Bidyadhar Sa

An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean.

Objectives: This study explored the empathy profile of students across five years of medical training. In addition the study examined whether the Jefferson Scale for Physician Empathy correlated with a measure of cognitive empathy, the Reading the Mind in the Eyes Test and a measure of affective empathy, the Toronto Empathy Questionnaire. Methods: The study was a comparative cross-sectional design at one Caribbean medical school. Students were contacted in class, participation was voluntary and empathy was assessed using all three instruments Descriptive statistics were calculated and differences between groups evaluated using non-parametric tests. Results: Overall 669 students participated (response rate, 67%). There was a significant correlation between the Jefferson Scale of Physician Empathy and the Toronto Empathy Questionnaire (P = 0.48), both scales indicating a decline in medical student empathy scores over time. There was, however, little correlation between scores from the Reading the Mind in the Eyes Test and the Jefferson Scale of Physician Empathy. Female students demonstrated significantly higher scores on all three measures. Conclusions: Medical students’ lower empathy scores during their final years of training appear to be due to a change in the affective component of empathy. These findings may reflect an adaptive neurobiological response to the stressors associated with encountering new clinical situations. Attention should be paid not only to providing empathy training for students but also to teaching strategies for improved cognitive processing capacity when they are encountering new and challenging circumstances.

Nonverbal communication in a Caribbean medical school: "Touch is a touchy issue".

Background: The heath communication curriculum at the Trinidad campus of the University of the West Indies was developed out of practices advocated in large Western countries. Many students and tutors observed that the nonverbal skills advocated in these approaches did not fit the complex cultural dynamics of the Caribbean. Purpose: A study was developed to understand the problems Caribbean students faced with these nonverbal communication practices. Methods: Thirty-six students representing different Caribbean territories were randomly selected from the two compulsory communication skills courses: Communication Skills for Health Personnel and Communication Skills for the Health Professions class list. These students participated in 4 focus group discussions (FGD). The FGD questions were formulated on the nonverbal skills advanced in the Calgary–Cambridge Guide to the doctor–patient interview. Results: The findings supported the view that recommended nonverbal skills were in conflict with expected doctor–patient behavior in different Caribbean territories. Students felt that nonverbal communication needed to be treated with greater cultural sensitivity. Conclusions: These findings stimulated changes to the health communication program. This article identifies changes made to the communication skills program in response to cultural difference.

Stakeholder perspectives on outcome expectations of pharmacy graduates from a Caribbean school of pharmacy.

Objectives. To explore stakeholders’ views regarding the performance of pharmacy graduates upon entering the workforce and to identify curricular deficiencies and possible solutions. Methods. Practicing pharmacists, many of whom were members of government and pharmacy organizations, were asked to complete a 40-item questionnaire to determine their views regarding the educational outcomes of pharmacy graduates from a Caribbean pharmacy school. In addition, the stakeholders participated in focus group discussions to capture feedback not gathered on the questionnaire. Results. Ten stakeholders completed the questionnaire and 11 participated in the focus group discussions. Stakeholders rated graduates higher than average in 13 educational outcomes: application of knowledge and skills, patient care, communication skills, confidentiality, ethics, problem solving, and innovation. However, responses to open-ended questions and comments made during the focus group discussions identified deficiencies, which included a lack of clinical faculty members and qualified preceptors to teach pharmacy students, and the need to revise basic sciences courses. Conclusion. Feedback from key stakeholders suggests that the quality of pharmacy graduates is above average for the most part; however, additional work is needed to address the deficiencies identified.

The relationship between the monitored performance of tutors and students at PBL tutorials and the marked hypotheses generated by students in a hybrid curriculum

ABSTRACT Introduction: There have been a number of published studies examining the link between the effectiveness of the problem-based learning (PBL) process and students’ performance in examinations. In a hybrid PBL/lectures curriculum, the results of such studies are of limited use because of the difficulty in dissociating the knowledge gained at lectures from that gained through PBL-related activities. Hence, the objectives of this study were: (1) to develop an instrument to measure the performance of tutors and students at PBL tutorials, and (2) to explore the contribution of such performances to the marks attained by students from the hypotheses generated at PBL tutorials. Methods: A monitoring instrument for assessing the performances of non-expert tutors and students at tutorials was developed and validated using principal component analysis and reliability analysis. Also, a rubric was formulated to enable a content expert to assign marks to the quality of hypotheses generated. Results: The monitoring instrument was found to be valid and reliable. There was a significant correlation between the performance of tutors at tutorials and hypotheses marks. In contrast, there was no significant correlation between the performance of students and hypotheses marks. Discussion: The monitoring instrument is a useful tool for improving the PBL process, especially where the medical programme depends on non-expert PBL tutors. In addition to ensuring good PBL processes, it is important that students achieve the desired output at PBL tutorials by producing hypotheses that help them understand the basic sciences underlying the clinical cases. The latter is achieved by the use of an open-ended rubric by a subject expert to assign marks to the hypotheses, a method that also provides additional motivation to students to develop relevant and detailed hypotheses.