Madawa Chandratilake

Cultural similarities and differences in medical professionalism: a multi-region study

Medical Education 2012: 46: 257–266

Perception of Educational Environment Among Undergraduate Students in a Chiropractic Training Institution

PURPOSE The impact of the educational environment in student learning is well documented. However, there is a scarcity in the literature exploring the educational environment in chiropractic training institutions. This study aimed to identify the perceived educational environment in a chiropractic training institution and the possible perceptual differences among different demographic groups. METHODS The perceived educational environment was surveyed using Dundee Ready Education Environment (DREEM), which is a validated, self-administered, and Likert-type inventory. DREEM items focus on subdomains related to learning, teachers, self-confidence, academic atmosphere, and social environment. The results were analyzed and interpreted in relation to standard norms of DREEM and demographic variables. RESULTS The survey was completed by 124 chiropractic undergraduate students (response rate 83%). Statistically, the inventory items showed high correlation and the subdomains showed a close relationship. Overall the DREEM score was very high: 156.1/200 (78%). The subdomain scores were also at very high levels. However, the scoring of four items by students was consistently poor: lack of a support system for stressed students, 1.8 (SD 1.1); authoritarian teachers, 1.8 (SD 1.2); inadequate school time-tabling, 2.0 (SD 1.1); and overemphasis on factual learning, 2.0 (SD 1.0). There were no statistically significant differences in DREEM scores between gender, age, minority, and ethnicity groups. CONCLUSIONS In general, students perceived that a sound educational environment is fostered by the institution and its educational program for all students despite their demographic variations. However, certain specific elements of the educational process may need to be addressed to improve the educational experience.

Low fidelity, high quality: a model for e-learning.

Background:  E‐learning continues to proliferate as a method to deliver continuing medical education. The effectiveness of e‐learning has been widely studied, showing that it is as effective as traditional forms of education. However, most reports focus on whether the e‐learning is effective, rather than discussing innovations to allow clinical educators to ask ‘how’ and ‘why’ it is effective, and to facilitate local reproduction.

How medical professionalism is conceptualised in Arabian context: A validation study

Professionalism has been increasingly recognised as an explicit component of medical education, especially in the western world. Professionalism is culture-sensitive. Few efforts have been made to conceptualise professionalism in relation to the Arabian context. The aim of this study is to validate the components of professionalism framework of the American Board of Internal Medicine (ABIM) to the Arabian context. The authors invited a heterogeneous group of native Arab health professionals and academics to contribute to a reference panel. They represented a variety of disciplines, and seniority levels, and from different healthcare institutions and medical schools in Egypt, Saudi Arabia and United Arab Emirates. They were queried about their perception of the importance of each domain of professionalism as proposed by the ABIM, and were encouraged to suggest new domains if they thought it necessary. Thirty two out of the 45 invited health professionals and educators (71%) contributed to the reference panel. The panel confirmed the appropriateness of the six ABIM domains to the Arabian context, and further proposed the Autonomy of professionals as an additional domain. The modified framework, based on ABIM domains, demonstrated the Arabian conceptualisation of professionalism.

Preparing medical students for clinical decision making: A pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention

Background: Junior doctors are frequently faced with making difficult clinical decisions and previous studies have shown that they are unprepared for some aspects of clinical decision making. Aim: To explore medical students’ feelings and strategies when responsible for making clinical decisions and to obtain students’ views of the effectiveness of a clinical decision making teaching intervention. Methods: A teaching intervention was developed, consisting of a clinical decision making tool, a tutorial and scenarios within a simulated ward environment. A total of 23 volunteer students participated in individual interviews immediately after their simulator sessions. The qualitative data from the interviews were analysed to identify emerging themes. Results: Despite extended shadowing programmes, students feel unprepared for clinical decision making as FY1s, and lack effective decision making strategies. Experiencing complex decision making scenarios through individually orientated simulation results in students being subjectively more prepared for work as FY1s. Conclusion: Students continue to feel unprepared for the responsibility of clinical decision making. A teaching intervention, including simulated individual clinical scenarios, later in undergraduate training, appeared to be useful in improving medical students’ decision making, specifically in relation to making a diagnosis, prioritising, asking for help and multi-tasking, but further work is required.

Preliminary benchmarking of appropriate sanctions for lapses in undergraduate professionalism in the health professions

Objective: To investigate the extent of consensus between faculty and students in order to benchmark appropriate sanctions for first-time offences with no mitigating factors in the area of Academic Probity by quota sampling in one cohort of medical, nursing and dental students in a Scottish university. Methods: This study reports administration of a web-based preliminary inventory derived from the international research literature to a target population of health professions staff and students. This study was conducted at Scottish University College of Medicine, Dentistry, Nursing and Midwifery. Subjects: 57 faculty and 689 students in the College in first quarter of 2009 participated in this study. Results: 50% of medical students, 26% of dental students, 22% of nursing students and 27% of midwifery students responded; 22% of faculty responded. Administration of a preliminary 41-item inventory to 57 faculty and 689 students from a Scottish College of Medicine, Dentistry, Nursing and Midwifery has allowed us to preliminarily rank the sanctions that are broadly agreed between the two cohorts as well as to identify a small cluster of behaviours which are viewed less severely by students than by faculty. Conclusions: These data will give guidance to undergraduate Fitness to Practice committees but also guidance to curriculum planners about the areas in which students may need more teaching. The results informed the reduction of the inventory and its refinement in to a 30-item e-learning tool that is being field tested for generalisability within and beyond the UK. The researchers have also been invited to adapt the proposed teaching and learning tools beyond the health professions.

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.

Medical student rankings of proposed sanction for unprofessional behaviours relating to academic integrity: results from a Scottish medical school:

The General Medical Council emphasizes the cultivation of professional behaviours among medical students from early undergraduate years. Learning professional behaviours, however, is a progression and is constituted of several developmental stages. Behaving with academic integrity may be the first stage. In an educational setting, academic integrity is represented by a collection of diverse behaviours. Although there is consensus within the medical community that the absence of (or lapses in) academic integrity is unacceptable, the level of sanctions recommended for medical students is controversial. In the main, these punitive decisions over students are taken by teachers and clinicians. What sanctions would students suggest for a colleague who is academically unprofessional? This study reports the sanctions recommended by 375/700 (54%) of the students of one Scottish medical school in relation to lapses in academic integrity.

Progress and divergence in palliative care education for medical students: A comparative survey of UK course structure, content, delivery, contact with patients and assessment of learning

Background: Effective undergraduate education is required to enable newly qualified doctors to safely care for patients with palliative care and end-of-life needs. The status of palliative care teaching for UK medical students is unknown. Aim: To investigate palliative care training at UK medical schools and compare with data collected in 2000. Design: An anonymised, web-based multifactorial questionnaire. Settings/participants: Results were obtained from palliative care course organisers at all 30 medical schools in 2013 and compared with 23 medical schools (24 programmes) in 2000. Results: All continue to deliver mandatory teaching on ‘last days of life, death and bereavement’. Time devoted to palliative care teaching time varied (2000: 6–100 h, mean 20 h; 2013: 7–98 h, mean 36 h, median 25 h). Current palliative care teaching is more integrated. There was little change in core topics and teaching methods. New features include ‘involvement in clinical areas’, participation of patient and carers and attendance at multidisciplinary team meetings. Hospice visits are offered (22/24 (92%) vs 27/30 (90%)) although they do not always involve patient contact. There has been an increase in students’ assessments (2000: 6/24, 25% vs 2013: 25/30, 83%) using a mixture of formative and summative methods. Some course organisers lack an overview of what is delivered locally. Conclusion: Undergraduate palliative care training continues to evolve with greater integration, increased teaching, new delivery methods and wider assessment. There is a trend towards increased patient contact and clinical involvement. A minority of medical schools offer limited teaching and patient contact which could impact on the delivery of safe palliative care by newly qualified doctors.

An evaluation of operative self-assessment by UK postgraduate trainees

Background: Surgeons in training undertake procedure-based assessment (PBA) with their trainers. Time pressures limit when this occurs. Self-assessment would provide additional opportunities but requires evaluation of your own skills and knowledge. Aim: To investigate the validity of a self-assessment PBA in the operating theatre and evaluate learning needs and change in practice identified. Methods: In a prospective study, postgraduate UK trainees performed a self-assessment PBA after formally reflecting on appendicectomy surgery. Later, they performed their usual external assessment PBA on the same case and outcomes were compared. Learning outcomes were analysed independently by two trainers. Results: There were 25 trainees (14 males), of age 29 years (25–33). They had performed a median of five previous appendicectomies (2–21) after a median three years of speciality training (range 1–4). There were no significant differences in global summary scores, trainee satisfaction or learning outcomes between external and self-assessment PBAs. Construct validity of the self-assessment PBA was demonstrated. The self-assessment PBA was more likely to identify non-technical skills. Conclusion: Our results suggest self-assessment PBA is valid for formative assessment. It identified a wide range of learning outcomes. Self-assessment PBA would help trainees maximise every learning opportunity and practice self-assessment skills.