Int. Med. Educ., Volume 3, Issue 1 (March 2024) – 9 articles

(1) Background: Final-year medical students often feel under prepared for their transition into clinical practice. Clinical ward rounds and shadowing approach this issue by building transferable skills; however, they are highly variable, with teaching clinicians experiencing a large number of work-related interruptions. Simulated ward rounds have garnered significant interest by translating clinical encounters into standardised educational opportunities for students. This review evaluates the impact of simulated ward rounds in promoting the clinical competencies required for work in final-year medical students and assesses the impact of simulated ward rounds on the experience of clinical learning for medical students. (2) Methods: A computer-assisted search was performed in the Medline, Embase, and CINAHL databases. Studies that evaluated simulated ward rounds in final-year medical student cohorts were included. (3) Results: In total, 107 articles were identified by the search and 26 articles were eligible for full-text analysis. The analysis of these studies showed that simulated ward rounds were effective in improving confidence, as well as the technical and non-technical skills of final-year medical students; however this is on the basis of highly heterogeneous and lower-quality evidence. (4) Conclusion: Our systematic review highlights that simulated ward rounds provide final-year medical students with increased confidence and preparedness for clinical work and identifies the need to pursue more methodologically rigorous research to inform the best practice delivery of simulated ward rounds. Full article

Digital health, encompassing the use of digital technologies in healthcare, and telemedicine, facilitating healthcare delivery across long distances, have witnessed widespread applications across various healthcare domains. The COVID-19 pandemic accelerated the adoption of digital solutions in healthcare, overcoming barriers to access and fostering transitions to new care models. However, healthcare professionals often lack digital health competencies, necessitating targeted training initiatives. This study presents a project initiated by the Order of Physicians and Dentists of Rome, promoting a comprehensive training program in digital health for healthcare professionals. This investigation aims to describe the project, report demographic characteristics of participants, and analyze survey results on participants’ perceptions of the training program. The Erasmus+ project, titled ‘Training of Physician Trainers in Telemedicine, eHealth, and Digital Medicine,’ facilitated the digital transition of the healthcare sector through international training. The project involved structured courses, job-shadowing, and support activities in Malta and Madrid. A survey, developed using the Delphi methodology, assessed participants’ views on telemedicine. Thirty participants, selected based on merit, engaged in the project. Survey responses highlighted a strong impact on participants’ understanding of digital health concepts and increased confidence in utilizing digital tools. Notably, 85% acknowledged significant skill acquisition in healthcare digitalization. The project addressed a critical training gap among healthcare professionals, emphasizing the need for ongoing education in digital health. Despite existing recommendations, formal digital health education remains limited. The study underscores the importance of educational efforts to foster a digitalized healthcare model. Full article

Medical students (MS) are at higher risk for depression than their peers. Incoming U.S. MS completed a survey that included the validated RS-14, which measures resilience and its two subcomponents: self-assuredness and drive. Surveys were administered before classes started in 2019 (pre-pandemic-cohort; n = 178) and 2020 (pandemic-cohort; n = 181). Resiliency, self-assuredness, and drive were not different between cohorts. Demographic subgroup analyses revealed that underrepresented in medicine (URiM) MS in the pre-pandemic-cohort scored higher on drive (p = 0.007) than non-URiM MS (6.07 ± 1.00 vs. 5.59 ± 0.97); however, this difference was not significant in the pandemic-cohort. Additionally, students in the pandemic-cohort were more likely to agree that peer discussions about emotional challenges would be beneficial (p = 0.014). Qualitative analysis revealed that 45.9% of pandemic-cohort respondents felt more motivated to pursue medicine. This is the first study to report differences in drive between URiM MS cohorts matriculating before and during a pandemic, a positive correlation between multiple-mini-interview (MMI) scores and drive, and a negative correlation between MCAT scores and drive. Collectively, these results suggest that the circumstances of 2020 may have negatively influenced the drive of URiM students, positively impacted the receptivity of MS to peer discussions, and motivated students to pursue medicine. Full article

In the context of Canadian medical education, Distributed Medical Education (DME) plays a crucial role in addressing healthcare disparities, particularly in rural areas. This study focuses on the Department of Psychiatry at Dalhousie University, analyzing psychiatrists’ engagement and willingness to participate in research at DME sites in Nova Scotia (NS) and New Brunswick (NB). The cross-sectional study, encompassing data from an environmental scan, surveyed 60 psychiatrists involved in medical education across seven health zones. Results revealed significant associations between gender, type of graduates, and specialist training. A majority of psychiatrists (68.3%) do not currently engage in mental health or translational research, citing barriers such as a lack of protected time and financial incentives. Notably, participants expressed interest in future research areas, including health services/quality improvement and addiction research. Geriatric psychiatry, predominantly female-dominated, lacked current research activities. The study emphasizes the need to address barriers and promote motivators, both intrinsic and extrinsic, to enhance psychiatrists’ research engagement. This strategic approach is essential for fostering active participation in research, thereby contributing to the expansion of DME sites in Atlantic Canada and beyond. Full article

South Africa faces healthcare challenges due to inefficiencies, resource constraints, and disease burden. The AfriMEDS curriculum framework was adopted as part of curriculum reform to facilitate the training of comprehensive healthcare professionals capable of addressing healthcare challenges. However, the curriculum ideologies underlying this framework have not been explored. This research aimed to qualitatively describe the curriculum ideologies underlying the AfriMEDS framework as a proxy to determine how it could facilitate the training of healthcare practitioners fit to address South African healthcare challenges. ChatGPT was used to extract data from the framework using a previously validated document analysis protocol. Interpretive analysis was employed to analyze the extracted data to determine inferred curriculum ideologies. A complex interplay of curriculum ideologies was found, with the discipline- and service-centered ideologies most dominant, followed by the citizenship-centered ideology, while the student-centered ideology was found the least. It was also found that the six components of curriculum ideologies exhibit varying degrees of ideological representation. It is concluded that, while the AfriMEDS curriculum framework could produce technically skilled and service-oriented practitioners, its effectiveness in nurturing well-rounded medical professionals may be limited. Integrating a balanced representation of all curriculum ideologies is recommended. Full article

Traditional approaches to marking short-answer questions face limitations in timeliness, scalability, inter-rater reliability, and faculty time costs. Harnessing generative artificial intelligence (AI) to address some of these shortcomings is attractive. This study aims to validate the use of ChatGPT for evaluating short-answer assessments in an undergraduate medical program. Ten questions from the pre-clerkship medical curriculum were randomly chosen, and for each, six previously marked student answers were collected. These sixty answers were evaluated by ChatGPT in July 2023 under four conditions: with both a rubric and standard, with only a standard, with only a rubric, and with neither. ChatGPT displayed good Spearman correlations with a single human assessor (r = 0.6–0.7, p < 0.001) across all conditions, with the absence of a standard or rubric yielding the best correlation. Scoring differences were common (65–80%), but score adjustments of more than one point were less frequent (20–38%). Notably, the absence of a rubric resulted in systematically higher scores (p < 0.001, partial η² = 0.33). Our findings demonstrate that ChatGPT is a viable, though imperfect, assistant to human assessment, performing comparably to a single expert assessor. This study serves as a foundation for future research on AI-based assessment techniques with potential for further optimization and increased reliability. Full article

Background: The development of clinical reasoning (CR) abilities in Thai medical students during their pre-clinical years lacked well-designed establishment. Methods: This study utilized a pre-test and post-test design without a control group and was conducted at Walailak University, Thailand, in May 2022. We collected participant baseline characteristics and compared scores evaluated by the instructor and participants before and after the intervention. Additionally, we conducted a post-intervention survey on workshop satisfaction, perspectives on CR, and its learning impact. Results: Nineteen third-year medical students were included in the analysis, and twelve (63.2%) were women. The mean age was 20.6 years (standard deviation, SD: 0.5). The total score evaluated by the instructor after the intervention (8.95; SD, 1.81) was significantly higher than that before the intervention (1.68; SD, 0.67), p < 0.001. The total score evaluated by the participants after the intervention (8.22; SD = 1.44) was significantly higher than that before the intervention (2.34; SD, 2.06), p < 0.001. Overall, satisfaction was high. Conclusions: A short interactive workshop effectively taught CR principles and practice to Thai third-year medical students. These findings support the possibility of implementing this in pre-clinical curricula to prepare them for clinical practice. Full article

This narrative review is a detailed look at how we make multiple-choice questions (MCQs) based on medical cases in today’s medical teaching. Moving from old-style MCQs to ones that are more related to real clinical situations is really important. It helps in growing critical thinking and practical use, especially since MCQs are still the primary method for testing knowledge in medicine. We look at the history, design ideas, and both manual and computer-based methods that have helped create MCQs. Technologies like Artificial Intelligence (AI) and Natural Language Processing (NLP) are receiving a lot of focus for their ability to automate the creation of question. We also talk about the challenges of using real patient cases, like the need for exact clinical information, reducing unclear information, and thinking about ethical issues. We also investigate the measures of validity and reliability that are crucial to maintaining the honesty of case-based MCQs. Finally, we look ahead, speculating on where medical education is headed as new technologies are incorporated and the value of case-based evaluations continues to rise. Full article

Background. There are few studies about post myocardial infarction follow-up using telemedicine. We organized a post-discharge telemedicine service with a dedicated team. To do this, it was necessary that all stakeholders involved in the organization and use of the telemedicine service were properly educated and informed. Methods. We designed a theoretical–practical mini-course to train healthcare personnel and increase skills, with excellent learning outcomes and satisfaction. Thereafter, we enrolled patients affected by acute myocardial infarction with ST elevation (STEMI), MINOCA (myocardial infarction with no obstructive coronary atherosclerosis), Takotsubo syndrome or spontaneous coronary dissection, and high-risk acute myocardial infarction without ST elevation (NSTEMI). At discharge, the cardiology technician performed counselling for the patient, using regional platforms, such as televisit, at 1 and 4 months, allowed us to monitor major adverse cardiac events (MACE), heart failure, arrhythmias, unstable angina and non-cardiovascular events, therapy adherence, target therapy and customer satisfaction. Results. Between November 2021 and February 2023, we enrolled 110 patients: 72% affected by STEMI, 22% by NSTEMI. At the 1-month follow up, 12 patients did not reach the pressure target and 23 patients did not reach the LDL target. We observed three patients requiring hospital readmission, three requiring hospital visits for further investigation, and one death. To date, a four month follow up was performed for 54 patients. No readmissions or deaths occurred. We detected a rate of 96% of customer satisfaction. Conclusions. A health coordination center with a dedicated team makes televisit safe as a follow-up for post-myocardial infarction patients. Beforehand, it is fundamental for healthcare professionals to acquire theoretical knowledge and updates, and the acquisition of manual, technical and practical skills. Full article