart rate variability. Further investigation into these potential biomarkers with larger cohort sizes is required to fully characterize their clinical utility. Full article

(1) Background: This qualitative study aimed to identify and describe course components which affect a student’s motivation to learn within a blended-learning competency-based curriculum. (2) Methods: The data were gathered via two consecutive semi-structured group interviews. The participants were purposefully sampled from medical students attending the Family Medicine (FM) class at Saarland University (UdS) in Winter 2020. The two interviews were transcribed verbatim and inductively analysed using content analysis. (3) Results: Three categories of curricular components that affected motivation were inductively formed: (a) the provision of structure (curriculum design), where providing external learning milestones to self-regulated learning positively influenced an interviewee’s learning motivation; (b) the provision of interpersonal interactions and emotional relatedness by staff, where constructive feedback and enthusiasm from a teacher facilitated intrinsic motivation and real-life examples helped the students to remember content more easily; and (c) perceived gain in self-efficacy, where a participant’s motivation to learn a particular subject area was especially high if it appeared to be highly relevant to practice or exams and the applicability of the knowledge gained was readily apparent. (4) Conclusions: It is important for educators to be aware of how they influence a student’s motivation. This study may help to provide an orientation on what to avoid and what to include in a curriculum design project to purposefully foster motivation in students. Full article

In recent decades, there has been a shift towards competency-based approaches in surgical training. The effectiveness of video-based learning (VBL) in enhancing surgical skills, particularly in the context of self-regulated learning (SR-VBL), was assessed in this study. While VBL is cost-effective, flexible, and can improve proficiency in technical skills prior to clinical practice, it is resource-challenging. SR-VBL includes many of VBL’s benefits but has utility in individual and distance settings due to its autarkic nature. This study identified and analyzed contemporary literature on SR-VBL using PRISMA guidelines, focusing on original randomized controlled studies published in international peer-reviewed journals during the COVID-19 pandemic in 2020–2022. Seven studies with 462 participants were included, with three eligible for the meta-analysis. The results showed that self-regulated video-based learning contributes to the learning of technical skills and can be applied to learners of all levels across surgical specialties. The meta-analysis revealed that improvements in validated outcome assessment scores (OSATS) were at least equal to traditional methods with a statistically significant result, though the effect was modest. Therefore, contemporary surgical training could incorporate SR-VBL for technical training to help surgeons of all levels in surgical self-assessment. Full article

This study aims to investigate nursing interns’ training experiences in emergency departments (EDs) in Saudi Arabia and explore the factors influencing their experiences. A descriptive research design was employed utilizing a survey distributed to nursing interns who completed their ED rotation within the last three months. The data were analyzed using SPSS version 27, and principal component analysis (PCA) was conducted to identify the challenges encountered by the interns. This study analyzed the responses of 126 nursing internship students in various regions of Saudi Arabia to assess their training experiences in emergency departments. The principal component analysis revealed two significant factors: (1) “Emergency Department Training and Skill Development”, which focused on challenges faced during training, and (2) “Integrated Emergency Department Training and Competence Development”, which provided a holistic view of nursing internship students’ experiences and preparedness for their careers. The results indicated moderately below-average challenges and a moderately positive overall training experience. The findings suggest a need to address these challenges to improve the training experience and better prepare nursing internship students for careers in emergency departments. This study recommends enhancing the nursing curricula alignment with practical training objectives, focusing on technical and interpersonal skills development. A supportive learning environment in emergency departments is crucial, including effective communication and collaboration. Diverse clinical experiences and reflection on training can guide students in exploring potential career paths in emergency departments or other specialized nursing areas. Full article

Background and Aim: Medical students are required to complete a number of clinical rotations in hospital departments, affiliated with the Azrieli Faculty of Medicine, under the supervision of a department tutor. Our experience shows that departments receiving good scores typically also receive good feedback for their tutor. Accordingly, our aim was to assess the tutor contribution to students’ overall satisfaction from clinical rotations in hospital departments across northern Israel. Methods: Here, we recorded the students’ reported satisfaction with tutors as well as the satisfaction with clinical rotations in different departments of Galilee Medical Center (GMC) in Naharia, and Baruch Padeh Medical Center in Poria. The students’ reported satisfaction was assessed numerically and verbally using questionnaires over a period of three years. Results: We find that the students reported satisfaction with a clinical rotation is positively and significantly correlated with the student satisfaction with the tutor, and less with other factors such as hospital organization and department facilities, geographical distance from home, working hours, etc. Conclusion: Our findings suggest that medical schools can increase students’ satisfaction through investment in good tutors. Full article

Patients with ocular emergencies often visit emergency doctors before they visit an ophthalmologist. Therefore, emergency physicians must have adequate knowledge for preliminary diagnosis. We aimed to assess emergency resident doctors’ training in managing eye emergencies, as well as their level of confidence, competence, and equipment use skills in dealing with ocular emergencies. This cross-sectional, multicenter, questionnaire-based study included all emergency resident doctors in the Western, Central, and Eastern regions of Saudi Arabia. In total, 181 emergency residents were enrolled. Moreover, 28.2% received adequate training in the management of eye emergencies, and 72.2% reported that they received training from senior emergency medical staff. Overall, 14.9% of residents expressed confidence in handling emergency eye cases, compared with 66.3% who expressed less confidence. The prevalence of residents demonstrating confidence in the management of emergency eye cases was significantly high among those who received instructions on how to use an ophthalmoscope (p < 0.001), those who had been taught to use the slit lamp (p < 0.001), and those who expressed confidence in using the slit lamp (p < 0.001). We advise integrating basic ophthalmic clinical skills into emergency resident training programs to help gain greater insight, reduce the workload of ophthalmic services, and provide proper emergency eye care. Full article

Background: As a contribution to developing interprofessional education (IPE) synergy between medical education systems in the European Higher Education Area (EHEA), this review aims to describe the IPE experiences for undergraduate medical students implemented in EHEA member countries. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted on SCOUPS and MEDLINE databases. Inclusion criteria were peer-reviewed English language articles about undergraduate medical students, interprofessional education, and EHEA countries, published January 2000–September 2022. Results: The 32 included studies were from 14 of the 49 EHEA countries. In most of the studies, the theoretical background leading the intervention was not reported (n = 25), and in several studies (n = 16) the students were from two professions only. The reported outcomes were related to self-assessment knowledge about IPE and satisfaction about the program. In 24 studies, the assessment was based on the study’s ad hoc measures only. Limitations ranged from selection bias to lack of objective measures. Conclusion: Future directions should envision developing IPE among EHEA countries, including agreement and consistency across EHEA countries in reporting theories, educational methods, and standardized IPE evaluation measures. Full article

Indonesia is currently revamping its medical sector—a process dubbed medical transformation. In place of this transformation, medical education has also received spotlights due to the number of medical universities and the lack of medical specialists in Indonesia. Therefore, several plans will revolutionize Indonesian medical education and its health system. This commentary will briefly comment on those transformations and their potential impact in the near and distant future. Full article

Due to the COVID-19 pandemic, educational institutions globally were forced to close, resulting in a transition to online learning. However, this transition increased screen time and made e-learners more vulnerable to biopsychosocial issues. This study aimed to assess the impact of online learning on the eyes and mental health of medical science students, including those pursuing MBBS, Nursing, Optometry, Pharmacy, and Veterinary degrees during the COVID-19 lockdown period. A cross-sectional quantitative study was conducted, collecting online data from 182 samples using a socio-demographic data sheet (SDVS), Computer Vision Symptom Scale (CVSS 17), and the Perceived Stress Scale (PSS 10). Results revealed that most students spent between 2 and 4 h and >7 h on electronic devices before and during COVID-19, respectively, with many reporting moderate mental stress and eye strain. A weak positive correlation (r = 0.204 at p < 0.05) was found between perceived stress and eye strain, with the 24–29 age group reporting higher mean scores for eye strain. Female participants in the study reported higher mean scores for both eye strain and perceived stress. Additionally, the study found significant associations between eye strain and the electronic devices used, the program of study, and perceived stress levels. The participants’ ethnicity was also found to impact eye strain levels. The study concludes that the transition to online learning during COVID-19 caused moderate to severe levels of eye strain and mental stress, indicating the need for interventions for the student community. Full article

Background: The effect of the COVID-19 pandemic has transformed medical education and is likely to have long-lasting effects on student learning, mental well-being, and eating behaviour. This study aimed to examine the learning behaviours of medical students at the American University of Integrative Sciences (AUIS), Barbados, during the COVID-19 pandemic. Methods: A cross-sectional web-based on-line survey was administered to medical students at AUIS from July to November 2021. The data collecting instrument recorded students’ demographic and learning behaviour information and eating disorders (SCOFF questionnaire). Results: The overall response rate was 55% (n = 120). In relation to learning behaviour, students agreed with the following statements: ‘deterioration in work performance and studying’ (48.4%), ‘remember subject’s contents appropriately’ (40.4%), ‘concentration on the studies’ (40.3%), ‘difficulty in performing two tasks simultaneously’ (38.7%), ‘difficulty in performing mental calculations’ (33.9%), ‘difficulty in recalling recent information’ (32.3%), and ‘difficulty in recalling old information’ (38.7%). Among the eight dimensions of learning behaviours, deterioration in work performance or studying and difficulties in recalling recent information were found to be significantly associated with the gender of the students. For the SCOFF questionnaire, approximately 24.2% screened positive for eating disorders. Screening with the SCOFF test demonstrated that females, older (>25 years), overweight + obese, Clinical Sciences + PreMed, and non-USA-based students were at more risk of eating disorders. Conclusions: The results indicate that during the COVID-19 pandemic, AUIS students have developed learning difficulties and are likely to have eating disorders. University policymakers should take appropriate measures to support a healthy learning environment and improve students’ mental well-being and eating behaviours. Full article

Reviews of the literature on leadership training in undergraduate medical education have been conducted since 2014. Previous reviews have not identified networks, defined leadership, studied the selection criteria for instructors, nor analyzed leadership as interprofessional or transprofessional education. This scoping review fills these gaps. Inclusion criteria included use of competency-based education to teach leadership in universities, and quality assessment. Indexes and grey literature in Spanish, Portuguese, and English languages were included from six databases. Hand searching and consultation were employed for selected bodies of literature. This review identified leadership interventions in nine countries which had national and international networks primarily in English-speaking and European countries. No literature was found in Spanish-speaking or Portuguese-speaking countries, nor in Africa. Teaching leadership was linked mainly with undergraduate medical education and interprofessional education. This review identified 23 leadership and leader definitions and underscored the importance of including values in leadership definitions. Instructors were selected by discipline, role, experience, and expertise. This review may be used to inform the teaching of leadership in undergraduate medical curricula by suggesting potential networks, reflecting on diverse leadership definitions and interprofessional/transprofessional education, and assisting in selection of instructors. Full article

Introduction: The purpose of our report is to describe the design and implementation of the first antimicrobial stewardship certificate program (ASCP) in the United Arab Emirates (UAE). Methods: The ASCP was implemented in January 2019. A needs assessment was conducted before the implementation of the program. The program delivery utilized a blended learning format with both a live and an experiential component. Learner assessments consisted of pre- and post-course assessments, as well as structured feedback throughout the course. Course assessments and post-course evaluation results were utilized to assess the certificate program (CP) outcomes. Results: Between January 2019 to March 2020, 24 pharmacists were trained through the program. All participants passed the post-course assessment. Participants scored a median of 40 percent on the pre-course assessment at the start of the program and a median of 80 percent on the post-course assessment (p-value < 0.0001), demonstrating a significant improvement in their baseline knowledge. Overall, participants were highly satisfied with the program and felt that it would enhance their ability to take care of patients and/or result in practice change in their institution. Conclusions: The ASCP enhanced the knowledge of pharmacists in antimicrobial stewardship. The implemented model provides a sustainable blueprint for future CPs in specialty areas of practice for the Middle East region. Full article

Problem-based learning (PBL) is an active learning technique that promotes a life-long learning approach to understanding and using the principles of clinical medicine. It does so by helping learners hone their critical thinking skills in a team-based environment. It was originally developed for use in live, in-person settings. During the COVID-19 pandemic, it has had to be rapidly adapted for online delivery. In this article, we first highlight the key challenges faced by educators and learners in making this transition. We then share five lessons for effectively translating in-person PBL curricula to online and hybrid learning formats. Full article

Providing international medical educators with opportunities for faculty development has become a favorable moment for capacity building and the creation of partnerships with universities around the world. It has also become a social responsibility when such a development implies growth and improvement for the institutions involved. In 2018 and 2019, the University of Alberta Faculty of Medicine & Dentistry designed and delivered an international faculty development program (IFDP) in Edmonton, Canada, in collaboration with the faculty management from Jilin University and Wenzhou Medical University, and Shandong University. The inspiration for program driven by capacity development for three universities in China, all of whom were developing strategies to respond to new government policies for medical education. The focus of the course was based on the needs that the three institutions expressed: teaching innovation, research, and quality curriculum development. By design, the two-week, in-person program included lectures, personal tutorials, class and laboratories observations, as well as guided teaching visits to hospitals and university museums. Recommendations are offered to assist other international faculty development programs focused on capacity building for medical education. Full article

Background: Social accountability is defined as “the obligation of medical schools to direct their education, research and service activities toward addressing the priority health concerns of the community, region, and/or nation that they have a mandate to serve”. It is becoming increasingly critical in evaluating medical school performance and education quality. Medical students must have an appropriate understanding of social accountability. This study explores knowledge, attitudes and institutional readiness as perceived by medical students towards social accountability. Method: An independent online cross-sectional survey was conducted, which included 121 medical students recruited through a convenience sampling technique. The survey instruments were validated through a pilot study and the responses were analyzed using chi-squared (χ²) tests. Frequencies and percentages were computed. Results: A total of 69% of students understood SA, 61.2% believed they demonstrated SA, and 82.6% believed it has a positive impact on their attitudes and behaviors. About 52.1% believed that their school has a positive impact on the community with a curriculum that includes (52.9%) and reflects the needs of the population that they will serve (49.6%). Conclusion: Based on the findings, a significant number of students have knowledge about social accountability, have a positive attitude towards the concept, and believe that their institution demonstrates readiness. Full article

Good Clinical Judgment (GCJ) is associated with clinical excellence and accolades whereas poor clinical judgment is often associated with suboptimal care and the need for remediation. Although commonly referenced in practice, a shared definition for GCJ based on primary data is lacking. We interviewed 16 clinicians and surgeons across different specialties at one Canadian academic center to understand their conceptualization of GCJ. The data analysis led to the formulation of three pillars that were viewed by participants as core ingredients of GCJ. These included (1) a strong baseline knowledge and breadth of clinical experience, (2) the demonstration of curiosity, reflection, and wisdom, and (3) an ability to attend to contextual factors and understand the “bigger picture” when providing care to patients. Although there were inconsistent opinions regarding whether GCJ is innate or learned, participants reflected on strategies to support the development or improvement in clinical judgement for trainees. Full article

Background: Delivering impactful feedback is a skill that is difficult to measure. To date there is no generalizable assessment instrument which measures the quality of medical education feedback. The purpose of the present study was to create an instrument for measuring educator feedback skills. Methods: Building on pilot work, we refined an assessment instrument and addressed content and construct validity using expert validation (qualitative and quantitative). This was followed by cognitive interviews of faculty from several clinical departments, which were transcribed and analyzed using ATLAS.ti qualitative software. A research team revised and improved the assessment instrument. Results: Expert validation and cognitive interviews resulted in the Educator Feedback Skills Assessment, a scale with 10 items and three response options for each. Conclusions: Building on the contemporary medical education literature and empiric pilot work, we created and refined an assessment instrument for measuring educator feedback skills. We also started the argument on validity and addressed content validity. Full article