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Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students
Peter Barbosa, Gaye Raymond, Cheryl Zlotnick, James Wilk, Robert Toomey III, James Mitchell III
January-April 2013, 26(1):9-14
DOI:10.4103/1357-6283.112794  PMID:23823667
Introduction: Graduate healthcare students experience significant stressors during professional training. Mindfulness-Based Stress Reduction (MBSR) is a behavioural intervention designed to teach self-regulatory skills for stress reduction and emotion management. This study examines the impact of MBSR training on students from five healthcare graduate programs in a quasi-experimental trial. Methods : A total of 13 students completed the MBSR program and were compared with 15 controls. Both groups answered validated questionnaires measuring anxiety, burnout and empathy at baseline, at conclusion of the course (week 8) and 3 weeks post-course completion (week 11). Results : Significant decrease in anxiety at weeks 8 and 11 compared with baseline (P<0.001 and P<0.01, respectively) was observed using the Burns Anxiety Inventory. Significant increase in empathy at week 8 (P<0.0096) was observed using the Jefferson Scale of Physician Empathy. Week 11 demonstrated a decrease in empathy from baseline (not statistically significant) across all subjects. No significant differences in burnout scores at weeks 8 and 11 were observed between those in the intervention and control groups. Conclusions : These results provide supportive evidence of MBSR as a behavioural intervention to reduce anxiety and increase empathy among graduate healthcare students.
  29,657 5,768 71
Community-based medical education: Is success a result of meaningful personal learning experiences?
Len Kelly, Lucie Walters, David Rosenthal
January-April 2014, 27(1):47-50
DOI:10.4103/1357-6283.134311  PMID:24934943
Background: Community-based medical education (CBME) is the delivery of medical education in a specific social context. Learners become a part of social and medical communities where their learning occurs. Longitudinal integrated clerkships (LICs) are year-long community-based placements where the curriculum and clinical experience is typically delivered by primary care physicians. These programs have proven to be robust learning environments, where learners develop strong communication skills and excellent clinical reasoning. To date, no learning model has been offered to describe CBME. Methods: The characteristics of CBME are explored by the authors who suggest that the social and professional context provided in small communities enhances medical education. The authors postulate that meaningfulness is engendered by the authentic context, which develops over time. These relationships with preceptors, patients and the community provide meaningfulness, which in turn enhances learning. Results and Discussion: The authors develop a novel learning model. They propose that the context-rich environment of CBME allows for meaningful relationships and experiences for students and that such meaningfulness enhances learning.
  21,253 2,237 24
Factors causing stress among students of a Medical College in Kolkata, India
Soma Gupta, Supriyo Choudhury, Manisha Das, Aparna Mondol, Richeek Pradhan
January-April 2015, 28(1):92-95
DOI:10.4103/1357-6283.161924  PMID:26261123
Background: Medical students feel a significant amount of stress due to a variety of factors. Few studies have explored the relative size of these various stressors to identify which are most important. This study was undertaken to quantify the magnitude of various sources of stress among students of a medical college at Kolkata, West Bengal, and also to assess the reliability of Medical Students' Stressor Questionnaire (MSSQ-40) in this context. Methods: We evaluated the degree of stress along various dimensions using the MSSQ-40, a scale to measure stress among medical students that has been validated in other countries. Differences in stress and its causal factors were analyzed across demographic subgroups. The reliability of the MSSQ-40 was evaluated using Cronbach's alpha. Results: The overall prevalence of stress was 91.1% and the vast majority of students (94.9%) were stressed due to academic reasons. Academic related stress was found to be higher among students who are not conversant with the local language, experienced a change in medium of teaching from secondary school to medical school, and resided in a hostel. The MSSQ-40 in general, and its academic-related stress domain specifically, were found to be reliable in our setting. Discussion: Early detection and remedying stressors will help to build physical and mental health in medical students. Language training early during the medical course might reduce academic stress among our students. Further studies should relate individuals' stress with their academic performance.
  17,539 1,733 24
India's foreign medical graduates: an opportunity to correct India's physician shortage
Sharma Anjali, Zodpey Sanjay, Batra Bipin
January-April 2016, 29(1):42-46
DOI:10.4103/1357-6283.178932  PMID:26996798
Background: India's current estimated doctor-population ratio of 1:1700 against targeted ratio of 1: 1000 shows a clear shortage. A mismatch in number of medical aspirants and available seats, intense competition and unaffordable costs of medical education prompt many Indian students to pursue training opportunities abroad. Many later return to India, and these foreign medical graduates (FMGs) must pass a qualification test which is a required to practice medicine in India. This review undertakes a situational analysis of FMGs in India and suggests a roadmap to better utilize this resource pool of physicians. Methods: A thorough literature search was carried out using Google Scholar, PubMed and websites of the Central Board of Secondary Education and Medical Council of India. Foreign Medical Graduate Examination (FMGE) data was obtained from India's National Board of Examinations. Results: From 2002 to 2014, growth was seen in the number of FMGs who took the FMGE, with more having trained in China than any other country. However, typically only 25% of FMGs pass the FMGE. In 2013, 9,700 FMGs were unable to pass the FMGE to enter practice in India. At least 7,500 FMG physicians are unable to become licensed each year for failure to pass the FMGE, including those who retake and again fail the exam. Discussion: There are possible solutions. Additional training and hands-on apprenticeships can be introduced to help FMGs build their skills to then be able to pass the FMGE. FMGs can now learn by participating as observers in the established programs. Opportunities also exist for FMGs to work outside of clinical care, including in research, hospital administration and public health. As of now, FMGs are an untapped resource and lost opportunity to a country with shortages of physicians.
  17,616 625 2
Low back pain and associated risk factors among undergraduate students of a medical college in Delhi
Nupur Aggarwal, Tanu Anand, Jugal Kishore, Gopal Krishna Ingle
May-August 2013, 26(2):103-108
DOI:10.4103/1357-6283.120702  PMID:24200731
Context: Low back pain (LBP) is the most common orthopedic problem worldwide and is known to affect both younger and older adults. The stressful and time consuming curriculum of medical students predisposes them to this problem. Few statistics are available on prevalence rates of LBP among medical students in India. This study assesses the prevalence and risk factors of LBP in students of a medical college in Delhi. Methods: A cross-sectional study was carried out in a medical college in Delhi. The study subjects (n = 160; 100% participation) were selected via stratified random sampling from all undergraduate medical students (aged 17-25 years). A validated questionnaire was used to collect the data. Results: The overall prevalence of LBP among the students over the past one year was 47.5% (n = 76) with a prevalence of 32.5% at the time of data collection. Prevalence among males and females was 45.3% and 50%, respectively. Significant associations were found between LBP in the past year and coffee drinking (Regular = 57%, Occasional = 38.9%, Never = 65.2%, χ2 = 7.24, P= 0.02), body posture (Normal = 32.6%, Abnormal = 75%, χ2 = 18.97, P < 0.001), place of study (Study table = 33.8%, Bed = 58.6, Both = 61.5% χ2 = 10.51, P = 0.01), family history of LBP (Present = 75%, Absent = 38.3%, χ2 = 16.17, P < 0.001) and carrying backpacks (Regular = 50%, Occasional = 33%, Never = 0%, χ2 = 16.17, P < 0.001). The mean scores of depression (2.7 vs. 1.6), anxiety (3.5 vs 1.9), and monotonous work (3.9 vs. 1.8) were found to be significantly higher in group with LBP than in the non-LBP group. However, no association with LBP was seen for weight lifting, watching television/working on computers, driving, wearing heels, or body mass index. Discussion: The high prevalence of LBP among medical students and its association with poor study habits, lifestyle habits, and psychological factors highlight a need for life skills training, education, counseling, and restructuring of the medical curriculum.
  15,580 2,486 25
Application of Kern's Six-step approach to curriculum development by global health residents
Leigh R Sweet, Debra L Palazzi
May-August 2015, 28(2):138-141
DOI:10.4103/1357-6283.170124  PMID:26609014
Background: Global health practitioners have a responsibility to deliver appropriate and effective health education to patients and families. We demonstrate how residents in a global health elective can utilize Kern's six-step approach to develop educational products for patients and their families. Methods: Residents completed a pre-curricular survey of knowledge, skills and attitudes regarding curriculum development. Kern's six-steps were introduced through a series of lectures; workshop exercises highlighted the application of each step: (i) Problem identification and general needs assessment, (ii) targeted needs assessment, (iii) goals and objectives, (iv) educational strategies, (v) implementation and (vi) evaluation and feedback. Residents used the six-steps to develop health education projects they subsequently implemented locally and abroad. Reflective exercises were conducted after utilization of each of the six steps. Residents also completed a post-curricular assessment of knowledge, skills and attitudes regarding curriculum development. Results: Mean scores on pre- and post-curricular self-assessment of knowledge were 18 and 26.5 (out of 28); skills 19.8 and 33.5 (out of 35); and attitudes 13.3 and 19.8 (out of 21), respectively. Reflective exercises highlighted resident sentiment that the six steps enabled them to be more thoughtful of the interventions they were undertaking in communities locally and abroad. They were impressed how the model allowed them to ensure their goals were aligned with those of patients and their families, fully engage their audience and effectively implement the curricula. Discussion: Kern's six-step approach to curriculum development is an effective method for global health residents to develop educational products for patients and families.
  14,661 2,507 12
The Social Accountability of Medical Schools and its Indicators
Charles Boelen, Shafik Dharamsi, Trevor Gibbs
September-December 2012, 25(3):180-194
DOI:10.4103/1357-6283.109785  PMID:23823638
Context : There is growing interest worldwide in social accountability for medical and other health professional schools. Attempts have been made to apply the concept primarily to educational reform initiatives with limited concern towards transforming an entire institution to commit and assess its education, research and service delivery missions to better meet priority health needs in society for an efficient, equitable an sustainable health system. Methods : In this paper, we clarify the concept of social accountability in relation to responsibility and responsiveness by providing practical examples of its application; and we expand on a previously described conceptual model of social accountability (the CPU model), by further delineating the parameters composing the model and providing examples on how to translate them into meaningful indicators. Discussion : The clarification of concepts of social responsibility, responsiveness and accountability and the examples provided in designing indicators may help medical schools and other health professional schools in crafting their own benchmarks to assess progress towards social accountability within the context of their particular environment.
  13,192 3,216 55
Facilitating Students' Reflective Practice in a Medical Course: Literature Review
Lisa Jane Chaffey, Evelyne Johanna Janet de Leeuw, Gerard Anthony Finnigan
September-December 2012, 25(3):198-203
DOI:10.4103/1357-6283.109787  PMID:23823640
Introduction : Reflection and reflective practice is of increasing importance in medical education curricula. The aim of this review is to summarise the literature published around facilitating reflection in a medical course, and to answer the question : W0 hat is the current evidence regarding learning and development moments across the medical curriculum in developing students' reflective practice? Methods : A review of the literature was undertaken using defined databases and the search terms 'medical students', 'medical education', 'reflection', 'reflect*' and 'medicine'. The search was limited to peer-reviewed published material in English and between the years 2001 and 2011, and included research, reviews and opinion pieces. Results : Thirty-six relevant articles were found, identifying enhancing factors and barriers to effectively teaching reflective practice within medical curricula, relating to: The breadth of the meaning of reflection; facilitating reflection by medical educators; using written or web-based portfolios to facilitate reflection; and assessing the reflective work of students. Discussion : A variety of reflective purposes was found in this literature review. Evidence indicates that, if students are unclear as to the purpose of reflection and do not see educators modelling reflective behaviours, they are likely to undervalue this important skill regardless of the associated learning and development opportunities embedded in the curriculum.
  13,712 2,522 42
A longitudinal study of relationships between previous academic achievement, emotional intelligence and personality traits with psychological health of medical students during stressful periods
Muhamad Saiful Bahri Yusoff, Ab Rahman Esa, Mohamad Najib Mat Pa, See Ching Mey, Rosniza Abdul Aziz, Ahmad Fuad Abdul Rahim
January-April 2013, 26(1):39-47
DOI:10.4103/1357-6283.112800  PMID:23823672
Context: There is considerable evidence that emotional intelligence, previous academic achievement (i.e. cumulative grade point average (GPA)) and personality are associated with success in various occupational settings. This study evaluated the relationships of these variables with psychological health of first year medical students during stressful periods. Methods: A 1-year prospective study was done with students accepted into the School of Medical Sciences, Universiti Sains Malaysia. Information on emotional intelligence, GPA and personality traits were obtained prior to admission. The validated Universiti Sains Malaysia Emotional Quotient Inventory and Universiti Sains Malaysia Personality Inventory were used to measure emotional intelligence and personality traits, respectively. Stress, anxiety and depression were measured by the 21-item Depression Anxiety Stress Scale during the end-of-course (time 1) and final (time 2) examinations. Results: At the less stressful period (time 1), stress level was associated with agreeableness and the final GPA, anxiety level was associated with emotional control and emotional conscientiousness and depression level was associated with the final GPA and extraversion. At the more stressful period (time 2), neuroticism associated with stress level, anxiety level was associated with neuroticism and emotional expression, and depression level was associated with neuroticism. Conclusions: This study found that neuroticism was the strongest associated factor of psychological health of medical students during their most stressful testing period. Various personality traits, emotional intelligence and previous academic performance were associated factors of psychological health during a less stressful period. These data suggest that early identification of medical students who are vulnerable to the stressful environment of medical schools might help them maintain psychological well-being during medical training.
  13,462 1,860 20
Medical students' and residents' conceptual structure of empathy: A qualitative study
Muneyoshi Aomatsu, Takashi Otani, Ai Tanaka, Nobutaro Ban, Jan van Dalen
January-April 2013, 26(1):4-8
DOI:10.4103/1357-6283.112793  PMID:23823666
Background: Empathy is a crucial component of medicine. However, many studies that have used quantitative methods have revealed decline of learners' empathy during undergraduate and postgraduate medical education. We identified medical students' and residents' conceptual structures of empathy in medicine to examine possible differences between the groups in how they conceive empathy. Methods: We conducted a qualitative study with two focus group discussions in which six medical students and seven residents participated separately. The transcripts of the focus group discussions were analysed combining qualitative data analysis and theoretical coding. Results: Medical students and residents had different conceptual structures of empathy. While medical students thought that sharing emotions with patients was essential to showing empathy, residents expressed empathy according to their evaluation of patients' physical and mental health status. If the residents thought that showing empathy was necessary for the care of patients, they could show it, regardless of whether they shared the patients' emotions or not. Conclusions: The comparison of medical students' and residents' conceptual structures of empathy reveals a qualitative difference. Residents show more empathy to their patients by a cognitive decision as clinicians than medical students do. Communication skills training should consider the qualitative change of students' and residents' empathy with clinical experience. We should consider the change when we evaluate learners' empathy and introduce methods that cover the qualitative range of empathy.
  10,817 3,657 20
Case vignette: A promising complement to clinical case presentations in teaching
Jeyashree Kathiresan, Binod K Patro
January-April 2013, 26(1):21-24
DOI:10.4103/1357-6283.112796  PMID:23823669
Introduction: Case studies are widely used in medical education. They help students recognise and interpret important data coming from the patient's problem thereby enabling students to arrive at a correct diagnosis and best treatment course. We have used the case vignette method, a variant of the case study method, for teaching family medicine residents, and here we assess their perceptions of its advantages and limitations. Methods: In the case vignette method, residents studied a particular case of interest from the community. Before presenting it to peers, they prepared and circulated a brief case vignette outlining the salient features of the case, the preferred line of management and suggested discussion probes. Structured notes were taken by programme faculty during the presentations, and feedback was obtained from residents. Results: Major advantages perceived by residents were that the case vignette method demanded their active participation in the preparation and presentation of the case. The need to prepare a vignette helped them better organise their thinking and experience peer teaching. However, some felt that the exercise was time consuming and the discussion sometimes wandered from the intended course. Conclusions: The case vignette method helps meet specific learning objectives in teaching sessions. Residents feel that it improves their skills as physicians and teachers. This study finds that case vignettes are a promising complement to existing methods of teaching medicine. Further research is required to more firmly establish this method's value.
  12,996 1,274 9
Towards Unity for Health Utilising Community-Oriented Primary Care in Education and Practice
B Art, L De Roo, J De Maeseneer
August 2007, 20(2):74-74
Context: Although the evidence is overwhelming that healthcare is delivered more effectively if one involves the targeted communities in decisions concerning their health, top-down programs still rule the world. Objectives: In order to highlight the benefits of a community-oriented approach, we report the experiences from Ghent, Belgium on COPC styled healthcare initiatives and COPC modelled multidisciplinary education. Community-oriented Primary Care and Education: COPC is a five-step model combining primary health care, public health and community data and resources. The involvement of community (members) is a crucial element in any effort to effectively enhance health (care) in a given community. Small scale examples from two health centers are given. In order to train future healthcare workers to be able to function with the communities, they participate in a one-week interdisciplinary course based on the COPC cycle at the University of Ghent. The COPC program in relation to Its practical organisation, goals and limitations are presented and discussed. Conclusion: In order to reach health objectives set out by disease-specific or health promotion programs, a community-sensitive approach is needed, especially for the most deprived communities. The COPC model offers inspiration and can be a practical tool to work with communities. It is also feasible to create a short COPC exercise to prepare future healthcare workers for complex community work. This model is one of the ways to concretise some of the main objectives of TUFH.
  4,545 8,627 -
Problem-based learning: Constructivism in medical education
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
September-December 2013, 26(3):197-198
DOI:10.4103/1357-6283.126013  PMID:25001357
  9,989 2,815 5
The Practice and Tradition of Bonesetting
A Agarwal, R Agarwal
April 2010, 23(1):225-225
Context: Traditional bonesetting is an art that in the face of urbanization, lack of public attention and lack of modern facilities has survived more than 3,000 years. This article explores the role of bonesetters in the developing world, their successes and failures and possible utilization of their services as part of the healthcare system of a country. Methods: Articles depicting working or techniques of bonesetters or those related to training and education issues of traditional bonesetters, especially in developing countries, were reviewed. The current scenario of healthcare delivery and medical education along with existing socioeconomic conditions prevailing in India were analyzed with generalization of findings to the healthcare delivery systems of other developing countries. Findings: Bonesetting has its strengths and weaknesses. With current socioeconomic conditions and the types of health needs prevailing in developing countries, it would be difficult to abolish traditional bonesetting. These providers have widespread community acceptance and support. Complications can be minimized and practice potentially improved with training and education. Conclusions: Pending infrastructure and socioeconomic development, it appears that traditional bonesetters will remain providers of healthcare. Their methodology utilizes regional resources and is commonly believed to be cheaper and effective. Although the deficiencies of traditional bonesetters have been shown, with adequate training in the basics of orthopaedic care, they can be utilized to provide useful health services at the primary care level.
  11,854 832 -
Application of the Health Belief Model for Osteoporosis Prevention among Middle School Girl Students, Garmsar, Iran
SM Hazavehei, MH Taghdisi, M Saidi
March 2007, 20(1):23-23
Introduction: Osteoporosis is a serious metabolic bone disorder that often results in hip fracture and is usually asymptomatic in its initial stages. Since the majority of bone formation occurs during childhood and adolescence, it is important to begin primary prevention at an early age, although the optimal way for instilling this preventive behavior in youth has not yet been defined. The purpose of this study was to assess the effectiveness of a health education intervention based on the Health Belief Model (HBM) in reducing the risk of osteoporosis development in female adolescents. Methods: The study population consisted of 206 female students from the middle schools of the city of Garmdsar, Iran. The students were randomly assigned to one of three groups. Students in Group 1, the experimental group, participated in two health education sessions of one hour, based on components of the HBM. Students in Group II took part in the traditional didactic health education curriculum on osteoporosis. Group III students had no specific educational program for osteoporosis prevention. Data were collected at three points: before the intervention, immediately after the intervention, and one month after the intervention. The data-gathering instrument was a validated and reliable questionnaire (67 questions) that was developed based on the following HBM domains: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and health behavior action for osteoporosis prevention). Results: Group 1's pre-tests, post- tests and one month follow up tests revealed a significant increase in the students' mean scores in the domains of knowledge (about osteoporosis) (p<0.001), perceived susceptibility (p<0.001), perceived severity (p<0.001), and perceived benefits of reducing risk factors (p<0.001)), as well as taking health action (p<0.001). The mean scores of Group II only improved significantly in the domains of knowledge and perceived susceptibility (p<0.001). Group III showed no significant changes. Discussion and Conclusion: The findings of this study support the feasibility of a health education program based on HBM to induce behavior change for osteoporosis prevention in middle school females.
  10,612 1,192 -
How do medical student journals fare? A global survey of journals run by medical students
Yassar Alamri
May-August 2016, 29(2):136-141
DOI:10.4103/1357-6283.188756  PMID:27549653
Medical students have made significant contributions to the medical and scientific fields in the past. Today, medical students still contribute to biomedical research; however, they often face disappointment from journals when trying to publish their findings. This led to the development of medical student journals, which take a more "student-friendly" approach. This article reviews the current medical student journals published in English and sheds light on current trends and challenges.
  11,134 564 3
Leary's rose to improve negotiation skills among health professionals: Experiences from a Southeast Asian culture
Astrid Pratidina Susilo, Valerie van den Eertwegh, Jan van Dalen, Albert Scherpbier
January-April 2013, 26(1):54-59
DOI:10.4103/1357-6283.112803  PMID:23823674
Context: Although inter-professional collaboration is important for patient safety, effective collaboration can be difficult to achieve, especially in settings with a strong hierarchical or blame culture. Educational Model: Leary's Rose is a model that gives insight into the hierarchical positions people take during a negotiation process. The assumption behind this tool is that the default reaction we intuitively choose is not always the most effective. Becoming aware of this default reaction makes it possible to choose to behave differently, in a more effective way. We propose to use this model to make health professionals more aware of their attitudes and communication styles when negotiating and provide them with a tool to improve communication by modifying their natural responses. Application: Leary's Rose can be used in simulated and authentic work-based educational settings. To train the communication skills of nurses to be the patients' advocates, for example Leary's Rose was used in role plays in which nurses have to negotiate in the patients' interest with the doctor while they have to maintain partnership relationship and avoid opposition with the doctor.
  10,146 1,273 2
Reducing obesity prejudice in medical education
Kabir Matharu, Johanna F Shapiro, Rachel R Hammer, RL Kravitz, Machelle D Wilson, Faith T Fitzgerald
September-December 2014, 27(3):231-237
DOI:10.4103/1357-6283.152176  PMID:25758385
Background: Healthcare worker attitudes toward obese individuals facilitate discrimination and contribute to poor health outcomes. Previous studies have demonstrated medical student bias toward obese individuals, but few have examined effects of the educational environment on these prejudicial beliefs. We sought to determine whether an innovative educational intervention (reading a play about obesity) could diminish obesity prejudice relative to a standard medical lecture. Methods: We conducted a randomized, controlled trial enrolling medical students (n = 129) from three universities. Students were assigned to play-reading or a standard lecture. Explicit attitudes and implicit bias toward obese individuals were assessed prior to intervention and after four months. Results: At baseline, students demonstrated moderate explicit and implicit bias toward obese people despite high scores on empathy. Students randomized to the play-reading group had significantly decreased explicit fat bias (P = 0.01) at follow-up, while students in the lecture group showed increased endorsement of a prescriptive model of care at the expense of a patient-centered approach (P = 0.03). There was a significant increase in empathy for those in both the theater (P = 0.007) and lecture group (P = 0.02). The intervention had no significant effect on implicit bias or regard for obesity as a civil rights issue. Discussion: Dramatic reading may be superior to traditional medical lectures for showcasing patient rights and preferences. The present study demonstrates for the first time that play-reading diminishes conscious obesity bias. Further research should determine whether nontraditional methods of instruction promote improved understanding of and care for obese patients.
  9,644 1,706 16
A first step in addressing medical education Curriculum gaps in lesbian-, gay-, bisexual-, and transgender-related content: The University of Louisville Lesbian, Gay, Bisexual, and Transgender Health Certificate Program
Susan Sawning, Stacie Steinbock, Rachel Croley, Ryan Combs, Ann Shaw, Toni Ganzel
May-August 2017, 30(2):108-114
DOI:10.4103/efh.EfH_78_16  PMID:28928340
Background: Individuals who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming, and/or born with differences of sex development have specific health needs and significant health disparities exacerbated by a lack of training among health professionals. The University of Louisville LGBT Health Certificate Program used an interdisciplinary approach to increase training, potentially enabling future physicians to provide quality healthcare to LGBT patients. Methods: A pretest-post-test design was used to investigate medical students' (n = 39) attitude and knowledge outcomes after program participation. Attitudinal items with Likert-type responses were analyzed using the Wilcoxon signed-rank test. Baseline frequency and percentage of correct responses were tabulated for knowledge questions. At both pre- and post-test, the 11 knowledge items were summed to establish a total knowledge score, creating two total scores. The paired sample t-test was used to evaluate the pre- and post-change, and Cohen's D was used to assess effect size. All P values were two-tailed. Statistical significance was set by convention at P < 0.05. Results: Students correctly answered 69% or less of the knowledge questions at baseline. Total correct knowledge scores significantly increased post intervention with the effect size being large (Cohen's D = 0.90, P < 0.001). Attitudes significantly increased post intervention on two items (P = 0.019 and P = 0.037). Some attitude items decreased post intervention: students felt it is more challenging to conduct a patient history with a LGB patient (pre-mean agreement = 2.44; post-mean agreement = 2.97, P = 0.018). Conclusions: Medical educators can play a critical role in decreasing LGBT healthcare disparities. The University of Louisville LGBT Health Certificate Program played an important first step in increasing medical students' knowledge and improving certain attitudes about LGBT patients.
  9,187 1,503 28
Writing patient case reports for publication
Deepak Juyal, Shweta Thaledi, Vijay Thawani
May-August 2013, 26(2):126-129
DOI:10.4103/1357-6283.120707  PMID:24200736
A case report is a description of a clinical case that has unique features. It may include a previously unreported clinical condition or observation of a disease, a unique use of imaging or diagnostic tool to reveal a disease, a new therapeutic intervention of a known disease, a previously unreported complication of a disease, or a new adverse event from a medication. A case report should be crisp, focused, and include few figures and references. A case report generally has a short unstructured or no abstract, a brief or no introduction, a description of the case, a discussion and a brief conclusion. Case reports are valuable sources of new and unusual information that may stimulate further research and applicability to clinical practice. Writing case reports properly is important if they are to be accepted by journals and credible and useful to readers.
  8,958 1,501 6
Perceptions of HPV and cervical cancer among Haitian immigrant women: Implications for vaccine acceptability
E Kobetz, J Menard, G Hazan, T Koru-Sengul, T Joseph, J Nissan, B Barton, J Blanco, J Kornfeld
December 2011, 24(3):479-479
Introduction: Women in Haiti and throughout the Haitian Diaspora shoulder a disproportionate burden of cervical cancer morbidity and mortality. The widespread Human Papillomavirus (HPV) vaccination holds promise for helping to attenuate this disparity. However, previous research has not fully examined Haitian women's perceptions of, and barriers to, HPV vaccination, which is essential for informing future intervention. The current paper aims to fill this gap. Methods: As part of ongoing Community-Based Participatory Research (CBPR) efforts, we conducted a series of focus groups with Haitian immigrant women in Little Haiti, the predominantly Haitian neighborhood in Miami, Florida, U.S. Focus group questions assessed women's knowledge and beliefs about cervical cancer and HPV, their opinions of vaccines in general, their knowledge and perceptions of the HPV vaccine specifically and health communications preferences for cervical cancer prevention. Results: Among the participants who had heard of HPV, many held misconceptions about virus transmission and did not understand the role of HPV in the development of cervical cancer. Virtually all participants expressed support for vaccines in general as beneficial for health. Some women had heard of the HPV vaccine, primarily as the result of a contemporary popular media campaign promoting the Gardasil; vaccine. Physician recommendation was commonly mentioned as a reason for vaccination, in addition to having more than one sex partner. Women felt the HPV vaccine was less appropriate for adolescent girls who are presumed as not sexually active. Women indicated a strong preference to obtain health information through trusted sources, such as Haitian physicians, Haitian Community Health Workers, and especially Kreyol-language audiovisual media. Discussion: Study findings indicate a need for culturally and linguistically appropriate educational initiatives to promote awareness of HPV and its role in cervical cancer, the importance of vaccination against the virus, explicitly differentiating HPV from HIV and providing specific information about vaccine safety. Conclusion: In the U.S., there is a substantial lack of educational information available in Haitian Kreyol about HPV and cervical cancer. This gap results in missed opportunities to promote disease prevention through vaccination and regular screening. Addressing such gaps is essential for achieving health equity among Haitian immigrant women and other, similarly underserved women, who are disproportionately burdened by cervical cancer.
  9,331 641 -
Online Faculty Development for Creating E-learning Materials
Virginia Niebuhr, Bruce Niebuhr, Julie Trumble, Mary Jo Urbani
September-December 2014, 27(3):255-261
DOI:10.4103/1357-6283.152186  PMID:25758389
Background: Faculty who want to develop e-learning materials face pedagogical challenges of transforming instruction for the online environment, especially as many have never experienced online learning themselves. They face technical challenges of learning new software and time challenges of not all being able to be in the same place at the same time to learn these new skills. The objective of the Any Day Any Place Teaching (ADAPT) faculty development program was to create an online experience in which faculty could learn to produce e-learning materials. Methods: The ADAPT curriculum included units on instructional design, copyright principles and peer review, all for the online environment, and units on specific software tools. Participants experienced asynchronous and synchronous methods, including a learning management system, PC-based videoconferencing, online discussions, desktop sharing, an online toolbox and optional face-to-face labs. Project outcomes were e-learning materials developed and participants' evaluations of the experience. Likert scale responses for five instructional units (quantitative) were analyzed for distance from neutral using one-sample t-tests. Interview data (qualitative) were analyzed with assurance of data trustworthiness and thematic analysis techniques. Results: Participants were 27 interprofessional faculty. They evaluated the program instruction as easy to access, engaging and logically presented. They reported increased confidence in new skills and increased awareness of copyright issues, yet continued to have time management challenges and remained uncomfortable about peer review. They produced 22 new instructional materials. Discussion: Online faculty development methods are helpful for faculty learning to create e-learning materials. Recommendations are made to increase the success of such a faculty development program.
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Tips for Developing a Valid and Reliable Bank of Multiple Choice Questions (MCQs)
Shazia Sadaf, Sadaf Khan, Syeda Kauser Ali
September-December 2012, 25(3):195-197
DOI:10.4103/1357-6283.109786  PMID:23823639
Introduction: Multiple choice questions (MCQs) are one of the most frequently used written assessments particularly when there is a large body of material to be tested and a large number of students to be assessed. MCQ examinations have manageable logistics, are easy to administer, can be scored rapidly and difficulty indices and the discriminatory value of each item can be easily calculated, facilitating standard application. Methods of ensuring quality assurance are essential when assessment is used for the purposes of certification. Methods: Developing MCQs requires a concerted effort from curriculum planners, content experts, course coordinators and medical educators. This article aims at outlining a stepwise approach towards ensuring quality assurance in written assessments in an integrated curriculum from aligning assessment with the learning to ensuring banking of good quality MCQs. Discussion: Coordinated efforts and a stepwise approach towards item development, coupled with focused faculty development exercises, is a cost-effective means of developing a huge 'Question Data Bank' of valid and reliable test items which can serve as a National Resource for the Professional Regulatory Councils in the country for their Licensure Examination.
  7,918 1,328 7
Stress and Coping Strategies among Arab Medical Students: Towards a Research Agenda
MA Elzubeir, KE Elzubeir, ME Magzoub
April 2010, 23(1):355-355
Background: Research conducted in the past ten years in the area of stress and coping among Arab medical students has identified some important issues, but other significant aspects have not yet been explored. Objectives: To provide a systematic review of studies reporting on stress, anxiety and coping among Arab medical students and to identify implications for future research. Methods: PubMed was searched to identify peer-reviewed English-language studies published between January 1998 and October 2009 reporting on stress and coping among undergraduate Arab medical students. Search strategy used combinations of the terms: Arab medical student, stress, PBL, psychological distress, depression, anxiety and coping strategies. Demographic information on respondents, instruments used, prevalence data and statistically significant associations were abstracted. Results: The search identified 8 articles that met the specified inclusion criteria. Within the limited range of Arab medical students studied, studies suggest these students have a high prevalence of perceived stress, depression and anxiety, with levels of perceived psychological stress as high as those reported in the international literature for medical students of other regions of the world. Limited data were available regarding coping strategies, the impact of stress on academic performance and attrition among Arab students. No data were available regarding the impact of problem-based learning on stress and coping. Conclusions: The existing literature confirms that stress, depression and anxiety are common among Arab medical students, as for students elsewhere. Little is known about the contribution of different curricula approaches to perceived stress and what coping strategies institutions and students apply to help alleviate stress. Large, prospective, multicentre, multi-method studies are needed to identify personal and curricula features that influence stress, depression, anxiety and coping strategies among Arab students. Keywords: Arab, coping, stress, literature review, medical students, research
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Student-led Peer-assisted Learning: The Kuppi Experience at the Medical School of the University of Ruhuna in Sri Lanka
M Kommalage, H Thabrew
August 2011, 24(2):516-516
Context: Peer-assisted learning (PAL) is described in the literature and is generally initiated with faculty assistance. The PAL process described here, called Kuppi classes, is exclusively organized and run by the students of the medical school of the University of Ruhuna. Aim: To explore students' experiences with Kuppi classes as a learning process. Methods: A phenomenological research method with focus group discussions and in-depth interviews for data collection was used. Selection of students for the study ensured representation of genders, academic years of study, both Kuppi tutors and tutees, and both those who did and did not pass the prior examination in the medical school on the first attempt. Findings: According to tutee and tutors, Kuppi was developed as a parallel process to fill in gaps in students' understanding and better explain unclear aspects of the formal curriculum. Within the Kuppi, students successfully use informality, familiarity and social bonds with one another to acquire the knowledge required for their examinations. Conclusions: This student-initiated PAL process appears to be succeeding for the students of our school. Some of their experiences may be helpful in implementing a PAL process or even improving the formal teaching processes in medical schools with similar academic, social and cultural environments. The need for a second, student-led curriculum should alert faculty to shortcomings in the formal curriculum and classes.
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