Jeroen Donkers

A Delphi study of medical professionalism in Arabian countries: The Four-Gates model

Abstract Background: Medical professionalism has been described as a set of attributes and behaviors, yet the Western frameworks of medical professionalism may not resonate with the cultural values of non-Western countries. Aim: This study aims to formulate a professionalism framework for healthcare providers as interpreted by local medical professionals in Arabian countries. Methods: A purposive sample of 17 experts from diverse disciplines participated in a Delphi study in three rounds. Consensus was identified by content analysis and by numerical analysis of responses on the basic attributes of medical professionalism in Arabian context. Results: Eight professional traits were shortlisted and coupled in four themes (Gates): dealing with self, dealing with tasks, dealing with others and dealing with God. Self-accountability and self-motivation were interpreted from a faithful viewpoint as “taqwa” and “ehtesab”, respectively, in Arabic. Discussion: The Four-Gates Model helps in better understanding of medical professionalism as grounded in the minds and culture of Arabs. The model may act as a genuine framework for teaching and learning of medical professionalism in Arab medical schools. Conclusion: The study highlights the divergent interpretation of medical professionalism between Western and Arabian contexts. The Four-Gates Model may work for faith-driven societies, but not for non-Muslims Arabs students or teachers or in institutions with humanistic values.

Flexible electronic feedback using the virtues of progress testing.

The potential richness of the feedback for learners and teachers is one of the educational advantages of progress tests (PTs). Every test administration yields information on a students knowledge level in each sub-domain of the test (cross-sectional information), and it adds a next point to the corresponding knowledge growth curve (longitudinal information). Traditional paper-based feedback has severe limitations and requires considerable effort from the learners to give meaning to the data. We reasoned that the PT data should be flexibly accessible in all pathways and with any available comparison data, according to the personal interest of the learner. For that purpose, a web-based tool (Progress test Feedback, the ProF system) was developed. This article presents the principles and features of the generated feedback and shows how it can be used. In addition to enhancement of the feedback, the ProF database of longitudinal PT-data also provides new opportunities for research on knowledge growth, and these are currently being explored.

Medical professionalism: Development and validation of the Arabian LAMPS

Aim: This study aims to develop and validate a questionnaire that measures attitudes of medical students on professionalism in the Arabian context. Method: Thirty-two experts contributed to item generation in particular domains. The instrument was administered to Arab medical students and interns and responses were collected using five-point Likert scale. Data were analyzed to estimate the reliability of the instrument. The inventory in its final version was labeled as the Learners’ Attitude of Medical Professionalism Scale (LAMPS). Results: A total of 413 medical students and interns responded from two universities in Egypt and Saudi Arabia. Means of item response ranged from 2.38 to 4.72. The highest mainly deals with “Respect to others,” while the lowest belong to “Honor/Integrity.” The final version of the LAMPS has 28 items in five domains, with a reliability of 0.79. Discussion: The LAMPS has salient features compared to other similar instrument. It was designed based on a reliable framework in explicit behavioral items, not abstract attributes of professionalism. The LAMPS can help teachers to identify learning gaps regarding professionalism amongst their students and track attitude changes over time or as the result of interventions. Conclusion: To the best of our knowledge, the LAMPS is the first context-specific inventory on medical professionalism attitudes in the Arabian context.

Faculty development for learning and teaching of medical professionalism

Abstract Introduction: Professionalism must be explicitly taught, but teaching professionalism is challenging, because medical teachers are not prepared to teach this content area. Aim: This study aims at designing and evaluating a faculty development programme on learning and teaching professionalism in the Arabian context. Programme development: The study used a participatory design, where four authors and 28 teachers shared the responsibility in programme design in three steps: orientation workshop for teachers, vignette development, and teaching professionalism to students. The workshop provided the cognitive base on the salient attributes of professionalism in the Arabian context. After the workshop, authors helped teachers to develop a total of 32 vignettes in various clinical aspects, portraying a blend of professionalism dilemmas. A battery of seven questions/triggers was suggested to guide students’ reflection. Programme evaluation: The programme was evaluated with regard to its “construct” and its “outcomes”. The programme has fulfilled the guiding principles for its design and it has emerged from a genuine professionalism framework from local scholarly studies in the Arabian context. Programme outcomes were evaluated at the four levels of Kirkpatrick’s model; reaction, learning, behaviour, and results. Discussion: The study communicates a number of context-specific issues that should be considered when teaching professionalism in Arabian culture with respect to teachers and students. Three lessons were learned from developing vignettes, as reported by the authors. This study advocates the significance of transforming faculty development from the training discourse of stand-alone interventions to mentorship paradigm of the communities of learning. Conclusion: A three-step approach (orientation workshop, vignettes development, and teaching professionalism) proved effective for faculty development for learning and teaching of professionalism. Professionalism can be taught using vignettes that demonstrate professionalism dilemmas in a particular context.

Embedding of the progress test in an assessment program designed according to the principles of programmatic assessment

Abstract Background: Progress tests (PT) are used to assess students on topics from all medical disciplines. Progress testing is usually one of the assessment methods of the cognitive domain. There is limited knowledge on how positioning of the PT in a program of assessment (PoA) influences students’ PT scores, use of PT feedback and perceived learning value. Methods: We compared PT total scores and use of a PT test feedback (ProF) system in two medical courses, where the PT is either used as a summative assessment or embedded in a comprehensive PoA and used formatively. In addition, an interview study was used to explore the students’ perception on use of PT feedback and perceived learning value. Results: PT total scores were higher, with considerable effect sizes (ESs) and students made more use of ProF when the PT was embedded in a comprehensive PoA. Analysis of feedback in the portfolio stimulated students to look for patterns in PT results, link the PT to other assessment results, follow-up on learning objectives, and integrate the PT in their learning for the entire PoA. Conclusions: Embedding the PT in an assessment program designed according to the principles of programmatic assessment positively affects PT total scores, use of PT feedback, and perceived learning value.

An Equivalence Trial Comparing Instructor-Regulated With Directed Self-Regulated Mastery Learning of Advanced Cardiac Life Support Skills.

Introduction Instructor-led simulation-based mastery learning of advanced cardiac life support (ACLS) skills is an effective and focused approach to competency-based education. Directed self-regulated learning (DSRL) may be an effective and less resource–intensive way to teach ACLS skills. Methods Forty first-year internal medicine residents were randomized to either simulation-based DSRL or simulation-based instructor-regulated learning (IRL) of ACLS skills using a mastery learning model. Residents in each intervention completed pretest, posttest, and retention test of their performance in leading an ACLS response to a simulated scenario. Performance tests were assessed using a standardized checklist. Residents in the DSRL intervention were provided assessment instruments, a debriefing guide, and scenario-specific teaching points, and they were permitted to access relevant online resources. Residents in the IRL intervention had access to the same materials; however, the teaching and debriefing were instructor led. Results Skills of both the IRL and DSRL interventions showed significant improvement after the intervention, with an average improvement on the posttest of 21.7%. After controlling for pretest score, there was no difference between intervention arms on the posttest [F(1,37) = 0.02, P = 0.94] and retention tests [F(1,17) = 1.43, P = 0.25]. Cost savings were realized in the DSRL intervention after the fourth group (16 residents) had completed each intervention, with an ongoing savings of

Beyond standard checklist assessment: Question sequence may impact student performance

80 per resident. Conclusions Using a simulation-based mastery learning model, we observed equivalence in learning of ACLS skills for the DSRL and IRL conditions, whereas DSRL was more cost effective.

How e-Learning Can Support PBL Groups: A Literature Review

IntroductionClinical encounters are often assessed using a checklist. However, without direct faculty observation, the timing and sequence of questions are not captured. We theorized that the sequence of questions can be captured and measured using coherence scores that may distinguish between low and high performing candidates.MethodsA logical sequence of key features was determined using the standard case checklist for an observed structured clinical exam (OSCE). An independent clinician educator reviewed each encounter to provide a global rating. Coherence scores were calculated based on question sequence. These scores were compared with global ratings and checklist scores.ResultsCoherence scores were positively correlated to checklist scores and to global ratings, and these correlations increased as global ratings improved. Coherence scores explained more of the variance in student performance as global ratings improved.DiscussionLogically structured question sequences may indicate a higher performing student, and this information is often lost when using only overall checklist scores.ConclusionsThe sequence test takers ask questions can be accurately recorded, and is correlated to checklist scores and to global ratings. The sequence of questions during a clinical encounter is not captured by traditional checklist scoring, and may represent an important dimension of performance.

Belief Networks for Bioinformatics

E-learning, broadly defined as all IT employed to support or improve the learning process of students, is becoming mainstream. Can e-learning also support the learning principles of problem-based learning (PBL)? This chapter focuses on how e-learning has been described to support PBL in groups working either face-to-face or online. A systematic literature search has been conducted. Characteristics of the 151 included studies are described, followed by a description of common ways to support PBL groups as well as examples of more innovative support. Two aspects of the PBL process are often supported: contextual learning and collaborative learning. There are only a few studies that focus explicitly on other aspects, such as support for activation of prior knowledge, cognitive elaboration, structuring and restructuring of information, and self-directed learning (although these aspects are frequently claimed as side effects of computer-mediated communication). Chances and risks of implementing e-learning in PBL settings are discussed, followed by conclusions and future directions.

Probabilistic Opponent-Model Search in Bao

Recent publications illustrate successful applications of belief networks1 (BNs) and related probabilistic networks in the domain of bioinformatics. Examples are the modeling of gene regulation networks [6,14,26], the discovering of metabolic [40,83] and signalling pathways [94], sequence analysis [9, 10], protein structure [16, 28, 76], and linkage analysis [55]. Belief networks are applied broadly in health care and medicine for diagnosis and as a data mining tool [57, 60, 61]. New developments in learning belief networks from heterogeneous data sources [40, 56, 67, 80, 82, 96] show that belief networks are becoming an important tool for dealing with high-throughput data at a large scale, not only at the genetic and biochemical level, but also at the level of systems biology.