Joanna Bates

A Review of e-Learning Practices for Undergraduate Medical Education

This paper describes the findings of a literature review conducted on the current usage, lessons, and limitations of e-learning for undergraduate medical education with an emphasis on synchronous delivery in the first 2 years. The review was conducted as part of an initiative to expand the UBC undergraduate medical program in British Columbia, Canada. The 50 e-learning articles included in the review described the deployment of various types of e-learning technology and content in different settings. The seven videoconferencing articles provided product information, health education examples, and innovative approaches. The six review articles provided general guidelines and trends on e-learning in undergraduate medical education in United States and Europe. Overall, while the literature is informative, there are few reported studies that address distributed synchronous learning in these undergraduate programs.

Untangling the Roots of Some IMGs' Poor Academic Performance.

International medical graduates (IMGs) make up 18% of postgraduate medical trainees in the United States and approximately 20% in Canada. The majority of these IMGs are training in primary care specialties such as family medicine, pediatrics, and general internal medicine. Overall, IMGs are less successful on national licensing examinations, than are graduates of North American medical schools. There is also evidence that some of these trainees do less well during their postgraduate training and require more remediation. As a result, postgraduate program directors may be reluctant to consider IMG applicants to their programs because of perceived difficulties in training these physicians. IMGs themselves have written movingly about the difficulties they face entering medical practice in North America, and faculty have written about the difficulties facing IMGs in training. While many IMGs successfully complete residency training with few serious problems, the problems some do encounter may be difficult to remediate without a deeper understanding of the underlying issues specific to IMGs. Between 1994 and 2000, the University of British Columbia (UBC) Family Practice Residency program trained 18 IMGs in a community-based family medicine program associated with St. Paul’s Hospital, an inner-city, tertiary care teaching hospital in Vancouver. They were part of a cohort of 72 family practice residents who trained at this site during that time. The IMGs accessed the family medicine training primarily through a government-paid program for licensure. These IMGs were carefully selected to minimize training difficulties, and final outcomes were excellent in that all graduates were licensed and are practicing in the community, many providing medical care to the ethnic groups to which they themselves belong. However, both the family practice faculty and the IMG residents experienced problems in the course of training that required careful exploration and new responses. Problems presented as academic, attitudinal, or behavioral issues and the difficulties encountered were complicated by differences in the structure of medical training in the IMGs’ countries of origin, cultural differences, language difficulties, and the different life stages and stresses of the IMG residents. The family medicine program at UBC is a community-based residency, eight months of family medicine training taking place in community family practices, eight months in hospitalbased rotations, and the remainder of the time allotted to elective experiences. In the family medicine rotations, at any sign of academic difficulty, a faculty member with experience in direct observation and evaluation is called in to participate with the preceptor and site director in delineating the problem and recommending interventions. These problems were logged and tracked and the descriptions below arise from our experiences with IMG residents in the two-year program. Some of the scenarios have been altered to protect the anonymity of the residents involved, although the content is derived from actual experiences. SITUATION A

A study of a rural community's readiness for telehealth

A qualitative approach was used to explore the readiness of a rural community for the implementation of telehealth services. There were four domains of interest: patient, practitioner, public and organization. Sixteen semistructured telephone interviews (three to five in each domain) were carried out with key informants and recorded on audio-tape. Two community awareness sessions were held, which were followed by five audio-taped focus groups (with five to eight people in each) in the practitioner, patient and public domains. In addition, two in-depth interviews were conducted with community physicians. Analysis of the data suggested that there were four types of community readiness: core, engagement, structural and non-readiness. The level of readiness varied across domains. There were six main themes: core readiness; structural readiness; projection of benefits; assessment of risk; awareness and education; and intra-group and inter-group dynamics. The results of the study can be used to investigate the readiness of rural and remote communities for telehealth, which should improve the chance of successful implementation.

Student perceptions of assessment and feedback in longitudinal integrated clerkships

Objectives  This study was conducted to elucidate how the learning environment and the student–preceptor relationship influence student experiences of being assessed and receiving feedback on performance. Thus, we examined how long‐term clinical clerkship placements influence students’ experiences of and views about assessment and feedback.

Evidence regarding the utility of multiple mini-interview (MMI) for selection to undergraduate health programs: A BEME systematic review: BEME Guide No. 37

Abstract Background: In the 11 years since its development at McMaster University Medical School, the multiple mini-interview (MMI) has become a popular selection tool. We aimed to systematically explore, analyze and synthesize the evidence regarding MMIs for selection to undergraduate health programs. Methods: The review protocol was peer-reviewed and prospectively registered with the Best Evidence Medical Education (BEME) collaboration. Thirteen databases were searched through 34 terms and their Boolean combinations. Seven key journals were hand-searched since 2004. The reference sections of all included studies were screened. Studies meeting the inclusion criteria were coded independently by two reviewers using a modified BEME coding sheet. Extracted data were synthesized through narrative synthesis. Results: A total of 4338 citations were identified and screened, resulting in 41 papers that met inclusion criteria. Thirty-two studies report data for selection to medicine, six for dentistry, three for veterinary medicine, one for pharmacy, one for nursing, one for rehabilitation, and one for health science. Five studies investigated selection to more than one profession. MMIs used for selection to undergraduate health programs appear to have reasonable feasibility, acceptability, validity, and reliability. Reliability is optimized by including 7–12 stations, each with one examiner. The evidence is stronger for face validity, with more research needed to explore content validity and predictive validity. In published studies, MMIs do not appear biased against applicants on the basis of age, gender, or socio-economic status. However, applicants of certain ethnic and social backgrounds did less well in a very small number of published studies. Performance on MMIs does not correlate strongly with other measures of noncognitive attributes, such as personality inventories and measures of emotional intelligence. Discussion: MMI does not automatically mean a more reliable selection process but it can do, if carefully designed. Effective MMIs require careful identification of the noncognitive attributes sought by the program and institution. Attention needs to be given to the number of stations, the blueprint and examiner training. Conclusion: More work is required on MMIs as they may disadvantage groups of certain ethnic or social backgrounds. There is a compelling argument for multi-institutional studies to investigate areas such as the relationship of MMI content to curriculum domains, graduate outcomes, and social missions; relationships of applicants’ performance on different MMIs; bias in selecting applicants of minority groups; and the long-term outcomes appropriate for studies of predictive validity.

Free choice and career choice: clerkship electives in medical education

Introduction  Medical education experiences, particularly in clinical years, are reported determinants of career choice. Less is known about features of clinical education experiences including length, discipline, setting and choice, which may serve as landmarks in career choice decisions. This studys purpose was to explore the benefits of a free choice clerkship elective, and more specifically, its role in clarifying career choice.

Student learning experiences in a longitudinal clerkship programme.

Objective  To identify how medical student learning experiences in a new longitudinally integrated clinical clerkship (LICC) programme impacted students’ learning.

Randomized Trial of a Virtual Cardiac Rehabilitation Program Delivered at a Distance via the Internet

With an aging population in many Western countries and increases in risk factors such as obesity, the number of patients with cardiovascular diseases (CVDs) is increasing.1 These patients are at greater risk of subsequent events, comorbidities, and premature mortality, therefore effective and ongoing management is needed to reduce this risk. Cardiac rehabilitation programs (CRPs) are effective at improving lifestyle behaviors and reducing risk factors in patients with CVD, as well as reducing CVD events and premature mortality, while being cost-effective.2–5 As a result, the American Heart Association, and others, have highlighted participation in CRP as an essential element of secondary prevention in patients with CVD.6–8 Despite the known benefits of CRP, as little as 10% to 30% of eligible patients attend these programs.9–13 The majority of these programs are limited to hospitals in large urban areas with geographical accessibility as one of the main barriers to attendance.14,15 Lack of access is more pronounced for patients in rural areas that do not have CRP,16,17 although risk factors such as smoking and obesity are higher in rural populations18 resulting in a greater rate of hospitalizations than urban populations.19 Home-based CRP have been developed to address the accessibility issue, and a review of these studies found no difference to hospital-based CRP with respect to improvements in CVD risk.20 However, these programs generally consist of a mix of on-site exercise sessions, clinic or home visits, telephone calls from staff, and diaries, which still require patients to attend some sort of clinic and therefore do not accommodate patients in outlying areas. The proliferation of low-cost communications technology, such as the Internet, has opened up an array of opportunities for patient communication while bridging geographic distance. The …

Developing a medical school: Expansion of medical student capacity in new locations: AMEE Guide No. 55

Background: A concern about an impending shortage of physicians and a worry about the continued maldistribution of physicians to medically underserved areas have encouraged the expansion of medical school training places in many countries, either by the creation of new medical schools or by the creation of regional campuses. Aims: In this Guide, the authors, who have helped create new regional campuses and medical schools in Australia, Canada, UK, USA, and Thailand share their experiences, triumphs, and tribulations, both from the views of the regional campus and from the views of the main Medical School campus. While this Guide is written from the perspective of building new regional campuses of existing medical schools, many of the lessons are applicable to new medical schools in any country of the world. Many countries in all regions of the world are facing rapid expansion of medical training facilities and we hope this Guide provides ideas to all who are contemplating or engaged in expanding medical school training places, no matter where they are. Description: This Guide comprises four sections: planning; getting going; pitfalls to avoid; and maturing and sustaining beyond the first years. While the context of expanding medical schools may vary in terms of infrastructure, resources, and access to technology, many themes, such as developing local support, recruiting local and academic faculty, building relationships, and managing change and conflict in rapidly changing environments are universal themes facing every medical academic development no matter where it is geographically situated. Further information: The full AMEE Guide, printed separately, in addition contains case examples from the authors’ experiences of successes and challenges they have faced.

Mapping the dark matter of context: a conceptual scoping review.

Like dark matter, the contexts for medical education are largely invisible to those within them, although context can have profound influences on teaching, learning and practice. For something that is so intrinsic to the field of medical education, the concept of context remains troubling to scholars and those running medical education programmes. This paper reports on a critical and conceptual review of the concept of context within the medical education literature and beyond.