Darko Hren

Teaching research methodology in medical schools: students' attitudes towards and knowledge about science

Objective  To explore the relationship between teaching scientific methodology in Year 2 of the medical curriculum and student attitudes towards and knowledge about science and scientific methodology.

Academic misconduct among medical students in a post-communist country

Aim  To assess the prevalence of, attitudes towards and willingness to report different forms of academic dishonesty among medical students in a post‐communist transitional country.

Traumatic and Overuse Injuries Among International Elite Junior Rowers

Background Junior rowers have competed internationally for over 4 decades, and there are no epidemiological data available on traumatic and overuse injury in this population. Objective To define the types of musculoskeletal problems present in international elite-level junior rowers and to determine whether gender, physical stature, rowing discipline, and training programs affect the incidence of reported injuries. Study Design Descriptive epidemiology study. Methods Injury data were obtained from a total of 398 rowers (42% female, 58% male) who completed a 4-page questionnaire on injury incidence while participating at the Junior World Rowing Championships in Beijing, People’s Republic of China, in August 2007. Results Overall, 290 (73.8%) reported injuries involved overuse, and 103 (26.2%) were related to a single traumatic event. Female rowers were injured more frequently than male rowers (110.2 vs 90.5 injuries per 100 rowers). In both genders, the most common injury site was the low back followed by the knee and the forearm/wrist. The severity of reported injuries was incidental in 65.1%, minor in 21.4%, moderate in 10.4%, and major in 3.1% of cases. The rowers with traumatic injuries had less rowing experience than the uninjured rowers (median [C] ± interquartile range [Q] = 3 ± 3 years vs 4 ± 3 years; P = .043, Mann-Whitney test). Sweep rowers who changed rowing side during the current season had significantly more acute-onset low back injuries (P = .012, χ2 test) than those who did not change rowing side during the same period. The incidence of traumatic injuries was significantly lower in rowers who regularly performed more than 10 minutes of posttraining stretching (P = .030, χ2 test). Athletes who ran more than once a week had more overuse knee injuries than those who ran once or less per week (P = .033, χ2 test). Conclusion Elite junior rowers attending the World Rowing Championships reported predominantly overuse injuries of low severity during the current rowing season. Low back injuries were the most frequent complaint of elite-level junior rowers.

Regression of moral reasoning during medical education: combined design study to evaluate the effect of clinical study years.

Background Moral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning. Methods We used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education. Results In the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3rd year medical students scored higher on Postconventional schema score than all other study years (p<0.001). There were no statistically significant differences among 3 cohorts of 2nd year medical students, demonstrating the absence of cohort or point-of-measurement effects. Longitudinal study of 3 cohorts demonstrated that students regressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum. Interpretation Our study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum.

Students' moral reasoning, Machiavellianism and socially desirable responding: implications for teaching ethics and research integrity

Objective  To investigate the relationship between psychological constructs related to professional and research integrity and moral reasoning among medical students.

Quantification of Authors’ Contributions and Eligibility for Authorship: Randomized Study in a General Medical Journal

BACKGROUNDAssessment of authorship contribution is often based on unreliable questionnaires.OBJECTIVETo assess if the use of different formats for the disclosure of authorship contributions influences authors’ compliance with the criteria of the International Committee of Medical Journal Editors (ICMJE).DESIGNRandomized study.PARTICIPANTS AND MEASUREMENTSEight hundred sixty-five authors of 181 manuscripts submitted to the Croatian Medical Journal from January to July 2005 were randomly allocated into 2 groups: 456 authors (94 manuscripts) received an ordinal rating form to rate their contributions to the submitted manuscript in 12 categories on a scale from 0 (none) to 4 (full), whereas 409 authors (87 manuscripts) received a binary rating form to tick the categories in which they made a contribution.RESULTSThe ordinal rating form identified twice as many authors (87.9%) as meeting the ICMJE criteria than the binary rating form (39.2%, P < .001). The group answering the ordinal rating form also had 5 times more manuscripts (71.6%) with all authors meeting the ICMJE criteria than the binary rating form group (15.5%, P < .001). The fraction of authors who reported contributions on each item on the binary rating form was similar to the fraction of authors who reported at least moderate participation to the same items on the ordinal rating form except “Final approval of the article.”CONCLUSIONSOrdinal scales for reporting authors’ contributions to manuscripts were more sensitive than tick boxes for assessing the appropriateness of authorship. The exception is “Final approval of the article,” which should be considered a dichotomous variable and may not be appropriate for the ICMJE definition of authorship.

Perceptions of authorship criteria: effects of student instruction and scientific experience

Objective: To analyse medical students’, graduate students’ and doctors’ and medical teachers’ perceptions of research contributions as criteria for authorship in relation to the authorship criteria defined by the International Committee of Medical Journal Editors (ICMJE). Design: Medical students with (n = 152) or without (n = 85) prior instruction on ICMJE criteria, graduate students/doctors (n = 125) and medical teachers (n = 112) rated the importance of 11 contributions as authorship qualifications. They also reported single contributions eligible for authorship, as well as acceptable combinations of two or three qualifying contributions. Results: Conception and design, Analysis and interpretation and Drafting of article formed the most important cluster in all four groups. Students without prior instruction rated Critical revision and Final approval lower than the other three groups. “Final approval” was a part of the least important cluster in all groups except among students with instruction. Conclusions: Conception and design, Analysis and interpretation and Drafting of article were recognised as the most important of the ICMJE criteria by all participants. They can be considered independent of previous instruction or experience. Final approval and Critical revision should be actively taught as important authorship criteria to future scientists.

Five-step authorship framework to improve transparency in disclosing contributors to industry-sponsored clinical trial publications

Authorship guidelines have established criteria to guide author selection based on significance of contribution and helped to define associated responsibilities and accountabilities for the published findings. However, low awareness, variable interpretation, and inconsistent application of these guidelines can lead to confusion and a lack of transparency when recognizing those who merit authorship. This article describes a research project led by the Medical Publishing Insights and Practices (MPIP) Initiative to identify current challenges when determining authorship for industry-sponsored clinical trials and develop an improved approach to facilitate decision-making when recognizing authors from related publications. A total of 498 clinical investigators, journal editors, publication professionals and medical writers were surveyed to understand better how they would adjudicate challenging, real-world authorship case scenarios, determine the perceived frequency of each scenario and rate their confidence in the responses provided. Multiple rounds of discussions about these results with journal editors, clinical investigators and industry representatives led to the development of key recommendations intended to enhance transparency when determining authorship. These included forming a representative group to establish authorship criteria early in a trial, having all trial contributors agree to these criteria and documenting trial contributions to objectively determine who warrants an invitation to participate in the manuscript development process. The resulting Five-step Authorship Framework is designed to create a more standardized approach when determining authorship for clinical trial publications. Overall, these recommendations aim to facilitate more transparent authorship decisions and help readers better assess the credibility of results and perspectives of the authors for medical research more broadly.Please see related article: http://www.biomedcentral.com/1741-7015/12/214.

Large volume leukapheresis: Efficacy and safety of processing patient's total blood volume six times

Large-volume leukapheresis (LVL) differs from standard leukapheresis by increased blood flow and an altered anticoagulation regimen. An open issue is to what degree a further increase in processed blood volume is reasonable in terms of higher yields and safety. In 30 LVL performed in patients with hematologic malignancies, 6 total blood volumes were processed. LVL resulted in a higher CD34+ cell yield without a change in graft quality. Although a marked platelet decrease can be expected, LVL is safe and can be recommended as the standard procedure for patients who mobilize low numbers of CD34+ cells and when high number of CD34+ cells are required.

Survey of attitudes towards curriculum reforms among medical teachers in different socio-economic and cultural environments

Background: Curriculum reforms in medical schools require cultural and conceptual changes from the faculty. Aims and Methods: We assessed attitudes towards curriculum reforms in different academic, economic, and social environments among 776 teachers from 2 Western European medical schools (Belgium and Denmark) and 7 medical schools in 3 countries in post-communist transition (Croatia, Slovenia, Bosnia and Herzegovina). The survey included a 5-point Likert-type scale on attitudes towards reforms in general and towards reforms of medical curriculum (10 items each). Results: Teaching staff from medical schools in Bosnia and Herzegovina had a more positive attitude towards reforms of medical curriculum (mean score 36.8 out of maximum 50 [95% CI 36.1 to 37.3]) than those from medical schools in Croatia or Slovenia (30.7 [29.8 to 31.6]) or Western Europe (27.7 [27.1 to 28.3]) (P < 0.001, ANOVA). Significant predictors of positive attitudes towards medical curriculum reform in post-communist transition countries, but not in Western European schools, was younger age, as well as female gender in Bosnia and Herzegovina. Conclusions: Factors influencing faculty attitudes may not be easy to identify and may be specific for different settings. Their identification and management is necessary for producing sustainable curriculum reform.